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Şahin ET, Orhan E, Tutar V, Tutar H, Gündüz B. The Effect of Different Sensory Perturbations on Postural Control and Fall Risk in Benign Paroxysmal Positional Vertigo Patients. Am J Audiol 2024:1-8. [PMID: 39052352 DOI: 10.1044/2024_aja-23-00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) patients may experience balance problems in various environmental conditions other than positional dizziness. Therefore, there is a need to investigate the postural control abilities and the ability to use sensory inputs in BPPV patients in different conditions. OBJECTIVE The aim of this study was to examine the postural control performance of middle-aged adult BPPV patients in easy and difficult balance tasks, the effect of vestibular stimulation on the maintenance of balance, and the risk of falling, by posturographic evaluation in various conditions. METHOD A total of 26 patients diagnosed with posterior canal BPPV and 26 controls were included in the study. Sensory Organization Test (SOT), Vestibular Stimulation Test (VST), and fall risk assessment (FRA) were applied to the participants, respectively. RESULTS Significant difference was observed in SOT medio-lateral (ML) plane in Conditions 2 and 5 (p < .05). A significant difference was observed in the vestibular score in the SOT ML plane. No significant difference was observed in VST test scores (p > .05). In the FRA test, a significant difference was observed in the energy and gain parameters in the anterio-posterior plane (p < .05). CONCLUSIONS The current study examined postural control abilities of patients with BPPV in extensive external conditions and in both planes, using various sensory perturbations and stimulation. It was thought that while BPPV patients were in the active phase of the disease, their postural control skills in the ML plane decreased and they might be at risk of falling.
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Affiliation(s)
- Esma Temiçin Şahin
- Faculty of Health Science, Department of Audiology, Gazi University, Ankara, Turkey
| | - Emre Orhan
- Faculty of Health Science, Department of Audiology, Gazi University, Ankara, Turkey
| | - Volkan Tutar
- Faculty of Health Science, Department of Audiology, Gazi University, Ankara, Turkey
| | - Hakan Tutar
- Faculty of Medicine, Department of Oto-Rhino-Laryngology, Gazi University, Ankara, Turkey
| | - Bülent Gündüz
- Faculty of Health Science, Department of Audiology, Gazi University, Ankara, Turkey
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Melo-Alonso M, Murillo-Garcia A, Leon-Llamas JL, Villafaina S, Gomez-Alvaro MC, Morcillo-Parras FA, Gusi N. Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review. J Clin Med 2024; 13:635. [PMID: 38276141 PMCID: PMC10816706 DOI: 10.3390/jcm13020635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The risk for an unexpected fall can be due to increasing age, health conditions, and loss of cognitive, sensory, or musculoskeletal functions. Falls have personal and economic consequences in many countries. Different disturbances can occur during gait, such as tripping, slipping, or other unexpected circumstances that can generate a loss of balance. The strategies used to recover balance depend on many factors, but selecting a correct response strategy influences the success of balance recovery. OBJECTIVES (1) To collect and clarify the definitions of compensatory protective step strategies to recover balance in older adults; (2) to identify the most used methods to induce loss of balance; and (3) to identify the most used spatiotemporal variables in analyzing these actions. METHODS The present review has followed the PRISMA guideline extension for Scoping Review (PRISMA-ScR) and the phases proposed by Askery and O'Malley. The search was conducted in three databases: PubMed, Web of Science, and Scopus. RESULTS A total of 525 articles were identified, and 53 studies were included. Forty-five articles were quasi-experimental studies, six articles were randomized controlled trials, and two studies had an observational design. In total, 12 compensatory protective step strategies have been identified. CONCLUSIONS There are 12 compensatory protective step strategies: lowering and elevating strategy, short- and long-step strategy, backward and forward stepping for slip, single step, multiple steps, lateral sidesteps or loaded leg sidestep unloaded leg sidestep, crossover step (behind and front), and medial sidestep. To standardize the terminology applied in future studies, we recommend collecting these strategies under the term of compensatory protective step strategies. The most used methods to induce loss of balance are the tether-release, trip, waist-pull, and slip methods. The variables analyzed by articles are the number of steps, the acceleration phase and deceleration phase, COM displacement, the step initiation or step duration, stance phase time, swing phase time and double-stance duration, stride length, step length, speed step, speed gait and the type of step.
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Affiliation(s)
- Maria Melo-Alonso
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Alvaro Murillo-Garcia
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Juan Luis Leon-Llamas
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Mari Carmen Gomez-Alvaro
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Felipe Alejandro Morcillo-Parras
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
- International Institute for Innovation in Aging, Universidad de Extremadura, 10003 Caceres, Spain
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Yousefi M, Zivari S, Yiou E, Caderby T. Effect of Chronic Ankle Instability on the Biomechanical Organization of Gait Initiation: A Systematic Review. Brain Sci 2023; 13:1596. [PMID: 38002555 PMCID: PMC10669647 DOI: 10.3390/brainsci13111596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
This systematic review was conducted to provide an overview of the effects of chronic ankle instability (CAI) on the biomechanical organization of gait initiation. Gait initiation is a classical model used in the literature to investigate postural control in healthy and pathological individuals. PubMed, ScienceDirect, Scopus, Web of Science, and Google Scholar were searched for relevant articles. Eligible studies were screened and data extracted by two independent reviewers. An evaluation of the quality of the studies was performed using the Downs and Black checklist. A total of 878 articles were found in the initial search, but only six studies met the inclusion criteria. The findings from the literature suggest that CAI affects the characteristics of gait initiation. Specifically, individuals with CAI exhibit notable differences in reaction time, the spatiotemporal parameters of anticipatory postural adjustments (APAs) and step execution, ankle-foot kinematics, and muscle activation compared to healthy controls. In particular, the observed differences in APA patterns associated with gait initiation suggest the presence of supraspinal motor control alterations in individuals with CAI. These findings may provide valuable information for the rehabilitation of these patients. However, the limited evidence available calls for caution in interpreting the results and underscores the need for further research.
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Affiliation(s)
- Mohammad Yousefi
- Faculty of Sport Sciences, University of Birjand, Birjand 9717434765, Iran; (M.Y.); (S.Z.)
| | - Shaghayegh Zivari
- Faculty of Sport Sciences, University of Birjand, Birjand 9717434765, Iran; (M.Y.); (S.Z.)
| | - Eric Yiou
- Complexité, Innovation, Activités Motrices et Sportives (CIAMS), Université Paris-Saclay, 91400 Orsay, France
- Complexité, Innovation, Activités Motrices et Sportives (CIAMS), Université d’Orléans, 45067 Orléans, France
| | - Teddy Caderby
- Laboratoire IRISSE—EA 4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, 97430 Le Tampon, La Réunion, France;
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Hayek R, Gottlieb U, Gutman I, Springer S. Peroneal muscle response to single-leg drop-jump and unexpected leg-drop in young and middle-aged adults before and after one session of neuromuscular training. Eur Rev Aging Phys Act 2023; 20:11. [PMID: 37330500 DOI: 10.1186/s11556-023-00321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/11/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Changes in neuromuscular ability in middle age (MA) may lead to deterioration of postural control. The aim of this study was to investigate the anticipatory response of the peroneus longus muscle (PL) to landing after a single-leg drop-jump (SLDJ), and its postural response after an unexpected leg-drop in MA and young adults. A second aim was to investigate the influence of neuromuscular training on PL postural responses in both age groups. METHODS Twenty-six healthy MA (55.3 ± 4 years) and 26 healthy young adults (26.3 ± 3.6 years) participated in the study. Assessments were performed before (T0) and after (T1) PL EMG biofeedback (BF) neuromuscular training. Subjects performed SLDJ, and PL EMG activity in preparation for landing (% of flight time) was calculated. To measure PL time to activation onset and time to peak activation in response to an unexpected leg-drop, subjects stood on a customized trapdoor device that produced a sudden 30° ankle inversion. RESULTS Before training, the MA group showed significantly shorter PL activity in preparation for landing compared to the young adults (25.0% vs. 30.0%, p = 0.016), while after training there was no difference between the groups (28.0% vs. 29.0%, p = 0.387). There were no differences between groups in peroneal activity after the unexpected leg-drop before and after training. CONCLUSIONS Our results suggest that automatic anticipatory peroneal postural responses are decreased at MA, whereas reflexive postural responses appear to be intact in this age group. A short PL EMG-BF neuromuscular training may have an immediate positive effect on PL muscle activity at MA. This should encourage the development of specific interventions to ensure better postural control in this group. TRIAL REGISTRATION ClinicalTrials.gov NCT05006547.
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Affiliation(s)
- Roee Hayek
- Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular & Human Performance Laboratory, Ariel University, Medicine and Health Science Building, Rm 30, 40700, Ariel, Israel
| | - Uri Gottlieb
- Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular & Human Performance Laboratory, Ariel University, Medicine and Health Science Building, Rm 30, 40700, Ariel, Israel
| | - Itai Gutman
- Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular & Human Performance Laboratory, Ariel University, Medicine and Health Science Building, Rm 30, 40700, Ariel, Israel
| | - Shmuel Springer
- Faculty of Health Sciences, Department of Physical Therapy, The Neuromuscular & Human Performance Laboratory, Ariel University, Medicine and Health Science Building, Rm 30, 40700, Ariel, Israel.
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Sota, K, Uchiyama, Y, Kaida, K, Wakasugi, T, Takemura, D, Sasanuma, N, Ikegame K, Domen K. Balance Function after Balance Exercise Assist Robot Therapy in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: A Pilot Study. Prog Rehabil Med 2023; 8:20230003. [PMID: 36793372 PMCID: PMC9904881 DOI: 10.2490/prm.20230003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
Objectives This study compared the balance function in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) with their balance function after subsequent training sessions with a Balance Exercise Assist Robot (BEAR). Methods In this prospective observational study, inpatients who underwent allo-HSCT from human leukocyte antigen-mismatched relatives were enrolled from December 2015 to October 2017. Patients were allowed to leave their clean room after allo-HSCT and underwent balance exercise training using the BEAR. Sessions (20-40 min) were performed 5 days per week and consisted of three games that were performed four times each. A total of 15 sessions were performed by each patient. Patient balance function was assessed before BEAR therapy according to the mini-balance evaluation systems test (mini-BESTest), and patients were divided into two groups (Low and High) based on a 70% cut-off value for the total mini-BESTest score. Patient balance was also assessed after BEAR therapy. Results Fourteen patients providing written informed consent fulfilled the protocol: six patients in the Low group, and eight patients in the High group. In the Low group, there was a statistically significant difference between pre- and post-evaluations in postural response, which a sub-item of the mini-BESTest. In the High group, there was no significant difference between pre- and post-evaluations in the mini-BESTest. Conclusions BEAR sessions improve balance function in patients undergoing allo-HSCT.
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Affiliation(s)
- Koichiro Sota,
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Hyogo, Japan
| | - Yuki Uchiyama,
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Katsuji Kaida,
- Division of Hematology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Tatsushi Wakasugi,
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Daiki Takemura,
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Naoki Sasanuma,
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Kazuhiro Ikegame
- Division of Hematology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo Medical University, Nishinomiya, Japan
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Buková A, Kováčiková Z, Sarvestan J, Neumannová K, Pecho J, Zemková E. Advancing age is associated with more impaired mediolateral balance control after step down task. Gait Posture 2023; 100:165-170. [PMID: 36535105 DOI: 10.1016/j.gaitpost.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/19/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND To prevent the risk of stair descent falls and associated injuries in the older adults, it is important to understand the factors that affect this frequent locomotion of daily living. The fact that falls are in most cases the result of the interaction between intrinsic and extrinsic factors is very often underestimated when designing test protocols. RESEARCH QUESTION This study aimed at evaluating balance control during and immediately after step down onto an unstable surface. METHODS Physically active men and women aged 60-69 years (n = 28) and 70-79 years (n = 18) were asked to perform a step down onto a foam pad and stand still for 30 s (restabilization phase). Centre of pressure (CoP) velocity and standard deviation of CoP sway in anteroposterior and mediolateral direction were evaluated during the step down (CoP VAP, CoP VML, CoP SDAP, CoP SDML) and in the first 5 s of restabilization (CoP VAP5, CoP VML5, CoP SDAP5, CoP SDML5). In addition, time to complete step was investigated. RESULTS Participants aged 70-79 years presented worse ML balance control after step down onto an unstable surface than their younger counterparts. This was represented by the significantly higher values of CoP SDML5 and CoP VML5 (p = 0.022 and p = 0.017). No other significant differences were detected. SIGNIFICANCE Age is associated with a more significant ML center of pressure velocity and sway after step down onto a foam pad in physically active older adults. Exercises aimed at improving ML balance control in unstable conditions should be the subject of physical interventions even in older adults with overall good state of health and physical fitness.
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Affiliation(s)
- Alena Buková
- Institute of Physical Education and Sport, Pavol Jozef Šafárik University in Košice, Košice, Slovakia
| | - Zuzana Kováčiková
- Institute of Physical Education and Sport, Pavol Jozef Šafárik University in Košice, Košice, Slovakia.
| | - Javad Sarvestan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kateřina Neumannová
- Department of Physiotherapy, Faculty of Physical Culture, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Juraj Pecho
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
| | - Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia
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Kim HK, Lu SH, Lu TW, Chou LS. Contribution of lower extremity muscles to center of mass acceleration during walking: Effect of body weight. J Biomech 2023; 146:111398. [PMID: 36459848 DOI: 10.1016/j.jbiomech.2022.111398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
Abstract
Overweight or obesity is known to be associated with altered activations of lower extremity muscles. Such changes in muscular function may lead to the development of mobility impairments or joint diseases. However, little is known about how individual lower extremity muscles contribute to the whole-body center of mass (COM) control during walking and the effect of body weight. This study examined the contribution of individual lower extremity muscle force to the COM accelerations during walking in overweight and non-overweight individuals. Musculoskeletal simulations were performed for the stance phase of walking with data collected from 11 overweight and 13 non-overweight adults to estimate lower extremity muscle forces and their contributions to the COM acceleration. Mean time-series data from each parameter were compared between body size groups using Statistical Parametric Mapping. Compared to the non-overweight group, the overweight group revealed a greater gastrocnemius contribution to the mediolateral (p = 0.006) and vertical (p < 0.001) COM accelerations during mid-stance, and had a lower vastus contribution to the anteroposterior COM acceleration (p < 0.001) during pre-swing. Increased contributions from the large posterior calf muscles to the mediolateral COM acceleration may be related to efforts to alleviate COM sway in overweight individuals.
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Affiliation(s)
- Hyun Kyung Kim
- Department of Kinesiology, Iowa State University, Ames, IA, USA; School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA
| | - Shiuan-Huei Lu
- Department of Biomedical Engineering, National Taiwan University, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taiwan
| | - Li-Shan Chou
- Department of Kinesiology, Iowa State University, Ames, IA, USA.
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Artificial intelligence-based volumetric analysis of muscle atrophy and fatty degeneration in patients with hip osteoarthritis and its correlation with health-related quality of life. Int J Comput Assist Radiol Surg 2023; 18:71-78. [PMID: 36571719 PMCID: PMC9883321 DOI: 10.1007/s11548-022-02797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/16/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Artificial intelligence (AI) technologies have enabled precise three-dimensional analysis of individual muscles on computed tomography (CT) or magnetic resonance images via automatic segmentation. This study aimed to perform three-dimensional assessments of pelvic and thigh muscle atrophy and fatty degeneration in patients with unilateral hip osteoarthritis using CT and to evaluate the correlation with health-related quality of life (HRQoL). METHODS The study included one man and 43 women. Six muscle groups were segmented, and the muscle atrophy ratio was calculated volumetrically. The degree of fatty degeneration was defined as the difference between the mean CT values (Hounsfield units [HU]) of the healthy and affected sides. HRQoL was evaluated using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). RESULTS The mean muscle atrophy rate was 16.3%, and the mean degree of muscle fatty degeneration was 7.9 HU. Multivariate correlation analysis revealed that the WOMAC stiffness subscale was significantly related to fatty degeneration of the hamstrings, the WOMAC physical function subscale was significantly related to fatty degeneration of the iliopsoas muscle, and the JHEQ movement subscale was significantly related to fatty degeneration of the hip adductors. CONCLUSION We found that fatty degeneration of the hamstrings, iliopsoas, and hip adductor muscles was significantly related to HRQoL in patients with hip osteoarthritis. These findings suggest that these muscles should be targeted during conservative rehabilitation for HOA and perioperative rehabilitation for THA.
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Komisar V, Dojnov A, Yang Y, Shishov N, Chong H, Yu Y, Bercovitz I, Cusimano MD, Becker C, Mackey DC, Robinovitch SN. Injuries from falls by older adults in long-term care captured on video: Prevalence of impacts and injuries to body parts. BMC Geriatr 2022; 22:343. [PMID: 35439948 PMCID: PMC9019961 DOI: 10.1186/s12877-022-03041-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background Falls are the leading cause of injuries in older adults. However, most falls in older adults do not cause serious injury, suggesting that older adults may fall in a manner that reduces the likelihood of impact to body sites that are most vulnerable to injury. In this observational study of falls in long-term care (LTC), we tested whether body parts differed in their probability of impact and injury. Methods We recorded and analyzed videos of 2388 falls by 658 LTC residents (mean age 84.0 (SD = 8.1); 56.4% female). We used Linear Mixed Models to test for differences between body parts in the probability of impact and injury, and injury when impacts occurred. Results Injuries were reported in 38.2% of falls, and 85.9% of injuries involved direct impact to the injured body part. Impact occurred most often to the hip/pelvis (probability (standard error) = 0.95 (0.01); p < .001 relative to other body parts), and least often to the head (0.35 (0.01)). Conversely, injury occurred most often to the head (p < .001 relative to other body parts). The probability of injury when impacts occurred was 0.40 (0.01) for the head, and 0.11 or less for all other body parts. Conclusion Our results help to explain why most falls by older adults in LTC do not cause serious injury: residents land on body parts that are the most resilient to injury. The high susceptibility of the head to injury reinforces the need to enhance upper limb protective responses for fall arrest. The dominant role of direct impact as the mechanism of injury supports approaches to attenuate impact forces through strategies like protective clothing and compliant flooring.
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Affiliation(s)
- Vicki Komisar
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,School of Engineering, The University of British Columbia, 1137 Alumni Ave, Kelowna, BC, V1V 1V7, Canada.
| | - Aleksandra Dojnov
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.,Institute of Biomedical Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
| | - Yijian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, SAR, Shenzhen, China
| | - Nataliya Shishov
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Helen Chong
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Ying Yu
- Department of Statistics and Actuarial Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Ian Bercovitz
- Department of Statistics and Actuarial Science, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Michael D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, Unity Health, LiKaShing Knowledge Institute, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Clemens Becker
- Robert Bosch Hospital, Auerbachstraße 110, 70376, Stuttgart, Germany.,Unit of Digital Geriatric Medicine, University Hospital, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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The influence of net ground reaction force orientation on mediolateral stability during walking. Gait Posture 2021; 90:73-79. [PMID: 34418868 DOI: 10.1016/j.gaitpost.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous work has linked the eccentricity of the net ground reaction force (GRFnet) to increased mediolateral instability during single-step voluntary and compensatory stepping responses. The present work sought to understand the extent to which such control mechanisms for mediolateral stability are present during gait. RESEARCH QUESTION How do gait velocity and step width constraints influence the kinetic control of mediolateral stability control among healthy participants? METHODS 25 participants performed three walking conditions - normal walking with self-selected speed and foot-placement, fast walking with self-selected foot-placement, and narrowbase walking - across a 10-meter walkway. Lateral instability was quantified by the mediolateral margin of stability (MoSML). The frontal-plane eccentricity of the GRFnet was calculated as the difference between GRFnet vector orientation and that of a line joining the coordinates of COPnet and COM. Two discrete time-points (P1 and P2) following foot-contact were examined, as they have been suggested to be indicative of proactive and reactive COM control, respectively. Task-related differences in the magnitude and timing of kinematic and kinetic outcome variables were analysed using one-way ANOVAs with repeated-measures. RESULTS With constraints on step-width in narrow-base walking, participants exhibited reduced stability as evidenced by reduced MoSML, alongside reductions in the peak GRFnet eccentricity (θd) at P1. Participants exhibited no reduction in stability during fast walking, as revealed by the MoSML in part because of a similar onset of P1 within the gait cycle. P2 magnitude was larger in narrow-base walking relative to fast-walking, and occurred at an earlier point in the gait cycle. SIGNIFICANCE Findings suggest proactive mechanisms (i.e. P1) may predominantly regulate mediolateral stability during walking. Reactive mechanisms (i.e. P2), however, may be capable of offsetting instability in situations where proactive mechanisms are insufficient.
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Wray P, Ward CK, Nelson C, Sulzer SH, Dakin CJ, Thompson BJ, Vierimaa M, Das Gupta D, Bolton DAE. Pickleball for Inactive Mid-Life and Older Adults in Rural Utah: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8374. [PMID: 34444124 PMCID: PMC8391496 DOI: 10.3390/ijerph18168374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022]
Abstract
Many diseases, disabilities, and mental health conditions associated with aging can be delayed or prevented through regular exercise. Several barriers to exercise, many of which are exacerbated in rural communities, prevent mid-life and older adults from accessing its benefits. However, recently, a racquet sport named pickleball has become popular among older adults, and it appears to overcome some of these barriers. We conducted a feasibility study to evaluate the impact of a six-week pickleball intervention on measures of muscle function, cognitive function, perceived pain, and cardio-metabolic risk, as well as several psychosocial factors contributing to adherence in sedentary rural participants. Participants improved their vertical jump, cognitive performance, and reported a decrease in self-reported pain, suggesting improved physical and cognitive health across the sample. Participants also reported high levels of satisfaction and demonstrated good adherence over the duration of the study. Perhaps of greatest value was the overwhelmingly positive response from participants to the intervention and follow-up interviews reporting a desire to continue pickleball play beyond the study period. Overall, pickleball appears to be a promising intervention to, (1) elicit functional- and cognitive-related improvements, and (2) motivate mid-life and older adults to adhere to exercise sufficiently long to benefit their health.
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Affiliation(s)
- Paige Wray
- Department of Home and Community, Utah State University Extension, Monticello, San Juan County, UT 84535, USA;
| | - Callahan K. Ward
- Department of Home and Community, Utah State University Extension, Panguitch, Garfield County, UT 84759, USA;
| | - Cindy Nelson
- Department of Home and Community, Utah State University Extension, Beaver, Beaver County, UT 84713, USA;
| | - Sandra H. Sulzer
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.H.S.); (C.J.D.); (B.J.T.); (D.D.G.)
| | - Christopher J. Dakin
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.H.S.); (C.J.D.); (B.J.T.); (D.D.G.)
| | - Brennan J. Thompson
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.H.S.); (C.J.D.); (B.J.T.); (D.D.G.)
| | - Matthew Vierimaa
- School of Kinesiology, Acadia University, Wolfville, NS B4P 2R6, Canada;
| | - Debasree Das Gupta
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.H.S.); (C.J.D.); (B.J.T.); (D.D.G.)
| | - David A. E. Bolton
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.H.S.); (C.J.D.); (B.J.T.); (D.D.G.)
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12
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Muscle synergy differences between voluntary and reactive backward stepping. Sci Rep 2021; 11:15462. [PMID: 34326376 PMCID: PMC8322057 DOI: 10.1038/s41598-021-94699-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/08/2021] [Indexed: 11/08/2022] Open
Abstract
Reactive stepping responses are essential to prevent falls after a loss of balance. It has previously been well described that both voluntary and reactive step training could improve the efficacy of reactive stepping in different populations. However, the effect of aging on neuromuscular control during voluntary and reactive stepping remains unclear. Electromyography (EMG) signals during both backward voluntary stepping in response to an auditory cue and backward reactive stepping elicited by a forward slip-like treadmill perturbation during stance were recorded in ten healthy young adults and ten healthy older adults. Using muscle synergy analysis, we extracted the muscle synergies for both voluntary and reactive stepping. Our results showed that fewer muscle synergies were used during reactive stepping than during voluntary stepping in both young and older adults. Minor differences in the synergy structure were observed for both voluntary and reactive stepping between age groups. Our results indicate that there is a low similarity of muscle synergies between voluntary stepping and reactive stepping and that aging had a limited effect on the structure of muscle synergies. This study enhances our understanding of the neuromuscular basis of both voluntary and reactive stepping as well as the potential effect of aging on neuromuscular control during balance tasks.
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Malloggi C, Scarano S, Cerina V, Catino L, Rota V, Tesio L. The curvature peaks of the trajectory of the body centre of mass during walking: A new index of dynamic balance. J Biomech 2021; 123:110486. [PMID: 34004391 DOI: 10.1016/j.jbiomech.2021.110486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/26/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
During walking, falling is most likely to occur towards the side of the supporting lower limb during the single stance. Timely lateral redirection of the centre of mass (CoM) preceding the no-return position is necessary for balance. We analysed the curvature peaks (the inverse of the radius of curvature) of the three-dimensional path of the CoM during the entire stride. Twelve healthy adults walked on a force-sensorized treadmill at constant velocities from 0.4 to 1.2 m s-1, in 0.2 m s-1 increments. The three-dimensional displacements of the CoM, the muscular power sustaining the CoM motion with respect to the ground, and the efficiency of the pendulum-like transfer of the CoM were computed via the double integration of the ground reaction forces. The curvatures of the CoM trajectory were measured (Frenet-Serret formula). During the single stance, the curvature showed a bell-shaped increment, lasting a few tenths of a millisecond, and peaking at 365-683 m-1 (radius of 2.7-1.4 mm, respectively), the higher the walking velocity. The CoM was redirected towards the swinging lower limb. The curvature increment was sustained by muscle-driven braking of the CoM. Smoother increments of curvature (peaking at approximately 37-150 m-1), further orienting the CoM towards the leading lower limb, were observed during the double stance. The peaks of the curvatures were symmetric between the two sides. The high curvature peaks during the single stance may represent an index of dynamic balance during walking. This index might be useful for both rehabilitation and sports training purposes.
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Affiliation(s)
- Chiara Malloggi
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy
| | - Stefano Scarano
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Valeria Cerina
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy
| | - Luigi Catino
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Viviana Rota
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy
| | - Luigi Tesio
- Istituto Auxologico Italiano, IRCCS, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milano, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
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14
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Okubo Y, Schoene D, Caetano MJD, Pliner EM, Osuka Y, Toson B, Lord SR. Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests. Ageing Res Rev 2021; 66:101238. [PMID: 33352293 DOI: 10.1016/j.arr.2020.101238] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/31/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers. DATA SOURCE PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles. STUDY SELECTION Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65). RESULTS A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers. CONCLUSIONS This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.
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15
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Rogers MW, Creath RA, Gray V, Abarro J, McCombe Waller S, Beamer BA, Sorkin JD. Comparison of Lateral Perturbation-Induced Step Training and Hip Muscle Strengthening Exercise on Balance and Falls in Community-Dwelling Older Adults: A Blinded Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2021; 76:e194-e202. [PMID: 33491052 DOI: 10.1093/gerona/glab017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This factorial, assessor-blinded, randomized, and controlled study compared the effects of perturbation-induced step training (lateral waist-pulls), hip muscle strengthening, and their combination, on balance performance, muscle strength, and prospective falls among older adults. METHODS Community-dwelling older adults were randomized to 4 training groups. Induced step training (IST, n = 25) involved 43 progressive perturbations. Hip abduction strengthening (HST, n = 25) utilized progressive resistance exercises. Combined training (CMB, n = 25) included IST and HST, and the control performed seated flexibility/relaxation exercises (SFR, n = 27). The training involved 36 sessions for a period of 12 weeks. The primary outcomes were the number of recovery steps and first step length, and maximum hip abduction torque. Fall frequency during 12 months after training was determined. RESULTS Overall, the number of recovery steps was reduced by 31% and depended upon the first step type. IST and CMB increased the rate of more stable single lateral steps pre- and post-training than HST and SFR who used more multiple crossover and sequential steps. The improved rate of lateral steps for CMB exceeded the control (CMB/SFR rate ratio 2.68). First step length was unchanged, and HST alone increased hip torque by 25%. Relative to SFR, the fall rate ratios (falls/person/year) [95% confidence interval] were CMB 0.26 [0.07-0.90], IST 0.44 [0.18-1.08], and HST 0.30 (0.10-0.91). CONCLUSIONS Balance performance through stepping was best improved by combining perturbation and strength training and not strengthening alone. The interventions reduced future falls by 56%-74% over the control. Lateral balance perturbation training may enhance traditional programs for fall prevention.
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Affiliation(s)
- Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US.,Department of Exercise Science, Lebanon Valley College, Annville, Pennsylvania, US
| | - Vicki Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Janice Abarro
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Sandy McCombe Waller
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Brock A Beamer
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, US.,Baltimore VA Medical Center, Geriatric Research, Education, and Clinical Center (GRECC), Maryland, US
| | - John D Sorkin
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, US.,Baltimore VA Medical Center, Geriatric Research, Education, and Clinical Center (GRECC), Maryland, US
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16
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Effects of different initial foot positions on kinematics, muscle activation patterns, and postural control during a sit-to-stand in younger and older adults. J Biomech 2021; 117:110251. [PMID: 33493710 DOI: 10.1016/j.jbiomech.2021.110251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/19/2020] [Accepted: 01/03/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Performing a sit-to-stand (STS) can be a challenging task for older adults because of age-related declines in neuromuscular strength and coordination. We investigated the effects of different initial foot positions (IFPs) on kinematics, muscle activation patterns, and balance control during a STS in younger and older adults. METHODS Ten younger and ten older healthy adults participated in this study. Four symmetric IFPs were studied: (1) reference (REF), (2) toes-out with heels together (TOHT), (3) toes-out (TO), and (4) Wide. Lower-extremity muscle activation patterns and kinetic and kinematic data in the sagittal and frontal planes were measured. RESULTS The trunk forward-tilt angle and hip extension torque during uprising were smaller in TO and Wide for both age groups. Postural sway and center of pressure sway area were smallest in TO after completion of uprising with no difference between age groups. Adductor longus and gluteus medius activity was greater in TO than in the other IFPs, and older adults activated these muscles to a greater degree than younger adults. CONCLUSION Smaller trunk flexion angles with greater activation of the hip abductor and adductor muscles in TO contributed to improving postural stability during the STS. SIGNIFICANCE STS training with a toes-out foot position could be an effective rehabilitation strategy for older adults to strengthen hip muscles that control medio-lateral balance required for balance during a STS.
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17
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Lin SI, Tsai YJ, Lee PY. Balance performance when responding to visual stimuli in patients with Benign Paroxysmal Positional Vertigo (BPPV). J Vestib Res 2020; 30:267-274. [PMID: 32925126 DOI: 10.3233/ves-200709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with Benign Paroxysmal Positional Vertigo (BPPV) often report a sensation of disequilibrium before treatment with the canalith repositioning maneuvers. Apart from vestibular information, visual input also contributes to balance control. How visual stimuli influence balance control in BPPV patients is unclear. OBJECTIVE To investigate the influence of visual stimuli on balance performance in BPPV patients. METHODS Three groups of participants, patients with BPPV, and healthy young and older adults, were instructed to stand under three conditions: 1) eyes open (EO); 2) while watching a static picture via a video display; and 3) while watching a rotating visual scene. Antero-posterior (AP), lateral (ML), and total sway path during standing were analyzed. RESULTS In all conditions, patients with BPPV showed significantly larger AP, ML and total sway path than young, whereas older adults only showed significantly larger AP and total sway path than young adults. During the visual stimuli, all participants exhibited significantly increased AP and total sway while watching a static image and a moving scene as compared with the EO condition. CONCLUSIONS Patients with BPPV have similar balance control to older adults, but poorer balance control than young adults. The reduced lack of standing balance control in the coronal plane of patients with BPPV, might affect balance strategy after external perturbations.
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Affiliation(s)
- Sang-I Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ju Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Yun Lee
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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18
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Caderby T, Caron N, Verkindt C, Bonazzi B, Dalleau G, Peyrot N. Obesity-related alterations in anticipatory postural mechanisms associated with gait initiation. Exp Brain Res 2020; 238:2557-2567. [DOI: 10.1007/s00221-020-05914-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/26/2020] [Indexed: 02/08/2023]
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19
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Gray VL, Fujimoto M, Rogers MW. Lateral Perturbation-Induced and Voluntary Stepping in Fallers and Nonfallers After Stroke. Phys Ther 2020; 100:1557-1567. [PMID: 32529236 PMCID: PMC7608778 DOI: 10.1093/ptj/pzaa109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/23/2020] [Accepted: 04/09/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A loss of balance poststroke from externally induced perturbations or during voluntary movements is often recovered by stepping. The purpose of this study was to characterize stepping behavior during lateral induced waist-pull perturbations and voluntary steps in community-dwelling fallers and nonfallers with chronic stroke. METHODS This study used a cohort design. Thirty participants >6 months poststroke were exposed to 24 externally triggered lateral waist-pull perturbations and 20 voluntary steps. Balance tolerance limit (BTL) (transition from single to multiple steps) and first step type were determined for the waist-pull perturbations. Step parameters of initiation time, velocity, first step length, and clearance were calculated at and above BTL and for the voluntary steps. Hip abductor/adductor torque, foot cutaneous sensation, and self-reported falls that occurred 6 months prior were evaluated. RESULTS Twelve participants were classified retrospectively as fallers and 18 as nonfallers. Fallers had a reduced BTL and took more medial first steps than nonfallers. Above BTL, no between-group differences were found in medial steps. At BTL, the nonparetic step clearance was reduced in fallers. Above BTL, fallers took longer to initiate a paretic and nonparetic step and had a reduced nonparetic step length and clearance compared with nonfallers. There was a between-group difference in step initiation time for voluntary stepping with the paretic leg (P < .05). Fallers had a reduced paretic abductor torque and impaired paretic foot cutaneous sensation. CONCLUSION A high fall rate poststroke necessitates effective fall prevention strategies. Given that more differences were found during perturbation-induced stepping between fallers and nonfallers, further research assessing perturbation-induced training on reducing falls is needed. IMPACT Falls assessments should include both externally induced perturbations along with voluntary movements in determining the fall risk.
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Affiliation(s)
| | - Masahiro Fujimoto
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, Kashiwa, Japan
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine
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20
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Yang F, Liu W. Biomechanical mechanism of Tai-Chi gait for preventing falls: A pilot study. J Biomech 2020; 105:109769. [PMID: 32278527 DOI: 10.1016/j.jbiomech.2020.109769] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/28/2020] [Accepted: 03/28/2020] [Indexed: 01/22/2023]
Abstract
Tai-Chi (TC) practice has been increasingly used to prevent falls in older adults. However, the biomechanical mechanisms underlying the effects of TC practice on fall risk among older adults remain unanswered. The objective of this pilot study was to examine how TC gait biomechanically impacts the human body in terms of dynamic gait stability and lower limb muscle strength in comparison with regular walking gait. Ten healthy adults performed five trials of TC gait following three to seven trials of regular walking. Full body kinematics and kinetics were collected, and then dynamic gait stability and lower limb joint moments were determined. During TC gait, individuals were less stable, moved more slowly and experienced a larger mediolateral movement in comparison with regular walking gait. The peak moment at the ankle joint on the sagittal and transverse planes, at the knee joint on all three planes, and at the hip joint on the frontal plane was significantly different when performing TC gait than during regular gait. The results indicate that TC gait challenges body balance and requires more muscle strength of the lower limb joints compared to regular walking gait. To cope with these challenges, the body could develop neuromuscular control strategies to maintain body balance and thus reduce the risk of falls. The findings and methodology in this study could provide preliminary guidance for identifying optimal TC forms in order to maximize the effects of TC-based fall prevention interventions among various populations with elevated risk of falls.
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Affiliation(s)
- Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA 30303, United States
| | - Wei Liu
- Division of Osteopathic Rehabilitation, Edward Via College of Osteopathic Medicine, Auburn, AL 36832, United States.
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21
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Pigman J, Reisman DS, Pohlig RT, Jeka JJ, Wright TR, Conner BC, Petersen DA, Crenshaw JR. Anterior fall-recovery training applied to individuals with chronic stroke. Clin Biomech (Bristol, Avon) 2019; 69:205-214. [PMID: 31382163 PMCID: PMC6823156 DOI: 10.1016/j.clinbiomech.2019.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/02/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND To study the effects of the initial stepping limb on anterior fall-recovery performance and kinematics, as well as to determine the benefits of fall-recovery training on those outcomes in individuals with chronic stroke. METHODS Single-group intervention of 15 individuals with chronic stroke who performed up to six sessions of fall-recovery training. Each session consisted of two progressions of treadmill-induced perturbations to induce anterior falls from a standing position. Progressions focused on initial steps with the paretic or non-paretic limb. Fall-recovery performance (the highest disturbance level achieved and the proportion of successful recoveries), as well as step and trunk kinematics were compared between the initial stepping limbs on the first session. Limb-specific outcomes were also compared between the first and last training sessions. FINDINGS There were no between-limb differences in fall-recovery performance in the first session. With training, participants successfully recovered from a higher proportion of falls (p's = 0.01, Cohen's d's > 0.7) and progressed to larger perturbation magnitudes (p's < 0.06, d's > 0.5). Initial steps with the paretic limb were wider and shorter relative to the center of mass (p's < 0.06, d's > 0.5). With training, initial paretic-limb steps became longer relative to the CoM (p = 0.03, d = 0.7). Trunk forward rotation was reduced when first stepping with the non-paretic limb (p = 0.03, d = 0.6). INTERPRETATION The initial stepping limb affects relevant step kinematics during anterior fall recovery. Fall-recovery training improved performance and select kinematic outcomes in individuals with chronic stroke.
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Affiliation(s)
- Jamie Pigman
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE, USA.
| | - John J Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
| | - Tamara R Wright
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - Benjamin C Conner
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; College of Medicine - Phoenix, University of Arizona, Phoenix, AZ, USA.
| | - Drew A Petersen
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA; College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA.
| | - Jeremy R Crenshaw
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
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22
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Verniba D, Gage WH. Stepping threshold with platform-translation and shoulder-pull postural perturbation methods. J Biomech 2019; 94:224-229. [PMID: 31395277 DOI: 10.1016/j.jbiomech.2019.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/29/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
The type of balance recovery, feet-in-place or stepping, is predicated on the perturbation intensity, often defined by the combination of applied force and displacement. Few studies examined the relationship between characteristics required to produce a stepping response with one of the postural perturbation methods. The purpose of this study was to investigate the relationship between perturbation characteristics (applied force and displacement) required to elicit a forward stepping response with platform-translation and shoulder-pull methods, and to establish whether a common set of perturbation characteristics existed across both perturbation methods. Fourteen young healthy males participated. Temporally unexpected platform translations and shoulder pulls were induced by release of free weights, which fell a controlled height exerting a pull on the platform or on the participant via a shoulder harness. Participants responded with either feet-in-place or stepping responses. The force and displacement were varied to investigate the range of force-displacement combinations required to elicit stepping responses. Force-displacement combinations that elicited stepping responses were recorded and normalized to the participant's body weight (BW) and the base of support (BOS; participant's foot length). The lowest force and associated displacement that elicited stepping responses showed an inverse linear relationship during both platform-translation and shoulder-pull trials. The lowest force-displacement combination common to both perturbation methods was found to be 8.75%BW and 105%BOS, which, in the future work, could enable a direct comparison of the neuromuscular and biomechanical responses to different perturbation methods in a manner that attempts to equilibrate the perturbation stimulus across the methods.
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Affiliation(s)
- Dmitry Verniba
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada.
| | - William H Gage
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
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23
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Tesio L, Rota V. The Motion of Body Center of Mass During Walking: A Review Oriented to Clinical Applications. Front Neurol 2019; 10:999. [PMID: 31616361 PMCID: PMC6763727 DOI: 10.3389/fneur.2019.00999] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/02/2019] [Indexed: 01/04/2023] Open
Abstract
Human walking is usually conceived as the cyclic rotation of the limbs. The goal of lower-limb movements, however, is the forward translation of the body system, which can be mechanically represented by its center of mass (CoM). Lower limbs act as struts of an inverted pendulum, allowing minimization of muscle work, from infancy to old age. The plantar flexors of the trailing limbs have been identified as the main engines of CoM propulsion. Motion of the CoM can be investigated through refined techniques, but research has been focused on the fields of human and animal physiology rather than clinical medicine. Alterations in CoM motion could reveal motor impairments that are not detectable by clinical observation. The study of the three-dimensional trajectory of the CoM motion represents a clinical frontier. After adjusting for displacement due to the average forward speed, the trajectory assumes a figure-eight shape (dubbed the “bow-tie”) with a perimeter about 18 cm long. Its lateral size decreases with walking velocity, thus ensuring dynamic stability. Lateral redirection appears as a critical phase of the step, requiring precise muscle sequencing. The shape and size of the “bow-tie” as functions of dynamically equivalent velocities do not change from child to adulthood, despite anatomical growth. The trajectory of the CoM thus appears to be a promising summary index of both balance and the neural maturation of walking. In asymmetric gaits, the affected lower limb avoids muscle work by pivoting almost passively, but extra work is required from the unaffected side during the next step, in order to keep the body system in motion. Generally, the average work to transport the CoM across a stride remains normal. In more demanding conditions, such as walking faster or uphill, the affected limb can actually provide more work; however, the unaffected limb also provides more work and asymmetry between the steps persists. This learned or acquired asymmetry is a formerly unsuspected challenge to rehabilitation attempts to restore symmetry. Techniques of selective loading of the affected side, which include constraining the motion of the unaffected limb or forcing the use of the affected limb on split-belt treadmills which impose a different velocity and power to either limb, are now under scrutiny.
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Affiliation(s)
- Luigi Tesio
- Department of Biomedical Sciences for Health, Università degli Studi, Milan, Italy.,Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Viviana Rota
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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Martinez KM, Rogers MW, Blackinton MT, Cheng MS, Mille ML. Perturbation-Induced Stepping Post-stroke: A Pilot Study Demonstrating Altered Strategies of Both Legs. Front Neurol 2019; 10:711. [PMID: 31333566 PMCID: PMC6618516 DOI: 10.3389/fneur.2019.00711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/17/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Asymmetrical sensorimotor function after stroke creates unique challenges for bipedal tasks such as walking or perturbation-induced reactive stepping. Preference for initiating steps with the less-involved (preferred) leg after a perturbation has been reported with limited information on the stepping response of the more-involved (non-preferred) leg. Understanding the capacity of both legs to respond to a perturbation would enhance the design of future treatment approaches. This pilot study investigated the difference in perturbation-induced stepping between legs in stroke participant and non-impaired controls. We hypothesized that stepping performance will be different between groups as well as between legs for post-stroke participants. Methods: Thirty-six participants (20 persons post-stroke, 16 age matched controls) were given an anterior perturbation from three stance positions: symmetrical (SS), preferred asymmetrical (PAS−70% body weight on the preferred leg), and non-preferred asymmetrical (N-PAS−70% body weight on the non-preferred leg). Kinematic and kinetic data were collected to measure anticipatory postural adjustment (APA), characteristics of the first step (onset, length, height, duration), number of steps, and velocity of the body at heel strike. Group differences were tested using the Mann-Whitney U-test and differences between legs tested using the Wilcoxon signed-rank test with an alpha level of 0.05. Results: Stepping with the more-involved leg increased from 11.5% of trials in SS and N-PAS up to 46% in PAS stance position for participants post-stroke. Post-stroke participants had an earlier APA and always took more steps than controls to regain balance. However, differences between post-stroke and control participants were mainly found when stance position was modified. Compare to controls, steps with the preferred leg (N-PAS) were earlier and shorter (in time and length), whereas steps with the non-preferred leg (PAS) were also shorter but took longer. For post-stroke participants, step duration was longer and utilized more steps when stepping with the more-involved leg compared to the less-involved leg. Conclusions: Stepping with the more-involved leg can be facilitated by unweighting the leg. The differences between groups, and legs in post-stroke participants illustrate the simultaneous bipedal role (support and stepping) both legs have in reactive stepping and should be considered for reactive balance training.
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Affiliation(s)
- Katherine M Martinez
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mary T Blackinton
- Physical Therapy Program, Nova Southeastern University, Tampa, FL, United States
| | - M Samuel Cheng
- Physical Therapy Program, Nova Southeastern University, Fort-Lauderdale, FL, United States
| | - Marie-Laure Mille
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,UFR-STAPS, Université de Toulon, La Garde, France.,Institut des Sciences du Mouvement (ISM UMR 7287), Aix Marseille Université and CNRS, Marseille, France
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25
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Handelzalts S, Steinberg-Henn F, Levy S, Shani G, Soroker N, Melzer I. Insufficient Balance Recovery Following Unannounced External Perturbations in Persons With Stroke. Neurorehabil Neural Repair 2019; 33:730-739. [PMID: 31315506 DOI: 10.1177/1545968319862565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Persons with stroke (PwS) are at increased risk of falls, especially toward the paretic side, increasing the probability of a hip fracture. The ability to recover from unexpected loss of balance is a critical factor in fall prevention. Objectives. We aimed to compare reactive balance capacity and step kinematics between PwS and healthy controls. Methods. Thirty subacute PwS and 15 healthy controls were exposed to forward, backward, right, and left unannounced surface translations in 6 increasing intensities while standing. Single step threshold, multiple step threshold, and fall threshold (ie, perturbation intensity leading to a fall into harness system) were recorded as well as reactive step initiation time, step length, and step velocity. Results. Twenty-five PwS fell into harness system during the experiment while healthy controls did not fall. Fourteen out of 31 falls occurred in response to surface translations toward the nonparetic side, that is, falling toward the paretic side. Compared with healthy controls, PwS demonstrated significantly lower fall threshold and multiple step threshold in response to forward, backward, and lateral surface translations. Impairments were more pronounced in response to forward surface translation and toward the nonparetic side (ie, loss of balance toward the paretic side). A trend toward significant shorter step length in response to lateral surface translations was found in PwS compared with healthy controls. Conclusions. Findings highlight the importance of assessing reactive balance capacity in response to perturbations in different directions and intensities in addition to the routine assessment in PwS.
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Affiliation(s)
- Shirley Handelzalts
- 1 Ben-Gurion University, Beer-Sheva, Israel.,2 Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Flavia Steinberg-Henn
- 1 Ben-Gurion University, Beer-Sheva, Israel.,2 Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Sigal Levy
- 3 The Academic College of Tel-Aviv-Yaffo, Tel-Aviv-Yaffo, Israel
| | - Guy Shani
- 1 Ben-Gurion University, Beer-Sheva, Israel
| | - Nachum Soroker
- 2 Loewenstein Rehabilitation Hospital, Raanana, Israel.,4 Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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26
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Abstract
The study purposes were to record the lower extremity sagittal and frontal joint moments and powers during gait initiation (GI); evaluate GI support moments in both planes; and analyze planar energy patterns in a group of 15 healthy, young adults. 3D motion and ground reaction force data were used to calculate support moments (SM) and joint moments and powers as well as center of mass (COM) kinematics. STEP1 had no visible SM. It appeared in STEP2 and, by STEP3, resembled that seen in steady-state gait. Joint moments demonstrated a similar development towards typical patterns over the three steps. Correlations of moment data between planes indicate that the frontal plane component of the SM acts to keep the COM centered. It is suggested that Winter’s 1980 SM definition be extended to include both a support (sagittal) component and a centering (frontal) component. Energy was calculated for individual bursts of joint powers in both planes and each step had characteristic patterns in each plane, with patterns resembling steady-state gait appearing in the third step. Test-retest reliability (ICC range: 0.796 – 0.945) was high with CV values in the sagittal plane (36.6 – 37.5%) being less variable than in the frontal plane (39.0 – 82.0%). COM kinematics revealed that acceleration peaked in STEP2 (ICC range: 0.950 – 0.980, CV < 20.0%). Data supported hypotheses regarding the dominance of the frontal plane power in STEP1, with substantial power coming from hip flexors. As well, powers in the sagittal plane were generally of larger magnitude than in the frontal plane.
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Abram SJ, Selinger JC, Donelan JM. Energy optimization is a major objective in the real-time control of step width in human walking. J Biomech 2019; 91:85-91. [DOI: 10.1016/j.jbiomech.2019.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/23/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Gray VL, Yang CL, Fujimoto M, McCombe Waller S, Rogers MW. Stepping characteristics during externally induced lateral reactive and voluntary steps in chronic stroke. Gait Posture 2019; 71:198-204. [PMID: 31078009 PMCID: PMC6589388 DOI: 10.1016/j.gaitpost.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 03/23/2019] [Accepted: 05/01/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stepping is critical for responding to perturbations, whether externally induced or self-initiated. Falls post-stroke is equally likely to happen from either mechanism. The objective of the study was, to examine lateral stepping performance during waist-pull induced reactive steps and voluntary choice reaction time steps in chronic stroke and controls. METHODS In this cross-sectional study participants with chronic stroke (N = 10) and age- and gender-matched controls (N = 10) performed reactive and voluntary lateral steps. Step initiation time, global step length, step clearance, and step velocity were calculated. Other measures for reactive step included, Balance tolerance limit (perturbation magnitude when recovery transitioned from single to multiple steps), and step type. The Community Balance & Mobility Scale, and hip abductor and adductor isokinetic asymmetry torque ratio were assessed. RESULTS The paretic and non-paretic leg were combined since step characteristics did not differ. Step (voluntary vs. reactive) by group (stroke vs. controls) was significant for step initiation time. The stroke group took longer initiating a voluntary step (P = 0.004). Reactive and voluntary steps were executed slower (P = 0.041), with a reduced step length (P = 0.028) by the stroke group. The stroke group had a lower balance tolerance limit (P = 0.01) and took reactive medial steps more frequently (P = 0.001). The Community Balance & Mobility Scale (P > 0.001), and hip abductor and adductor asymmetry torque ratio (P > 0.001; P = 0.015) was reduced in the stroke group. SIGNIFICANCE Our findings indicate individuals post-stroke are slower initiating and executing reactive and voluntary steps. Though the reactive step timing is less impaired, this may be a method for enhancing faster voluntary movements and training reactive balance.
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Affiliation(s)
- Vicki L Gray
- Department of Physical Therapy and Rehabilitation, University of Maryland, Baltimore, United States.
| | - Chieh-Ling Yang
- Department of Physical Therapy and Rehabilitation, University of Maryland, Baltimore, United States
| | - Masahiro Fujimoto
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Sandy McCombe Waller
- Department of Physical Therapy and Rehabilitation, University of Maryland, Baltimore, United States
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation, University of Maryland, Baltimore, United States
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Caderby T, Begue J, Peyrot N, Dalleau G. Effect of speed on mediolateral dynamic stability during stepping in older adults. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- T. Caderby
- Laboratoire IRISSE –EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, Saint-Denis, France
| | - J. Begue
- Laboratoire IRISSE –EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, Saint-Denis, France
| | - N. Peyrot
- Laboratoire IRISSE –EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, Saint-Denis, France
- Motricité, Interactions, Performance, MIP – EA4334, Le Mans Université, Le Mans, France
| | - G. Dalleau
- Laboratoire IRISSE –EA4075, UFR des Sciences de l’Homme et de l’Environnement, Université de La Réunion, Saint-Denis, France
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30
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The Effect of Active Physical Training Interventions on Reactive Postural Responses in Older Adults: A Systematic Review. J Aging Phys Act 2019; 27:252-264. [PMID: 29989462 DOI: 10.1123/japa.2017-0347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A variety of physical interventions have been used to improve reactive balance in older adults. PURPOSE To summarize the effectiveness of active treatment approaches to improve reactive postural responses in community-dwelling older adults. DESIGN Systematic review guided by PRISMA guidelines. STUDY SELECTION A literature search included the databases PubMed, OVID, CINAHL, ClinicalTrials.gov, OTseeker, and PEDro up to December 2017. Randomized controlled trials that evaluated quantitative measures of reactive postural responses in healthy adults following participation in an active physical training program were included. DATA SYNTHESIS Of 4,481 studies initially identified, 11 randomized controlled trials covering 313 participants were selected for analysis. Study designs were heterogeneous, preventing a quantitative analysis. Nine of the 11 studies reported improvements in reactive postural responses. CONCLUSIONS Several clinically feasible training methods have the potential to improve reactive postural responses in older adults; however, conclusions on the efficacy of treatment methods are limited because of numerous methodological issues and heterogeneity in outcomes and intervention procedures.
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Daun F, Kibele A. Different strength declines in leg primary movers versus stabilizers across age-Implications for the risk of falls in older adults? PLoS One 2019; 14:e0213361. [PMID: 30845168 PMCID: PMC6405087 DOI: 10.1371/journal.pone.0213361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/20/2019] [Indexed: 11/19/2022] Open
Abstract
This study investigated differences in the declines of isometric strength in hip abductors and adductors versus knee extensors across four different age groups (n = 31: 11.2 ± 1.0 y, n = 30: 23.1 ± 2.7 y, n = 27: 48.9 ± 4.4 y, and n = 33: 70.1 ± 4.2 y) with a total of 121 female subjects. As a starting point, we assumed that, during their daily activities, elderly people would use their leg stabilizers less frequently than their leg primary movers as compared to younger people. Given that muscle strength decreases in the course of the aging process, we hypothesized that larger strength declines in hip abductors and hip adductors as compared to knee extensors would be detected across age. Maximal isometric force for these muscle groups was assessed with a digital hand-held dynamometer. Measurements were taken at 75% of the thigh or shank length and expressed relative to body weight and lever arm length. Intratester reliability of the normalized maximal torques was estimated by using Cronbach’s alpha and calculated to be larger than 0.95. The obtained results indicate a clearly more pronounced strength decline in hip abductors and hip adductors across age than in the knee extensors. Therefore, a particular need for strength training of the lower extremity stabilizer muscles during the aging process is implied.
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Affiliation(s)
- Franziska Daun
- Institute for Sports and Sport Science, University of Kassel, Germany
| | - Armin Kibele
- Institute for Sports and Sport Science, University of Kassel, Germany
- * E-mail:
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32
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Tanel MR, Weaver TB, Laing AC. Standing Versus Stepping-Exploring the Relationships Between Postural Steadiness and Dynamic Reactive Balance Control. J Appl Biomech 2018; 34:488-495. [PMID: 29989471 DOI: 10.1123/jab.2017-0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 04/20/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
While the literature has characterized balance control during quasi-static and/or dynamic tasks, comparatively few studies have examined relationships across paradigms. This study investigated whether quiet-stance postural steadiness metrics were associated with reactive control parameters (during both stepping and restabilization phases) following a lean-and-release perturbation. A total of 40 older adults participated. Postural steadiness (center of the pressure range, root mean square, velocity, and frequency) was evaluated in "feet together" and "tandem stance" positions. During the reactive control trials, the step length, step width, movement time, and reaction time were measured, in addition to the postural steadiness variables measured during the restabilization phase following the stepping response. Out of 64 comparisons, only 10 moderate correlations were observed between postural steadiness and reactive spatio-temporal stepping parameters (P ≤ .05, r = -.312 to -.534). However, postural steadiness metrics were associated with the center of pressure velocity and frequency during the restabilization phase of the reactive control trials (P ≤ .02, r = .383 to .775 for velocity and P ≤ .01, r = .386 to .550 for frequency). Although some elements of quasi-static center of pressure control demonstrated moderate associations with dynamic stepping responses, relationships were stronger for restabilization phase dynamics after foot-contact. Future work should examine the potential association between restabilization phase control and older adult fall-risk.
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33
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Deacon M, Parsons J, Mathieson S, Davies TC. Can Wii Balance? Evaluating a Stepping Game for Older Adults. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1783-1793. [PMID: 30072333 DOI: 10.1109/tnsre.2018.2862146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Decline in balance control is an issue for older adults as it leads to an increased risk of falling which may result in serious injury. Mitigating this risk may be achieved through balance training and exercise, but lack of adherence to an exercise program often occurs. Improvement in balance control may be difficult to quantify in an unbiased manner given the therapist providing the treatment also assesses the patient. We developed a gamified system using an off-the-shelf technology through an iterative feedback with therapists and clients to evaluate a response time during stepping as a measure of balance control. The game was designed using serious game strategies to increase participant engagement. This game included two Nintendo Wii balance boards between which the individual was required to step while the times were recorded. To provide evidence that the system could be used in a clinical environment, we conducted a cross-sectional study collecting data for five minutes at the beginning of a physiotherapy assessment. One hundred and four individuals older than 50 years of age were recruited who were able to step forward with or without an aid. The response time for a step using the system was negatively correlated to the Berg balance score.
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Robert T, Vallée P, Tisserand R, Buloup F, Bariatinsky D, Vercher JL, Fitzpatrick RC, Mille ML. Stepping boundary of external force-controlled perturbations of varying durations: Comparison of experimental data and model simulations. J Biomech 2018; 75:89-95. [PMID: 29793765 DOI: 10.1016/j.jbiomech.2018.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/06/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Abstract
This study investigated the stepping boundary - the force that can be resisted without stepping - for force-controlled perturbations of different durations. Twenty-two healthy young adults (19-37 years old) were instructed to try not to step in response to 86 different force/time combinations of forward waist-pulls. The forces at which 50% of subjects stepped (F50) were identified for each tested perturbation durations. Results showed that F50 decreased hyperbolically when the perturbation's duration increased and converged toward a constant value (about 10%BW) for longer perturbations (over 1500 ms). The effect of perturbation duration was critical for the shortest perturbations (less than 1 s). In parallel, a simple function was proposed to estimate this stepping boundary. Considering the dynamics of a linear inverted pendulum + foot model and simple balance recovery reactions, we could express the maximum pulling force that can be withstood without stepping as a simple function of the perturbation duration. When used with values of the main model parameters determined experimentally, this function replicated adequately the experimental results. This study demonstrates for the first time that perturbation duration has a major influence on the outcomes of compliant perturbations such as force-controlled pulls. The stepping boundary corresponds to a constant perturbation force-duration product and is largely explained by only two parameters: the reaction time and the displacement of the center of pressure within the functional base of support. Future work should investigate pathological populations and additional parameters characterizing the perturbation time-profile such as the time derivative of the perturbation.
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Affiliation(s)
- T Robert
- Université Claude Bernard Lyon 1, Villeurbanne, France; IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France
| | - P Vallée
- Université Claude Bernard Lyon 1, Villeurbanne, France; IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France
| | - R Tisserand
- Université Claude Bernard Lyon 1, Villeurbanne, France; IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France
| | - F Buloup
- Aix Marseille Univ, CNRS, ISM, Marseille 13288, France
| | - D Bariatinsky
- Aix Marseille Univ, CNRS, ISM, Marseille 13288, France
| | - J L Vercher
- Aix Marseille Univ, CNRS, ISM, Marseille 13288, France
| | | | - M L Mille
- Université de Toulon, La Garde 83957, France; Aix Marseille Univ, CNRS, ISM, Marseille 13288, France; Department of Physical Therapy and Human Movement Sciences, Northwestern University Medical School, Chicago, IL 60611, United States.
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Batcir S, Sharon H, Shani G, Levitsky N, Gimmon Y, Kurz I, Shapiro A, Melzer I. The inter-observer reliability and agreement of lateral balance recovery responses in older and younger adults. J Electromyogr Kinesiol 2018; 40:39-47. [PMID: 29621683 DOI: 10.1016/j.jelekin.2018.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/05/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022] Open
Abstract
The purpose of this study was to evaluate the inter-observer reliability and agreement of balance recovery responses, step and multiple-steps thresholds, and kinematic parameters of stepping responses. Older and younger adults were exposed to 36 progressively challenging right and left unannounced surface translations during quiet standing. Subjects were instructed to "react naturally". Step threshold and multiple-step threshold were defined as the minimum disturbance magnitude that consistently elicited one and more than one recovery step, respectively. Fall threshold is defined as the minimum disturbance magnitude from which a fall resulted (i.e., fall into harness system or grasped one of the anchor straps of the harness, or grasped the research assistant to maintain balance). The inter-observer reliability of balance recovery responses for older adults were excellent, especially for step and multiple-step thresholds (ICC2,1 = 0.978 and ICC2,1 = 0.971, respectively; p < 0.001). Also kinematic parameters of stepping responses such as step recovery duration and step length were excellent (ICC2,1 > 0.975 and ICC2,1 = 0.978, respectively; p < 0.001), substantial reliability was found for swing phase duration (ICC2,1 = 0.693, p < 0.001). Younger adults showed similar ICCs. The Bland-Altman plots demonstrated excellent limits of agreement (LOA > 90%) for most kinematic step parameters and stepping thresholds. These results suggest that balance recovery responses and kinematic parameters of stepping including step threshold and multiple-step threshold are extremely reliable parameters. The measure of balance recovery responses from unexpected loss of balance is feasible and can be used in clinical setting and research-related assessments of fall risk.
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Affiliation(s)
- Shani Batcir
- Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hadar Sharon
- Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Guy Shani
- Department of Information Systems, Faculty of Engineering Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Noa Levitsky
- Department of Information Systems, Faculty of Engineering Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Yoav Gimmon
- Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Kurz
- Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Shapiro
- Department of Mechanical Engineering, Faculty of Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itshak Melzer
- Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Abstract
Impairments of balance and gait leading to loss of mobility, falls, and disability are common occurrences in many neurologic conditions and with older age. Much of our current understanding about posture and balance control and its impairments has come from investigations of how healthy individuals and those with neurologic disorders respond to situations that perturb standing balance during instructed voluntary tasks or in reaction to externally imposed challenges to stability. Knowledge obtained from these investigations has come from documenting the physical and physiologic characteristics of the perturbations together with the body's electrophysiologic, structural, kinetic, kinematic, and behavioral responses. From these findings, basic mechanisms, diagnostic and pathologic criteria, and targets for clinical care have been identified while continued gaps in understanding have been exposed. In this chapter, we synthesize and discuss current concepts and understanding concerning the sensorimotor control of posture and balance while standing. We draw insights gained from perturbation studies investigating these functions in healthy adults, and those with neurologic pathologies.
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Affiliation(s)
- Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Marie-Laure Mille
- Faculty of Sciences and Techniques of Physical Activities and Sport, Université de Toulon, La Garde, France; Institute of Movement Sciences ISM UMR7287, Aix-Marseille Université & CNRS, Marseille, France; Department of Physical Therapy and Human Movement Sciences, Northwestern University Medical School, Chicago IL, United States
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37
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Gafner SC, Bastiaenen CH, Ferrari S, Gold G, Terrier P, Hilfiker R, Allet L. Hip muscle and hand-grip strength to differentiate between older fallers and non-fallers: a cross-sectional validity study. Clin Interv Aging 2017; 13:1-8. [PMID: 29317804 PMCID: PMC5743114 DOI: 10.2147/cia.s146834] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hip muscle weakness in older people seems to be an influencing factor of falls. Currently, it is unclear which muscles out of the hip muscle group play an important role in older people. A validating process in the measurement regarding muscle strength related to falls is necessary before answering that question. Objective Firstly, we aimed to investigate which hip muscle group strength shows an acceptable level of distinction between older adult fallers and non-fallers compared to a predefined external criterion regarding falling. Secondly, we aimed to compare the same outcomes and questions for hand-grip strength in relation to the same external criterion. Design This study was a cross-sectional validity study. Methods The maximum voluntary isometric strength (MVIS) and the rate of force generation of hip abductors (ABD), adductors, internal and external rotators, extensors, and flexors were measured with a dynamometer fixed to a custom-made frame as well as hand-grip strength with a Martin Vigorimeter in 60 older people aged over 65 years (38 females and 22 males). Results The area under the curve (AUC) and the results of the mean decrease in Gini index assessed by random forest approach show that of all the assessed parameters, hip ABD MVIS showed the highest discriminative value regarding the chosen external criterion in older people (AUC ABD MVIS 0.825, 95% confidence interval: 0.712-0.938). Conclusion Results indicate that ABD MVIS is a useful measure to distinguish between older adult fallers and non-fallers regarding the chosen external criterion.
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Affiliation(s)
- Simone C Gafner
- Department of Physiotherapy, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland.,Department of Epidemiology, Research Program Functioning and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Caroline H Bastiaenen
- Department of Epidemiology, Research Program Functioning and Rehabilitation, CAPHRI, Maastricht University, Maastricht, the Netherlands.,Department of Health, School of Health Professions, Zurich University of Applied Sciences, Winterthur
| | | | - Gabriel Gold
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva
| | - Philippe Terrier
- Department of Research, Clinique romande de réadaptation SUVACare.,Department of Research, Institute for Research in Rehabilitation, Sion
| | - Roger Hilfiker
- Department of Physiotherapy, School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts of Western Switzerland, Valais
| | - Lara Allet
- Department of Physiotherapy, HES-SO University of Applied Sciences and Arts of Western Switzerland, Geneva, Switzerland.,Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland
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38
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Yoga’s effect on falls in rural, older adults. Complement Ther Med 2017; 35:57-63. [DOI: 10.1016/j.ctim.2017.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 11/21/2022] Open
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Graham DF, Carty CP, Lloyd DG, Barrett RS. Muscle contributions to the acceleration of the whole body centre of mass during recovery from forward loss of balance by stepping in young and older adults. PLoS One 2017; 12:e0185564. [PMID: 29069097 PMCID: PMC5656315 DOI: 10.1371/journal.pone.0185564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/14/2017] [Indexed: 01/01/2023] Open
Abstract
The purpose of this study was to determine the muscular contributions to the acceleration of the whole body centre of mass (COM) of older compared to younger adults that were able to recover from forward loss of balance with a single step. Forward loss of balance was achieved by releasing participants (14 older adults and 6 younger adults) from a static whole-body forward lean angle of approximately 18 degrees. 10 older adults and 6 younger adults were able to recover with a single step and included in subsequent analysis. A scalable anatomical model consisting of 36 degrees-of-freedom was used to compute kinematics and joint moments from motion capture and force plate data. Forces for 92 muscle actuators were computed using Static Optimisation and Induced Acceleration Analysis was used to compute individual muscle contributions to the three-dimensional acceleration of the whole body COM. There were no significant differences between older and younger adults in step length, step time, 3D COM accelerations or muscle contributions to 3D COM accelerations. The stance and stepping leg Gastrocnemius and Soleus muscles were primarily responsible for the vertical acceleration experienced by the COM. The Gastrocnemius and Soleus from the stance side leg together with bilateral Hamstrings accelerated the COM forwards throughout balance recovery while the Vasti and Soleus of the stepping side leg provided the majority of braking accelerations following foot contact. The Hip Abductor muscles provided the greatest contribution to medial-lateral accelerations of the COM. Deficits in the neuromuscular control of the Gastrocnemius, Soleus, Vasti and Hip Abductors in particular could adversely influence balance recovery and may be important targets in interventions to improve balance recovery performance.
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Affiliation(s)
- David F. Graham
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Christopher P. Carty
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - David G. Lloyd
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Rod S. Barrett
- School of Allied Health Sciences, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
- * E-mail:
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Watanabe T, Saito K, Ishida K, Tanabe S, Nojima I. Auditory stimulus has a larger effect on anticipatory postural adjustments in older than young adults during choice step reaction. Eur J Appl Physiol 2017; 117:2409-2423. [PMID: 29027033 DOI: 10.1007/s00421-017-3727-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/12/2017] [Indexed: 01/17/2023]
Abstract
PURPOSE The study aim was to compare the influence of an auditory stimulus (AS) on anticipatory postural adjustments (APAs) between young and older adults during a choice step reaction. METHODS Sixteen young and 19 older adults stepped forward in response to a visual imperative stimulus of an arrow. We used a choice reaction time (CRT) task and a Simon task which consisted of congruent and incongruent conditions. The direction of the presented arrow and its spatial location matched in the congruent condition while they did not in the incongruent condition. The AS was presented randomly and simultaneously with the visual stimulus. Incorrect weight shifts before lifting off the foot, termed APA errors, stepping errors, temporal parameters, and APA amplitudes were analyzed. RESULTS The APA error rate was higher in trials with than without AS in all task conditions for the older group, while this increase occurred only in the incongruent condition for the young group. The stepping error rate was also increased in the presence of AS in the incongruent condition for the older group. Reaction times were faster with AS in both groups. The APA amplitude of erroneous APA trials became larger with AS in the incongruent condition for both groups, and this effect appeared greater for the older group. CONCLUSIONS The effect of AS on APAs is larger in the elderly during a choice step reaction. In the presence of incongruent visual information, this effect becomes even greater, potentially inducing not only APA errors but also stepping errors.
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Affiliation(s)
- Tatsunori Watanabe
- Department of Physical Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya-shi, Aichi, 461-8673, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kotaro Saito
- Department of Physical Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya-shi, Aichi, 461-8673, Japan
| | - Kazuto Ishida
- Department of Physical Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya-shi, Aichi, 461-8673, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Toyoake, Aichi, 470-1192, Japan
| | - Ippei Nojima
- Department of Physical Therapy, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya-shi, Aichi, 461-8673, Japan.
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Menz HB, Auhl M, Munteanu SE. Preliminary evaluation of prototype footwear and insoles to optimise balance and gait in older people. BMC Geriatr 2017; 17:212. [PMID: 28893202 PMCID: PMC5594507 DOI: 10.1186/s12877-017-0613-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 09/06/2017] [Indexed: 11/23/2022] Open
Abstract
Background Footwear has the potential to influence balance in either a detrimental or beneficial manner, and is therefore an important consideration in relation to falls prevention. The objective of this study was to evaluate balance ability and gait patterns in older women while wearing prototype footwear and insoles designed to improve balance. Methods Older women (n = 30) aged 65 – 83 years (mean 74.4, SD 5.6) performed a series of laboratory tests of balance ability (postural sway on a foam rubber mat, limits of stability and tandem walking, measured with the Neurocom® Balance Master) and gait patterns (walking speed, cadence, step length and step width at preferred speed, measured with the GAITRite® walkway) while wearing (i) flexible footwear (Dunlop Volley™), (ii) their own footwear, and (iii) prototype footwear and insoles designed to improve dynamic balance. Perceptions of the footwear were also documented using a structured questionnaire. Results There was no difference in postural sway, limits of stability or gait patterns between the footwear conditions. However, when performing the tandem walking test, there was a significant reduction in step width and end sway when wearing the prototype footwear compared to both the flexible footwear and participants’ own footwear. Participants perceived their own footwear to be more attractive, comfortable, well-fitted and easier to put on and off compared to the prototype footwear. Despite this, most participants (n = 18, 60%) reported that they would consider wearing the prototype footwear to reduce their risk of falling. Conclusion The prototype footwear and insoles used in this study improve balance when performing a tandem walk test, as evidenced by a narrower step width and decreased sway at completion of the task. However, further development of the design is required to make the footwear acceptable to older women from the perspective of aesthetics and comfort. Trial registration Australian New Zealand Clinical Trials Registry. ACTRN12617001128381, 01/08/2017 (retrospectively registered).
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Affiliation(s)
- Hylton B Menz
- Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, 3086, Australia. .,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, 3086, Australia.
| | - Maria Auhl
- Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, 3086, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, 3086, Australia
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42
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Aprigliano F, Martelli D, Tropea P, Pasquini G, Micera S, Monaco V. Aging does not affect the intralimb coordination elicited by slip-like perturbation of different intensities. J Neurophysiol 2017; 118:1739-1748. [PMID: 28701547 DOI: 10.1152/jn.00844.2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 11/22/2022] Open
Abstract
This study was aimed at verifying whether aging modifies intralimb coordination strategy during corrective responses elicited by unexpected slip-like perturbations delivered during steady walking on a treadmill. To this end, 10 young and 10 elderly subjects were asked to manage unexpected slippages of different intensities. We analyzed the planar covariation law of the lower limb segments, using the principal component analysis, to verify whether elevation angles of older subjects covaried along a plan before and after the perturbation. Results showed that segments related to the perturbed limbs of both younger and older people do not covary after all perturbations. Conversely, the planar covariation law of the unperturbed limb was systematically held for younger and older subjects. These results occurred despite differences in spatio-temporal and kinematic parameters being observed among groups and perturbation intensities. Overall, our analysis revealed that aging does not affect intralimb coordination during corrective responses induced by slip-like perturbation, suggesting that both younger and older subjects adopt this control strategy while managing sudden and unexpected postural transitions of increasing intensities. Accordingly, results corroborate the hypothesis that balance control emerges from a governing set of biomechanical invariants, that is, suitable control schemes (e.g., planar covariation law) shared across voluntary and corrective motor behaviors, and across different sensory contexts due to different perturbation intensities, in both younger and older subjects. In this respect, our findings provide further support to investigate the effects of specific task training programs to counteract the risk of fall.NEW & NOTEWORTHY This study was aimed at investigating how aging affects the intralimb coordination of lower limb segments, described by the planar covariation law, during unexpected slip-like perturbations of increasing intensity. Results revealed that neither the aging nor the perturbation intensity affects this coordination strategy. Accordingly, we proposed that the balance control emerges from an invariant set of control schemes shared across different sensory motor contexts and despite age-related neuromuscular adaptations.
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Affiliation(s)
| | - Dario Martelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Mechanical Engineering, Columbia University, New York, New York
| | - Peppino Tropea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
| | - Guido Pasquini
- MARE Lab, Don Carlo Gnocchi Foundation, Florence, Italy; and
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; .,MARE Lab, Don Carlo Gnocchi Foundation, Florence, Italy; and
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43
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Development of a falls reduction yoga program for older adults—A pilot study. Complement Ther Med 2017; 31:118-126. [DOI: 10.1016/j.ctim.2017.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/29/2017] [Accepted: 01/30/2017] [Indexed: 11/18/2022] Open
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Caderby T, Yiou E, Peyrot N, de Viviés X, Bonazzi B, Dalleau G. Effects of Changing Body Weight Distribution on Mediolateral Stability Control during Gait Initiation. Front Hum Neurosci 2017; 11:127. [PMID: 28396629 PMCID: PMC5366317 DOI: 10.3389/fnhum.2017.00127] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/06/2017] [Indexed: 12/16/2022] Open
Abstract
During gait initiation, anticipatory postural adjustments (APA) precede the execution of the first step. It is generally acknowledged that these APA contribute to forward progression but also serve to stabilize the whole body in the mediolateral direction during step execution. Although previous studies have shown that changes in the distribution of body weight between both legs influence motor performance during gait initiation, it is not known whether and how such changes affect a person's postural stability during this task. The aim of this study was to investigate the effects of changing initial body weight distribution between legs on mediolateral postural stability during gait initiation. Changes in body weight distribution were induced under experimental conditions by modifying the frontal plane distribution of an external load located at the participants' waists. Fifteen healthy adults performed a gait initiation series at a similar speed under three conditions: with the overload evenly distributed over both legs; with the overload strictly distributed over the swing-limb side; and with the overload strictly distributed over the stance-leg side. Our results showed that the mediolateral location of center-of-mass (CoM) during the initial upright posture differed between the experimental conditions, indicating modifications in the initial distribution of body weight between the legs according to the load distribution. While the parameters related to the forward progression remained unchanged, the alterations in body weight distribution elicited adaptive changes in the amplitude of APA in the mediolateral direction (i.e., maximal mediolateral shift of the center of pressure (CoP)), without variation in their duration. Specifically, it was observed that the amplitude of APA was modulated in such a way that mediolateral dynamic stability at swing foot-contact, quantified by the margin of stability (i.e., the distance between the base of support boundary and the extrapolated CoM position), did not vary between the conditions. These findings suggest that APA seem to be scaled as a function of the initial body weight distribution between both legs so as to maintain optimal conditions of stability during gait initiation.
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Affiliation(s)
- Teddy Caderby
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
| | - Eric Yiou
- Laboratoire CIAMS, Université Paris Sud, Université Paris-SaclayOrsay, France; Laboratoire CIAMS, Université d'OrléansOrléans, France
| | - Nicolas Peyrot
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
| | - Xavier de Viviés
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
| | - Bruno Bonazzi
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
| | - Georges Dalleau
- Laboratoire IRISSE, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion Ile de la Réunion, France
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Martelli D, Aprigliano F, Tropea P, Pasquini G, Micera S, Monaco V. Stability against backward balance loss: Age-related modifications following slip-like perturbations of multiple amplitudes. Gait Posture 2017; 53:207-214. [PMID: 28208109 DOI: 10.1016/j.gaitpost.2017.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/06/2016] [Accepted: 02/02/2017] [Indexed: 02/02/2023]
Abstract
Falls are one of the most serious problems in the elderly. Although previous studies clearly link the increased risk of falls with ageing, the mechanisms responsible for the modifications of reactive motor behaviours in response to external perturbations are not yet fully understood. This study investigated how the stability against backward balance loss is affected by aging and intensity of perturbations. The Margin of Stability (MoS) was estimated while eight young and eight elderly adults managed three slip-like perturbations of different intensities while walking at the same normalized speed. A compensatory step was necessary to regain stability. The forward swing phase of the trailing leg was rapidly interrupted and reversed in direction. Results have shown that ageing significantly affects the time required to select the most appropriate biomechanical response: even if the characteristic of the backward step was similar between groups, elderly subjects took more time to reverse the movement of their swinging limb, thus achieving a less efficient action to counteract the backward balance loss (lower MoS both during and at the end of the early compensatory reaction). In addition, young and elderly subjects scaled their reactions with respect to the perturbations intensity in a similar way by increasing the length of their backward step, thus revealing a context-dependent tuning of the biomechanical response that was not affected by aging. These behavioural features can be helpful in identifying the causes of increased fall risk among the elderly in order to define more suited intervention in fall prevention programs.
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Affiliation(s)
- Dario Martelli
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera (PI), Italy; Department of Mechanical Engineering, Columbia University, 220 S. W. Mudd Building, 500 West 120th Street, 10027, New York, NY, USA.
| | - Federica Aprigliano
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera (PI), Italy
| | - Peppino Tropea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera (PI), Italy
| | - Guido Pasquini
- MARE Lab, Don Carlo Gnocchi Foundation, Via di Scandicci 269, 50143, Firenze, Italy
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera (PI), Italy; Translational Neural Engineering Lab, Center for Neuroprosthetics, Swiss Federal Institute of Technology Lausanne (EPFL), Route Cantonale 1015 Lausanne, Switzerland
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, 56025, Pontedera (PI), Italy; MARE Lab, Don Carlo Gnocchi Foundation, Via di Scandicci 269, 50143, Firenze, Italy
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Tisserand R, Robert T, Chabaud P, Bonnefoy M, Chèze L. Elderly Fallers Enhance Dynamic Stability Through Anticipatory Postural Adjustments during a Choice Stepping Reaction Time. Front Hum Neurosci 2016; 10:613. [PMID: 27965561 PMCID: PMC5126045 DOI: 10.3389/fnhum.2016.00613] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/16/2016] [Indexed: 12/12/2022] Open
Abstract
In the case of disequilibrium, the capacity to step quickly is critical to avoid falling in elderly. This capacity can be simply assessed through the choice stepping reaction time test (CSRT), where elderly fallers (F) take longer to step than elderly non-fallers (NF). However, the reasons why elderly F elongate their stepping time remain unclear. The purpose of this study is to assess the characteristics of anticipated postural adjustments (APA) that elderly F develop in a stepping context and their consequences on the dynamic stability. Forty-four community-dwelling elderly subjects (20 F and 24 NF) performed a CSRT where kinematics and ground reaction forces were collected. Variables were analyzed using two-way repeated measures ANOVAs. Results for F compared to NF showed that stepping time is elongated, due to a longer APA phase. During APA, they seem to use two distinct balance strategies, depending on the axis: in the anteroposterior direction, we measured a smaller backward movement and slower peak velocity of the center of pressure (CoP); in the mediolateral direction, the CoP movement was similar in amplitude and peak velocity between groups but lasted longer. The biomechanical consequence of both strategies was an increased margin of stability (MoS) at foot-off, in the respective direction. By elongating their APA, elderly F use a safer balance strategy that prioritizes dynamic stability conditions instead of the objective of the task. Such a choice in balance strategy probably comes from muscular limitations and/or a higher fear of falling and paradoxically indicates an increased risk of fall.
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Affiliation(s)
- Romain Tisserand
- IFSTTAR, UMR_T9406, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC), Université de Lyon, Université Claude Bernard Lyon 1 Lyon, France
| | - Thomas Robert
- IFSTTAR, UMR_T9406, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC), Université de Lyon, Université Claude Bernard Lyon 1 Lyon, France
| | - Pascal Chabaud
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), Université de Lyon, Université Claude Bernard Lyon 1 Villeurbanne, France
| | - Marc Bonnefoy
- Service de Médecine Gériatrique, Centre Hospitalier Lyon Sud Pierre-Bénite, France
| | - Laurence Chèze
- IFSTTAR, UMR_T9406, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC), Université de Lyon, Université Claude Bernard Lyon 1 Lyon, France
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47
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Effect of aging on dynamic postural stability and variability during a multi-directional lean and reach object transportation task. Arch Gerontol Geriatr 2016; 66:154-60. [DOI: 10.1016/j.archger.2016.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/13/2016] [Accepted: 06/05/2016] [Indexed: 11/22/2022]
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Rogers MW, Mille ML. Timing paradox of stepping and falls in ageing: not so quick and quick(er) on the trigger. J Physiol 2016; 594:4537-47. [PMID: 26915664 DOI: 10.1113/jp271167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/06/2015] [Indexed: 01/06/2023] Open
Abstract
Physiological and degenerative changes affecting human standing balance are major contributors to falls with ageing. During imbalance, stepping is a powerful protective action for preserving balance that may be voluntarily initiated in recognition of a balance threat, or be induced by an externally imposed mechanical or sensory perturbation. Paradoxically, with ageing and falls, initiation slowing of voluntary stepping is observed together with perturbation-induced steps that are triggered as fast as or faster than for younger adults. While age-associated changes in sensorimotor conduction, central neuronal processing and cognitive functions are linked to delayed voluntary stepping, alterations in the coupling of posture and locomotion may also prolong step triggering. It is less clear, however, how these factors may explain the accelerated triggering of induced stepping. We present a conceptual model that addresses this issue. For voluntary stepping, a disruption in the normal coupling between posture and locomotion may underlie step-triggering delays through suppression of the locomotion network based on an estimation of the evolving mechanical state conditions for stability. During induced stepping, accelerated step initiation may represent an event-triggering process whereby stepping is released according to the occurrence of a perturbation rather than to the specific sensorimotor information reflecting the evolving instability. In this case, errors in the parametric control of induced stepping and its effectiveness in stabilizing balance would be likely to occur. We further suggest that there is a residual adaptive capacity with ageing that could be exploited to improve paradoxical triggering and other changes in protective stepping to impact fall risk.
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Affiliation(s)
- Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Marie-Laure Mille
- Université de Toulon, La Garde, 83957, France.,Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, 13288, France.,Department of Physical Therapy and Human Movement Sciences, Northwestern University Medical School, Chicago, IL, 60611, USA
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49
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Pizzigalli L, Micheletti Cremasco M, Mulasso A, Rainoldi A. The contribution of postural balance analysis in older adult fallers: A narrative review. J Bodyw Mov Ther 2016; 20:409-17. [DOI: 10.1016/j.jbmt.2015.12.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/19/2015] [Accepted: 12/09/2015] [Indexed: 01/23/2023]
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50
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Age-related challenges in reactive control of mediolateral stability during compensatory stepping: A focus on the dynamics of restabilisation. J Biomech 2016; 49:749-755. [DOI: 10.1016/j.jbiomech.2016.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 01/01/2016] [Accepted: 02/03/2016] [Indexed: 11/21/2022]
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