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van Dieën JH, Bruijn SM, Afschrift M. Assessment of stabilizing feedback control of walking: A tutorial. J Electromyogr Kinesiol 2024; 78:102915. [PMID: 38936234 DOI: 10.1016/j.jelekin.2024.102915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
Walking without falling requires stabilization of the trajectory of the body center of mass relative to the base of support. Model studies suggest that this requires active, feedback control, i.e., the nervous system must process sensory information on the state of the body to generate descending motor commands to the muscles to stabilize walking, especially in the mediolateral direction. Stabilization of bipedal gait is challenging and can be impaired in older and diseased individuals. In this tutorial, we illustrate how gait analysis can be used to assess the stabilizing feedback control of gait. We present methods ranging from those that require limited input data (e.g. position data of markers placed on the feet and pelvis only) to those that require full-body kinematics and electromyography. Analyses range from simple kinematics analyses to inverse dynamics. These methods assess stabilizing feedback control of human walking at three levels: 1) the level of center of mass movement and horizontal ground reaction forces, 2) the level of center of mass movement and foot placement and 3) the level of center of mass movement and the joint moments or muscle activity. We show how these can be calculated and provide a GitHub repository (https://github.com/VU-HMS/Tutorial-stabilizing-walking) which contains open access Matlab and Python code to calculate these. Finally, we discuss what information on feedback control can be learned from each of these.
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Affiliation(s)
- Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Sjoerd M Bruijn
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Maarten Afschrift
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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2
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Zhang J, Veltink PH, van Asseldonk EHF. Reframing Whole-Body Angular Momentum: Exploring the Impact of Low-Pass Filtered Dynamic Local Reference Frames During Straight-Line and Turning Gaits. IEEE Trans Neural Syst Rehabil Eng 2024; 32:3167-3178. [PMID: 39186427 DOI: 10.1109/tnsre.2024.3449706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Accurately estimating whole-body angular momentum (WBAM) during daily activities may benefit from choosing a locally-defined reference frame aligned with anatomical axes, particularly during activities involving body turns. Local reference frames, potentially defined by pelvis heading angles, horizontal center of mass velocity (vCoM), or average angular velocity ( Aω ), can be utilized. To minimize the impact of inherent mediolateral oscillations of these frames, such as those caused by pelvis or vCoM rotation in the transverse plane, a low-pass filter is recommended. This study investigates how differences among global, local reference frames pre- and post-filtering affect WBAM component distribution across anatomical axes during straight-line walking and various turning tasks, which is lacking in the literature. Results highlighted significant effects of reference frame choice on WBAM distribution in the anteroposterior (AP) and mediolateral (ML) axes in all tasks. Specifically, expressing WBAM in the vCoM-oriented local reference frame yielded significantly lower (or higher) WBAM in the AP (or ML) axes compared to pelvis-oriented and Aω -oriented frames. However, these significant differences disappeared after employing a low-pass filter to local reference frames. Therefore, employing low-pass filtered local reference frames is crucial to enhance their applicability in both straight-line and turning tasks, ensuring more precise WBAM estimates. In applications that require expressing anatomical axes-dependent biomechanical parameters in a local reference frame, pelvis- and vCoM-oriented frames are more practical compared to the A ω -oriented frame, as they can be determined by a reduced optical marker set or inertial sensors in future applications when the whole-body kinematics is not available.
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Harter MJ, Redfern MS, Sparto PJ, Geyer H. Modelling strategies supplemental to foot placement for frontal-plane stability in walking. J R Soc Interface 2024; 21:20240191. [PMID: 39226925 PMCID: PMC11371431 DOI: 10.1098/rsif.2024.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/14/2024] [Accepted: 07/16/2024] [Indexed: 09/05/2024] Open
Abstract
Walking is unstable and requires active control. Foot placement is the primary strategy to maintain frontal-plane balance with contributions from lateral ankle torques, ankle push-off and trunk postural adjustments. Because these strategies interact, their individual contributions are difficult to study. Here, we used computational modelling to understand these individual contributions to frontal-plane walking balance control. A three-dimensional bipedal model was developed based on linear inverted pendulum dynamics. The model included controllers that implement the stabilization strategies seen in human walking. The control parameters were optimized to mimic human gait biomechanics for typical spatio-temporal parameters during steady-state walking and when perturbed by mediolateral ground shifts. Using the optimized model as a starting point, the contributions of each stabilization strategy were explored by progressively removing strategies. The lateral ankle and trunk strategies were more important than ankle push-off, with their removal causing up to 20% worse balance recovery compared with the full model, while removing ankle push-off led to minimal changes. Our results imply a potential benefit of preferentially training these strategies in populations with poor balance. Moreover, the proposed model could be used in future work to investigate how walking stability may be preserved in conditions reflective of injury or disease.
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Affiliation(s)
- Michelle J. Harter
- Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall 3700 O’Hara Street, Pittsburgh, PA15260, USA
| | - Mark S. Redfern
- Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall 3700 O’Hara Street, Pittsburgh, PA15260, USA
| | - Patrick J. Sparto
- Department of Physical Therapy, University of Pittsburgh, 100 Technology Drive, Pittsburgh, PA15219, USA
| | - Harmut Geyer
- Robotics Institute, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA15213, USA
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Tillman M, Liu JM, Hirsch ZM, Molino J, Zaferiou AM. Healthy older adults generate transverse-plane momenta required for 90° turns while walking during the same phases of gait as used in straight-line gait. J Neuroeng Rehabil 2024; 21:145. [PMID: 39180079 PMCID: PMC11342545 DOI: 10.1186/s12984-024-01437-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 08/02/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Generation and regulation (control) of linear and angular momentum is a challenge during turning while walking which may be exacerbated by age-related changes. In healthy older adults, little is known about how momentum is controlled during turns, especially within each phase of gait. Each phase of gait affords unique mechanical contexts to control momenta and regulate balance. In healthy young adults, we found that the transverse-plane linear and angular momenta generation strategies observed within specific phases of gait during straight-line gait were also used during turns. Therefore, in this study, we investigated whether healthy older adults shared similar momentum control strategies specific to each gait phase during straight-line gait and turns. METHODS Nine healthy older adults completed straight-line gait and 90° leftward walking turns. We compared the change in transverse-plane whole-body linear and angular momentum across gait phases (left and right single and double support). We also compared the average leftward force and transverse-plane moment across gait phases. RESULTS We found that leftward linear momentum was generated most during right single support in straight-line gait and leftward turns. However, in contrast to straight-line gait, during leftward turns, average leftward force was applied across gait phases, with left single support generating significantly less leftward average force than other gait phases. Leftward angular momentum generation and average moment were greatest during left double support in both tasks. We observed some within-participant results that diverged from the group statistical findings, illustrating that although they are common, these momenta control strategies are not necessary. CONCLUSIONS Older adults generated transverse-plane linear and angular momentum during consistent phases of gait during straight-line gait and 90° turns, potentially indicating a shared control strategy. Understanding momentum control within each phase of gait can help design more specific targets in gait and balance training interventions.
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Affiliation(s)
- Mitchell Tillman
- Department of Biomedical Engineering, Stevens Institute of Technology, Castle Point on the Hudson, Hoboken, NJ, 07030, USA
| | - Jun Ming Liu
- Department of Biomedical Engineering, Stevens Institute of Technology, Castle Point on the Hudson, Hoboken, NJ, 07030, USA
| | - Zahava M Hirsch
- Department of Biomedical Engineering, Stevens Institute of Technology, Castle Point on the Hudson, Hoboken, NJ, 07030, USA
| | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
- Lifespan Biostatistics, Epidemiology, and Research Design Core, Rhode Island Hospital, Providence, RI, USA
| | - Antonia M Zaferiou
- Department of Biomedical Engineering, Stevens Institute of Technology, Castle Point on the Hudson, Hoboken, NJ, 07030, USA.
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van Leeuwen AM, Bruijn SM, Dean JC. Force-field perturbations and muscle vibration strengthen stability-related foot placement responses during steady-state gait in healthy adults. Hum Mov Sci 2024; 96:103243. [PMID: 38870744 DOI: 10.1016/j.humov.2024.103243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/30/2024] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
Mediolateral gait stability can be maintained by coordinating our foot placement with respect to the center-of-mass (CoM) kinematic state. Neurological impairments can reduce the degree of foot placement control. For individuals with such impairments, interventions that could improve foot placement control could thus contribute to improved gait stability. In this study we aimed to better understand two potential interventions, by investigating their effect in neurologically intact individuals. The degree of foot placement control can be quantified based on a foot placement model, in which the CoM position and velocity during swing predict subsequent foot placement. Previously, perturbing foot placement with a force-field resulted in an enhanced degree of foot placement control as an after-effect. Moreover, timed muscle vibration enhanced the degree of foot placement control whilst the vibration was applied. Here, we replicated these two findings and further investigated whether Q1) timed muscle vibration leads to an after-effect and Q2) whether combining timed muscle vibration with force-field perturbations leads to a larger after-effect, as compared to force-field perturbations only. In addition, we evaluated several potential contributors to the degree of foot placement control, by considering foot placement errors, CoM variability and the CoM position gain (βpos) of the foot placement model, next to the R2 measure as the degree of foot placement control. Timed muscle vibration led to a higher degree of foot placement control as an after-effect (Q1). However, combining timed muscle vibration and force-field perturbations did not lead to a larger after-effect, as compared to following force-field perturbations only (Q2). Furthermore, we showed that the improved degree of foot placement control following force-field perturbations and during/following muscle vibration, did not reflect diminished foot placement errors. Rather, participants demonstrated a stronger active response (higher βpos) as well as higher CoM variability.
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Affiliation(s)
- A M van Leeuwen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands; Institute of Brain and Behavior, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Research Program(s), Amsterdam, the Netherlands.
| | - S M Bruijn
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands; Institute of Brain and Behavior, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Research Program(s), Amsterdam, the Netherlands
| | - J C Dean
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Health Care System, Charleston, SC, USA
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Wang Y, Mei Q, Jiang H, Hollander K, Van den Berghe P, Fernandez J, Gu Y. The Biomechanical Influence of Step Width on Typical Locomotor Activities: A Systematic Review. SPORTS MEDICINE - OPEN 2024; 10:83. [PMID: 39068296 PMCID: PMC11283446 DOI: 10.1186/s40798-024-00750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Step width is a spatial variable in the frontal plane, defined as the mediolateral distance between the heel (forefoot during sprinting) of bilateral feet at initial contact. Variations in step width may impact the lower limb biomechanics. This systematic review aimed to synthesize the published findings to determine the influence of acute changes in step width on locomotion biomechanics and provide implications for injury prevention and enhanced sports performance. METHODS Literature was identified, selected, and appraised in accordance with the methods of a systematic review. Four electronic databases (Web of Science, MEDLINE via PubMed, Scopus, and ScienceDirect) were searched up until May 2023 with the development of inclusion criteria based on the PICO model. Study quality was assessed using the Downs and Black checklist and the measured parameters were summarized. RESULTS Twenty-three articles and 399 participants were included in the systematic review. The average quality score of the 23 studies included was 9.39 (out of 14). Step width changed the kinematics and kinetics in the sagittal, frontal, and transverse planes of the lower limb, such as peak rearfoot eversion angle and moment, peak hip adduction angle and moment, knee flexion moment, peak knee internal rotation angle, as well as knee external rotation moment. Alteration of step width has the potential to change the stability and posture during locomotion, and evidence exists for the immediate biomechanical effects of variations in step width to alter proximal kinematics and cues to impact loading variables. CONCLUSION Short-term changes in step width during walking, running, and sprinting influenced multiple lower extremity biomechanics. Narrower step width may result in poor balance and higher impact loading on the lower extremities during walking and running and may limit an athlete's sprint performance. Increasing step width may be beneficial for injury rehabilitation, i.e., for patients with patellofemoral pain syndrome, iliotibial band syndrome or tibial bone stress injury. Wider steps increase the supporting base and typically enhance balance control, which in turn could reduce the risks of falling during daily activities. Altering the step width is thus proposed as a simple and non-invasive treatment method in clinical practice.
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Affiliation(s)
- Yuan Wang
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China
- Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Qichang Mei
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China.
- Research Academy of Grand Health, Ningbo University, Ningbo, China.
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
| | - Hanhui Jiang
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China
- Research Academy of Grand Health, Ningbo University, Ningbo, China
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | | | - Justin Fernandez
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China
- Research Academy of Grand Health, Ningbo University, Ningbo, China
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, No. 818, Fenghua Rd, Jiangbei District, Ningbo, Zhejiang, China.
- Research Academy of Grand Health, Ningbo University, Ningbo, China.
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
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Patil NS, Dingwell JB, Cusumano JP. A model of task-level human stepping regulation yields semistable walking. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.05.583616. [PMID: 38979349 PMCID: PMC11230222 DOI: 10.1101/2024.03.05.583616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
A simple lateral dynamic walker, with swing leg dynamics and three adjustable input parameters, is used to study how motor regulation affects frontal plane stepping. Motivated by experimental observations and phenomenological models, we imposed task-level multiobjective regulation targeting the walker's optimal lateral foot placement at each step. The regulator prioritizes achieving step width and lateral body position goals to varying degrees by choosing a mixture parameter. Our model thus integrates a lateral mechanical template, which captures fundamental mechanics of frontal-plane walking, with a lateral motor regulation template, an empirically verified model of how humans manipulate lateral foot placements in a goal-directed manner. The model captures experimentally observed stepping fluctuation statistics and demonstrates how linear empirical models of stepping dynamics can emerge from first-principles nonlinear mechanics. We find that task-level regulation gives rise to a goal equivalent manifold in the system's extended state space of mechanical states and inputs, a subset of which contains a continuum of period-1 gaits forming a semistable set: perturbations off of any of its gaits result in transients that return to the set, though typically to different gaits.
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Affiliation(s)
- Navendu S. Patil
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA
- Department of Engineering Science & Mechanics, Pennsylvania State University, University Park, PA 16802, USA
| | - Jonathan B. Dingwell
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA
| | - Joseph P. Cusumano
- Department of Engineering Science & Mechanics, Pennsylvania State University, University Park, PA 16802, USA
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Jiang Y, Yang J, Tian H, Jiang C, Wang H. Comparative study of the effects of custom-made insole and ordinary insole in adults with flexible flatfoot on different slopes. Technol Health Care 2024:THC231785. [PMID: 39031402 DOI: 10.3233/thc-231785] [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: 07/22/2024]
Abstract
BACKGROUND Flatfoot (pes planus) is a common foot deformity, and its causes are mainly related to age, gender, weight, and genetics. Previous studies have shown that custom-made insoles could have a positive effect in improving plantar pressure and symptoms in individuals with flexible flatfeet, but it remains to be explored whether they can still show benefits in daily walking on different slopes. OBJECTIVE This study aims to investigate a custom-made insole based on plantar pressure redistribution and to verify its effectiveness by gait analysis on different slopes. METHODS We recruited 10 subjects and compared the peak pressure and impulse in each area between custom-made insole (CI) and ordinary insole (OI) groups. RESULTS The results illustrate that CI raises the pressure in T area, improves the ability of the subjects to move forward in the slope walking, which was beneficial to gait stability. CONCLUSION The redistribution of pressure in MF and MH area is promoted to provide active protection for subjects. Meanwhile, CI could decrease the impulse in MF area during uphill and level walking, which effectively reduces the accumulation of fatigue during gait. Moreover, avoiding downhill walking could be able to protect foot from injury in daily life.
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Affiliation(s)
- Yangzheng Jiang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Jiantao Yang
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Hui Tian
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Chuan Jiang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Hongzhu Wang
- Women's Hospital School of Medicine Zhejiang University, Hangzhou, China
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Jeffcoat S, Aragon A, Kuch A, Farrokhi S, Sanchez N. Perception of task duration affects metabolic cost during split-belt adaptation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.24.595558. [PMID: 38826397 PMCID: PMC11142228 DOI: 10.1101/2024.05.24.595558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Humans continuously adapt locomotor patterns. Whether metabolic cost reduction is the primary objective or a by-product of the observed biomechanical changes during adaptation is not known. The main goal of our study is to determine if perception of task duration affects the adaptation of locomotor patterns to reduce energetic cost during split-belt walking. We tested the hypothesis that individuals who believe they will sustain a locomotor adaptation task for a prolonged time will reduce metabolic cost by adapting toward a walking pattern associated with lower mechanical work. N=14 participants walked on a split-belt treadmill for 10 minutes with knowledge of task duration (group K), while N=15 participants performed the task under the assumption that they would walk for 30 minutes (group U). Both groups walked for 10 minutes with the belts moving at 1.5 and 0.5 m/s, followed by 6 minutes of walking with both belts at 1.0 m/s. We observed a significant main effect of Time (p<0.001, observed power 1.0) and the interaction of Time×Group (p=0.004, observed power 0.84) on metabolic cost. Participants in the U group had a metabolic cost that was 12% lower during adaptation compared to the K group, which did not reduce metabolic cost during adaptation. The metabolic cost reduction observed in group U was not associated with biomechanical changes during adaptation. Our results indicate that metabolic cost reduction has a primary role in tasks that need to be sustained for a prolonged time, and this reduction is not only related to biomechanical factors.
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Affiliation(s)
- S.N. Jeffcoat
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University
| | - A. Aragon
- Department of Applied Human Physiology, Crean College of Health and Behavioral Sciences, Chapman University
| | - A. Kuch
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University
| | - S. Farrokhi
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University
| | - N. Sanchez
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University
- Department of Electrical Engineering and Computer Science, Fowler School of Engineering, Chapman University
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Biere J, Groen BE, Keijsers NLW. Impact of visual rotations on heading direction and center of mass control during steady-state gait. J Neurophysiol 2024; 131:1260-1270. [PMID: 38748413 DOI: 10.1152/jn.00304.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Abstract
Visual information is essential to navigate the environment and maintain postural stability during gait. Visual field rotations alter the perceived heading direction, resulting in gait trajectory deviations, known as visual coupling. It is unclear how center of mass (CoM) control relative to a continuously changing base of support (BoS) is adapted to facilitate visual coupling. This study aimed to characterize mediolateral (ML) balance control during visual coupling in steady-state gait. Sixteen healthy participants walked on an instrumented treadmill, naive to sinusoidal low-frequency (0.1 Hz) rotations of the virtual environment around the vertical axis. Rotations were continuous with 1) high or 2) low amplitude or were 3) periodic with 10-s intervals. Visual coupling was characterized with cross-correlations between CoM trajectory and visual rotations. Balance control was characterized with the ML margin of stability (MoSML) and by quantifying foot placement control as the relation between CoM dynamics and lateral foot placement. Visual coupling was strong on a group level (continuous low: 0.88, continuous high: 0.91, periodic: 0.95) and moderate to strong on an individual level. Higher rotation amplitudes induced stronger gait trajectory deviations. The MoSML decreased toward the deviation direction and increased at the opposite side. Foot placement control was similar compared with regular gait. Furthermore, pelvis and foot reorientation toward the rotation direction was observed. We concluded that visual coupling was facilitated by reorientating the body and shifting the extrapolated CoMML closer to the lateral BoS boundary toward the adjusted heading direction while preserving CoM excursion and foot placement control.NEW & NOTEWORTHY Healthy, naive participants were unaware of subtle, low-frequency rotations of the visual field but still coupled their gait trajectory to a rotating virtual environment. In response, participants decreased their margin of stability toward the new heading direction, without changing the center of mass excursion magnitude and foot placement strategy.
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Affiliation(s)
- Joost Biere
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Brenda E Groen
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Noël L W Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Lorenz DL, van den Bogert AJ. A comprehensive dataset on biomechanics and motor control during human walking with discrete mechanical perturbations. PeerJ 2024; 12:e17256. [PMID: 38699182 PMCID: PMC11064863 DOI: 10.7717/peerj.17256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Background Humans have a remarkable capability to maintain balance while walking. There is, however, a lack of publicly available research data on reactive responses to destabilizing perturbations during gait. Methods Here, we share a comprehensive dataset collected from 10 participants who experienced random perturbations while walking on an instrumented treadmill. Each participant performed six 5-min walking trials at a rate of 1.2 m/s, during which rapid belt speed perturbations could occur during the participant's stance phase. Each gait cycle had a 17% probability of being perturbed. The perturbations consisted of an increase of belt speed by 0.75 m/s, delivered with equal probability at 10%, 20%, 30%, 40%, 50%, 60%, 70%, or 80% of the stance phase. Data were recorded using motion capture with 25 markers, eight inertial measurement units (IMUs), and electromyography (EMG) from the tibialis anterior (TA), soleus (SOL), lateral gastrocnemius (LG), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), and gluteus maximus (GM). The full protocol is described in detail. Results We provide marker trajectories, force plate data, EMG data, and belt speed information for all trials and participants. IMU data is provided for most participants. This data can be useful for identifying neural feedback control in human gait, biologically inspired control systems for robots, and the development of clinical applications.
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Affiliation(s)
- Dana L. Lorenz
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, Ohio, United States
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12
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Zhao JL, Ma LD, Xiao X, Lin LJ, Xie H, Ng SSM, Chen PM. Community integration and its predictors in people with stroke: a multicenter longitudinal study. J Rehabil Med 2024; 56:jrm21372. [PMID: 38659375 PMCID: PMC11066660 DOI: 10.2340/jrm.v56.21372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To investigate the community integration of patients following stroke and determine the predictors of their level of community integration at 1-year follow-up. DESIGN A multicenter, longitudinal, and observational study. SUBJECTS Sixty-five inpatients (41 men) with a mean age of 56.9 (standard deviation = 17.0) years, who had their first stroke at least 1 month prior to this study were recruited from 4 rehabilitation inpatient wards in China. METHODS In the initial assessment, the participants were evaluated using the Community Integration Questionnaire, the Fugl-Meyer Assessment, the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, and the Modified Ashworth Scale. In the follow-up assessments, which were conducted via telephone no less than 1 year after discharge, the participants were evaluated using the Community Integration Questionnaire and also assessed for other disease-related conditions. RESULTS The participants' scores on the Community Integration Questionnaire in the follow-up assessment were significantly greater than those at the initial assessment (p < 0.05). In addition, the participants' Community Integration Questionnaire scores in the follow-up assessment were significantly correlated with their ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination scores in the initial assessment (p < 0.05), and marginally significantly correlated with their scores on Fugl-Meyer Assessment in the initial assessment (p = 0.058). The participants' ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination, Fugl-Meyer Assessment of the lower extremity, and Fugl-Meyer Assessment scores in the initial assessment were predictive of their Community Integration Questionnaire scores at follow-up, with coefficients of determination ranging from 0.254 to 0.056 (p < 0.05). CONCLUSIONS The level of community integration of the participants was generally low, but it was greater at 1-year follow-up than it was initially. Balance function and daily living ability may be key predictors of community integration of patients following stroke.
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Affiliation(s)
- Jiang-Li Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Lian-Dong Ma
- Department of Acupuncture and Rehabilitation Medicine, The Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Xiang Xiao
- Department of Rehabilitation Medicine, The Shenzhen Luohu Hospital Group Luohu People's Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Li-Jun Lin
- Department of Acupuncture and Rehabilitation Medicine, The Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Hao Xie
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China. shamay
| | - Pei-Ming Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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Boekesteijn RJ, Keijsers NLW, Defoort K, Geurts ACH, Smulders K. Individuals with knee osteoarthritis show few limitations in balance recovery responses after moderate gait perturbations. Clin Biomech (Bristol, Avon) 2024; 114:106218. [PMID: 38479343 DOI: 10.1016/j.clinbiomech.2024.106218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Knee osteoarthritis causes structural joint damage. The resultant symptoms can impair the ability to recover from unexpected gait perturbations. This study compared balance recovery responses to moderate gait perturbations between individuals with knee osteoarthritis and healthy individuals. METHODS Kinematic data of 35 individuals with end-stage knee osteoarthritis, and 32 healthy individuals in the same age range were obtained during perturbed walking on a treadmill at 1.0 m/s. Participants received anteroposterior (acceleration or deceleration) or mediolateral perturbations during the stance phase. Changes from baseline in margin of stability, step length, step time, and step width during the first two steps after perturbation were compared between groups using a linear regression model. Extrapolated center of mass excursion was descriptively analyzed. FINDINGS After all perturbation modes, extrapolated center of mass trajectories overlapped between individuals with knee osteoarthritis and healthy individuals. Participants predominantly responded to mediolateral perturbations by adjusting their step width, and to anteroposterior perturbations by adjusting step length and step time. None of the perturbation modes yielded between-group differences in changes in margin of stability and step width during the first two steps after perturbation. Small between-group differences were observed for step length (i.e. 2 cm) of the second step after mediolateral and anteroposterior perturbations, and for step time (i.e. 0.01-0.02 s) of first step after mediolateral perturbations and the second step after outward and belt acceleration perturbations. INTERPRETATION Despite considerable pain and damage to the knee joint, individuals with knee osteoarthritis showed comparable balance recovery responses after moderate gait perturbations to healthy participants.
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Affiliation(s)
- R J Boekesteijn
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, the Netherlands.
| | - N L W Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, the Netherlands; Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - K Defoort
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - A C H Geurts
- Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, the Netherlands
| | - K Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands
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Kooiman V, van der Cruijsen J, Leijendekkers R, Verdonschot N, Solis-Escalante T, Weerdesteyn V. The influence of prosthetic suspension on gait and cortical modulations is persons with a transfemoral amputation: socket-suspended versus bone-anchored prosthesis. J Neuroeng Rehabil 2024; 21:35. [PMID: 38454427 PMCID: PMC10921721 DOI: 10.1186/s12984-024-01331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Persons with a transfemoral amputation (TFA) often experience difficulties in daily-life ambulation, including an asymmetrical and less stable gait pattern and a greater cognitive demand of walking. However, it remains unclear whether this is effected by the prosthetic suspension, as eliminating the non-rigid prosthetic connection may influence stability and cortical activity during walking. Spatiotemporal and stability-related gait parameters, as well as cortical activity during walking, were evaluated between highly active individuals (MFC-level K3-4) with a TFA and able-bodied (AB) persons, and between persons with a bone-anchored prosthesis (BAP) and those with a socket-suspended prosthesis (SSP). METHODS 18 AB persons and 20 persons with a unilateral TFA (10 BAP-users, 10 SSP-users) walked on a treadmill at their preferred speed. Spatiotemporal and margin of stability parameters were extracted from three-dimensional movement recordings. In addition, 126-channel electroencephalogram (EEG) was recorded. Brain-related activity from several cortical areas was isolated using independent component analysis. Source-level data were divided into gait cycles and subjected to time-frequency analysis to determine gait-cycle dependent modulations of cortical activity. RESULTS Persons with TFA walked with smaller and wider steps and with greater variability in mediolateral foot placement than AB subjects; no significant differences were found between BAP- and SSP-users. The EEG analysis yielded four cortical clusters in frontal, central (both hemispheres), and parietal areas. No statistically significant between-group differences were found in the mean power over the entire gait cycle. The event-related spectral perturbation maps revealed differences in power modulations (theta, alpha, and beta bands) between TFA and AB groups, and between BAP- and SSP-users, with largest differences observed around heel strike of either leg. CONCLUSIONS The anticipated differences in gait parameters in persons with TFA were confirmed, however no significant effect of the fixed suspension of a BAP was found. The preliminary EEG findings may indicate more active monitoring and control of stability in persons with TFA, which appeared to be timed differently in SSP than in BAP-users. Future studies may focus on walking tasks that challenge stability to further investigate differences related to prosthetic suspension.
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Affiliation(s)
- Vera Kooiman
- Orthopedic Research Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Joris van der Cruijsen
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ruud Leijendekkers
- Orthopedic Research Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nico Verdonschot
- Orthopedic Research Laboratory, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Teodoro Solis-Escalante
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Sint Maartenskliniek, Research & Rehabilitation, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands
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15
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Simpkins C, Yang F. Dynamic Gait Stability and Spatiotemporal Gait Parameters During Overground Walking in Professional Ballet Dancers. J Dance Med Sci 2024; 28:28-36. [PMID: 37830340 DOI: 10.1177/1089313x231202824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Introduction: It has been recognized that practicing ballet could strengthen the leg muscles, improve balance, and reduce fall risk. However, few studies have investigated how ballet practice alters a person's gait pattern, and this knowledge gap could present a barrier to designing ballet-based training programs. This study examined dynamic gait stability and spatiotemporal gait parameters among professional ballet dancers during normal level overground walking. Methods: Twenty young adults were recruited: 10 ballet dancers (24.5 ± 4.9 years) and 10 age- and sex-matched non-dancers (22.6 ± 3.4 years). Participants walked on a 10 m linear walkway at their self-selected speed. Dynamic gait stability and common gait parameters (step length, step width, gait speed, and cadence) were determined from the collected kinematic data and compared between groups with a significance level of .05. Results: The results showed that both groups displayed comparable dynamic gait stability at touchdown (P = .140) and liftoff (P = .638). However, ballet dancers walked with a longer (P = .054), narrower (P = .009), and faster step (P = .014) at a marginally quicker speed (P = .063) than non-dancers. Conclusion: Our study suggests that young professional ballet dancers have different gait patterns, but similar dynamic gait stability compared to non-dancers. These findings not only provide insight into the mechanisms of dynamic stability control among young ballet dancers during gait but expand our understanding of the control of dynamic gait balance of human locomotion across a wide variety of populations and walking conditions.
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Affiliation(s)
- Caroline Simpkins
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
| | - Feng Yang
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, USA
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16
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Reimann H, Bruijn SM. The condition for dynamic stability in humans walking with feedback control. PLoS Comput Biol 2024; 20:e1011861. [PMID: 38498569 PMCID: PMC10997112 DOI: 10.1371/journal.pcbi.1011861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 04/05/2024] [Accepted: 01/24/2024] [Indexed: 03/20/2024] Open
Abstract
The walking human body is mechanically unstable. Loss of stability and falling is more likely in certain groups of people, such as older adults or people with neuromotor impairments, as well as in certain situations, such as when experiencing conflicting or distracting sensory inputs. Stability during walking is often characterized biomechanically, by measures based on body dynamics and the base of support. Neural control of upright stability, on the other hand, does not factor into commonly used stability measures. Here we analyze stability of human walking accounting for both biomechanics and neural control, using a modeling approach. We define a walking system as a combination of biomechanics, using the well known inverted pendulum model, and neural control, using a proportional-derivative controller for foot placement based on the state of the center of mass at midstance. We analyze this system formally and show that for any choice of system parameters there is always one periodic orbit. We then determine when this periodic orbit is stable, i.e. how the neural control gain values have to be chosen for stable walking. Following the formal analysis, we use this model to make predictions about neural control gains and compare these predictions with the literature and existing experimental data. The model predicts that control gains should increase with decreasing cadence. This finding appears in agreement with literature showing stronger effects of visual or vestibular manipulations at different walking speeds.
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Affiliation(s)
- Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States of America
| | - Sjoerd M. Bruijn
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Institute of Brain and Behavior, Amsterdam, The Netherlands
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17
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Schonhaut EB, Howard KE, Jacobs CJ, Knight HL, Chesnutt AN, Dean JC. Altered foot placement modulation with somatosensory stimulation in people with chronic stroke. J Biomech 2024; 166:112043. [PMID: 38484654 PMCID: PMC11009041 DOI: 10.1016/j.jbiomech.2024.112043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 04/13/2024]
Abstract
Many individuals who experience a stroke exhibit reduced modulation of their mediolateral foot placement, an important gait stabilization strategy. One factor that may contribute to this deficit is altered somatosensory processing, which can be probed by applying vibration to the involved muscles (e.g., the hip abductors). The purpose of this study was to investigate whether appropriately controlled hip abductor vibration can increase foot placement modulation among people with chronic stroke. 40 people with chronic stroke performed a series of treadmill walking trials without vibration and with vibration of either the hip abductors or lateral trunk (a control condition) that scaled with their real-time mediolateral motion. To assess participants' vibration sensitivity, we also measured vibration detection threshold and lateral sway evoked by abductor vibration during quiet standing. As a group, foot placement modulation increased significantly with either hip or trunk vibration, compared to without vibration. However, these changes were quite variable across participants, and were not predicted by either vibration detection threshold or the lateral sway evoked by hip vibration during standing. Overall, we found that somatosensory stimulation had small, positive effects on post-stroke foot placement modulation. Unexpectedly, these effects were observed with both hip abductor and lateral trunk vibration, perhaps indicating that the trunk can also provide useful somatosensory feedback during walking. Future work is needed to determine whether repeated application of such somatosensory stimulation can produce sustained effects on this important gait stabilization strategy.
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Affiliation(s)
- Ethan B Schonhaut
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Keith E Howard
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Camden J Jacobs
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Heather L Knight
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Alyssa N Chesnutt
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Jesse C Dean
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Health Care System, USA.
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Tankink T, Hijmans JM, Carloni R, Houdijk H. Human-in-the-loop optimization of rocker shoes via different cost functions during walking. J Biomech 2024; 166:112028. [PMID: 38492537 DOI: 10.1016/j.jbiomech.2024.112028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/24/2024] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
Personalised footwear could be used to enhance the function of the foot-ankle complex to a person's maximum. Human-in-the-loop optimization could be used as an effective and efficient way to find a personalised optimal rocker profile (i.e., apex position and angle). The outcome of this process likely depends on the selected optimization objective and its responsiveness to the rocker parameters being tuned. This study aims to explore whether and how human-in-the-loop optimization via different cost functions (i.e., metabolic cost, collision work as measure for external mechanical work, and step distance variability as measure for gait stability) affects the optimal apex position and angle of a rocker profile differently for individuals during walking. Ten healthy individuals walked on a treadmill with experimental rocker shoes in which apex position and angle were optimized using human-in-the-loop optimization using different cost functions. We compared the obtained optimal apex parameters for the different cost functions and how these affected the selected gait related objectives. Optimal apex parameters differed substantially between participants and optimal apex positions differed between cost functions. The responsiveness to changes in apex parameters differed between cost functions. Collision work was the only cost function that resulted in a significant improvement of its performance criteria. Improvements in metabolic cost or step distance variability were not found after optimization. This study showed that cost function selection is important when human-in-the-loop optimization is used to design personalised footwear to allow conversion to an optimum that suits the individual.
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Affiliation(s)
- Thijs Tankink
- Universityof Groningen, University Medical Center Groningen, Department of Human Movement Sciences, 9713 GZ Groningen, the Netherlands.
| | - Juha M Hijmans
- Universityof Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, 9713 GZ Groningen, the Netherlands
| | - Raffaella Carloni
- University of Groningen, Bernoulli Institute for Mathematics, Computer Science and Artificial Intelligence, Faculty of Science and Engineering, 9747 AG Groningen, the Netherlands
| | - Han Houdijk
- Universityof Groningen, University Medical Center Groningen, Department of Human Movement Sciences, 9713 GZ Groningen, the Netherlands
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Howard KE, Reimold NK, Knight HL, Embry AE, Knapp HA, Agne AA, Jacobs CJ, Dean JC. Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke. Gait Posture 2024; 109:9-14. [PMID: 38237508 PMCID: PMC10939767 DOI: 10.1016/j.gaitpost.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 12/18/2023] [Accepted: 01/13/2024] [Indexed: 03/16/2024]
Abstract
BACKGROUND Many people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS. RESEARCH QUESTION Are biomechanical metrics of mediolateral step modulation related to common clinical balance measures among PwCS? METHODS In this cross-sectional study, 93 PwCS walked on a treadmill at their self-selected speed for 3-minutes. We quantified mediolateral step modulation for both paretic and non-paretic steps by calculating partial correlations between mediolateral pelvis displacement at the start of each step and step width (ρSW), mediolateral foot placement relative to the pelvis (ρFP), and final mediolateral location of the pelvis (ρPD) at the end of the step. We also assessed several common clinical balance measures (Functional Gait Assessment [FGA], Activities-specific Balance Confidence scale [ABC], self-reported fear of falling and fall history). We performed Spearman correlations to relate each biomechanical metric of step modulation to FGA and ABC scores. We performed Wilcoxon rank sum tests to compare each biomechanical metric between individuals with and without a fear of falling and a history of falls. RESULTS Only ρFP for paretic steps was significantly related to all four clinical balance measures; higher paretic ρFP values tended to be observed in participants with higher FGA scores, with higher ABC scores, without a fear of falling and without a history of falls. However, the strength of each of these relationships was only weak to moderate. SIGNIFICANCE While the present results do not provide insight into causality, they justify future work investigating whether interventions designed to increase ρFP can improve clinical measures of post-stroke balance in parallel.
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Affiliation(s)
- Keith E Howard
- College of Health Professions; Medical University of South Carolina, USA
| | - Nicholas K Reimold
- College of Health Professions; Medical University of South Carolina, USA
| | - Heather L Knight
- College of Health Professions; Medical University of South Carolina, USA
| | - Aaron E Embry
- College of Health Professions; Medical University of South Carolina, USA; Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA
| | - Holly A Knapp
- College of Health Professions; Medical University of South Carolina, USA
| | - Alexa A Agne
- College of Health Professions; Medical University of South Carolina, USA
| | - Camden J Jacobs
- College of Health Professions; Medical University of South Carolina, USA
| | - Jesse C Dean
- College of Health Professions; Medical University of South Carolina, USA; Ralph H. Johnson Veterans Affairs Health Care System, Charleston, SC, USA.
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20
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Wang Z, Xie H, Chien JH. The margin of stability is affected differently when walking under quasi-random treadmill perturbations with or without full visual support. PeerJ 2024; 12:e16919. [PMID: 38390385 PMCID: PMC10883149 DOI: 10.7717/peerj.16919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Background Sensory-motor perturbations have been widely used to assess astronauts' balance in standing during pre-/post- spaceflight. However, balance control during walking, where most falls occur, was less studied in these astronauts. A study found that applying either visual or platform oscillations reduced the margin of stability (MOS) in the anterior-posterior direction (MOSap) but increased MOS in the medial-lateral direction (MOSml) as a tradeoff. This tradeoff induced an asymmetric gait. This study extended the current knowledge to investigate overall stability under unpredictable environments. This study aimed to determine (1) whether quasi-random treadmill perturbations with or without full vision support would result in a significant reduction in MOSap but an increase in MOSml and (2) regardless of whether vision support was provided, quasi-random treadmill perturbations might result in asymmetric gait patterns. Methods Twenty healthy young adults participated in this study. Three experimental conditions were semi-randomly assigned to these participants as follows: (1) the control condition (Norm), walking normally with their preferred walking speed on the treadmill; (2) the treadmill perturbations with full vision condition (Slip), walking on the quasi-random varying-treadmill-belt-speeds with full vision support; and (3) the treadmill perturbations without full vision condition (Slip_VisionBlocked, blackout vision through customized vision-blocked goggles), walking on the quasi-random varying-treadmill-belt-speeds without full vision support. The dependent variables were MOSap, MOSml, and respective symmetric indices. A one-way repeated ANOVA measure or Friedman Test was applied to investigate the differences among the conditions mentioned above. Results There was an increase in MOSap in Slip (p = 0.001) but a decrease in MOSap in Slip_VisionBlocked (p = 0.001) compared to Norm condition. The MOSml was significantly greater in both Slip and Slip_VisionBlocked conditions compared to the Norm condition (p = 0.011; p < 0.001). An analysis of Wilcoxon signed-rank tests revealed that the symmetric index of MOSml in Slip_VisionBlocked (p = 0.002) was greater than in the Norm condition. Conclusion The novelty of this study was to investigate the effect of vision on the overall stability of walking under quasi-random treadmill perturbations. The results revealed that overall stability and symmetry were controlled differently with/without full visual support. In light of these findings, it is imperative to take visual support into consideration while developing a sensory-motor training protocol. Asymmetric gait also required extra attention while walking on the quasi-random treadmill perturbations without full vision support to maintain overall stability.
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Affiliation(s)
- Zhuo Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haoyu Xie
- Department of Health & Rehabilitation Science, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Jung H. Chien
- Independent Researcher, Omaha, NE, United States of America
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Jiang A, Grover FM, Bucklin M, Deol J, Shafer A, Gordon KE. Prior uncertainty impedes discrete locomotor adaptation. PLoS One 2024; 19:e0291284. [PMID: 38363788 PMCID: PMC10871477 DOI: 10.1371/journal.pone.0291284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/04/2024] [Indexed: 02/18/2024] Open
Abstract
The impact of environmental uncertainty on locomotor adaptation remains unclear. Environmental uncertainty could either aid locomotor adaptation by prompting protective control strategies that stabilize movements to assist learning or impede adaptation by reducing error sensitivity and fostering hesitance to pursue corrective movements. To explore this, we investigated participants' adaptation to a consistent force field after experiencing environmental uncertainty in the form of unpredictable balance perturbations. We compared the performance of this group (Perturbation) to the adaptive performance of a group that did not experience any unpredictable perturbations (Non-Perturbation). Perturbations were delivered using a cable-driven robotic device applying lateral forces to the pelvis. We assessed whole-body center of mass (COM) trajectory (COM signed deviation), anticipatory postural adjustments (COM lateral offset), and first step width. The Perturbation group exhibited larger disruptions in COM trajectory (greater COM signed deviations) than the Non-Perturbation group when first walking in the force field. While the COM signed deviations of both groups decreased towards baseline values, only the Non-Perturbation group returned to baseline levels. The Perturbation groups COM signed deviations remained higher, indicating they failed to fully adapt to the force field before the end. The Perturbation group also did not adapt their COM lateral offset to counter the predictable effects of the force field as the Non-Perturbation group did, and their first step width increased more slowly. Our findings suggest that exposure to unpredictable perturbations impeded future sensorimotor adaptations to consistent perturbations.
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Affiliation(s)
- Aojun Jiang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States of America
| | - Francis M. Grover
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Mary Bucklin
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States of America
| | - Jasjit Deol
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Anna Shafer
- Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States of America
| | - Keith E. Gordon
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States of America
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Clarke LM, Jones RM, Hiremath SV, Franklin C, Wright WG, Tucker CA. The Effects of Age and Height on Gait Smoothness in Adolescent Athletes. CHILDREN (BASEL, SWITZERLAND) 2024; 11:223. [PMID: 38397335 PMCID: PMC10887815 DOI: 10.3390/children11020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
(1) Background: Despite evidence of increased rates of sports injury during the years surrounding peak growth in adolescents, little is known regarding the relationship between adolescent growth and gait stability. The aim of this study was to gain a better understanding of how chronological age and height relate to gait stability in both male and female adolescents. (2) Methods: Participants (N = 67; females: n = 34, ages 8.7-15.9 years; males: n = 33, ages 10.0-16.7 years) completed two trials of treadmill walking at varying speeds: the preferred walking speed and 30% above and below. Trials were separated by a bout of fatiguing exercises. HarmonicRatios of the trunk, calculated from acceleration signals taken during walking, were used to quantify gait stability. Data were separated by sex and relationships between height and chronological age, and HarmonicRatios were assessed using multiple linear regression. (3) Results: Females' HarmonicRatios improved with chronological age both before and after fatigue. Males' HarmonicRatios increased with chronological age before fatigue; however, this effect was eliminated post-fatigue. Females' height was negatively associated with HarmonicRatios post-fatigue. Males' height was positively associated with HarmonicRatios pre-fatigue. (4) Conclusions: The study findings suggest sex differences in the effects of fatigue on gait stability during adolescence. In both sexes, HarmonicRatios increased with chronological age. These improvements were eliminated for males and altered for females with fatigue. The results of this study indicate the need for the reevaluation of sports progression based on chronological age in adolescents.
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Affiliation(s)
- Lindsay M. Clarke
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA 19122, USA; (S.V.H.); (W.G.W.)
| | - Resa M. Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19122, USA;
- Fox Chase Cancer Center, Temple University Health, Philadelphia, PA 19140, USA
| | - Shivayogi V. Hiremath
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA 19122, USA; (S.V.H.); (W.G.W.)
| | - Corinna Franklin
- Department of Pediatric Orthopedic Surgery, Yale University School of Medicine, New Haven, CT 06520, USA;
| | - W. Geoffrey Wright
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA 19122, USA; (S.V.H.); (W.G.W.)
| | - Carole A. Tucker
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX 77555, USA;
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Brough LG, Neptune RR. A comparison of the effects of mediolateral surface and foot placement perturbations on balance control and response strategies during walking. Gait Posture 2024; 108:313-319. [PMID: 38199090 DOI: 10.1016/j.gaitpost.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Balance perturbation studies during walking have improved our understanding of balance control in various destabilizing conditions. However, it is unknown to what extent balance recovery strategies can be generalized across different types of mediolateral balance perturbations. RESEARCH QUESTION Do similar mediolateral perturbations (foot placement versus surface translation) have similar effects on balance control and corresponding balance response strategies? METHODS Kinetic and kinematic data were previously collected during two separate studies, each with 15 young, healthy participants walking on an instrumented treadmill. In both studies, medial and lateral balance perturbations were applied at 80% of the gait cycle either by a treadmill surface translation or a pneumatic force applied to the swing foot. Differences in balance control (frontal plane whole body angular momentum) and balance response strategies (hip abduction moment, ankle inversion moment, center of pressure excursion and frontal plane trunk moment) between perturbed and unperturbed gait cycles were evaluated using statistical parametric mapping. RESULTS Balance disruptions after foot placement perturbations were larger and sustained longer compared to surface translations. Changes in joint moment responses were also larger for the foot placement perturbations compared to the surface translation perturbations. Lateral hip, ankle, and trunk strategies were used to maintain balance after medial foot placement perturbations, while a trunk strategy was primarily used after surface translations. SIGNIFICANCE Surface and foot placement perturbations influence balance control and corresponding response strategies differently. These results can help inform the development of perturbation-based balance training interventions aimed at reducing fall risk in clinical populations.
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Affiliation(s)
- Lydia G Brough
- Walker Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA.
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24
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Kreter N, Fino PC. Consequences of changing planned foot placement on balance control and forward progress. J R Soc Interface 2024; 21:20230577. [PMID: 38350615 PMCID: PMC10864096 DOI: 10.1098/rsif.2023.0577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
While walking humans generally plan foot placement two steps in advance. However, it is often necessary to rapidly alter foot placement position just before stepping due to the appearance of a new obstacle. While humans are quite capable of rapidly altering foot placement position, such changes can have major effects on centre of mass dynamics. We investigated how rapid changes to planned foot placement impact centre of mass dynamics, and how such changes influence the control of balance and forward progress, during both straight- and turning-gait. Thirteen young adults walked along a virtually projected walkway with precision footholds oriented either in a straight line or with a single 60°, 90° or 120° turn. On a subset of trials, participants were required to rapidly avoid stepping on select footholds. We found that if the centre of mass was disrupted such that it interfered with task success (i.e. staying upright and continuing along the planned path), walkers were more likely to sacrifice forward progress than the upright stability. Further, walkers appear to control centre of mass dynamics differently following inhibited steps during step turns than during spin turns, which may reflect a larger threat to task success when spin turns are interrupted.
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Affiliation(s)
- Nicholas Kreter
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Peter C. Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
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25
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Li YC, Bruijn SM, Lemaire KK, Brumagne S, van Dieën JH. Vertebral level specific modulation of paraspinal muscle activity based on vestibular signals during walking. J Physiol 2024; 602:507-525. [PMID: 38252405 DOI: 10.1113/jp285831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Evoking muscle responses by electrical vestibular stimulation (EVS) may help to understand the contribution of the vestibular system to postural control. Although paraspinal muscles play a role in postural stability, the vestibulo-muscular coupling of these muscles during walking has rarely been studied. This study aimed to investigate how vestibular signals affect paraspinal muscle activity at different vertebral levels during walking with preferred and narrow step width. Sixteen healthy participants were recruited. Participants walked on a treadmill for 8 min at 78 steps/min and 2.8 km/h, at two different step width, either with or without EVS. Bipolar electromyography was recorded bilaterally from the paraspinal muscles at eight vertebral levels from cervical to lumbar. Coherence, gain, and delay of EVS and EMG responses were determined. Significant EVS-EMG coupling (P < 0.01) was found at ipsilateral and/or contralateral heel strikes. This coupling was mirrored between left and right relative to the midline of the trunk and between the higher and lower vertebral levels, i.e. a peak occurred at ipsilateral heel strike at lower levels, whereas it occurred at contralateral heel strike at higher levels. EVS-EMG coupling only partially coincided with peak muscle activity. EVS-EMG coherence slightly, but not significantly, increased when walking with narrow steps. No significant differences were found in gain and phase between the vertebral levels or step width conditions. In summary, vertebral level specific modulation of paraspinal muscle activity based on vestibular signals might allow a fast, synchronized, and spatially co-ordinated response along the trunk during walking. KEY POINTS: Mediolateral stabilization of gait requires an estimate of the state of the body, which is affected by vestibular afference. During gait, the heavy trunk segment is controlled by phasic paraspinal muscle activity and in rodents the medial and lateral vestibulospinal tracts activate these muscles. To gain insight in vestibulospinal connections in humans and their role in gait, we recorded paraspinal surface EMG of cervical to lumbar paraspinal muscles, and characterized coherence, gain and delay between EMG and electrical vestibular stimulation, during slow walking. Vestibular stimulation caused phasic, vertebral level specific modulation of paraspinal muscle activity at delays of around 40 ms, which was mirrored between left, lower and right, upper vertebral levels. Our results indicate that vestibular afference causes fast, synchronized, and spatially co-ordinated responses of the paraspinal muscles along the trunk, that simultaneously contribute to stabilizing the centre of mass trajectory and to keeping the head upright.
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Affiliation(s)
- Yiyuan C Li
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Rehabilitation Sciences, Leuven, KU, Belgium
| | - Sjoerd M Bruijn
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Koen K Lemaire
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Simon Brumagne
- Department of Rehabilitation Sciences, Leuven, KU, Belgium
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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26
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Desmet DM, Kazanski ME, Cusumano JP, Dingwell JB. How Healthy Older Adults Enact Lateral Maneuvers While Walking. Gait Posture 2024; 108:117-123. [PMID: 38035512 PMCID: PMC10842127 DOI: 10.1016/j.gaitpost.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Walking requires frequent maneuvers to navigate changing environments with shifting goals. Humans accomplish maneuvers and simultaneously maintain balance primarily by modulating their foot placement, but a direct trade-off between these two objectives has been proposed. As older adults may rely more on foot placement to maintain lateral balance, they may be less able to adequately adapt stepping to perform lateral maneuvers. RESEARCH QUESTION How do older adults adapt stepping to enact lateral lane-change maneuvers, and how do physical and perceived ability influence their task performance? METHODS Twenty young (21.7 ± 2.6 yrs) and 18 older (71.6 ± 6.0 yrs) adults walked on a motorized treadmill in a virtual environment. Following an audible and visual cue, participants switched between two parallel paths, centered 0.6 m apart, to continue walking on their new path. We quantified when participants initiated the maneuver following the cue, as well as their step width, lateral position, and stepping variability ellipses at each maneuver step. RESULTS Young and older adults did not differ in when they initiated the maneuver, but participants with lower perceived ability took longer to do so. Young and older adults also did not exhibit differences in step width or lateral positions at any maneuver step, but participants with greater physical ability reached their new path faster. While only older adults exhibited stepping adaptations prior to initiating the maneuver, both groups traded off stability for maneuverability to enact the lateral maneuver. SIGNIFICANCE Physical and perceived balance ability, rather than age per se, differentially influenced maneuver task performance. Humans must make decisions related to the task of walking itself and do so based on both physical and perceived factors. Understanding and targeting these interactions may help improve walking performance among older adults.
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Affiliation(s)
- David M Desmet
- Department of Kinesiology, Pennsylvania State University, University Park, PA, United States
| | - Meghan E Kazanski
- Department of Kinesiology, Pennsylvania State University, University Park, PA, United States; Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States
| | - Joseph P Cusumano
- Department of Engineering Science & Mechanics, Pennsylvania State University, University Park, PA, United States
| | - Jonathan B Dingwell
- Department of Kinesiology, Pennsylvania State University, University Park, PA, United States.
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27
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Sansare A, Arcodia M, Lee SCK, Jeka J, Reimann H. Immediate application of low-intensity electrical noise reduced responses to visual perturbations during walking in individuals with cerebral palsy. J Neuroeng Rehabil 2024; 21:14. [PMID: 38281953 PMCID: PMC10822182 DOI: 10.1186/s12984-023-01299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Ashwini Sansare
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Maelyn Arcodia
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Samuel C K Lee
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - John Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
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28
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Tramontano M, Manzari L, Bustos ASO, De Angelis S, Montemurro R, Belluscio V, Bergamini E, Vannozzi G. Instrumental assessment of dynamic postural stability in patients with unilateral vestibular hypofunction during straight, curved, and blindfolded gait. Eur Arch Otorhinolaryngol 2024; 281:83-94. [PMID: 37382626 DOI: 10.1007/s00405-023-08082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To characterise dynamic postural stability of gait in patients with vestibular hypofunction (PwVH) using a sensor-based assessment while performing dynamic tasks and to correlate the results of this evaluation with clinical scales. METHODS This cross-sectional study involved 22 adults between 18 and 70 years old from a healthcare hospital centre. Eleven patients suffering from chronic vestibular hypofunction (PwVH) and eleven healthy controls (HC) were evaluated through a combined inertial sensor-based and clinical scale assessment. Participants were equipped with five synchronised inertial measurement units (IMUs) (128 Hz, Opal, APDM, Portland, OR, USA): three IMUs were located on the occipital cranium bone, near the lambdoid suture of the head, at the centre of the sternum, and at L4/L5 level, just above the pelvis, and were used to quantify gait quality parameters, while the other two were located slightly above lateral malleoli and used to perform stride and step segmentation. Three different motor tasks were performed in a randomized order: the 10-m Walk Test (10mWT), the Figure of Eight Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). A set of gait quality parameters related to stability, symmetry and smoothness of gait were extracted from IMU data and correlated with the clinical scale scores. PwVH and HC results were compared to test for significant between-group differences. RESULTS Significant differences were found for the three motor tasks (10mWT, Fo8WT and FST) when comparing PwVH and HC groups. For the 10mWT and the Fo8WT, significant differences between the PwVH and HC groups were found for the stability indexes. Considering the FST, significant differences between the PwVH and HC groups were also found in the stability and symmetry of gait. A significant correlation was found between the Dizziness Handicap Inventory and gait indices during the Fo8WT. CONCLUSIONS In this study, we characterized the dynamic postural stability alterations during linear, curved, and blindfolded walking/stepping in PwVH combining an instrumental IMU-based with traditional clinical scales approach. Combining instrumental and clinical evaluation for dynamic stability of gait alterations in PwVH is useful in thoroughly evaluating the effects of unilateral vestibular hypofunction.
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Affiliation(s)
- M Tramontano
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
| | | | - A S Orejel Bustos
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135, Rome, Italy
| | - S De Angelis
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
| | - R Montemurro
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
| | - V Belluscio
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135, Rome, Italy
| | - E Bergamini
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135, Rome, Italy
| | - G Vannozzi
- Fondazione Santa Lucia IRCCS, 00179, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", 00135, Rome, Italy
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29
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Yoon JY, Shin SS. Impact of step width on trunk motion and gait adaptation in elderly women with knee osteoarthritis. J Back Musculoskelet Rehabil 2024; 37:989-996. [PMID: 38250757 DOI: 10.3233/bmr-230232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Step width during walking can provide important information about aging and pathology. Although knee osteoarthritis (OA) is a common disease in elderly women, little is known about how different step widths influence gait parameters in patients with knee OA. OBJECTIVE To address this, we investigated the differences between narrower and wider step width on the center of mass (CoM) and gait biomechanics of elderly women with knee OA. METHODS Gait and CoM data were measured using a three-dimensional motion capture system and anthropometric data were acquired via standing full-limb radiography. Thirty elderly women with knee OA were divided into two groups depending on the average step width value (0.16 m). Specifically, the narrower step width group included those with a below average step width (n= 15) and the wider step width group included those with an above average step width (n= 15). The differences between the two groups were analyzed using an independentt-test. RESULTS Walking speed, step length, knee and ankle sagittal excursion, and medial-lateral CoM range were significantly greater in the narrower group. In contrast, the medial-lateral CoM velocity, medial-lateral ground reaction force (GRF), and foot progression angle were significantly higher in wider group. The external knee adduction moment, vertical GRF, and vertical CoM did not differ between the groups. CONCLUSIONS Our data indicate that step width in women with knee OA is associated with trunk motion and gait patterns. People with a narrower step might improve their gait function by increasing trunk frontal control to maintain gait stability. In contrast, in those with a wider step, greater toe out angle and shorter step length might be a compensatory adaptation to reduce knee loading.
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Affiliation(s)
- Ji-Yeon Yoon
- Motion Analysis Laboratory, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Sun-Shil Shin
- Department of Physical Therapy, College of Healthcare Medical Science and Engineering, Inje University, Gimhae, Korea
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30
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Karabin MJ, Smith RW, Sparto PJ, Furman JM, Redfern MS. Balance strategies for recovery from perturbed overground walking. J Biomech 2024; 162:111898. [PMID: 38070294 PMCID: PMC10843714 DOI: 10.1016/j.jbiomech.2023.111898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 01/16/2024]
Abstract
Bipedal locomotion is naturally unstable and requires active control. Walking is believed to be primarily stabilized through the selection of foot placements; however, other strategies are available, including regulation of ankle inversion/eversion, ankle push-off, and angular momentum through trunk postural adjustments. The roles of these strategies in maintaining overall stability are often masked by the dominant foot placement strategy. The objectives of this study were to describe how the four strategies are used to respond to medial or lateral ground perturbations during overground walking in healthy individuals and determine reliance on each strategy. Fifteen healthy adults walked with and without perturbations applied to the right foot at heel strike while body kinematics and surface electromyographic activity were measured. Medial perturbations resulted in decreased step width on the first step after the perturbation, increased ankle inversion, increased ankle push-off, and rightward trunk sway. Lateral perturbations resulted in increased step width, decreased ankle inversion, no change in ankle push-off, and leftward trunk sway. EMG activity was consistent with the observed strategies (e.g. increased peroneus longus EMG activity during ankle eversion) with the exception of increased bilateral erector spinae activity for all perturbations. Foot placement was the dominant strategy in response to perturbations, with other strategies showing reduced, yet significant, roles. This work demonstrates that multiple strategies are recruited to improve the balance response in addition to foot placement alone. These results can serve as a reference for future studies of populations with impaired balance to identify potential deficits in strategy selection.
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Affiliation(s)
- Michelle J Karabin
- University of Pittsburgh, Swanson School of Engineering Department of Bioengineering, 302 Benedum Hall 3700 O'Hara Street Pittsburgh, PA 15260, USA.
| | - Richard W Smith
- University of Pittsburgh, Swanson School of Engineering Department of Bioengineering, 302 Benedum Hall 3700 O'Hara Street Pittsburgh, PA 15260, USA
| | - Patrick J Sparto
- University of Pittsburgh, School of Health and Rehabilitation Sciences Department of Physical Therapy, 100 Technology Drive Pittsburgh, PA 15219, USA
| | - Joseph M Furman
- University of Pittsburgh, School of Medicine Department of Otolaryngology Eye & Ear Institute Suite, 500 Lothrop Street Pittsburgh, PA 15213, USA
| | - Mark S Redfern
- University of Pittsburgh, Swanson School of Engineering Department of Bioengineering, 302 Benedum Hall 3700 O'Hara Street Pittsburgh, PA 15260, USA
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31
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Morris A, Petersell TL, Pelo R, Hill S, Cassidy B, Jameson T, Iriye T, Burke J, Dibble LE, Fino PC. Use of Reactive Balance Assessments With Clinical Baseline Concussion Assessments in Collegiate Athletes. J Athl Train 2024; 59:39-48. [PMID: 36583958 PMCID: PMC10783474 DOI: 10.4085/1062-6050-0231.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Current clinical concussion evaluations assess balance deficits using static or dynamic balance tasks while largely ignoring reactive balance. Including a reactive balance assessment might provide a more comprehensive concussion evaluation. OBJECTIVES To identify redundancy in current clinical baseline assessments of concussion and determine whether reactive balance adds unique information to these evaluations. DESIGN Cross-sectional study. SETTING Clinical assessment. PATIENTS OR OTHER PARTICIPANTS A total of 279 healthy National Collegiate Athletic Association Division I athletes. INTERVENTION(S) Two cohorts of data were collected at the beginning of the athletic season. For cohort 1 (n = 191), the Immediate Post-Concussion Assessment and Cognitive Tool, instrumented modified push and release (I-mP&R), and Balance Error Scoring System (BESS) were administered. For cohort 2 (n = 88), the I-mP&R, BESS, timed tandem gait, walking with eyes closed, and clinical reaction time were administered. MAIN OUTCOME MEASURE(S) The strengths of the relationships between the Immediate Post-Concussion Assessment and Cognitive Tool cognitive indices, mP&R clinical score, instrumented measures (BESS sway; I-mP&R time to stability, latency, and step length), BESS score, timed tandem gait, walking time to completion, and clinical reaction time were characterized. RESULTS The strongest interinstrument correlation value was between single-task time to stability from the I-mP&R and clinical reaction time but was considered weak (r = 0.35, P = .001). The mP&R and I-mP&R clinical scores were weakly associated with the other assessments. CONCLUSIONS Weak correlations between interassessment variables indicated that little redundancy was present in the current clinical evaluations. Furthermore, reactive balance represents a unique domain of function that may improve the comprehensiveness of clinical assessments.
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Affiliation(s)
- Amanda Morris
- Department of Health & Kinesiology, University of Utah, Salt Lake City
| | - Tessa L Petersell
- Department of Health & Kinesiology, University of Utah, Salt Lake City
| | - Ryan Pelo
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City
| | - Sarah Hill
- Department of Health & Kinesiology, University of Utah, Salt Lake City
| | - Benjamin Cassidy
- Department of Health & Kinesiology, University of Utah, Salt Lake City
| | - Trevor Jameson
- Department of Athletics, University of Utah, Salt Lake City
| | - Tom Iriye
- Department of Athletics, University of Utah, Salt Lake City
| | - Jon Burke
- Department of Athletics, University of Utah, Salt Lake City
| | - Leland E Dibble
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City
| | - Peter C Fino
- Department of Health & Kinesiology, University of Utah, Salt Lake City
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32
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Dingwell JB, Render AC, Desmet DM, Cusumano JP. Generalizing stepping concepts to non-straight walking. J Biomech 2023; 161:111840. [PMID: 37897990 PMCID: PMC10880122 DOI: 10.1016/j.jbiomech.2023.111840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
People rarely walk in straight lines. Instead, we make frequent turns or other maneuvers. Spatiotemporal parameters fundamentally characterize gait. For straight walking, these parameters are well-defined for the task of walking on a straight path. Generalizing these concepts to non-straight walking, however, is not straightforward. People follow non-straight paths imposed by their environment (sidewalk, windy hiking trail, etc.) or choose readily-predictable, stereotypical paths of their own. People actively maintain lateral position to stay on their path and readily adapt their stepping when their path changes. We therefore propose a conceptually coherent convention that defines step lengths and widths relative to predefined walking paths. Our convention simply re-aligns lab-based coordinates to be tangent to a walker's path at the mid-point between the two footsteps that define each step. We hypothesized this would yield results both more correct and more consistent with notions from straight walking. We defined several common non-straight walking tasks: single turns, lateral lane changes, walking on circular paths, and walking on arbitrary curvilinear paths. For each, we simulated idealized step sequences denoting "perfect" performance with known constant step lengths and widths. We compared results to path-independent alternatives. For each, we directly quantified accuracy relative to known true values. Results strongly confirmed our hypothesis. Our convention returned vastly smaller errors and introduced no artificial stepping asymmetries across all tasks. All results for our convention rationally generalized concepts from straight walking. Taking walking paths explicitly into account as important task goals themselves thus resolves conceptual ambiguities of prior approaches.
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Affiliation(s)
- Jonathan B Dingwell
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Anna C Render
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - David M Desmet
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Joseph P Cusumano
- Department of Engineering Science & Mechanics, The Pennsylvania State University, University Park, PA 16802, USA
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Odanye O, Steffensen E, Hinton E, Bierner S, Hsiao HY, Knarr B. Treadmill Handrail-Use Increases the Anteroposterior Margin of Stability in Individuals' Post-Stroke. J Mot Behav 2023; 56:253-262. [PMID: 37994869 PMCID: PMC10957321 DOI: 10.1080/00222895.2023.2285383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/28/2023] [Indexed: 11/24/2023]
Abstract
Treadmills are important rehabilitation tools used with or without handrails. The handrails could be used to attain balance, prevent falls, and improve the walking biomechanics of stroke survivors, but it is yet unclear how the treadmill handrails impact their stability margins. Here, we investigated how 3 treadmill handrail-use conditions (no-hold, self-selected support, and light touch) impact stroke survivors' margins of stability (MoS). The anteroposterior MoS significantly increased for both legs with self-selected support while the mediolateral MoS of the unaffected leg decreased significantly when the participants walked with self-selected support in comparison to no-hold in both cases. We concluded that the contextual use of the handrail should guide its prescription for fall prevention or balance training in rehabilitation programs.
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Affiliation(s)
- Oluwaseye Odanye
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Emily Steffensen
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Erica Hinton
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Samuel Bierner
- Department of Physical Medicine and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, USA
| | - Brian Knarr
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
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Mahaki M, van Leeuwen AM, Bruijn SM, van der Velde N, van Dieën JH. Mediolateral foot placement control can be trained: Older adults learn to walk more stable, when ankle moments are constrained. PLoS One 2023; 18:e0292449. [PMID: 37910445 PMCID: PMC10619794 DOI: 10.1371/journal.pone.0292449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023] Open
Abstract
Falls are a problem, especially for older adults. Placing our feet accurately relative to the center-of-mass helps us to prevent falling during gait. The degree of foot placement control with respect to the center-of mass kinematic state is decreased in older as compared to young adults. Here, we attempted to train mediolateral foot placement control in healthy older adults. Ten older adults trained by walking on shoes with a narrow ridge underneath (LesSchuh), restricting mediolateral center-of-pressure shifts. As a training effect, we expected improved foot placement control during normal walking. A training session consisted of a normal walking condition, followed by a training condition on LesSchuh and finally an after-effect condition. Participants performed six of such training sessions, spread across three weeks. As a control, before the first training session, we included two similar sessions, but on normal shoes only. We evaluated whether a training effect was observed across sessions and weeks in a repeated-measures design. Whilst walking with LesSchuh, the magnitude of foot placement error reduced half-a-millimeter between sessions within a week (cohen's d = 0.394). As a training effect in normal walking, the magnitude of foot placement errors was significantly lower compared to the control week, by one millimeter in weeks 2 (cohen's d = 0.686) and 3 (cohen's d = 0.780) and by two millimeters in week 4 (cohen's d = 0.875). Local dynamic stability of normal walking also improved significantly. More precise foot placement may thus have led to improved stability. It remains to be determined whether the training effects were the result of walking on LesSchuh or from repeated treadmill walking itself. Moreover, enhancement of mechanisms beyond the scope of our outcome measures may have improved stability. At the retention test, gait stability returned to similar levels as in the control week. Yet, a reduction in foot placement error persisted.
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Affiliation(s)
- Mohammadreza Mahaki
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
| | - Anina Moira van Leeuwen
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
- Institute of Brain and Behavior, Amsterdam, The Netherlands
| | - Sjoerd M. Bruijn
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
- Institute of Brain and Behavior, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap H. van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Research Program(s), Amsterdam, The Netherlands
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Kazanski ME, Cusumano JP, Dingwell JB. How older adults regulate lateral stepping on narrowing walking paths. J Biomech 2023; 160:111836. [PMID: 37856977 PMCID: PMC11023624 DOI: 10.1016/j.jbiomech.2023.111836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/20/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
Walking humans often navigate complex, varying walking paths. To reduce falls, we must first determine how older adults purposefully vary their steps in contexts that challenge balance. Here, 20 young (21.7±2.6 yrs) and 18 older (71.6±6.0 yrs) healthy adults walked on virtual paths that slowly narrowed (from 45 cm to as narrow as 5 cm). Participants could switch onto an "easier" path whenever they chose. We applied our Goal Equivalent Manifold framework to quantify how participants adjusted their lateral stepping variability and step-to-step corrections of step width and lateral position as these paths narrowed. We also extracted these characteristics at the locations where participants switched paths. As paths narrowed, all participants reduced their lateral stepping variability, but older adults less so. To stay on the narrowing paths, young adults increasingly corrected step-to-step deviations in lateral position more, by correcting step-to-step deviations in step width less. Conversely, as older adults also increasingly corrected lateral position deviations, they did so without sacrificing correcting step-to-step deviations in step width, presumably to preserve balance. While older adults left the narrowing paths sooner, several of their lateral stepping characteristics remained similar to those of younger adults. Older adults largely maintained overall walking performance per se, but they did so by changing how they balanced the competing stepping regulation requirements intrinsic to the task: maintaining position vs. step width. Thus, balancing how to achieve multiple concurrent stepping goals while walking provides older adults the flexibility they need to appropriately adapt their stepping on continuously narrowing walking paths.
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Affiliation(s)
- Meghan E Kazanski
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA
| | - Joseph P Cusumano
- Department of Engineering Science & Mechanics, The Pennsylvania State University, University Park, PA 16802, USA
| | - Jonathan B Dingwell
- Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA.
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Gregg E, Beggs C, Bissas A, Nicholson G. A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women. PLoS One 2023; 18:e0293729. [PMID: 37906588 PMCID: PMC10617741 DOI: 10.1371/journal.pone.0293729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.
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Affiliation(s)
- Emily Gregg
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Clive Beggs
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Athanassios Bissas
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Gareth Nicholson
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
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Sterke BT, Poggensee KL, Ribbers GM, Lemus D, Vallery H. Light-Weight Wearable Gyroscopic Actuators Can Modulate Balance Performance and Gait Characteristics: A Proof-of-Concept Study. Healthcare (Basel) 2023; 11:2841. [PMID: 37957986 PMCID: PMC10647239 DOI: 10.3390/healthcare11212841] [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: 07/31/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Falling is a major cause of morbidity, and is often caused by a decrease in postural stability. A key component of postural stability is whole-body centroidal angular momentum, which can be influenced by control moment gyroscopes. In this proof-of-concept study, we explore the influence of our wearable robotic gyroscopic actuator "GyroPack" on the balance performance and gait characteristics of non-impaired individuals (seven female/eight male, 30 ± 7 years, 68.8 ± 8.4 kg). Participants performed a series of balance and walking tasks with and without wearing the GyroPack. The device displayed various control modes, which were hypothesised to positively, negatively, or neutrally impact postural control. When configured as a damper, the GyroPack increased mediolateral standing time and walking distance, on a balance beam, and decreased trunk angular velocity variability, while walking on a treadmill. When configured as a negative damper, both peak trunk angular rate and trunk angular velocity variability increased during treadmill walking. This exploratory study shows that gyroscopic actuators can influence balance and gait kinematics. Our results mirror the findings of our earlier studies; though, with more than 50% mass reduction of the device, practical and clinical applicability now appears within reach.
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Affiliation(s)
- Bram T. Sterke
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Katherine L. Poggensee
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Gerard M. Ribbers
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Rijndam Revalidatie, Westersingel 300, 3015 LJ Rotterdam, The Netherlands
| | - Daniel Lemus
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Heike Vallery
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
- Faculty of Mechanical Engineering, Rhine-Westphalia Technical University of Aachen, 52062 Aachen, Germany
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Kim D, Triolo R, Charkhkar H. Plantar somatosensory restoration enhances gait, speed perception, and motor adaptation. Sci Robot 2023; 8:eadf8997. [PMID: 37820003 DOI: 10.1126/scirobotics.adf8997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Lower limb loss is a major insult to the body's nervous and musculoskeletal systems. Despite technological advances in prosthesis design, artificial limbs are not yet integrated into the body's physiological systems. Therefore, lower limb amputees (LLAs) experience lower balance confidence, higher fear of falls, and impaired gait compared with their able-bodied peers (ABs). Previous studies have demonstrated that restored sensations perceived as originating directly from the missing limb via neural interfaces improve balance and performance in certain ambulatory tasks; however, the effects of such evoked sensations on neural circuitries involved in the locomotor activity are not well understood. In this work, we investigated the effects of plantar sensation elicited by peripheral nerve stimulation delivered by multicontact nerve cuff electrodes on gait symmetry and stability, speed perception, and motor adaptation. We found that restored plantar sensation increased stance time and propulsive force on the prosthetic side, improved gait symmetry, and yielded an enhanced perception of prosthetic limb movement. Our results show that the locomotor adaptation among LLAs with plantar sensation became similar to that of ABs. These findings suggest that our peripheral nerve-based approach to elicit plantar sensation directly affects central nervous pathways involved in locomotion and motor adaptation during walking. Our neuroprosthesis provided a unique model to investigate the role of somatosensation in the lower limb during walking and its effects on perceptual recalibration after a locomotor adaptation task. Furthermore, we demonstrated how plantar sensation in LLAs could effectively increase mobility, improve walking dynamics, and possibly reduce fall risks.
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Affiliation(s)
- Daekyoo Kim
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
- Department of Physical Education, Korea University, Seoul 02841, Korea
| | - Ronald Triolo
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
| | - Hamid Charkhkar
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA
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Eveld M, van der Kooij H, King S, Goldfarb M, Zelik K, van Asseldonk E. Center-of-Mass Based foot Placement in Stumble Recovery. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941231 DOI: 10.1109/icorr58425.2023.10304704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Exploring how foot placement relates to center-of-mass kinematics after unexpected disturbances for healthy adults could improve our understanding of human balance as well as inform the design/control of assistive device interventions to reduce fall risk. Therefore, in this work a kinematic dataset of stumble recovery responses from seven healthy adults was analyzed to investigate the effects of stumble perturbations on COM state, and the COM state's relationship to various foot placement metrics. COM velocity excursion after trips was significantly higher than excursion for unperturbed swing phases, increasing linearly as the trip occurred later in swing phase. Step length/width and foot position at heel-strike after the trip both increased with COM velocity at heel-strike, though weaker fits for foot positions suggest priority to other strategies. Swing durations were substantially longer for tripped swing phases versus normal swing phases and increased with COM velocity. This is the first investigation of these relationships for stumble recovery, and their alignment (or lack thereof) with previous models provides insights into the control of balance for this common daily-life disturbance.
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Namayeshi T, Haddara R, Ackland D, Lee PVS. The role of the ankle plantar flexor muscles in trip recovery during walking: a computational modeling study. Front Sports Act Living 2023; 5:1153229. [PMID: 37533583 PMCID: PMC10390771 DOI: 10.3389/fspor.2023.1153229] [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: 01/29/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Background Reactive lower limb muscle function during walking plays a role in balance, stability, and ultimately fall prevention. The objective of this study was to evaluate muscle and joint function used to regain balance after trip-based perturbations during walking. Research question How are lower limb muscles used to recover from external tripping during walking? Method The dominant legs of 20 healthy adult participants with similar athletic backgrounds were tripped using a split-belt instrumented treadmill. High- and medium-intensity trips were simulated by deceleration of the dominant leg at initial contact from the speed of 1.1 m/s to 0 m/s and back to 1.1 m/s in 0.4 s and 0.8 s, respectively. Lower limb kinematics, kinetics, and muscle forces following perturbations were computed to pre-perturbation values using statistical parametric mapping (SPM) paired t-test. Results A greater ankle dorsiflexion angle (mean difference: 5.3°), ankle plantar flexion moment (mean difference: 0.6 Nm / kg ), and gastrocnemius and soleus muscle forces (mean difference: 4.27 N / kg and 13.56 N / kg for GAS and SOL, respectively) were observed post-perturbation step despite the magnitude of the perturbation. Significance This study concludes that adequate timely response of ankle function during a compensatory step is required for a successful recovery after tripping during walking in young healthy adults. Weakness in plantar flexors suggests insufficient ankle moments, which ultimately can result in falls. The findings of this paper can be used as a reference for the joint moments and range of motion needed to recover trips in the design of assistive devices. In addition to that, clinicians can use the estimated values of muscle forces and the pattern of muscle activities to design targeted training in fall prevention among the elderly.
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Affiliation(s)
- Tayebeh Namayeshi
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Raneem Haddara
- Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - David Ackland
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Vee Sin Lee
- Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
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Afschrift M, van Asseldonk E, van Mierlo M, Bayon C, Keemink A, D'Hondt L, van der Kooij H, De Groote F. Assisting walking balance using a bio-inspired exoskeleton controller. J Neuroeng Rehabil 2023; 20:82. [PMID: 37370175 DOI: 10.1186/s12984-023-01205-9] [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: 12/09/2022] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Balance control is important for mobility, yet exoskeleton research has mainly focused on improving metabolic energy efficiency. Here we present a biomimetic exoskeleton controller that supports walking balance and reduces muscle activity. METHODS Humans restore balance after a perturbation by adjusting activity of the muscles actuating the ankle in proportion to deviations from steady-state center of mass kinematics. We designed a controller that mimics the neural control of steady-state walking and the balance recovery responses to perturbations. This controller uses both feedback from ankle kinematics in accordance with an existing model and feedback from the center of mass velocity. Control parameters were estimated by fitting the experimental relation between kinematics and ankle moments observed in humans that were walking while being perturbed by push and pull perturbations. This identified model was implemented on a bilateral ankle exoskeleton. RESULTS Across twelve subjects, exoskeleton support reduced calf muscle activity in steady-state walking by 19% with respect to a minimal impedance controller (p < 0.001). Proportional feedback of the center of mass velocity improved balance support after perturbation. Muscle activity is reduced in response to push and pull perturbations by 10% (p = 0.006) and 16% (p < 0.001) and center of mass deviations by 9% (p = 0.026) and 18% (p = 0.002) with respect to the same controller without center of mass feedback. CONCLUSION Our control approach implemented on bilateral ankle exoskeletons can thus effectively support steady-state walking and balance control and therefore has the potential to improve mobility in balance-impaired individuals.
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Affiliation(s)
- M Afschrift
- Department of Mechanical Engineering, Robotics Core Lab of Flanders Make, KU Leuven, Leuven, Belgium.
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - E van Asseldonk
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - M van Mierlo
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - C Bayon
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - A Keemink
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - L D'Hondt
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - H van der Kooij
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - F De Groote
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
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Symeonidou ER, Esposito NM, Reyes RD, Ferris DP. Practice walking on a treadmill-mounted balance beam modifies beam walking sacral movement and alters performance in other balance tasks. PLoS One 2023; 18:e0283310. [PMID: 37319297 PMCID: PMC10270570 DOI: 10.1371/journal.pone.0283310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/02/2023] [Indexed: 06/17/2023] Open
Abstract
The goals of this study were to determine if a single 30-minute session of practice walking on a treadmill mounted balance beam: 1) altered sacral marker movement kinematics during beam walking, and 2) affected measures of balance during treadmill walking and standing balance. Two groups of young, healthy human subjects practiced walking on a treadmill mounted balance beam for thirty minutes. One group trained with intermittent visual occlusions and the other group trained with unperturbed vision. We hypothesized that the subjects would show changes in sacrum movement kinematics after training and that there would be group differences due to larger improvements in beam walking performance by the visual occlusions group. We also investigated if there was any balance transfer from training on the beam to treadmill walking (margin of stability) and to standing static balance (center of pressure excursion). We found significant differences in sacral marker maximal velocity after training for both groups, but no significant differences between the two groups from training. There was limited evidence of balance transfer from beam-walking practice to gait margin of stability for treadmill walking and for single leg standing balance, but not for tandem stance balance. The number of step-offs while walking on a narrow beam had the largest change with training (partial η2 = 0.7), in accord with task specificity. Other balance metrics indicative of transfer had lower effect sizes (partial η2<0.5). Given the limited transfer across balance training tasks, future work should examine how intermittent visual occlusions during multi-task training improve real world functional outcomes.
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Affiliation(s)
- Evangelia-Regkina Symeonidou
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
- International Max Planck Research School for Systems and Cognitive Neuroscience, University of Tubingen, Tubingen, Germany
| | - Nicole M. Esposito
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Roehl-Dean Reyes
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
| | - Daniel P. Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States of America
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Best AN, Wu AR. Modified stepping behaviour during outdoor winter walking increases resistance to forward losses of stability. Sci Rep 2023; 13:8432. [PMID: 37225765 DOI: 10.1038/s41598-023-34831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/09/2023] [Indexed: 05/26/2023] Open
Abstract
Healthy humans are proficient at maintaining stability when faced with diverse walking conditions, however, the control strategies that lead to this proficiency are unclear. Previous laboratory-based research has predominantly concluded that corrective stepping is the main strategy, but whether this finding holds when facing everyday obstacles outside of the laboratory is uncertain. We investigated changes in gait stability behaviour when walking outdoors in the summer and winter, hypothesizing that as ground conditions worsened in the winter, the stepping strategy would be hindered. Stability would then be maintained through compensatory strategies such as with ankle torques and trunk rotation. Data was collected in the summer and winter using inertial measurement units to collect kinematics and instrumented insoles to collect vertical ground reaction forces. Using the goodness of fit for a multivariate regression between the centre of mass state and foot placement we found that, counter to our hypothesis, stepping was not hindered by winter conditions. Instead, the stepping strategy was modified to increase the anterior-posterior margin of stability, increasing the resistance to a forward loss of stability. With stepping being unhindered, we did not observe any additional compensation from the ankle or trunk strategies.
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Affiliation(s)
- Aaron N Best
- Mechanical and Materials Engineering, Ingenuity Labs Research Institute, Queen's University, Kingston, K7L 2N9, Canada.
| | - Amy R Wu
- Mechanical and Materials Engineering, Ingenuity Labs Research Institute, Queen's University, Kingston, K7L 2N9, Canada
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Shoja O, Shojaei M, Hassanlouei H, Towhidkhah F, Amiri M, Boroomand H, Rahimi N, Zhang L. Lack of visual information alters lower limb motor coordination to control center of mass trajectory during walking. J Biomech 2023; 155:111650. [PMID: 37245385 DOI: 10.1016/j.jbiomech.2023.111650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
Vision, as queen of the senses, plays a critical role in guiding locomotion. Little is known about the effects of vision on gait coordination in terms of variability. The uncontrolled manifold (UCM) approach offers a window to the structure of motor variability that has been difficult to obtain from the traditional correlation analysis. In this study, we used the UCM analysis to quantify how the lower limb motion is coordinated to control the center of mass (COM) while walking under different visual conditions. We also probed how synergy strength evolved along the stance phase. Ten healthy participants walked on the treadmill with and without visual information. Leg joint angle variance with respect to the whole-body COM was partitioned into good (i.e., the one that kept the COM) and bad (i.e., the one that changed the COM) variances. We observed that after vision was eliminated, both variances increased throughout the stance phase while the strength of the synergy (the normalized difference between the two variances) decreased significantly and even reduced to zero at heel contact. Thus, walking with restricted vision alters the strength of the kinematic synergy to control COM in the plane of progression. We also found that the strength of this synergy varied across different walking phases and gait events in both visual conditions. We concluded that the UCM analysis can quantify altered coordination of COM when vision is blocked and sheds insights on the role of vision in the synergistic control of locomotion.
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Affiliation(s)
- Otella Shoja
- Department of Motor Behavior, Faculty of Sport Sciences, Alzahra University, Tehran, Iran; Department of Neuroscience, University of Montreal, Montreal, QC, Canada.
| | - Masoumeh Shojaei
- Department of Motor Behavior, Faculty of Sport Sciences, Alzahra University, Tehran, Iran
| | - Hamidollah Hassanlouei
- Department of Motor Behavior, Faculty of Sport Sciences and Health, Shahid Beheshti University, Tehran, Iran
| | - Farzad Towhidkhah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Mohsen Amiri
- Department of Mechanical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Hesam Boroomand
- Department of Mechanical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Negar Rahimi
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Lei Zhang
- Institute for Neural Computation, Ruhr University Bochum, Germany
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Raffegeau TE, Clark M, Fawver B, Engel BT, Young WR, Williams AM, Lohse KR, Fino PC. The effect of mobility-related anxiety on walking across the lifespan: a virtual reality simulation study. Exp Brain Res 2023:10.1007/s00221-023-06638-1. [PMID: 37204506 DOI: 10.1007/s00221-023-06638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
Older adults who report a fear of falling are more likely to subsequently fall, yet, some gait anxiety-related alterations may protect balance. We examined the effect of age on walking in anxiety-inducing virtual reality (VR) settings. We predicted a high elevation-related postural threat would impair gait in older age, and differences in cognitive and physical function would relate to the observed effects. Altogether, 24 adults (age (y) = 49.2 (18.7), 13 women) walked on a 2.2-m walkway at self-selected and fast speeds at low (ground) and high (15 m) VR elevation. Self-reported cognitive and somatic anxiety and mental effort were greater at high elevations (all p < 0.001), but age- and speed-related effects were not observed. At high VR elevations, participants walked slower, took shorter steps, and reduced turning speed (all p < 0.001). Significant interactions with age in gait speed and step length showed that relatively older adults walked slower (β = - 0.05, p = 0.024) and took shorter steps (β = - 0.05, p = 0.001) at self-selected speeds at high compared to low elevation settings. The effect of Age on gait speed and step length disappeared between self-selected and fast speeds and at high elevation. At self-selected speeds, older adults took shorter and slower steps at high elevation without changing step width, suggesting that in threatening settings relatively older people change gait parameters to promote stability. At fast speeds, older adults walked like relatively younger adults (or young adults walked like older adults) supporting the notion that people opt to walk faster in a way that still protects balance and stability in threatening settings.
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Affiliation(s)
- Tiphanie E Raffegeau
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA.
- School of Kinesiology, George Mason University, 10890 George Mason Circle, Katherine Johnson Hall 201G, MSN 4E5, Manassas, VA, 20110, USA.
| | - Mindie Clark
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Bradley Fawver
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, USA
| | - Benjamin T Engel
- University of Utah, Spencer S. Eccles Health Sciences Library, Salt Lake City, UT, USA
| | - William R Young
- School of Sport and Health Science, The University of Exeter, Exeter, UK
| | - A Mark Williams
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- School of Sport and Health Science, The University of Exeter, Exeter, UK
| | - Keith R Lohse
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- Physical Therapy and Neurology, School of Medicine, Washington University, Saint Louis, MO, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
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46
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Walsh GS, Snowball J. Cognitive and visual task effects on gaze behaviour and gait of younger and older adults. Exp Brain Res 2023; 241:1623-1631. [PMID: 37148282 DOI: 10.1007/s00221-023-06627-4] [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: 01/10/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
Cognitive dual tasks alter gait of younger and older adults and recent research has demonstrated that they also influence gaze behaviour and standing postural control. These findings suggest that age-related changes in cognitive and gaze function might increase fall risk in older adults. The purpose of this study was to determine the effect cognitive and visual dual tasks on the gait and gaze behaviour of younger and older adults. Ten older and ten younger adults walked for 3 min on a treadmill at preferred walking speed under three conditions, single task, cognitive and visual dual task conditions. Gait dynamics were measured using accelerometry and gaze behaviour was measured using wearable eye-trackers. Stride time variability and centre of mass (COM) motion complexity increased in dual-task conditions in older adults but had no difference for younger adults. Dual tasks had limited effect on gaze behaviour; however, visual input duration was greater, and visual input frequency and saccade frequency were lower in older than younger adults. The gaze adaptations in older adults may be the result of slower visual processing or represent a compensatory strategy to suppress postural movement. The increase in gait COM motion complexity in older adults suggests the dual tasks led to more automatic gait control resulting from both cognitive and visual tasks.
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Affiliation(s)
- Gregory S Walsh
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, OX3 0BP, UK.
| | - James Snowball
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, OX3 0BP, UK
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47
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Tillman M, Molino J, Zaferiou AM. Gait-phase specific transverse-plane momenta generation during pre-planned and late-cued 90 degree turns while walking. Sci Rep 2023; 13:6846. [PMID: 37100853 PMCID: PMC10133231 DOI: 10.1038/s41598-023-33667-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
Turning while walking is ubiquitous and requires linear and angular momenta generation to redirect the body's trajectory and rotate towards the new direction of travel. This study examined strategies that healthy young adults used during each gait phase to generate transverse-plane momenta during pre-planned and late-cued 90° turns. During leftward turns, we expected that momenta would be generated most during the gait phases known to generate leftward linear and angular momenta during straight line gait. We found distinct roles of gait phases towards generating momenta during turns that partially supported our hypotheses. Supporting one hypothesis, the change in transverse-plane angular momentum and average moment were greater during double support with the left foot in front vs. other gait phases. Also, the change in leftward linear momentum and average leftward force were greater during right single support vs. other gait phases during straight-line gait and late-cued turns. However, during pre-planned turns, the average leftward force was not significantly greater during right single support vs. other gait phases. Overall, transverse-plane angular momentum generation during turns is similar to its generation during straight-line gait, suggesting that healthy young adults can leverage momenta control strategies used during straight-line gait during turns.
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Affiliation(s)
- Mitchell Tillman
- Department of Biomedical Engineering, Stevens Institute of Technology, Castle Point on the Hudson, Hoboken, NJ, 07030, USA
| | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
- Lifespan Biostatistics, Epidemiology, and Research Design Core, Rhode Island Hospital, Providence, RI, USA
| | - Antonia M Zaferiou
- Department of Biomedical Engineering, Stevens Institute of Technology, Castle Point on the Hudson, Hoboken, NJ, 07030, USA.
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Rossanigo R, Caruso M, Bertuletti S, Deriu F, Knaflitz M, Della Croce U, Cereatti A. Base of Support, Step Length and Stride Width Estimation during Walking Using an Inertial and Infrared Wearable System. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23083921. [PMID: 37112261 PMCID: PMC10144762 DOI: 10.3390/s23083921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/30/2023]
Abstract
The analysis of the stability of human gait may be effectively performed when estimates of the base of support are available. The base of support area is defined by the relative position of the feet when they are in contact with the ground and it is closely related to additional parameters such as step length and stride width. These parameters may be determined in the laboratory using either a stereophotogrammetric system or an instrumented mat. Unfortunately, their estimation in the real world is still an unaccomplished goal. This study aims at proposing a novel, compact wearable system, including a magneto-inertial measurement unit and two time-of-flight proximity sensors, suitable for the estimation of the base of support parameters. The wearable system was tested and validated on thirteen healthy adults walking at three self-selected speeds (slow, comfortable, and fast). Results were compared with the concurrent stereophotogrammetric data, used as the gold standard. The root mean square errors for the step length, stride width and base of support area varied from slow to high speed between 10-46 mm, 14-18 mm, and 39-52 cm2, respectively. The mean overlap of the base of support area as obtained with the wearable system and with the stereophotogrammetric system ranged between 70% and 89%. Thus, this study suggested that the proposed wearable solution is a valid tool for the estimation of the base of support parameters out of the laboratory.
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Affiliation(s)
- Rachele Rossanigo
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (S.B.); (F.D.); (U.D.C.)
| | - Marco Caruso
- PolitoBIOMed Lab—Biomedical Engineering Lab, Politecnico di Torino, 10129 Torino, Italy; (M.C.); (M.K.)
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
| | - Stefano Bertuletti
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (S.B.); (F.D.); (U.D.C.)
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (S.B.); (F.D.); (U.D.C.)
- Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, 07100 Sassari, Italy
| | - Marco Knaflitz
- PolitoBIOMed Lab—Biomedical Engineering Lab, Politecnico di Torino, 10129 Torino, Italy; (M.C.); (M.K.)
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
| | - Ugo Della Croce
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (S.B.); (F.D.); (U.D.C.)
| | - Andrea Cereatti
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy
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Yoshimoto K, Mani H, Hirose N, Kurogi T, Aiko T, Shinya M. Dynamic stability during level walking and obstacle crossing in children aged 2–5 years estimated by marker-less motion capture. Front Sports Act Living 2023; 5:1109581. [PMID: 37090815 PMCID: PMC10116057 DOI: 10.3389/fspor.2023.1109581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
In the present study, dynamic stability during level walking and obstacle crossing in typically developing children aged 2–5 years (n = 13) and healthy young adults (n = 19) was investigated. The participants were asked to walk along unobstructed and obstructed walkways. The height of the obstacle was set at 10% of the leg length. Gait motion was captured by three RGB cameras. 2D body landmarks were estimated using OpenPose, a marker-less motion capture algorithm, and converted to 3D using direct linear transformation (DLT). Dynamic stability was evaluated using the margin of stability (MoS) in the forward and lateral directions. All the participants successfully crossed the obstacles. Younger children crossed the obstacle more carefully to avoid falls, as evidenced by obviously decreased gait speed just before the obstacle in 2-year-olds and the increased in maximum toe height with younger age. There was no significant difference in the MoS at the instant of heel contact between children and adults during level walking and obstacle crossing in the forward direction, although children increased the step length of the lead leg to a greater extent than the adults to ensure base of support (BoS)-center of mass (CoM) distance. In the lateral direction, children exhibited a greater MoS than adults during level walking [children: 9.5%, adults: 6.5%, median, W = 39.000, p < .001, rank-biserial correlation = −0.684]; however, some children exhibited a smaller MoS during obstacle crossing [lead leg: −5.9% to 3.6% (min–max) for 4 children, 4.7%–6.4% [95% confidence interval (CI)] for adults, p < 0.05; trail leg: 0.1%–4.4% (min–max) for 4 children, 4.7%–6.4% (95% CI) for adults, p < 0.05]]. These results indicate that in early childhood, locomotor adjustment needed to avoid contact with obstacles can be observed, whereas lateral dynamic stability is frangible.
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Affiliation(s)
- Kohei Yoshimoto
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima, Japan
| | - Hiroki Mani
- Faculty of Welfare and Health Science, Oita University, Oita, Japan
| | - Natsuki Hirose
- Graduate School of Welfare and Health Science, Oita University, Oita, Japan
| | - Takaki Kurogi
- Faculty of Welfare and Health Science, Oita University, Oita, Japan
| | - Takumi Aiko
- Faculty of Welfare and Health Science, Oita University, Oita, Japan
| | - Masahiro Shinya
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima, Japan
- Correspondence: Masahiro Shinya
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50
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Small GH, Molina LK, Neptune RR. The influence of altered foot placement and cognitive load on balance control during walking in healthy young adults. Gait Posture 2023; 103:37-43. [PMID: 37084627 DOI: 10.1016/j.gaitpost.2023.04.007] [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: 08/20/2022] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Clinical populations often walk with altered foot placement, which can adversely affect balance control. However, it is unknown how balance control during walking is influenced when combining a cognitive load with altered foot placement. RESEARCH QUESTION Is balance control during walking adversely affected by the combination of a more complex motor task, such as walking with altered foot placements, with a cognitive load? METHODS Fifteen young healthy adults walked on a treadmill with and without a spelling cognitive load during normal walking, with step width targets (self-selected width, narrow, wide and extra wide), or with step length targets (self-selected length, short and long). RESULTS Cognitive performance, measured by correct spelling response rate, decreased from self-selected (2.407 ± 0.6 letters/s) to the extra wide width (2.011 ± 0.5 letters/s). The addition of the cognitive load caused a decrease in frontal plane balance control across all step lengths (15% change) and at the wider step widths (16% change), but only caused a slight decrease in the sagittal plane for the short step length (6.8% change). SIGNIFICANCE These results suggest that when combining a cognitive load with walking at non-self-selected widths, a threshold exists at wider steps where attentional resources become insufficient and balance control and cognitive performance decrease. Because decreased balance control increases the risk of falling, these results have implications for clinical populations who often walk with wider steps. Furthermore, the lack of changes to sagittal plane balance during altered step length dual-tasks further supports that frontal plane balance requires more active control.
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Affiliation(s)
- Gabriella H Small
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Lindsey K Molina
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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