1
|
Voß M, Zieschang T, Schmidt L, Hackbarth M, Koschate J, Stuckenschneider T. Reduced adaptability to balance perturbations in older adults with probable cognitive impairment after a severe fall. PLoS One 2024; 19:e0305067. [PMID: 38985810 PMCID: PMC11236103 DOI: 10.1371/journal.pone.0305067] [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: 02/12/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024] Open
Abstract
Falls in older individuals often result from unexpected balance disturbances during walking, necessitating the analysis of recovery strategies for effective falls prevention. This becomes particularly crucial for individuals with cognitive impairment, who face a higher fall risk compared to cognitively healthy adults. Hence, our study aimed to compare the recovery response to standardized walking perturbations on a treadmill between older adults with cognitive impairment and cognitively healthy older adults. 36 individuals with a recent history of a severe fall, leading to an emergency department visit without subsequent admission, were stratified into two groups (with and without probable cognitive impairment) based on scores of the Montreal Cognitive Assessment. Recovery performance was quantified using force plate data from a perturbation treadmill (M-Gait, Motek Medical B.V., Amsterdam, the Netherlands), specifically evaluating the number of steps needed to restore step length and width to pre perturbation baseline across two trials of nine different perturbations. Individuals with cognitive impairment (n = 18, mean age: 74.7) required significantly (p = 0.045, Cohen's d = 0.69) more steps to recover total steps after perturbations compared to cognitively healthy individuals (n = 18, mean age: 69.7). While step width recovery was similar between the groups, those with probable cognitive impairment required significantly more steps to recover their step length (p = 0.039, Cohen's d = 0.72). Thus, our findings indicate that older adults with probable cognitive impairment manifest inferior gait adaptability, especially in adapting step length, potentially underscoring a critical aspect for effective falls prevention in this population.
Collapse
Affiliation(s)
- Malte Voß
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Tania Zieschang
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Laura Schmidt
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Michel Hackbarth
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Jessica Koschate
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| | - Tim Stuckenschneider
- Department for Health Services Research, Geriatric Medicine, School of Medicine and Health Services, Carl von Ossietzky University, Oldenburg, Lower Saxony, Germany
| |
Collapse
|
2
|
Smith RE, Shelton AD, Sawicki GS, Franz JR. The effects of plantarflexor weakness and reduced tendon stiffness with aging on gait stability. PLoS One 2024; 19:e0302021. [PMID: 38625839 PMCID: PMC11020829 DOI: 10.1371/journal.pone.0302021] [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: 09/27/2023] [Accepted: 03/26/2024] [Indexed: 04/18/2024] Open
Abstract
Falls among older adults are a costly public health concern. Such falls can be precipitated by balance disturbances, after which a recovery strategy requiring rapid, high force outputs is necessary. Sarcopenia among older adults likely diminishes their ability to produce the forces necessary to arrest gait instability. Age-related changes to tendon stiffness may also delay muscle stretch and afferent feedback and decrease force transmission, worsening fall outcomes. However, the association between muscle strength, tendon stiffness, and gait instability is not well established. Given the ankle's proximity to the onset of many walking balance disturbances, we examined the relation between both plantarflexor strength and Achilles tendon stiffness with walking-related instability during perturbed gait in older and younger adults-the latter quantified herein using margins of stability and whole-body angular momentum including the application of treadmill-induced slip perturbations. Older and younger adults did not differ in plantarflexor strength, but Achilles tendon stiffness was lower in older adults. Among older adults, plantarflexor weakness associated with greater whole-body angular momentum following treadmill-induced slip perturbations. Weaker older adults also appeared to walk and recover from treadmill-induced slip perturbations with more caution. This study highlights the role of plantarflexor strength and Achilles tendon stiffness in regulating lateral gait stability in older adults, which may be targets for training protocols seeking to minimize fall risk and injury severity.
Collapse
Affiliation(s)
- Ross E. Smith
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, North Carolina, United States of America
| | - Andrew D. Shelton
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, North Carolina, United States of America
| | - Gregory S. Sawicki
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Jason R. Franz
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
3
|
Akiyama Y, Nishizaki A, Okamoto S, Yamada Y. Effect of forward moment on recovery motion against tripping. PLoS One 2024; 19:e0298045. [PMID: 38354130 PMCID: PMC10866475 DOI: 10.1371/journal.pone.0298045] [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: 09/14/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
Investigating the fall recovery motion mechanism is crucial to prevent fall injuries. Among the various parameters of motion and posture, the forward moment can be considered the representative parameter of the magnitude of tripping from a kinematic perspective. The effect of increasing the forward moment on the recovery motion after tripping was investigated in this study. A tripping experiment was performed on a treadmill, and the recovery motion was observed. The forward moment was artificially increased using several approaches, such as pulling the torso, increasing gait speed, and increasing body mass. Factor analysis was performed to establish the relationship between the recovery motion parameters and forward moment. The distribution of the factor scores implied the uniqueness of the recovery motion of the pull condition. Although the forward moment temporarily increased, it was compensated quickly. The other conditions and factors indicated qualitative similarity of the recovery motion among the different conditions. This study demonstrates that the recovery motion after tripping is robust against an increase in forward moment, regardless of the method used to increase the forward moment. The investigation of reaction motion pattern enables validation of the recovery motion and falling posture estimation. Such fall simulations will facilitate the development of a method of fall prevention and mitigation.
Collapse
Affiliation(s)
| | | | | | - Yoji Yamada
- National Institute of Technology, Toyota College, Toyota, Aichi, Japan
| |
Collapse
|
4
|
Sadeh S, Shen KH, Foroughi F, Hsiao HY. Leading limb biomechanical response following compelled forward and descending body shift in old versus young adults. Clin Biomech (Bristol, Avon) 2024; 112:106169. [PMID: 38211422 DOI: 10.1016/j.clinbiomech.2024.106169] [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: 04/19/2023] [Revised: 12/08/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Falls pose a significant health risk in older adults, with stair descent falls carrying particularly severe consequences. Reduced balance control and limb support due to aging-related physiological and neuromuscular decline are critical components in increased falling risk in older adults. Understanding the age-associated abnormalities in balance control and limb support strategies during sudden forward and downward body shift could reveal potential biomechanical deficits responsible for increased falling risks in older adults. This study investigates balance regulatory responses following first-time exposure to compelled forward and downward body shift in young and older adults. METHODS Thirteen healthy old and thirteen healthy young adults participated in this study. Participants stood on two adjacent perturbation platforms in modified tandem stance. The leading limb support surface dropped 3 in. vertically at an unknown time. The anterior margin of stability and center of mass velocity, peak vertical ground reaction forces, and leading limb ankle and knee joint angular displacement, torque, and power during the initial response phase were compared between age groups. FINDINGS Compared to young adults, older adults showed higher center of mass velocity, lower margin of stability, peak vertical ground reaction force, peak ankle and knee joint power, and peak knee joint torque during the initial response phase. INTERPRETATIONS The abnormalities potentially identified in our study, particularly in dynamic stability regulation, limb support force generation, and shock absorption may affect the ability to arrest the body's forward and downward motion. These deficits may contribute to an increased risk of forward falls in aging.
Collapse
Affiliation(s)
- Soroosh Sadeh
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| | - Keng-Hung Shen
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| | - Forouzan Foroughi
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| | - Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| |
Collapse
|
5
|
Bohlke K, Perera S, Baillargeon EM, Redfern MS, Sparto PJ, Sejdic E, Rosso AL. Exercise interventions, postural control, and prefrontal cortex activation in older adults. Brain Cogn 2023; 171:106063. [PMID: 37523831 PMCID: PMC10529535 DOI: 10.1016/j.bandc.2023.106063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
Improving postural control in older adults is necessary for reducing fall risk, and prefrontal cortex activation may also play a role. We sought to examine the impact of exercise interventions on postural control and prefrontal cortex activation during standing balance tasks. We hypothesized that balance would improve and prefrontal control would be reduced. We assessed a subset of participants enrolled in a randomized trial of two exercise interventions. Both groups completed strength and endurance training and the experimental treatment arm included training on timing and coordination of stepping. Postural control and prefrontal cortex activation were measured during dual-task standing balance tasks before and after the intervention. Eighteen participants in the standard strengthening and mobility training arm and 16 in the timing and coordination training arm were included. We examined pre- to post-intervention changes within each study arm, and compared them between interventions. Results did not show any pre- to post-intervention changes on standing postural control nor prefrontal cortex activation in either arm. In addition, there were no differences between the two intervention arms in either balance or prefrontal activation. While exercise interventions can improve mobility, we do not demonstrate evidence of improved standing balance or prefrontal control in standing.
Collapse
Affiliation(s)
- Kayla Bohlke
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
| | - Subashan Perera
- Department of Biostatistics, School of Public Health, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA; Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
| | - Emma M Baillargeon
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
| | - Patrick J Sparto
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
| | - Ervin Sejdic
- The Edward S. Rogers, Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, 27 King's College Cir, Toronto, Ontario ON M5S, Canada; North York General Hospital, 4001 Leslie St., Toronto, Ontario ON M2K, Canada.
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
| |
Collapse
|
6
|
Gerards M, Marcellis R, Senden R, Poeze M, de Bie R, Meijer K, Lenssen A. The effect of perturbation-based balance training on balance control and fear of falling in older adults: a single-blind randomised controlled trial. BMC Geriatr 2023; 23:305. [PMID: 37198543 DOI: 10.1186/s12877-023-03988-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/22/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Perturbation-based balance training (PBT) is an emerging intervention shown to improve balance recovery responses and reduce falls in everyday life in older adults. However, perturbation interventions were heterogeneous in nature and need improvement. This study aims to investigate the effects of a PBT protocol that was designed to address previously identified challenges of PBT, in addition to usual care, on balance control and fear of falling in older adults at increased risk of falling. METHODS Community-dwelling older adults (age ≥ 65 years) who visited the hospital outpatient clinic due to a fall incident were included. Participants received PBT in addition to usual care (referral to a physiotherapist) versus usual care alone. PBT consisted of three 30-minute sessions in three weeks. Unilateral treadmill belt accelerations and decelerations and platform perturbations (shifts and tilts) were applied during standing and walking on the Computer Assisted Rehabilitation Environment (CAREN, Motek Medical BV). This dual-belt treadmill embedded in a motion platform with 6 degrees of freedom is surrounded by a 180° screen on which virtual reality environments are projected. Duration and contents of the training were standardised, while training progression was individualised. Fear of falling (FES-I) and balance control (Mini-BESTest) were assessed at baseline and one week post-intervention. Primary analysis compared changes in outcome measures between groups using Mann-Whitney U tests. RESULTS Eighty-two participants were included (PBT group n = 39), with a median age of 73 years (IQR 8 years). Median Mini-BESTest scores did not clinically relevantly improve and were not significantly different between groups post-intervention (p = 0.87). FES-I scores did not change in either group. CONCLUSIONS Participation in a PBT program including multiple perturbation types and directions did not lead to different effects than usual care on clinical measures of balance control or fear of falling in community-dwelling older adults with a recent history of falls. More research is needed to explore how to modulate PBT training dose, and which clinical outcomes are most suitable to measure training effects on balance control. TRIAL REGISTRATION Nederlands Trial Register NL7680. Registered 17-04-2019 - retrospectively registered. https://www.trialregister.nl/trial/7680 .
Collapse
Affiliation(s)
- Marissa Gerards
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
- Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Rik Marcellis
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Rachel Senden
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Martijn Poeze
- Department of Surgery, division of Trauma Surgery, MUMC+, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Rob de Bie
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Antoine Lenssen
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| |
Collapse
|
7
|
Wang S, Bhatt T. Kinematic Measures for Recovery Strategy Identification following an Obstacle-Induced Trip in Gait. J Mot Behav 2023; 55:193-201. [PMID: 36603841 DOI: 10.1080/00222895.2022.2146043] [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: 01/07/2023]
Abstract
This study aimed to identify the kinematic measures determining balance outcome following an over-ground trip perturbation. 117 healthy older adults who experienced laboratory-induced trips were divided into loss of balance (LOB) and no LOB groups. The LOB group contained 27 fallers and 34 non-fallers, and the no LOB group contained 21 participants using cross-over strategy and 35 participants using obstacle-hit strategy. A 2-class hierarchical regression model for balance loss showed that margin of stabilty could determine the balance outcomes (LOB or not) with an overall accuracy of 92.7%. The 4-class model for recovery strategies showed that the combination of margin of stability, trunk angle, and COM velocity could determine 81.9% of strategies. Our findings would enhance intervention development for populations at risk of trip-induced falls.
Collapse
Affiliation(s)
- Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
8
|
Differences in motor response to stability perturbations limit fall-resisting skill transfer. Sci Rep 2022; 12:21901. [PMID: 36535994 PMCID: PMC9763399 DOI: 10.1038/s41598-022-26474-7] [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: 08/11/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
This study investigated transfer of improvements in stability recovery performance to novel perturbations. Thirty adults (20-53 yr) were assigned equally to three treadmill walking groups: groups exposed to eight trip perturbations of either low or high magnitude and a third control group that walked unperturbed. Following treadmill walking, participants were exposed to stability loss from a forward-inclined position (lean-and-release) and an overground trip. Lower limb joint kinematics for the swing phase of recovery steps was compared for the three tasks using statistical parametric mapping and recovery performance was analysed by margin of stability and base of support. The perturbation groups improved stability (greater margin of stability) over the eight gait perturbations. There was no group effect for stability recovery in lean-and-release. For the overground trip, both perturbation groups showed similar enhanced stability recovery (margin of stability and base of support) compared to controls. Differences in joint angle kinematics between treadmill-perturbation and lean-and-release were more prolonged and greater than between the two gait perturbation tasks. This study indicates that: (i) practising stability control enhances human resilience to novel perturbations; (ii) enhancement is not necessarily dependent on perturbation magnitude; (iii) differences in motor response patterns between tasks may limit transfer.
Collapse
|
9
|
McCrum C, Bhatt TS, Gerards MHG, Karamanidis K, Rogers MW, Lord SR, Okubo Y. Perturbation-based balance training: Principles, mechanisms and implementation in clinical practice. Front Sports Act Living 2022; 4:1015394. [PMID: 36275443 PMCID: PMC9583884 DOI: 10.3389/fspor.2022.1015394] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/20/2022] [Indexed: 02/05/2023] Open
Abstract
Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: "Principles and Mechanisms" and "Implementation in Practice." In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson's disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.
Collapse
Affiliation(s)
- Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Tanvi S. Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Marissa H. G. Gerards
- Department of Epidemiology, Care and Public Health Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Physiotherapy, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Mark W. Rogers
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, United States
| | - Stephen R. Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
10
|
Role of Knee and Ankle Extensors' Muscle-Tendon Properties in Dynamic Balance Recovery from a Simulated Slip. SENSORS 2022; 22:s22093483. [PMID: 35591172 PMCID: PMC9104373 DOI: 10.3390/s22093483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/24/2022] [Accepted: 04/29/2022] [Indexed: 02/05/2023]
Abstract
Participants exposed to a simulated slip with forward loss of balance (FLB) develop large lower limb joint moments which may be a limiting factor for those whose muscle-tendon units’ (MTUs) properties are deteriorated. Whether the age-related decline in these properties limits participants’ capacity to recover their balance following a slip with FLB remains unclear. We combined isokinetic dynamometry, ultrasound and EMG to understand how knee extensor and ankle plantarflexor muscle strength and power, rate of moment development, electromechanical delay, and tendon stiffness affected the balance of young (25.3 ± 3.9 years) and older adults (62.8 ± 7.1 years) when recovering from a single slip with FLB triggered whilst walking on a split-belt instrumented treadmill. Except for the patellar tendon’s stiffness, knee extensor and ankle plantarflexor electromechanical delays, older adults’ MTUs properties were deteriorated compared to those of young participants (p < 0.05). We found no significant relationship between age or the MTUs properties of participants and balance recovery. These findings provide additional support that neither maximal nor explosive strength training are likely to be successful in preventing a fall for healthy older adults, and that other type of interventions, such as task-specific training that has already proved efficacious in reducing the risk of falling, should be developed.
Collapse
|
11
|
Sozzi S, Schieppati M. Balance Adaptation While Standing on a Compliant Base Depends on the Current Sensory Condition in Healthy Young Adults. Front Hum Neurosci 2022; 16:839799. [PMID: 35399363 PMCID: PMC8989851 DOI: 10.3389/fnhum.2022.839799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/03/2022] [Indexed: 01/06/2023] Open
Abstract
Background Several investigations have addressed the process of balance adaptation to external perturbations. The adaptation during unperturbed stance has received little attention. Further, whether the current sensory conditions affect the adaptation rate has not been established. We have addressed the role of vision and haptic feedback on adaptation while standing on foam. Methods In 22 young subjects, the analysis of geometric (path length and sway area) and spectral variables (median frequency and mean level of both total spectrum and selected frequency windows) of the oscillation of the centre of feet pressure (CoP) identified the effects of vision, light-touch (LT) or both in the anteroposterior (AP) and mediolateral (ML) direction over 8 consecutive 90 s standing trials. Results Adaptation was obvious without vision (eyes closed; EC) and tenuous with vision (eyes open; EO). With trial repetition, path length and median frequency diminished with EC (p < 0.001) while sway area and mean level of the spectrum increased (p < 0.001). The low- and high-frequency range of the spectrum increased and decreased in AP and ML directions, respectively. Touch compared to no-touch enhanced the rate of increase of the low-frequency power (p < 0.05). Spectral differences in distinct sensory conditions persisted after adaptation. Conclusion Balance adaptation occurs during standing on foam. Adaptation leads to a progressive increase in the amplitude of the lowest frequencies of the spectrum and a concurrent decrease in the high-frequency range. Within this common behaviour, touch adds to its stabilising action a modest effect on the adaptation rate. Stabilisation is improved by favouring slow oscillations at the expense of sway minimisation. These findings are preliminary to investigations of balance problems in persons with sensory deficits, ageing, and peripheral or central nervous lesion.
Collapse
Affiliation(s)
- Stefania Sozzi
- Centro Studi Attività Motorie (CSAM), Istituti Clinici Scientifici Maugeri SB (IRCCS), Pavia, Italy
| | | |
Collapse
|
12
|
König M, Santuz A, Epro G, Werth J, Arampatzis A, Karamanidis K. Differences in muscle synergies among recovery responses limit inter-task generalisation of stability performance. Hum Mov Sci 2022; 82:102937. [PMID: 35217390 DOI: 10.1016/j.humov.2022.102937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 01/24/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
Generalisation of adaptations is key to effective stability control facing variety of postural threats during daily life activity. However, in a previous study we could demonstrate that adaptations to stability control do not necessarily transfer to an untrained motor task. Here, we examined the dynamic stability and modular organisation of motor responses to different perturbations (i.e. unpredictable gait-trip perturbations and subsequent loss of anterior stability in a lean-and-release protocol) in a group of young and middle-aged adults (n = 57; age range 19-53 years) to detect potential neuromotor factors limiting transfer of adaptations within the stability control system. We hypothesized that the motor system uses different modular organisation in recovery responses to tripping and lean-and-release, which may explain lack in positive transfer of adaptations in stability control. After eight trip-perturbations participants increased their dynamic stability during the first recovery step (p < 0.001), yet they showed no significant improvement to the untrained lean-and-release transfer task compared to controls who did not undergo the perturbation exposure (p = 0.44). Regarding the neuromuscular control of responses, lower number of synergies (3 vs. 4) was found for the lean-and-release compared to the gait-trip perturbation task, revealing profound differences in both the timing and function of the recruited muscles to match the biomechanical specificity of different perturbations. Our results provide indirect evidence that the motor system uses different modular organisation in diverse perturbation responses, what possibly inhibits inter-task generalisation of adaptations in stability control.
Collapse
Affiliation(s)
- Matthias König
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, SE1 0AA London, United Kingdom.
| | - Alessandro Santuz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; Berlin School of Movement Science, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Gaspar Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, SE1 0AA London, United Kingdom
| | - Julian Werth
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, SE1 0AA London, United Kingdom
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; Berlin School of Movement Science, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, SE1 0AA London, United Kingdom
| |
Collapse
|
13
|
Kim Y, Vakula MN, Bolton DAE, Dakin CJ, Thompson BJ, Slocum TA, Teramoto M, Bressel E. Which Exercise Interventions Can Most Effectively Improve Reactive Balance in Older Adults? A Systematic Review and Network Meta-Analysis. Front Aging Neurosci 2022; 13:764826. [PMID: 35115917 PMCID: PMC8804322 DOI: 10.3389/fnagi.2021.764826] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/24/2021] [Indexed: 01/07/2023] Open
Abstract
BackgroundReactive balance is the last line of defense to prevent a fall when the body loses stability, and beneficial effects of various exercise-based interventions on reactive balance in older adults have been reported. However, their pooled evidence on the relative effects has yet to be described.ObjectiveTo review and evaluate the comparative effectiveness of various exercise-based interventions on reactive balance in older adults.MethodsNine electronic databases and reference lists were searched from inception to August 2021. Eligibility criteria according to PICOS criteria were as follows: (1) population: older adults with the mean age of 65 years or above; (2) intervention and comparison: at least two distinct exercise interventions or one exercise intervention with a no-exercise controlled intervention (NE) compared in each trial; (3) outcome: at least one measure of reactive balance; (4) study: randomized controlled trial. The main network meta-analysis was performed on data from the entire older adult population, involving all clinical conditions as well as healthy older adults. Subgroup analyses stratified by characteristics of participants (healthy only) and reactive balance outcomes (simulated slip or trip while walking, simulated forward falls, being pushed or pulled, and movable platform) were also conducted.ResultsThirty-nine RCTs (n = 1388) investigating 17 different types of exercise interventions were included in the network meta-analysis. Reactive balance training as a single intervention presented the highest probability (surface under the cumulative ranking (SUCRA) score) of being the best intervention for improving reactive balance and the greatest relative effects vs. NE in the entire sample involving all clinical conditions [SUCRA = 0.9; mean difference (95% Credible Interval): 2.7 (1.0 to 4.3)]. The results were not affected by characteristics of participants (i.e., healthy older adults only) or reactive balance outcomes.Summary/ConclusionThe findings from the NMA suggest that a task-specific reactive balance exercise could be the optimal intervention for improving reactive balance in older adults, and power training can be considered as a secondary training exercise.
Collapse
Affiliation(s)
- Youngwook Kim
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
- *Correspondence: Youngwook Kim
| | - Michael N. Vakula
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
| | - David A. E. Bolton
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
| | - Christopher J. Dakin
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
| | - Brennan J. Thompson
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
| | - Timothy A. Slocum
- Department of Special Education and Rehabilitation Counseling, Utah State University, Logan, UT, United States
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, United States
| | - Eadric Bressel
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, United States
| |
Collapse
|
14
|
Grabiner MD, Kaufman KR. Developing and Establishing Biomechanical Variables as Risk Biomarkers for Preventable Gait-Related Falls and Assessment of Intervention Effectiveness. Front Sports Act Living 2021; 3:722363. [PMID: 34632378 PMCID: PMC8492908 DOI: 10.3389/fspor.2021.722363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/26/2021] [Indexed: 01/17/2023] Open
Abstract
The purpose of this review is to position the emerging clinical promise of validating and implementing biomechanical biomarkers of falls in fall prevention interventions. The review is framed in the desirability of blunting the effects of the rapidly growing population of older adults with regard to the number of falls, their related injuries, and health care costs. We propose that biomechanical risk biomarkers may be derived from systematic study of the responses to treadmill-delivered perturbations to both identify individuals with a risk of specific types of falls, such as trips and slips as well as quantifying the effectiveness of interventions designed to reduce that risk. The review follows the evidence derived using a specific public health approach and the published biomedical literature that supports trunk kinematics as a biomarker as having met many of the criteria for a biomarker for trip-specific falls. Whereas, the efficacy of perturbation training to reduce slip-related falls by older adults appears to have been confirmed, its effectiveness presently remains an open and important question. There is a dearth of data related to the efficacy and effectiveness of perturbation training to reduce falls to the side falls by older adults. At present, efforts to characterize the extent to which perturbation training can reduce falls and translate the approaches to the clinic represents an important research opportunity.
Collapse
Affiliation(s)
- Mark D Grabiner
- Biomechanics and Clinical Biomechanics Laboratory, Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - K R Kaufman
- Motion Analysis Laboratory, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
15
|
Debelle H, Maganaris CN, O'Brien TD. Biomechanical Mechanisms of Improved Balance Recovery to Repeated Backward Slips Simulated by Treadmill Belt Accelerations in Young and Older Adults. Front Sports Act Living 2021; 3:708929. [PMID: 34622205 PMCID: PMC8490723 DOI: 10.3389/fspor.2021.708929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Exposure to repeated gait perturbations improves the balance of older adults (OAs) and decreases their risks of falling, but little is known about the underpinning mechanical adjustments. We aimed to quantify the changing temporo-spatial and kinetic characteristics of balance recovery following repeated backward slips to better understand the mechanical adjustments responsible for improved balance. Methods: We exposed 17 young adults (YAs) (25.2 ± 3.7 years) and 17 OAs (62.4 ± 6.6 years) to 10 backward slips simulated on an instrumented treadmill by unilateral backward belt accelerations. We measured the balance of the participants (margin of stability: MoS), balance recovery (nsteps: number of steps necessary to return to a steady gait for at least three consecutive steps), temporo-spatial (step length), and kinetics [ground reaction force (GRF) angle, lower limb joint moments] for 15 steps following each slip. The results were compared with baseline. Results: Participants in both groups improved their MoS and nsteps with repeated exposure to the slips, but no significant effect of age was detected. During the perturbed step, the GRF vector was directed more posteriorly during mid-stance and more anteriorly during push-off than baseline, which resulted in a longer step. These adjustments were maintained from the first (Slip01) to the last (Slip10) slip, and by Slip10 were correlated with better balance (MoS) on the second recovery step. During the first recovery step following Slip01, participants developed lower plantarflexor and larger knee extensor moments whilst taking a shorter step, these adjustments were correlated with poorer balance and were not maintained with repeated slips. Joint moments and step length of the first recovery step returned to normal levels by Slip10. Conclusion: Young adults and OAs improved their balance with repeated slips. The adjustments that were positively correlated with balance (changes in step length, GRF angle) were maintained whilst those that were not (changes in joint moments) were discarded. All the responses observed in Slip10 were observed in Slip01. The observed balance improvements were achieved by refining the initial strategy rather than by developing a new one. The underlying mechanics were correlated with step length of the first recovery steps, which was associated with balance and should be monitored in fall prevention interventions.
Collapse
Affiliation(s)
- Héloïse Debelle
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Constantinos N Maganaris
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Thomas D O'Brien
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| |
Collapse
|
16
|
Bosquée J, Werth J, Epro G, Hülsdünker T, Potthast W, Meijer K, Ellegast R, Karamanidis K. The ability to increase the base of support and recover stability is limited in its generalisation for different balance perturbation tasks. Eur Rev Aging Phys Act 2021; 18:20. [PMID: 34615457 PMCID: PMC8493681 DOI: 10.1186/s11556-021-00274-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background The assessment of stability recovery performance following perturbations contributes to the determination of fall resisting skills. This study investigated the association between stability recovery performances in two perturbation tasks (lean-and-release versus tripping). Methods Healthy adults (12 young: 24 ± 3 years; 21 middle-aged: 53 ± 5 years; 11 old: 72 ± 5 years) were suddenly released from a forward-inclined position attempting to recover stability with a single step. In a second task, all participants experienced a mechanically induced trip during treadmill walking. To assess dynamic stability performance, the antero-posterior margin of stability (MoS), the base of support (BoS), and the rate of increase in BoS were determined at each foot touchdown (TD) for both tasks. Results Only weak to moderate correlations in dynamic stability performance parameters were found between the two tasks (0.568 > r > 0.305, 0.001 < p < 0.04). A separation of participants according to the number of steps required to regain stability in the lean-and-release task revealed that multiple- (more than one step) compared to single-steppers showed a significantly lower MoS at TD (p = 0.003; g = 1.151), lower BoS at TD (p = 0.019; g = 0.888) and lower rate of increase in BoS until TD (p = 0.002; g = 1.212) after release. Despite these profound subgroup differences in the lean-and-release task, no differences between multiple- and single-steppers were observed in the stability recovery performance during tripping. Conclusion The results provide evidence that the ability to effectively control dynamic stability following a sudden balance disturbance in adults across a wide age range is limited in its generalisation for different perturbation tasks.
Collapse
Affiliation(s)
- Jil Bosquée
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, 103 Borough Road, SE1 0AA, London, UK
| | - Julian Werth
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, 103 Borough Road, SE1 0AA, London, UK
| | - Gaspar Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, 103 Borough Road, SE1 0AA, London, UK
| | - Thorben Hülsdünker
- Department of Exercise and Sport Science, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne, Germany
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Rolf Ellegast
- Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), Sankt Augustin, Germany
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, 103 Borough Road, SE1 0AA, London, UK.
| |
Collapse
|
17
|
Grevendonk L, Connell NJ, McCrum C, Fealy CE, Bilet L, Bruls YMH, Mevenkamp J, Schrauwen-Hinderling VB, Jörgensen JA, Moonen-Kornips E, Schaart G, Havekes B, de Vogel-van den Bosch J, Bragt MCE, Meijer K, Schrauwen P, Hoeks J. Impact of aging and exercise on skeletal muscle mitochondrial capacity, energy metabolism, and physical function. Nat Commun 2021; 12:4773. [PMID: 34362885 PMCID: PMC8346468 DOI: 10.1038/s41467-021-24956-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/08/2021] [Indexed: 12/13/2022] Open
Abstract
The relationship between the age-associated decline in mitochondrial function and its effect on skeletal muscle physiology and function remain unclear. In the current study, we examined to what extent physical activity contributes to the decline in mitochondrial function and muscle health during aging and compared mitochondrial function in young and older adults, with similar habitual physical activity levels. We also studied exercise-trained older adults and physically impaired older adults. Aging was associated with a decline in mitochondrial capacity, exercise capacity and efficiency, gait stability, muscle function, and insulin sensitivity, even when maintaining an adequate daily physical activity level. Our data also suggest that a further increase in physical activity level, achieved through regular exercise training, can largely negate the effects of aging. Finally, mitochondrial capacity correlated with exercise efficiency and insulin sensitivity. Together, our data support a link between mitochondrial function and age-associated deterioration of skeletal muscle. Aging is associated with a progressive loss of muscle function. Here the authors characterize mitochondrial capacity and muscle function in young and older adults with similar habitual physical activity and also compared to older adults with exercise training or with physical impairment.
Collapse
Affiliation(s)
- L Grevendonk
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - N J Connell
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - C McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - C E Fealy
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - L Bilet
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - Y M H Bruls
- Department of Radiology and Nuclear Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J Mevenkamp
- Department of Radiology and Nuclear Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - V B Schrauwen-Hinderling
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Radiology and Nuclear Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J A Jörgensen
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - E Moonen-Kornips
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - G Schaart
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - B Havekes
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Endocrinology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - M C E Bragt
- Friesland-Campina, Amersfoort, The Netherlands
| | - K Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - P Schrauwen
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,TI Food and Nutrition, Wageningen, The Netherlands
| | - J Hoeks
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. .,TI Food and Nutrition, Wageningen, The Netherlands.
| |
Collapse
|
18
|
Werth J, Bohm S, Klenk J, König M, Sczuka KS, Schroll A, Epro G, Mandla-Liebsch M, Rapp K, Potthast W, Arampatzis A, Karamanidis K. Stability recovery performance in adults over a wide age range: A multicentre reliability analysis using different lean-and-release test protocols. J Biomech 2021; 125:110584. [PMID: 34217031 DOI: 10.1016/j.jbiomech.2021.110584] [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: 02/23/2021] [Revised: 06/01/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
The ability to effectively increase the base of support is crucial to prevent from falling due to stability disturbances and has been commonly assessed using the forward-directed lean-and-release test. With this multicentre study we examined whether the assessment of stability recovery performance using two different forward lean-and-release test protocols is reliable in adults over a wide age range. Ninety-seven healthy adults (age from 21 to 80 years) were randomly assigned to one out of two lean angle protocols: gradual increase to maximal forward-lean angle (maximal lean angle; n = 43; seven participants were excluded due to marker artefacts) or predefined lean angle (single lean angle; n = 26; 21 participants needed to be excluded due to multiple stepping after release or marker artefacts). Both protocols were repeated after 0.5 h and 48 h to investigate intra- and inter-session reliability. Stability recovery performance was examined using the margin of stability at release (MoSRL) and touchdown (MoSTD) and increase in base of support (BoSTD). Intraclass correlation coefficients (confidence intervals at 95%) for the maximal lean angle and for the single lean angle were respectively 0.93 (0.89-0.96) and 0.94 (0.89-0.97) in MoSRL, 0.85 (0.77-0.91) and 0.67 (0.48-0.82) in MoSTD and 0.88 (0.81-0.93) and 0.80 (0.66-0.90) in BoSTD, with equivalence being revealed for each parameter between all three measurements (p < 0.01). We concluded that the assessment of stability recovery performance parameters in adults over a wide age range with the means of the forward lean-and-release test is reliable, independent of the used lean angle protocol.
Collapse
Affiliation(s)
- J Werth
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom.
| | - S Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - J Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Baden-Wurttemberg, Germany; Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; IB University for Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - M König
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - K S Sczuka
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - A Schroll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - G Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - M Mandla-Liebsch
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - K Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - W Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - A Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - K Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| |
Collapse
|
19
|
Bakkum A, Donelan JM, Marigold DS. Savings in sensorimotor learning during balance-challenged walking but not reaching. J Neurophysiol 2021; 125:2384-2396. [PMID: 34038257 DOI: 10.1152/jn.00627.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Safe and successful motor performance relies on the ability to adapt to physiological and environmental change and retain what is learned. An open question is what factors maximize this retention? One overlooked factor is the degree to which balance is challenged during learning. We propose that the greater need for control and/or perceived threat of falling or injury associated with balance-challenging tasks increases the value assigned to maintaining a learned visuomotor mapping (i.e., the new relationship between visual input and motor output). And we propose that a greater-valued mapping is a more retainable mapping, as it serves to benefit future motor performance. Thus, we tested the hypothesis that challenging balance enhances motor memory, reflected by greater recall and faster relearning (i.e., savings). Four groups of participants adapted to a novel visuomotor mapping induced by prism lenses while performing a reaching or walking task, with and without an additional balance challenge. We found that challenging balance did not disrupt visuomotor adaptation during reaching or walking. We then probed recall and savings by having participants repeat the adaptation protocol 1 wk later. For reaching, we found evidence of initial recall, though neither group demonstrated savings upon reexposure to the prisms. In contrast, both walking groups demonstrated significant initial recall and savings. In addition, we found that challenging balance significantly enhanced savings during walking. Taken together, our results demonstrate the robustness of motor memories formed during walking and highlight the potential influence of balance control on sensorimotor learning.NEW & NOTEWORTHY Most everyday tasks challenge our balance. Yet, this aspect of daily motor behavior is often overlooked in adaptation paradigms. Here, we show that challenging balance does not impair sensorimotor adaptation during precision reaching and walking tasks. Furthermore, we show that challenging balance enhances savings of a learned visuomotor mapping during walking. These results provide evidence for the potential performance benefits associated with learning during unconstrained, naturalistic behaviors.
Collapse
Affiliation(s)
- Amanda Bakkum
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - J Maxwell Donelan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Daniel S Marigold
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
20
|
Harper SA, Beethe AZ, Dakin CJ, Bolton DAE. Promoting Generalized Learning in Balance Recovery Interventions. Brain Sci 2021; 11:402. [PMID: 33810159 PMCID: PMC8004641 DOI: 10.3390/brainsci11030402] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022] Open
Abstract
Recent studies have shown balance recovery can be enhanced via task-specific training, referred to as perturbation-based balance training (PBT). These interventions rely on principles of motor learning where repeated exposure to task-relevant postural perturbations results in more effective compensatory balance responses. Evidence indicates that compensatory responses trained using PBT can be retained for many months and can lead to a reduction in falls in community-dwelling older adults. A notable shortcoming with PBT is that it does not transfer well to similar but contextually different scenarios (e.g., falling sideways versus a forward trip). Given that it is not feasible to train all conditions in which someone could fall, this limited transfer presents a conundrum; namely, how do we best use PBT to appropriately equip people to deal with the enormous variety of fall-inducing scenarios encountered in daily life? In this perspective article, we draw from fields of research that explore how general learning can be promoted. From this, we propose a series of methods, gleaned from parallel streams of research, to inform and hopefully optimize this emerging field where people receive training to specifically improve their balance reactions.
Collapse
Affiliation(s)
- Sara A. Harper
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.A.H.); (A.Z.B.); (C.J.D.)
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Anne Z. Beethe
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.A.H.); (A.Z.B.); (C.J.D.)
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Christopher J. Dakin
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.A.H.); (A.Z.B.); (C.J.D.)
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - David A. E. Bolton
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA; (S.A.H.); (A.Z.B.); (C.J.D.)
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| |
Collapse
|
21
|
Weber A, Friemert D, Hartmann U, Epro G, Seeley J, Werth J, Nickel P, Karamanidis K. Obstacle avoidance training in virtual environments leads to limb-specific locomotor adaptations but not to interlimb transfer in healthy young adults. J Biomech 2021; 120:110357. [PMID: 33725521 DOI: 10.1016/j.jbiomech.2021.110357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/29/2021] [Accepted: 02/22/2021] [Indexed: 01/10/2023]
Abstract
Obstacle avoidance is one of the skills required in coping with challenging situations encountered during walking. This study examined adaptation in gait stability and its interlimb transfer in a virtual obstacle avoidance task. Twelve young adults walked on a treadmill while wearing a virtual reality headset with their body state represented in the virtual environment. At random times, but always at foot touchdown, 50 virtual obstacles of constant size appeared 0.8 m in front of the participant requiring a step over with the right leg. Early, mid and late adaptation phases were investigated by pooling data from trials 1-3, 24-26 and 48-50. One left-leg obstacle appearing after 50 right-leg trials was used to investigate interlimb transfer. Toe clearance and the anteroposterior margin of stability (MoS) at foot touchdown were calculated for the stepping leg. Toe clearance decreased over repeated practice between early and late phases from 0.13 ± 0.05 m to 0.09 ± 0.04 m (mean ± SD, p < 0.05). MoS increased from 0.05 ± 0.02 m to 0.08 ± 0.02 m (p < 0.05) between early and late phases, with no significant differences between mid and late phases. No differences were found in toe clearance and MoS between the practiced right leg for early phase and the single trial of the left leg. Obstacle avoidance during walking in a virtual environment stimulated adaptive gait improvements that were related in a nonlinear manner to practice dose, though such gait adaptations seemed to be limited in their transferability between limbs.
Collapse
Affiliation(s)
- A Weber
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom; Department of Mathematics and Technology, University of Applied Sciences Koblenz, Remagen, Germany; Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), Sankt Augustin, Germany.
| | - D Friemert
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Remagen, Germany
| | - U Hartmann
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Remagen, Germany
| | - G Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - J Seeley
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - J Werth
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - P Nickel
- Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), Sankt Augustin, Germany
| | - K Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| |
Collapse
|
22
|
Werth J, König M, Epro G, Seeley J, Potthast W, Karamanidis K. Volitional step execution is an ineffective predictor of recovery performance after sudden balance loss across the age range. Hum Mov Sci 2021; 76:102769. [PMID: 33581561 DOI: 10.1016/j.humov.2021.102769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/30/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Rapid stepping to preserve stability is a crucial action in avoiding a fall. It is also an important measure in the assessment of fall-resisting skills. We examined whether volitional step execution correlates with recovery stepping performance after sudden balance loss for adults of different ages. In addition, we investigated whether volitional step performance can discriminate between individuals with high and low balance recovery capabilities, i.e. between those making single versus multiple steps after balance perturbation. Healthy adults (28 young, 43 middle-aged and 26 older; 24 ± 4, 52 ± 5 and 72 ± 5 years respectively) performed a single step in the anterior direction volitionally in response to a mechanical stimulus to the heel. In a second stepping task, participants experienced sudden anterior balance loss in a lean-and-release protocol. For both tasks, an optical motion capture system was used to assess stepping kinematics. We found on average 28% shorter reaction times, 46% faster maximal step velocities and 48% higher rates of increase in base of support across all participants after sudden balance loss compared to volitional stepping (p < 0.001). There was a significant age-related decline in recovery stepping performance after sudden balance loss: 24/26 older, 15/43 middle-aged and none of the younger adults required two or more steps to regain balance (p < 0.001). Multiple- compared to single-steppers had on average 23% shorter step lengths and 12% lower maximal step velocities for the lean-and-release task (p < 0.01). Multiple-steppers also had reduced rates of increase in base of support for both stepping tasks (14% for balance recovery and 11% for volitional stepping). Furthermore, in examining the relationship between the results of the two tasks, only weak to moderate correlations were observed for step velocity and rate of increase in base of support (0.36 ≤ r ≤ 0.52; p < 0.001). Thus, performance in volitional step execution has a low potential to explain variability in recovery response after sudden balance loss in adults across the lifespan and hence seems less suitable to be used to identify deficiencies in reactive stepping responses necessary to cope with sudden balance disturbances.
Collapse
Affiliation(s)
- Julian Werth
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Matthias König
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom.
| | - Gaspar Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - John Seeley
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| |
Collapse
|
23
|
Rogers MW, Creath RA, Gray V, Abarro J, McCombe Waller S, Beamer BA, Sorkin JD. Comparison of Lateral Perturbation-Induced Step Training and Hip Muscle Strengthening Exercise on Balance and Falls in Community-Dwelling Older Adults: A Blinded Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2021; 76:e194-e202. [PMID: 33491052 DOI: 10.1093/gerona/glab017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This factorial, assessor-blinded, randomized, and controlled study compared the effects of perturbation-induced step training (lateral waist-pulls), hip muscle strengthening, and their combination, on balance performance, muscle strength, and prospective falls among older adults. METHODS Community-dwelling older adults were randomized to 4 training groups. Induced step training (IST, n = 25) involved 43 progressive perturbations. Hip abduction strengthening (HST, n = 25) utilized progressive resistance exercises. Combined training (CMB, n = 25) included IST and HST, and the control performed seated flexibility/relaxation exercises (SFR, n = 27). The training involved 36 sessions for a period of 12 weeks. The primary outcomes were the number of recovery steps and first step length, and maximum hip abduction torque. Fall frequency during 12 months after training was determined. RESULTS Overall, the number of recovery steps was reduced by 31% and depended upon the first step type. IST and CMB increased the rate of more stable single lateral steps pre- and post-training than HST and SFR who used more multiple crossover and sequential steps. The improved rate of lateral steps for CMB exceeded the control (CMB/SFR rate ratio 2.68). First step length was unchanged, and HST alone increased hip torque by 25%. Relative to SFR, the fall rate ratios (falls/person/year) [95% confidence interval] were CMB 0.26 [0.07-0.90], IST 0.44 [0.18-1.08], and HST 0.30 (0.10-0.91). CONCLUSIONS Balance performance through stepping was best improved by combining perturbation and strength training and not strengthening alone. The interventions reduced future falls by 56%-74% over the control. Lateral balance perturbation training may enhance traditional programs for fall prevention.
Collapse
Affiliation(s)
- Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US.,Department of Exercise Science, Lebanon Valley College, Annville, Pennsylvania, US
| | - Vicki Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Janice Abarro
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Sandy McCombe Waller
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, US
| | - Brock A Beamer
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, US.,Baltimore VA Medical Center, Geriatric Research, Education, and Clinical Center (GRECC), Maryland, US
| | - John D Sorkin
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, US.,Baltimore VA Medical Center, Geriatric Research, Education, and Clinical Center (GRECC), Maryland, US
| |
Collapse
|
24
|
Chen YC, Chou YC, Hwang IS. Reliance on Visual Input for Balance Skill Transfer in Older Adults: EEG Connectome Analysis Using Minimal Spanning Tree. Front Aging Neurosci 2021; 13:632553. [PMID: 33613272 PMCID: PMC7890183 DOI: 10.3389/fnagi.2021.632553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/07/2021] [Indexed: 01/29/2023] Open
Abstract
Skill transfer from trained balance exercises is critical to reduce the rate of falls in older adults, who rely more on vision to control postural responses due to age-dependent sensory reweighting. With an electroencephalography (EEG) minimum spanning tree (MST) structure, the purpose of this study was to compare the organization of supraspinal neural networks of transfer effect after postural training using full and intermittent visual feedbacks for older adults. Thirty-two older adults were randomly assigned to the stroboscopic vision (SV) (n = 16; age = 64.7 ± 3.0 years) and control (16; 66.3 ± 2.7 years) groups for balance training on a stabilometer (target task) with on-line visual feedback. Center-of-pressure characteristics and an MST-based connectome of the weighted phase-lag index during the bilateral stance on a foam surface (transfer task) were compared before and after stabilometer training. The results showed that both the SV and control groups showed improvements in postural stability in the trained task (p < 0.001). However, unlike the control group (p = 0.030), the SV group who received intermittent visual feedback during the stabilometer training failed to reduce the size of postural sway in the anteroposterior direction of the postural transfer task (unstable stance on the foam surface) in the post-test (p = 0.694). In addition, network integration for the transfer task in the post-test was absent in the SV group (p > 0.05). For the control group in the post-test, it manifested with training-related increases in leaf fraction in beta band (p = 0.015) and maximum betweenness in alpha band (p = 0.018), but a smaller diameter in alpha (p = 0.006)/beta (p = 0.021) bands and average eccentricity in alpha band (p = 0.028). In conclusion, stabilometer training with stroboscopic vision impairs generalization of postural skill to unstable stance for older adults. Adequate visual information is a key mediating factor of supraspinal neural networks to carry over balance skill in older adults.
Collapse
Affiliation(s)
- Yi-Ching Chen
- Department of Physical Therapy, College of Medical Science and Technology, Chung Shan Medical University, Taichung City, Taiwan.,Physical Therapy Room, Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Yu-Chen Chou
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ing-Shiou Hwang
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| |
Collapse
|
25
|
Dominguez L. Postural control and perturbation response in aging populations: fall risk implications. J Neurophysiol 2020; 124:1309-1311. [PMID: 32816613 DOI: 10.1152/jn.00767.2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Falls are an increasing cause of mortality in an ever-growing aging population. The main factors to consider in reducing mortality rates due to falls are postural control, consisting of the vestibular, visual, and proprioceptive system, and perturbation response. This Neuro Forum article reviews recent literature highlighting the developmental changes that occur in aging populations and the possible avenues for interventions and training to mitigate fall risk.
Collapse
Affiliation(s)
- Luis Dominguez
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| |
Collapse
|
26
|
Dusane S, Bhatt T. Mixed slip-trip perturbation training for improving reactive responses in people with chronic stroke. J Neurophysiol 2020; 124:20-31. [PMID: 32401150 DOI: 10.1152/jn.00671.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This study determined the effect of mixed (slip- and trip-like stance perturbation) training on reactive responses in people with chronic stroke (PwCS) and examined modulation of their reactive responses on higher intensity perturbations posttraining (scaling). Twelve PwCS were exposed to consecutive blocks of treadmill-based slip-like and trip-like perturbations and mixed-stance perturbations. A higher intensity trial was provided postblock and postmixed training. Postural stability [center-of-mass position (CoMP) and velocity (CoMV)], compensatory step length, step count, and trunk angle were examined. PwCS demonstrated an anterior positioning of the CoM, increased step length, and reduced compensatory step count with slip-like block training (P < 0.05). Trip-like block training resulted in reductions in step count, step length, and trunk angle (P < 0.05); however, CoMP remained unchanged (P > 0.05). With mixed training, there was a decrease rather than an increase in step length for slip-like perturbations but a continued decrease in step length and trunk angle was seen on trip-like perturbations (P < 0.05); however, CoMP and step count remained unchanged for both. For both perturbations, the higher intensity trials demonstrated no change from the last block trial. Postmixed block, the higher intensity trial demonstrated an increase only in step count on trip-like perturbation. Between postblock and postmixed higher intensity trials, an increase in step count and decrease in step length was noted only for slip-like perturbations. Block training with slip- and trip-like stance perturbations can enhance reactive responses among PwCS. Although mixed perturbation training continued to improve trip-induced adaptation, prior slip-induced adaptive changes were not maintained and further slip-adaptation was not seen. PwCS demonstrated partial scaling of reactive responses postblock and postmixed training.NEW & NOTEWORTHY Block perturbation training led to development of favorable reactive responses to counteract treadmill-based, slip-like and trip-like stance perturbations among people with chronic stroke. During mixed block, previously acquired adaptive changes in reactive responses from slip-block training were not maintained, probably due to interference offered by trip block. Instead, on trip-like perturbations, trip block-induced adaptation was maintained and continued to show further improvement. Our findings might provide future direction for designing effective mixed perturbation training paradigms to counteract both opposing perturbation types.
Collapse
Affiliation(s)
- Shamali Dusane
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois
| | - Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois
| |
Collapse
|