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Brown CB, Barrett TS, Long C, Corbridge S, Braeger A, Zollinger BJ, Harrison K, Poulsen SL, Boman T, Dakin CJ, Harper SA. Step edge highlighters and illuminance changes influence stair descent in a real-world setting. ERGONOMICS 2023; 66:1219-1228. [PMID: 36314061 DOI: 10.1080/00140139.2022.2141347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Studies investigating the effect of tread edge highlighters on descent speed differ, but collectively report the potential benefit of reduced fall risk. Here we examine the impact of adding high-contrast black vinyl striping to the front edge of each step's tread and its impact on descending gait speed (intervention), while controlling for illumination. Descending gait speed was estimated from 5,824 video observations using the stairway length and entry and exit times. A second stairway was unaltered (control) to compare to the intervention. Stair users were primarily 18-30 years old with a small percentage being middle-aged and older adults. Descending gait speed was significantly slower on the intervention stairway (Linear mixed effects model: standardised coefficient = -0.07, 95% CI = [-0.12, -0.02], p = .010) compared to the control and may be impacted by illuminance. We propose that the slowed gait speed could be due to changes in gait kinematics (e.g. foot clearance) and may reduce fall-risk. Practitioner summary: Tread-edge contrast enhancement could be a low-cost means to reduce fall-risk on stairways, but its impact on gait kinematics is not well understood. We found that contrast enhancement reduced descending gait speed, but descending gait speed's impact on fall risk reduction ultimately requires further investigation.
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Affiliation(s)
- Chayston B Brown
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Tyson S Barrett
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Christopher Long
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Samantha Corbridge
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Alex Braeger
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Brevin J Zollinger
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Kenneth Harrison
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Shandon L Poulsen
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Travis Boman
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
| | - Christopher J Dakin
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT, USA
| | - Sara A Harper
- Department of Kinesiology and Health Science, Utah State University, Logan, UT, USA
- Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT, USA
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Chai Y, Chen J, Hou M, Zheng J, Liu L, Chen Y, Fu S, Ma Y, Hong T, Wang X. Gait strategies for individuals with knee osteoarthritis when transitioning between floor and stair walking. Front Physiol 2023; 14:1026299. [PMID: 36760532 PMCID: PMC9904770 DOI: 10.3389/fphys.2023.1026299] [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: 08/23/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
Objective: Individuals with knee osteoarthritis are at higher risk for falls during transitions between floor and stair walking due to their reduced lower extremity function. However, the adjust gait characteristics of knee osteoarthritis subjects for dealing with stair transitions have not been explored. We aimed to investigate gait strategies in individuals with knee osteoarthritis compared to age-matched individuals without knee OA during the transition between walking on floor and stairs. Method: Gait of 30 individuals with knee osteoarthritis and 30 individuals without knee osteoarthritis during floor-to-stair and stair-to-floor walking transitions were accessed using a 3D motion capture system. Foot-tread clearance, and angles of lower extremity joints and trunk at Foot-tread clearance timepoint were analyzed by using biomechanical software (Visual 3D). Results: Compared with asymptomatic control group, the knee osteoarthritis group demonstrated no difference in vertical Foot-tread clearance and horizontal Foot-tread clearance during stair transitions. However, ankle dorsiflexion (p = 0.01) decreased, hip flexion (p = 0.02) and trunk lateral tilt (p = 0.02) increased in knee osteoarthritis group during the stair ascent transition. Moreover, trunk lateral tilt to the support side (p = 0.003) and pelvic rotation (p = 0.03) increased, while hip abduction of the swing leg (p = 0.03) decreased during the stair descent transition in individuals with knee osteoarthritis. Conclusion: Increased trunk lateral tilt and altered angle of hip may be a strategy utilized by individuals with knee OA to increase the foot clearance ability and compensate for the disease-related loss of lower extremity strength, range of motion, and balance. However, compensatory manifestations, such as the increased lateral tilt of the trunk and movement of the gravity center may enhance the risk of falls and result in more abnormal knee joint loading.
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Affiliation(s)
- Yatai Chai
- Fujian University of Traditional Chinese Medicine, Fuzhou, China,Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jian Chen
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Meijin Hou
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China
| | - Jiaqi Zheng
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lu Liu
- Fujian University of Traditional Chinese Medicine, Fuzhou, China,Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yongkang Chen
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shengxing Fu
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China
| | - Ye Ma
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fuzhou, China,Faculty of Sports Sciences, Research Academy of Grand Health, Ningbo University, Ningbo, China
| | | | - Xiangbin Wang
- Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education, Fujian University of Traditional Chinese Medicine, Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China,Rehabilitation Department of the Affiliated 3rd Peoples’ Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China,*Correspondence: Xiangbin Wang,
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Francksen N, Ackermans T, Holzer D, Maganaris C, Hollands M, Roys M, O'Brien T. Underlying mechanisms of fall risk on stairs with inconsistent going size. APPLIED ERGONOMICS 2022; 101:103678. [PMID: 35151119 DOI: 10.1016/j.apergo.2022.103678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/22/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
Serious falls occur frequently on stairs with inconsistent dimensions. Inconsistent smaller goings are thought to reduce user's foot clearances and foot contact lengths since individuals do not detect and alter their behaviour prior to the inconsistency, increasing the risk of a trip, heel-catch or over-step and potential slip on the stairs. So far, these mechanisms for a stair fall remain theoretical only. The aim of this paper was to identify the underlying mechanisms by which steps with inconsistent going size increase the risk of falls. For this study twenty-seven younger adults (24 ± 3 y, 1.74 ± 0.09 m, 71.41 ± 11.04 kg) and thirty-three older adults (70 ± 4 y, 1.68 ± 0.08 m, 67.90 ± 14.10 kg) ascended and descended a seven-step instrumented staircase in two conditions: 1) consistent dimensions with 200 mm risers and 250 mm goings and 2) inconsistent going dimensions where the going of the third step was reduced by 10 mm, and consequently the going of the second step was larger by 10 mm. Five repeated trials on the inconsistent stairs were performed to assess if there was an adaptation effect after first exposure. In descent in the first inconsistent trial, foot contact lengths were not significantly different between conditions for the younger and older adults on the inconsistently shorter step (∼1%, p = .121). Foot trajectories were pulled further back in the last 22% of swing before contact (p = .025), contradicting previous expectations. Younger adults then had reduced clearances over the next step (∼5 mm, p = .027), which was inconsistently longer, increasing the risk of a heel-catch, whereas foot clearances for older adults were not different. With repeated inconsistent trials the foot contact length of older adults reduced on the shorter step (p = .024). In ascent, in the first inconsistent trial, interaction effects were detected between groups and conditions on three steps: the inconsistently longer step (p = .003), the shorter step (p = .004), the next step (p = .006), as well as on the walkway (p = .048). Older adults positioned themselves further away from the stairs on the walkway compared to younger adults and then had a reduced foot contact length on the inconsistently shorter step (∼2.8%, p = .026), increasing the chances of under-stepping and slipping off the shorter step. Whereas younger adults were positioned closer to the stairs on the walkway, had increased foot contact lengths on the inconsistently longer step and contact lengths that were not different on the inconsistently shorter step. With repeated inconsistent trials, foot contact lengths were reduced on the longer step (p = .006) and then on the shorter step (p = .018). These findings contradict previous assumptions that individuals do not adapt to inconsistent goings on stairs. In descent on the first trial, both groups adjusted their stepping behaviour late in the swing prior to contact with the first inconsistent step. In ascent younger adults made changes to their position and stepping behaviour before stepping on the stairs. These behaviours to mitigate the risk of the inconsistent step, did not persist in the repeat trials. Future investigations should establish the magnitude at which inconsistencies are detectable and can be acted upon and should include a wider range of individuals. This type of research could help inform future initiatives to prevent serious stair falls.
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Affiliation(s)
- Natasha Francksen
- Research to Improve Stair Climbing Safety (RISCS), Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; Innovative Sports Training Inc., Chicago, IL, USA.
| | - Thijs Ackermans
- Research to Improve Stair Climbing Safety (RISCS), Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, KU, Leuven, Belgium
| | - Denis Holzer
- Research to Improve Stair Climbing Safety (RISCS), Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; Biomechanics in Sports, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Constantinos Maganaris
- Research to Improve Stair Climbing Safety (RISCS), Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Mark Hollands
- Research to Improve Stair Climbing Safety (RISCS), Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Mike Roys
- Rise and Going Consultancy, Watford, UK
| | - Thomas O'Brien
- Research to Improve Stair Climbing Safety (RISCS), Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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