1
|
Lockhart T, Frames C, Olson M, Moon SH, Peterson D, Lieberman A. Effects of protective step training on proactive and reactive motor adaptations in Parkinson's disease patients. Front Neurol 2023; 14:1211441. [PMID: 37965161 PMCID: PMC10642212 DOI: 10.3389/fneur.2023.1211441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
The aim of this study was to investigate to what extent PD affects the ability to walk, respond to balance perturbations in a single training session, and produce acute short-term effects to improve compensatory reactions and control of unperturbed walking stability. Understanding the mechanism of compensation and neuroplasticity to unexpected step perturbation training during walking and static stance can inform treatment of PD by helping to design effective training regimens that remediate fall risk. Current rehabilitation therapies are inadequate at reducing falls in people with Parkinson's disease (PD). While pharmacologic and surgical treatments have proved largely ineffective in treating postural instability and gait dysfunction in people with PD, studies have demonstrated that therapy specifically focusing on posture, gait, and balance may significantly improve these factors and reduce falls. The primary goal of this study was to assess the effectiveness of a novel and promising intervention therapy (protective step training - i.e., PST) to improve balance and reduce falls in people with PD. A secondary goal was to understand the effects of PST on proactive and reactive feedback responses during stance and gait tasks. Multiple-baseline, repeated measures analyses were performed on the multitude of proactive and reactive performance measures to assess the effects of PST on gait and postural stability parameters. In general, the results indicate that participants with PD were able to use experiences with perturbation training to integrate and adapt feedforward and feedback behaviors to reduce falls. The ability of the participants with PD to adapt to changes in task demands suggests that individuals with PD could benefit from the protective step training to facilitate balance control during rehabilitation.
Collapse
Affiliation(s)
- Thurmon Lockhart
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Chris Frames
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Markey Olson
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
- Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Seong H. Moon
- Locomotion Research Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, United States
| | - Dan Peterson
- Gait and Balance Dysfunction Laboratory, College of Health Solutions, Arizona State University, Tempe, AZ, United States
- Department of Veteran’s Affairs, Phoenix, AZ, United States
| | - Abraham Lieberman
- Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| |
Collapse
|
2
|
Hepp J, Shiraishi M, Tran M, Henson E, Ananthanarayanan M, Soangra R. Exploring Teslasuit's Potential in Detecting Sequential Slip-Induced Kinematic Changes among Healthy Young Adults. SENSORS (BASEL, SWITZERLAND) 2023; 23:6258. [PMID: 37514552 PMCID: PMC10383312 DOI: 10.3390/s23146258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
This study aimed to assess whether the Teslasuit, a wearable motion-sensing technology, could detect subtle changes in gait following slip perturbations comparable to an infrared motion capture system. A total of 12 participants wore Teslasuits equipped with inertial measurement units (IMUs) and reflective markers. The experiments were conducted using the Motek GRAIL system, which allowed for accurate timing of slip perturbations during heel strikes. The data from Teslasuit and camera systems were analyzed using statistical parameter mapping (SPM) to compare gait patterns from the two systems and before and after slip. We found significant changes in ankle angles and moments before and after slip perturbations. We also found that step width significantly increased after slip perturbations (p = 0.03) and total double support time significantly decreased after slip (p = 0.01). However, we found that initial double support time significantly increased after slip (p = 0.01). However, there were no significant differences observed between the Teslasuit and motion capture systems in terms of kinematic curves for ankle, knee, and hip movements. The Teslasuit showed promise as an alternative to camera-based motion capture systems for assessing ankle, knee, and hip kinematics during slips. However, some limitations were noted, including kinematics magnitude differences between the two systems. The findings of this study contribute to the understanding of gait adaptations due to sequential slips and potential use of Teslasuit for fall prevention strategies, such as perturbation training.
Collapse
Affiliation(s)
- Jacob Hepp
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Michael Shiraishi
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Michelle Tran
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Emmy Henson
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Mira Ananthanarayanan
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
| | - Rahul Soangra
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (J.H.); (M.S.); (M.T.); (E.H.); (M.A.)
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
| |
Collapse
|
3
|
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
|
4
|
Lee Y, Alexander NB, Madigan ML. A proposed methodology for trip recovery training without a specialized treadmill. Front Sports Act Living 2022; 4:1003813. [PMID: 36479551 PMCID: PMC9719936 DOI: 10.3389/fspor.2022.1003813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
Falls are the leading cause of accidental injuries among adults aged 65 years and older. Perturbation-based balance training is a novel exercise-based fall prevention intervention that has shown promise in reducing falls. Trip recovery training is a form of perturbation-based balance training that targets trip-induced falls. Trip recovery training typically requires the use of a specialized treadmill, the cost of which may present a barrier for use in some settings. The goal of this paper is to present a methodology for trip recovery training that does not require a specialized treadmill. A trial is planned in the near future to evaluate its effectiveness. If effective, non-treadmill trip recovery training could provide a lower cost method of perturbation-based balance training, and facilitate greater implementation outside of the research environment.
Collapse
Affiliation(s)
- Youngjae Lee
- Grado Department of Industrial and Systems Engineering (0118), Virginia Tech, Blacksburg, VA, United States
| | - Neil B. Alexander
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
- Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, United States
| | - Michael L. Madigan
- Grado Department of Industrial and Systems Engineering (0118), Virginia Tech, Blacksburg, VA, United States
- Department of Biomedical Engineering and Mechanics (0298), Virginia Tech, Blacksburg, VA, United States
- *Correspondence: Michael L. Madigan
| |
Collapse
|
5
|
Soh SLH. Measures of falls efficacy, balance confidence, or balance recovery confidence for perturbation-based balance training. Front Sports Act Living 2022; 4:1025026. [PMID: 36311214 PMCID: PMC9596795 DOI: 10.3389/fspor.2022.1025026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shawn Leng-Hsien Soh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore,Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Musselburgh, United Kingdom,*Correspondence: Shawn Leng-Hsien Soh
| |
Collapse
|
6
|
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: 20] [Impact Index Per Article: 10.0] [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
|