scholarly journals Exposure to unpredictable trips and slips while walking can improve balance recovery responses with minimum predictive gait alterations

2018 ◽  
Author(s):  
Yoshiro Okubo ◽  
Matthew A Brodie ◽  
Daina L Sturnieks ◽  
Cameron Hicks ◽  
Hilary Carter ◽  
...  
Keyword(s):  
Young Adults ◽  
Everyday Life ◽  
Gait Speed ◽  
Random Perturbation ◽  
Step Length ◽  
Centre Of Mass ◽  
Balance Recovery ◽  
Margin Of Stability ◽  
Slowing Down ◽  
Random Location

AbstractINTRODUCTIONThis study aimed to determine if repeated exposure to unpredictable trips and slips while walking can improve balance recovery responses when predictive gait alterations (e.g. slowing down) are minimised.METHODSTen young adults walked on a 10-m walkway that induced slips and trips in fixed and random locations. Participants were exposed to a total of 12 slips, 12 trips and 6 non-perturbed walks in three conditions: 1) right leg fixed location, 2) left leg fixed location and 3) random leg and location. Kinematics during non-perturbed walks and previous and recovery steps were analysed.RESULTSThroughout the three conditions, participants walked with similar gait speed, step length and cadence(p>0.05). Participants’ extrapolated centre of mass (XCoM) was anteriorly shifted immediately before slips at the fixed location (p<0.01), but this predictive gait alteration did not transfer to random perturbation locations. Improved balance recovery from trips in the random location was indicated by increased margin of stability and step length during recovery steps (p<0.05). Changes in balance recovery from slips in the random location was shown by reduced backward XCoM displacement and reduced slip speed during recovery steps (p<0.05).CONCLUSIONSEven in the absence of most predictive gait alterations, balance recovery responses to trips and slips were improved through exposure to repeated unpredictable perturbations. A common predictive gait alteration to lean forward immediately before a slip was not useful when the perturbation location was unpredictable. Training balance recovery with unpredictable perturbations may be beneficial to fall avoidance in everyday life.

scholarly journals Biomechanical Mechanisms of Improved Balance Recovery to Repeated Backward Slips Simulated by Treadmill Belt Accelerations in Young and Older Adults

2021 ◽  
Vol 3 ◽  
Author(s):  
Héloïse Debelle ◽  
Constantinos N. Maganaris ◽  
Thomas D. O'Brien
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Reaction Force ◽  
Knee Extensor ◽  
Step Length ◽  
Joint Moments ◽  
Balance Recovery ◽  
Initial Strategy ◽  
Prevention Interventions ◽  
Gait Perturbations

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.

scholarly journals Increased Arm Swing and Rocky Surfaces Reduces Postural Control in Healthy Young Adults

2021 ◽  
Vol 9 ◽  
Author(s):  
Cezar Mezher ◽  
Tarique Siragy ◽  
Julie Nantel
Keyword(s):  
Young Adults ◽  
Standard Deviation ◽  
Angular Velocity ◽  
Postural Control ◽  
Coefficient Of Variation ◽  
Financial Burden ◽  
Step Length ◽  
Postural Control System ◽  
Arm Swing ◽  
Margin Of Stability

Fall-induced injuries can stem from a disruption in the postural control system and place a financial burden on the healthcare system. Most gait research focused on lower extremities and neglected the contribution of arm swing, which have been shown to affect the movement of the center of mass when walking. This study evaluated the effect of arm swing on postural control and stability during regular and rocky surface walking. Fifteen healthy young adults (age = 23.4 ± 2.8) walked on these two surfaces with three arm motions (normal, held, and active) using the CAREN Extended-System (Motek Medical, Amsterdam, NL). Mean, standard deviation and maximal values of trunk linear and angular velocity were calculated in all three axes. Moreover, step length, time and width mean and coefficient of variation as well as margin of stability mean and standard deviation were calculated. Active arm swing increased trunk linear and angular velocity variability and peak values compared to normal and held arm conditions. Active arm swing also increased participants’ step length and step time, as well as the variability of margin of stability. Similarly, rocky surface walking increased trunk kinematics variability and peak values compared to regular surface walking. Furthermore, rocky surface increased the average step width while reducing the average step time. Though this surface type increased the coefficient of variation of all spatiotemporal parameters, rocky surface also led to increased margin of stability mean and variation. The spatiotemporal adaptations showed the use of “cautious” gait to mitigate the destabilizing effects of both the active arm swing and rocky surface walking and, ultimately, maintain dynamic stability.

scholarly journals Dynamic Asymmetries Do Not Match Spatiotemporal Step Asymmetries during Split-Belt Walking

Symmetry ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1089
Author(s):  
Stefano Scarano ◽  
Luigi Tesio ◽  
Viviana Rota ◽  
Valeria Cerina ◽  
Luigi Catino ◽  
...  
Keyword(s):  
Lower Limb ◽  
Step Length ◽  
Centre Of Mass ◽  
Mean Velocity ◽  
Rehabilitation Research ◽  
Joint Dynamics ◽  
Stance Time ◽  
After Effect ◽  
The Mean ◽  
Step Parameters

While walking on split-belt treadmills (two belts running at different speeds), the slower limb shows longer anterior steps than the limb dragged by the faster belt. After returning to basal conditions, the step length asymmetry is transiently reversed (after-effect). The lower limb joint dynamics, however, were not thoroughly investigated. In this study, 12 healthy adults walked on a force-sensorised split-belt treadmill for 15 min. Belts rotated at 0.4 m s−1 on both sides, or 0.4 and 1.2 m s−1 under the non-dominant and dominant legs, respectively. Spatiotemporal step parameters, ankle power and work, and the actual mean velocity of the body’s centre of mass (CoM) were computed. On the faster side, ankle power and work increased, while step length and stance time decreased. The mean velocity of the CoM slightly decreased. As an after-effect, modest converse asymmetries developed, fading within 2–5 min. These results may help to decide which belt should be assigned to the paretic and the unaffected lower limb when split-belt walking is applied for rehabilitation research in hemiparesis.

Mild Cognitive Impairment Affects Obstacle Negotiation in Older Adults: Results from “Gait and Brain Study”

Gerontology ◽  
2018 ◽  
Vol 65 (2) ◽  
pp. 164-173 ◽  
Author(s):  
Frederico Pieruccini-Faria ◽  
Yanina Sarquis-Adamson ◽  
Manuel Montero-Odasso
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Executive Function ◽  
Mild Cognitive Impairment ◽  
Dual Task ◽  
Gait Speed ◽  
Step Length ◽  
Gait Control ◽  
Dual Tasking ◽  
Brain Study

Background: Older adults with Mild Cognitive Impairment (MCI) are at higher risk of falls and injuries, but the underlying mechanism is poorly understood. Inappropriate anticipatory postural adjustments to overcome balance perturbations are affected by cognitive decline. However, it is unknown whether anticipatory gait control to avoid an obstacle is affected in MCI. Objective: Using the dual-task paradigm, we aim to assess whether gait control is affected during obstacle negotiation challenges in older adults with MCI. Methods: Seventy-nine participants (mean age = 72.0 ± 2.7 years; women = 30.3%) from the “Gait and Brain Study” were included in this study (controls = 27; MCI = 52). In order to assess the anticipatory control behaviour for obstacle negotiation, a 6-m electronic walkway embedded with sensors recorded foot prints to measure gait speed and step length variability, during early (3 steps before the late phase) and late (3 steps before the obstacle) pre-crossing phases of an ad hoc obstacle, set at 15% of participant’s height. Participants walked under single- and dual-task gait (counting backwards by 1’s from 100 while walking) conditions. Three-way mixed repeated-measures analysis of variance models examined differences in gait performance between groups when transitioning between pre-crossing phases towards an obstacle during single- and dual-task conditions. Analyses were adjusted for age, sex, years of education, lower limb function, fear of falling, medical status, depressive symptoms, baseline gait speed and executive function. Results: A significant three-way interaction among groups, pre-crossing phases and task showed that participants with MCI attenuated the gait deceleration (p = 0.02) and performed fewer step length adjustments (p = 0.03) when approaching the obstacle compared with controls while dual-tasking. These interactions were attenuated when executive function performance was added as a covariate in the adjusted statistical model. Conclusion: Older adults with MCI attenuate the anticipatory gait adjustments needed to avoid an obstacle when dual-tasking. Deficits in higher-order cognitive processing may limit obstacle negotiation capabilities in MCI populations, being a potential falls risk factor.

The Role of Knee Extensor Strength in Balance-Restoring Step Initiation and Execution

2008 ◽  
Author(s):  
Gregory W. King ◽  
Carl W. Luchies
Keyword(s):  
Knee Extensor ◽  
Step Length ◽  
Step Response ◽  
Balance Recovery ◽  
Step Initiation ◽  
Age Related ◽  
Knee Extensor Strength ◽  
Step Duration ◽  
Stepping Response

A stepping response is often used to restore balance following a fall. Using laboratory-induced balance perturbations, various researchers have reported age-related alterations in balance recovery step characteristics including earlier step liftoff time [1; 2], shorter step length [1; 3], and longer step duration [2]. Such age-related changes in the step response may be related to older adults’ reduced strength reserve, which is prominent in the lower extremities [4] and therefore likely plays an important role in balance recovery.

scholarly journals Mobility improvement in the first 6 postoperative weeks in orthogeriatric fracture patients

2021 ◽  
Author(s):  
Alexander M. Keppler ◽  
Jenny Holzschuh ◽  
Daniel Pfeufer ◽  
Johannes Gleich ◽  
Carl Neuerburg ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Gait Speed ◽  
Daily Living ◽  
Step Length ◽  
Care Hospital ◽  
Self Assessment ◽  
Postoperative Rehabilitation ◽  
Femur Fractures ◽  
Prospective Study Design

Abstract Background Physical activity is a relevant outcome parameter in orthopedic surgery, that can be objectively assessed. Until now, there is little information regarding objective gait parameters in the orthogeriatric population. This study focuses on the first 6 weeks of postoperative rehabilitation, and delivers objective data about gait speed and step length in typical orthogeriatric fracture patterns. Methods Thirty-one orthogeriatric fracture patients [pertrochanteric femur fractures (PFF), femoral neck (FN), and proximal humerus fractures (PHF)] were consecutively enrolled in a maximum care hospital in a prospective study design. All patients wore an accelerometer placed at the waist during the postoperative stay (24 h/d) and at 6-week follow-up, to measure real gait speed and step length. In addition, self-assessment of mobility (Parker mobility score) and activities of daily living (Barthel index) were collected at baseline, during the inpatient stay, and at 6-week follow-up. Results During postoperative hospitalization, significantly higher gait speed (m/s) was observed in the PHF group (0.52 ± 0.27) compared with the FN group (0.36 ± 0.28) and PFF group (0.19 ± 0.28) (p < 0.05). Six weeks postoperatively, gait speed improved significantly in all groups (PHF 0.90 ± 0.41; FN 0.72 ± 0.13; PFF 0.60 ± 0.23). Similarly, step length (m) differed between groups postoperatively [FN 0.16 ± 0.13; PFF 0.12 ± 0.15; PHF 0.31 ± 0.05 (p < 0.005)] and improved over time significantly (FN 0.47 ± 0.01; 0.39 ± 0.19; 0.50 ± 0.18). Self-assessment scores indicate that the majority of the patients had minor restrictions in mobility before the fracture. These values decreased immediately postoperatively and improved in the first 6 weeks, but did not reach the initial level. Conclusions Gait speed, step length, and self-assessment in terms of mobility and activities of daily living improve significantly in the first 6 postoperative weeks in orthogeriatric fracture patients. As very low postoperative mobility during hospitalization was observed, this collective shows great potential in postoperative rehabilitation regardless of their fracture pattern. For this reason, specific aftercare concepts similar to the “fast track” concepts in primary arthroplasty are crucial for orthogeriatric patients in clinical practice. Level of evidence Prospective cohort study, 2.

scholarly journals Kinetic Gait Changes after Robotic Exoskeleton Training in Adolescents and Young Adults with Acquired Brain Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Kiran K. Karunakaran ◽  
Naphtaly Ehrenberg ◽  
JenFu Cheng ◽  
Katherine Bentley ◽  
Karen J. Nolan
Keyword(s):  
Young Adults ◽  
Brain Injury ◽  
Therapeutic Effect ◽  
Acquired Brain Injury ◽  
Step Length ◽  
Gait Training ◽  
Adolescents And Young Adults ◽  
Motor Deficits ◽  
High Dose ◽  
Before And After

Background. Acquired brain injury (ABI) is one of the leading causes of motor deficits in children and adults and often results in motor control and balance impairments. Motor deficits include abnormal loading and unloading, increased double support time, decreased walking speed, control, and coordination. These deficits lead to diminished functional ambulation and reduced quality of life. Robotic exoskeletons (RE) for motor rehabilitation can provide the user with consistent, symmetrical, goal-directed repetition of movement, as well as balance and stability. Purpose. The goal of this preliminary prospective before and after study is to evaluate the therapeutic effect of RE training on the loading/unloading and spatial-temporal characteristics in adolescents and young adults with chronic ABI. Method. Seven participants diagnosed with ABI between the ages of 14 and 27 years participated in the study. All participants received twelve 45 minute sessions of RE gait training. The bilateral loading (linearity of loading and rate of loading), speed, step length, swing time, stance time, and total time were collected using Zeno™ walkway (ProtoKinetics, Havertown, PA, USA) before and after RE training. Results. Results from the study showed improved step length, speed, and an overall progression towards healthy bilateral loading, with linearity of loading showing a significant therapeutic effect ( p < 0.05 ). Conclusion. These preliminary results suggest that high dose, repetitive, consistent gait training using RE has the potential to induce recovery of function in adolescents and young adults diagnosed with ABI.

Effects of Self-Selected Step Length and Trunk Position on Joint Kinetics in Highly Physically Fit Older Adults

2020 ◽  
Vol 36 (3) ◽  
pp. 156-162
Author(s):  
Rebecca L. Krupenevich ◽  
Ross H. Miller
Keyword(s):  
Older Adults ◽  
Young Adults ◽  
Step Length ◽  
Physically Active ◽  
Joint Kinetics ◽  
Highly Active ◽  
Age Related ◽  
Starting Point ◽  
Trunk Posture ◽  
Trunk Position

The causes of age-related differences in lower-extremity joint moments and powers are unknown. The purpose of this study was to determine the effects of highly physically active older adults walking with (1) a step length similar to young adults and (2) an upright trunk posture, on hip and ankle joint kinetics. The authors hypothesized that, compared with their self-selected walking mechanics, older adults would exhibit decreased hip kinetics and increased ankle kinetics when prescribed a young adult step length, and would exhibit decreased hip extension moments when maintaining an upright trunk posture during walking. A total of 12 active older adults (67 [5] y) and 13 active young adults (21 [3] y) walked at 1.3 m/s. The older adults also walked at 1.3 m/s with step lengths prescribed from height-matched young adults and, in a separate condition, walked with an upright trunk. The older adults did not display larger ankle kinetics or smaller hip kinetics in either condition compared to walking with a self-selected step length. These findings indicate that step length and trunk position do not primarily contribute to age-related differences in kinetics in highly active older adults and should serve as a starting point for investigating alternative explanations.

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