Adding Light Touch While Walking in Older Adults: Biomechanical and Neuromotor Effects

2020 ◽  
Vol 28 (5) ◽  
pp. 680-685
Author(s):  
Alison R. Oates ◽  
Aaron Awdhan ◽  
Catherine Arnold ◽  
Joyce Fung ◽  
Joel L. Lanovaz
Keyword(s):  
Older Adults ◽  
Muscle Activity ◽  
Balance Control ◽  
Center Of Mass ◽  
Gait Pattern ◽  
Light Touch ◽  
Margin Of Stability ◽  
Complex Picture ◽  
Falls In Older Adults ◽  
Haptic Input

Adding haptic input may improve balance control and help prevent falls in older adults. This study examined the effects of added haptic input via light touch on a railing while walking. Participants (N = 53, 75.9 ± 7.9 years) walked normally or in tandem (heel to toe) with and without haptic input. During normal walking, adding haptic input resulted in a more cautious and variable gait pattern, reduced variability of center of mass acceleration and margin of stability, and increased muscle activity. During tandem walking, haptic input had minimal effect on step parameters, decreased lower limb muscle activity, and increased cocontraction at the ankle closest to the railing. Age was correlated with step width variability, stride length variability, stride velocity, variability of medial-lateral center of mass acceleration, and margin of stability for tandem walking. This complex picture of sensorimotor integration in older adults warrants further exploration into added haptic input during walking.

scholarly journals Reactive Postural Responses to Continuous Yaw Perturbations in Healthy Humans: The Effect of Aging

Sensors ◽  
2019 ◽  
Vol 20 (1) ◽  
pp. 63 ◽  
Author(s):  
Ilaria Mileti ◽  
Juri Taborri ◽  
Stefano Rossi ◽  
Zaccaria Del Prete ◽  
Marco Paoloni ◽  
...  
Keyword(s):  
Older Adults ◽  
Balance Control ◽  
Center Of Mass ◽  
Community Dwelling ◽  
Body Segments ◽  
Healthy Humans ◽  
Eyes Closed ◽  
Age Related ◽  
Postural Responses ◽  
Mass Displacement

Maintaining balance stability while turning in a quasi-static stance and/or in dynamic motion requires proper recovery mechanisms to manage sudden center-of-mass displacement. Furthermore, falls during turning are among the main concerns of community-dwelling elderly population. This study investigates the effect of aging on reactive postural responses to continuous yaw perturbations on a cohort of 10 young adults (mean age 28 ± 3 years old) and 10 older adults (mean age 61 ± 4 years old). Subjects underwent external continuous yaw perturbations provided by the RotoBit1D platform. Different conditions of visual feedback (eyes opened and eyes closed) and perturbation intensity, i.e., sinusoidal rotations on the horizontal plane at different frequencies (0.2 Hz and 0.3 Hz), were applied. Kinematics of axial body segments was gathered using three inertial measurement units. In order to measure reactive postural responses, we measured body-absolute and joint absolute rotations, center-of-mass displacement, body sway, and inter-joint coordination. Older adults showed significant reduction in horizontal rotations of body segments and joints, as well as in center-of-mass displacement. Furthermore, older adults manifested a greater variability in reactive postural responses than younger adults. The abnormal reactive postural responses observed in older adults might contribute to the well-known age-related difficulty in dealing with balance control during turning.

scholarly journals Hallux Valgus Surgery May Produce Early Improvements in Balance Control

2013 ◽  
Vol 103 (6) ◽  
pp. 489-497 ◽  
Author(s):  
Saba Sadra ◽  
Adam Fleischer ◽  
Erin Klein ◽  
Gurtej S. Grewal ◽  
Jessica Knight ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Study Design ◽  
Balance Control ◽  
Center Of Mass ◽  
Cross Sectional Study ◽  
Static Balance ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Eyes Open ◽  
Falls In Older Adults

Background: Hallux valgus (HV) is associated with poorer performance during gait and balance tasks and is an independent risk factor for falls in older adults. We sought to assess whether corrective HV surgery improves gait and balance. Methods: Using a cross-sectional study design, gait and static balance data were obtained from 40 adults: 19 patients with HV only (preoperative group), 10 patients who recently underwent successful HV surgery (postoperative group), and 11 control participants. Assessments were made in the clinic using body-worn sensors. Results: Patients in the preoperative group generally demonstrated poorer static balance control compared with the other two groups. Despite similar age and body mass index, postoperative patients exhibited 29% and 63% less center of mass sway than preoperative patients during double-and single-support balance assessments, respectively (analysis of variance P =.17 and P =.14, respectively [both eyes open condition]). Overall, gait performance was similar among the groups, except for speed during gait initiation, where lower speeds were encountered in the postoperative group compared with the preoperative group (Scheffe P = .049). Conclusions: This study provides supportive evidence regarding the benefits of corrective lower-extremity surgery on certain aspects of balance control. Patients seem to demonstrate early improvements in static balance after corrective HV surgery, whereas gait improvements may require a longer recovery time. Further research using a longitudinal study design and a larger sample size capable of assessing the long-term effects of HV surgical correction on balance and gait is probably warranted. (J Am Podiatr Med Assoc 103(6): 489–497, 2013)

scholarly journals Rethinking Margin of Stability: Incorporating Step-To-Step Regulation to Resolve the Paradox

2021 ◽  
Author(s):  
Meghan Kazanski ◽  
Joseph P. Cusumano ◽  
Jonathan B. Dingwell
Keyword(s):  
Inverted Pendulum ◽  
Balance Control ◽  
Center Of Mass ◽  
Frontal Plane ◽  
Lateral Instability ◽  
Foot Placement ◽  
Margin Of Stability ◽  
Increased Risk ◽  
Mediolateral Stability ◽  
Balance Dynamics

ABSTRACTMaintaining frontal-plane stability is a major objective of human walking. Derived from inverted pendulum dynamics, the mediolateral Margin of Stability (MoSML) is frequently used to measure people’s frontal-plane stability on average. However, typical MoSML-based analyses deliver paradoxical interpretations of stability status. To address mediolateral stability using MoSML, we must first resolve this paradox. Here, we developed a novel framework that unifies the well-established inverted pendulum model with Goal-Equivalent Manifold (GEM)-based analyses to assess how humans regulate step-to-step balance dynamics to maintain mediolateral stability. We quantified the extent to which people corrected fluctuations in mediolateral center-of-mass state relative to a MoSML-defined candidate stability GEM in the inverted pendulum phase plane. Participants’ variability and step-to-step correction of tangent and perpendicular deviations from the candidate stability GEM demonstrate that regulation of balance dynamics involves more than simply trying to execute a constant-MoSML balance control strategy. Participants adapted these step-to-step corrections to mediolateral sensory and mechanical perturbations. How participants regulated mediolateral foot placement strongly predicted how they regulated center-of-mass state fluctuations, suggesting that regulation of center-of-mass state occurs as a biomechanical consequence of foot placement regulation. We introduce the Probability of Instability (PoI), a convenient statistic that accounts for step-to-step variance to properly predict instability likelihood on any given future step. Participants increased lateral PoI when destabilized, as expected. These lateral PoI indicated an increased risk of lateral instability, despite larger (i.e., more stable) average MoSML. PoI thereby explicitly predicts instability risk to decisively resolve the existing paradox that arises from conventional MoSML implementations.

scholarly journals Perturbation-based balance training to improve balance control and reduce falls in older adults – study protocol for a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marissa H. G. Gerards ◽  
Rik G. J. Marcellis ◽  
Martijn Poeze ◽  
Antoine F. Lenssen ◽  
Kenneth Meijer ◽  
...  
Keyword(s):  
Older Adults ◽  
Fear Of Falling ◽  
Balance Control ◽  
Daily Life ◽  
Controlled Trial ◽  
Intervention Group ◽  
Balance Training ◽  
Randomized Controlled ◽  
Falls In Older Adults

Abstract Background Falls are a common cause of injuries and hospitalization among older adults. While conventional balance training appears effective in preventing falls, a relatively large number of training sessions are needed and retention of the effects after the training period is hard to accomplish. This may be because these interventions are not sufficiently task-specific for the mechanism of falls. Many falls in older adults occur due to unexpected external perturbations during gait, such as trips. Therefore, there is increasing interest in perturbation-based balance training (PBT), which is a more task-specific intervention to improve reactive balance control after unexpected perturbations. The literature suggests that PBT may be more effective and require fewer training sessions to reduce falls incidence in older adults, than conventional balance training. We aim to evaluate the effect of a three-session PBT protocol on balance control, daily life falls and fear of falling. Secondly, we will evaluate the acceptability of the PBT protocol. Methods This is a mixed-methods study combining a single-blind (outcome assessor) randomized controlled trial (RCT) using a parallel-group design, and qualitative research evaluating the acceptability of the intervention. The study sample consists of community-dwelling older adults aged 65 years and older who have recently fallen and visited the MUMC+ outpatient clinic. Subjects are randomized into two groups. The control group (n = 40) receives usual care, meaning referral to a physical therapist. The intervention group (n = 40) receives usual care plus three 30-min sessions of PBT in the Computer Assisted Rehabilitation Environment. Subjects’ balance control (Mini-BESTest) and fear of falling (FES-I) will be assessed at baseline, and 4 weeks and 3 months post-baseline. Daily life falls will be recorded with falls calendars until 6 months after the first follow-up measurement, long-term injurious falls will be recorded at 2-years’ follow-up via the electronic patient record. Acceptability of the PBT protocol will be evaluated with semi-structured interviews in a subsample from the intervention group. Discussion This study will contribute to the evidence for the effectiveness of PBT using a training protocol based on the available literature, and also give much needed insights into the acceptability of PBT for older adults. Trial registration Nederlands Trial Register NL7680. Registered 17-04-2019 – retrospectively registered.

Stability of gait and interlimb coordination in older adults

2012 ◽  
Vol 107 (9) ◽  
pp. 2560-2569 ◽  
Author(s):  
T. Krasovsky ◽  
M. C. Baniña ◽  
R. Hacmon ◽  
A. G. Feldman ◽  
A. Lamontagne ◽  
...  
Keyword(s):  
Older Adults ◽  
Center Of Mass ◽  
Interlimb Coordination ◽  
Forward Movement ◽  
Gait Stability ◽  
High Functioning ◽  
Double Support ◽  
Falls In Older Adults ◽  
Older Subjects

Most falls in older adults occur when walking, specifically following a trip. This study investigated the short- and longer term responses of young ( n = 24, 27.6 ± 4.5 yr) and older adults ( n = 18, 69.1 ± 4.2 yr) to a trip during gait at comfortable speed and the role of interlimb coordination in recovery from tripping. Subjects walked on a self-paced treadmill when forward movement of their dominant leg was unexpectedly arrested for 250 ms. Recovery of center of mass (COM) movements and of double-support duration following perturbation was determined. In addition, the disruption and recovery of interlimb coordination of the arms and legs was evaluated. Although young and older subjects used similar lower limb strategies in response to the trip, older adults had less stable COM movement patterns before perturbation, had longer transient destabilization (>25%) after perturbation, required more gait cycles to recover double-support duration (older, 3.48 ± 0.7 cycles; young, 2.88 ± 0.4 cycles), and had larger phase shifts that persisted after perturbation (older, −83° to −90°; young, −39° to −42°). Older adults also had larger disruptions to interlimb coordination of the arms and legs. The timing of the initial disruption in coordination was correlated with the disturbance in gait stability only in young adults. In older adults, greater initial COM instability was related to greater longer term arm incoordination. These results suggest a relationship between interlimb coordination and gait stability, which may be associated with fall risk in older adults. Reduced coordination and gait stability suggest a need for stability-related functional training even in high-functioning older adults.

scholarly journals Abnormal center of mass feedback responses during balance: A potential biomarker of falls in Parkinson’s disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252119
Author(s):  
J. Lucas McKay ◽  
Kimberly C. Lang ◽  
Sistania M. Bong ◽  
Madeleine E. Hackney ◽  
Stewart A. Factor ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Spatial Organization ◽  
Balance Control ◽  
Center Of Mass ◽  
The Body ◽  
Antagonist Muscle ◽  
Antagonist Muscles ◽  
Potential Biomarker ◽  
Balance Deficits ◽  
Sensorimotor Feedback

Although Parkinson disease (PD) causes profound balance impairments, we know very little about how PD impacts the sensorimotor networks we rely on for automatically maintaining balance control. In young healthy people and animals, muscles are activated in a precise temporal and spatial organization when the center of body mass (CoM) is unexpectedly moved that is largely automatic and determined by feedback of CoM motion. Here, we show that PD alters the sensitivity of the sensorimotor feedback transformation. Importantly, sensorimotor feedback transformations for balance in PD remain temporally precise, but become spatially diffuse by recruiting additional muscle activity in antagonist muscles during balance responses. The abnormal antagonist muscle activity remains precisely time-locked to sensorimotor feedback signals encoding undesirable motion of the body in space. Further, among people with PD, the sensitivity of abnormal antagonist muscle activity to CoM motion varies directly with the number of recent falls. Our work shows that in people with PD, sensorimotor feedback transformations for balance are intact but disinhibited in antagonist muscles, likely contributing to balance deficits and falls.

Older Adult Hill Transition Strategies are Determined by Task Demands and Cautious Gait Patterns

2015 ◽  
Vol 31 (3) ◽  
pp. 133-141 ◽  
Author(s):  
Riley C. Sheehan ◽  
Jinger S. Gottschall
Keyword(s):  
Older Adults ◽  
Muscle Activity ◽  
Fall Risk ◽  
Age Groups ◽  
Gait Pattern ◽  
Task Demands ◽  
Gait Patterns ◽  
Transition Strategies ◽  
Physical Abilities ◽  
The Relationship

Falls are the leading cause of injury for all age groups. However, adults over 65 are at a higher risk, with one-third falling each year. Transitioning between level and hill surfaces poses a greater fall risk than walking on either surface alone. Previous studies found that young adults adopted a cautious gait pattern to mitigate this risk. As older adults typically employ a cautious pattern during level walking, we investigated how they modify their gait pattern to safely transition between surfaces. Twenty adults over the age of 65 transitioned onto and off of a 15° ramp while we recorded kinematics and muscle activity. During the level-to-downhill and uphill-to-level transitions, participants took slower, shorter steps indicative of an exaggerated cautious gait pattern. The older adults also exhibited greater muscle activity during the transitions, which may be due to muscle weakness requiring compensatory strategies to meet the greater demands of the task. However, the slower, shorter steps when transitioning from uphill to level suggest that these compensations may not always be adequate. Thus, it is important to consider the relationship between physical abilities and task demands in evaluating walking terrains that may be excessively difficult or dangerous for older adults.

scholarly journals Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Rajal G Cohen ◽  
Jason L Baer ◽  
Ramyaa Ravichandra ◽  
Daniel Kral ◽  
Craig McGowan ◽  
...  
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Tai Chi ◽  
Balance Control ◽  
Dynamic Balance ◽  
Center Of Mass ◽  
Quiet Standing ◽  
Upright Posture ◽  
Healthy Older Adults ◽  
Eyes Open

Abstract Background and Objectives Increased fall risk in older adults is associated with declining balance. Previous work showed that brief postural instructions can affect balance control in older adults with Parkinson’s disease. Here, we assessed the effects of brief instructions on static and dynamic balance in healthy older adults. Research Design and Methods Nineteen participants practiced three sets of instructions, then attempted to implement each instructional set during: (1) quiet standing on foam for 30 s with eyes open; (2) a 3-s foot lift. “Light” instructions relied on principles of reducing excess tension while encouraging length. “Effortful” instructions relied on popular concepts of effortful posture correction. “Relax” instructions encouraged minimization of effort. We measured kinematics and muscle activity. Results During quiet stance, Effortful instructions increased mediolateral jerk and path length. In the foot lift task, Light instructions led to the longest foot-in-air duration and the smallest anteroposterior variability of the center of mass, Relax instructions led to the farthest forward head position, and Effortful instructions led to the highest activity in torso muscles. Discussion and Implications Thinking of upright posture as effortless may reduce excessive co-contractions and improve static and dynamic balance, while thinking of upright posture as inherently effortful may make balance worse. This may partly account for the benefits of embodied mindfulness practices such as tai chi and Alexander technique for balance in older adults. Pending larger-scale replication, this discovery may enable physiotherapists and teachers of dance, exercise, and martial arts to improve balance and reduce fall risk in their older students and clients simply by modifying how they talk about posture.

scholarly journals Ambulatory Assessment of the Dynamic Margin of Stability Using an Inertial Sensor Network

Sensors ◽  
2019 ◽  
Vol 19 (19) ◽  
pp. 4117 ◽  
Author(s):  
Michelangelo Guaitolini ◽  
Federica Aprigliano ◽  
Andrea Mannini ◽  
Silvestro Micera ◽  
Vito Monaco ◽  
...  
Keyword(s):  
Balance Control ◽  
Inertial Sensor ◽  
Center Of Mass ◽  
The Body ◽  
Lower Limbs ◽  
Measurement Unit ◽  
Margin Of Stability ◽  
Walking Velocity ◽  
Body Center ◽  
Base Of Support

Loss of stability is a precursor to falling and therefore represents a leading cause of injury, especially in fragile people. Thus, dynamic stability during activities of daily living (ADLs) needs to be considered to assess balance control and fall risk. The dynamic margin of stability (MOS) is often used as an indicator of how the body center of mass is located and moves relative to the base of support. In this work, we propose a magneto-inertial measurement unit (MIMU)-based method to assess the MOS of a gait. Six young healthy subjects were asked to walk on a treadmill at different velocities while wearing MIMUs on their lower limbs and pelvis. We then assessed the MOS by computing the lower body displacement with respect to the leading inverse kinematics approach. The results were compared with those obtained using a camera-based system in terms of root mean square deviation (RMSD) and correlation coefficient (ρ). We obtained a RMSD of ≤1.80 cm and ρ ≥ 0.85 for each walking velocity. The findings revealed that our method is comparable to camera-based systems in terms of accuracy, suggesting that it may represent a strategy to assess stability during ADLs in unstructured environments.

Sign in / Sign up

Export Citation Format

Share Document