Age differences in anticipatory and executory mechanisms of gait initiation following unexpected balance perturbations

Effects of an external load on anticipatory mechanisms of handstand walking initiation in experienced gymnasts

Anticipatory postural adjustments (APAs) are responsible for a successful first step execution in handstand walking. This study evaluates gymnasts' ability to adapt their APAs and stepping parameters in response to adding/removing an external load over repeated handstand walking initiation trials. Eighteen gymnasts performed five handstand walking initiation trials without load (PRE), eight trials with an external load (LOAD) and five trials with removed load (POST). Force platforms and a motion capture system were used to quantify mechanical parameters from the anticipatory phase and the stepping phase. During the first LOAD trial, APAs did not change, however, the step height decreased by 0.56 cm compared to PRE (p = 0.007). During the second and third LOAD trials, the mediolateral center of pressure APAs increased by 2.0 cm (p = 0.01) and 2.3 cm (p = 0.01) compared to the first LOAD trial, while the step parameters returned to baseline. The removed load did not change APAs, while the step parameters were initially altered and then returned to baseline. Results show gymnasts' ability to modify their APAs over repeated trials to adapt to an external load, enabling them to initiate accurate forward steps. Training exercises should target handstand walking preparatory mechanisms for a smooth transition between handstand and stepping.

Dynamical complexity of postural control system in autism spectrum disorder: a feasibility study of linear and non-linear measures in posturographic analysis of upright posture

BACKGROUND

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, characterized by impairments in social interaction and communication with restricted and repetitive behavior. Postural and motor disturbances occur more often in ASD, in comparison to typically developing subjects, affecting the quality of life. Linear and non-linear indexes derived from the trajectory of the center of pressure (COP) while subjects stand on force platforms are commonly used to assess postural stability. The aim of the present feasibility study was to investigate whether combining linear and non-linear parameters of the COP during stance in subjects with ASD, could provide insight on specific features of motor dysfunction possibly linked to ASD cognition and clinical characteristics.

METHODS

Twenty-two males, aged 10-15 years, including subjects with ASD and healthy controls (N = 11, respectively), were studied. They all had normal cognitive level and independent walking ability. A piezoelectric force platform was used to evaluate posture over three feet positions, with eyes open, closed and during visually-guided saccades. Linear (sway path, total area and root mean square) and non-linear parameters (fractal dimension and sample entropy) of the COP were measured to determine postural stability and the complexity and regularity of the COP signals. GLMM analyses were performed to assess COP parameter changes across experimental conditions and subject groups. Finally, Spearman correlations evaluated the significance of potential relationships between linear and non-linear measures as well as between non-linear parameters and clinical data in patients with ASD.

RESULTS

Compared to controls, subjects with ASD showed reduced postural stability and complexity, with higher regularity of COP trajectories, particularly in the most unstable feet positions, during visually-guided saccades and in the medial-lateral direction. Spearman correlations indicated that, in the patients' group, postural instability was associated with a decrease in the geometric complexity and an increase in the regularity of the COP trajectory. Moreover, the increase in regularity of the COP trajectory was associated to the severity of restricted and repetitive behavior.

CONCLUSIONS

The results of this study highlight the importance of combining linear and non-linear measures in evaluating postural control in patients with ASD, also with respect to the outcome of interventions on these patients targeting postural balance.

Analysis of anticipatory and compensatory postural adjustment in women of different age groups using surface electromyography

Postural balance is crucial for daily activities, relying on the coordination of sensory systems. Balance impairment, common in the elderly, is a leading cause of mortality in this population. To analyze balance, methods like postural adjustment analysis using electromyography (EMG) have been developed. With age, women tend to experience reduced mobility and greater muscle loss compared to men. However, few studies have focused on postural adjustments in women of different ages using EMG of the lower limbs during laterolateral and anteroposterior movements. This gap could reveal a decrease in muscle activation time with aging, as activation time is vital for postural adjustments. This study aimed to analyze muscle activation times in women of different ages during postural adjustments. Thirty women were divided into two groups: young and older women. A controlled biaxial force platform was used for static and dynamic balance tests while recording lower limb muscle activity using EMG. Data analysis focused on identifying muscle activation points and analyzing postural adjustment times. Results showed significant differences in muscle activation times between the two groups across various muscles and platform tilt conditions. Younger women had longer muscle activation times than older women, particularly during laterolateral platform inclinations. In anteroposterior movements, older women exhibited longer activation times compared to their laterolateral performance, with fewer differences between the groups. Overall, older women had shorter muscle activation times than younger women, suggesting a potential indicator of imbalance and increased fall risk.

Age and initial position affect movement biomechanics in sit to walk transitions: Whole body balance and trunk control

Maintaining dynamic balance during transitional movements like sit-to-walk (STW) can be challenging for older adults. Age-related neuromuscular decline can alter movement in STW, such as rising with greater trunk flexion, narrowing the feet, or using arms to push off. Initial foot and arm position can affect subsequent movement biomechanics, with different ground reaction forces (GRFs) that stabilize and advance the body center of mass (COM). The purpose of this study was to quantify whole-body biomechanics and trunk control of STW transitions. Fifteen younger adults (18-35 years) and fifteen older adults (50-79 years) performed STW from four initial foot positions and two arm positions. Three-dimensional (3D) GRFs, 3D body COM displacement, and integrated electromyography values from the lumbar paraspinals and gluteus medius were evaluated. Younger adults generated greater mediolateral GRF ranges while rising, whereas older adults generated greater mediolateral GRF ranges when stepping forward suggesting different strategies to laterally control the body COM. Initial foot position affected the STW movement, with narrow foot positions having smaller body COM displacement than wide foot positions, associated with smaller medial GRFs to move the body COM toward the stance limb. Rising with arm support required less lumbar paraspinal excitation, which was further reduced when with a posteriorly offset foot. Gluteus medius activity was greater for older adults compared to younger adults in STW. Completing STW with arm support can reduce the muscle activity required to stabilize the torso when rising, which likely has implications for balance control and low back loading.

Time course of surface electromyography during walking of children with spastic cerebral palsy treated with botulinum toxin type A and its rehabilitation implications

BACKGROUND

The timing of the effects of botulinum toxin A on spastic muscles is not yet fully clarified. The goal of this study was to follow the temporal changes of surface electromyographic activity of lower limb muscles during walking, after a therapeutic dose of botulinum toxin A injected into the calf muscles of children with spastic cerebral palsy.

METHODS

A group of children with spastic equinus foot was administered botulinum toxin A into the gastrocnemius medialis and lateralis muscles. Surface electromyographic activity of the tibialis anterior, gastrocnemius medialis, rectus femoris and medial hamstrings, was recorded before botulinum toxin A injections and after 4, 8, and 16 weeks. Children walked on ground and on a treadmill at an incline of 0% and 12%. The area of electromyographic activity and the index of muscle co-contraction were calculated for specific segments of gait cycle.

FINDINGS

Botulinum toxin A did not modify the speed of gait on ground. ANOVA showed significant differences in electromyography during the stance phase segments with a maximum decrease between 4 and 8 weeks' post botulinum toxin A and a full recovery at 16 weeks. A significant co-contraction of rectus femoris/gastrocnemius medialis, between 0 and 20% and 35-50% of the gait cycle, was observed from the 4th to the 8th week post- botulinum toxin A for both treadmill settings.

INTERPRETATION

The temporal identification of deterioration/recovery of electromyographic activity as well as of muscle co-contractions, could be key elements in a rehabilitation program planning combined with botulinum toxin A.

"Posture first": Interaction between posture and locomotion in people with low back pain during unexpectedly cued modification of gait initiation motor command

The ability to adapt anticipatory postural adjustments (APAs) in response to perturbations during single-joint movements is altered in people with chronic low back pain (LBP), but a comprehensive analysis during functional motor tasks is still missing. This study aimed to compare APAs and stepping characteristics during gait initiation between people with LBP and healthy controls, both in normal (without cue occurrence) condition and when an unexpected visual cue required to switch the stepping limb. Fourteen individuals with LPB and 10 healthy controls performed gait initiation in normal and switch conditions. The postural responses were evaluated through the analysis of center of pressure, propulsive ground reaction forces, trunk and whole-body kinematics, and activation onsets of leg and back muscles. During normal gait initiation, participants with LBP exhibited similar APAs and stepping characteristics to healthy controls. In the switch condition, individuals with LBP were characterized by greater mediolateral postural stability but decreased forward body motion and propulsion before stepping. The thorax motion was associated with forward propulsion parameters in both task conditions in people with LBP but not healthy controls. No between-group differences were found in muscle activation onsets. The results suggest that postural stability is prioritized over forward locomotion in individuals with LBP. Furthermore, the condition-invariant coupling between thorax and whole-body forward propulsion in LBP suggests an adaptation in the functional use of the thorax within the postural strategy, even in poor balance conditions.

Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks

The objective of this systematic review is to identify motion analysis parameters measured during challenging walking tasks which can predict fall risk in the older population. Numerous studies have attempted to predict fall risk from the motion analysis of standing balance or steady walking. However, most falls do not occur during steady gait but occur due to challenging centre of mass displacements or environmental hazards resulting in slipping, tripping or falls on stairs. We conducted a systematic review of motion analysis parameters during stair climbing, perturbed walking and obstacle crossing, predictive of fall risk in healthy older adults. We searched the databases of Pubmed, Scopus and IEEEexplore.A total of 78 articles were included, of which 62 simply compared a group of younger to a group of older adults. Importantly, the differences found between younger and older adults did not match those found between older adults at higher and lower risk of falls. Two prospective and six retrospective fall history studies were included. The other eight studies compared two groups of older adults with higher or lower risk based on mental or physical performance, functional decline, unsteadiness complaints or task performance. A wide range of parameters were reported, including outcomes related to success, timing, foot and step, centre of mass, force plates, dynamic stability, joints and segments. Due to the large variety in parameter assessment methods, a meta-analysis was not possible. Despite the range of parameters assessed, only a few candidate prognostic factors could be identified: older adults with a retrospective fall history demonstrated a significant larger step length variability, larger step time variability, and prolonged anticipatory postural adjustments in obstacle crossing compared to older adults without a fall history. Older adults who fell during a tripping perturbation had a larger angular momentum than those who did not fall. Lastly, in an obstacle course, reduced gait flexibility (i.e., change in stepping pattern relative to unobstructed walking) was a prognostic factor for falling in daily life. We provided recommendations for future fall risk assessment in terms of study design.In conclusion, studies comparing older to younger adults cannot be used to explore relationships between fall risk and motion analysis parameters. Even when comparing two older adult populations, it is necessary to measure fall history to identify fall risk prognostic factors.

Identifying the Effects of Age and Speed on Whole-Body Gait Symmetry by Using a Single Wearable Sensor

Studies on gait symmetry in healthy population have mainly been focused on small range of age categories, neglecting Teenagers (13–18 years old) and Middle-Aged persons (51–60 years old). Moreover, age-related effects on gait symmetry were found only when the symmetry evaluation was based on whole-body acceleration than on spatiotemporal parameters of the gait cycle. Here, we provide a more comprehensive analysis of this issue, using a Symmetry Index (SI) based on whole-body acceleration recorded on individuals aged 6 to 84 years old. Participants wore a single inertial sensor placed on the lower back and walked for 10 m at comfortable, slow and fast speeds. The SI was computed using the coefficient of correlation of whole-body acceleration measured at right and left gait cycles. Young Adults (19–35 years old) and Adults (36–50 years old) showed stable SI over the three speed conditions, while Children (6–12 years old), Teenagers (13–18 years old), Middle-Aged persons and Elderly (61–70 and 71–84 years old) exhibited lower SI values when walking at fast speed. Overall, this study confirms that whole-body gait symmetry is lower in Children and in Elderly persons over 60 years of age, showing, for the first time, that asymmetries appear also during teenage period and in Middle-Aged persons (51–60 years old).

How Does Lower Limb Respond to Unexpected Balance Perturbations? New Insights from Synchronized Human Kinetics, Kinematics, Muscle Electromyography (EMG) and Mechanomyography (MMG) Data

Making rapid and proper compensatory postural adjustments is vital to prevent falls and fall-related injuries. This study aimed to investigate how, especially how rapidly, the multiple lower-limb muscles and joints would respond to the unexpected standing balance perturbations. Unexpected waist-pull perturbations with small, medium and large magnitudes were delivered to twelve healthy young adults from the anterior, posterior, medial and lateral directions. Electromyographical (EMG) and mechanomyographical (MMG) responses of eight dominant-leg muscles (i.e., hip abductor/adductors, hip flexor/extensor, knee flexor/extensor, and ankle dorsiflexor/plantarflexors) together with the lower-limb joint angle, moment, and power data were recorded. The onset latencies, time to peak, peak values, and/or rate of change of these signals were analyzed. Statistical analysis revealed that: (1) agonist muscles resisting the delivered perturbation had faster activation than the antagonist muscles; (2) ankle muscles showed the largest rate of activation among eight muscles following both anteroposterior and mediolateral perturbations; (3) lower-limb joint moments that complied with the perturbation had faster increase; and (4) larger perturbation magnitude tended to evoke a faster response in muscle activities, but not necessarily in joint kinetics/kinematics. These findings provided insights regarding the underlying mechanism and lower-limb muscle activities to maintain reactive standing balance in healthy young adults.

Use of a Single Wearable Sensor to Evaluate the Effects of Gait and Pelvis Asymmetries on the Components of the Timed Up and Go Test, in Persons with Unilateral Lower Limb Amputation

The Timed Up and Go (TUG) test quantifies physical mobility by measuring the total performance time. In this study, we quantified the single TUG subcomponents and, for the first time, explored the effects of gait cycle and pelvis asymmetries on them. Transfemoral (TF) and transtibial (TT) amputees were compared with a control group. A single wearable inertial sensor, applied to the back, captured kinematic data from the body and pelvis during the 10-m walk test and the TUG test. From these data, two categories of symmetry indexes (SI) were computed: One SI captured the differences between the antero-posterior accelerations of the two sides during the gait cycle, while another set of SI quantified the symmetry over the three-dimensional pelvis motions. Moreover, the total time of the TUG test, the time of each subcomponent, and the velocity of the turning subcomponents were measured. Only the TF amputees showed significant reductions in each SI category when compared to the controls. During the TUG test, the TF group showed a longer duration and velocity reduction mainly over the turning subtasks. However, for all the amputees there were significant correlations between the level of asymmetries and the velocity during the turning tasks. Overall, gait cycle and pelvis asymmetries had a specific detrimental effect on the turning performance instead of on linear walking.

Age-Related Changes of the Anticipatory Postural Adjustments During Gait Initiation Preceded by Vibration of Lower Leg Muscles

Gait initiation (GI) challenges the balance control system, especially in the elderly. To date, however, there is no consensus about the age effect on the anticipatory postural adjustments (APAs). There is also a lack of research on APAs in older adults after proprioceptive perturbation in the sagittal plane. This study aimed to compare the ability of young and older participants to generate APAs in response to the vibratory-induced perturbation delivered immediately before GI. Twenty-two young and 22 older adults performed a series of GI trials: (1) without previous vibration; (2) preceded by the vibration of triceps surae muscles; and (3) preceded by the vibration of tibialis anterior muscles. The APAs magnitude, velocity, time-to-peak, and duration were extracted from the center of pressure displacement in the sagittal plane. Young participants significantly modified their APAs during GI, whereas older adults did not markedly change their APAs when the body vertical was shifted neither backward nor forward. Significant age-related declines in APAs were observed also regardless of the altered proprioception.The results show that young adults actively responded to the altered proprioception from lower leg muscles and sensitively scaled APAs according to the actual position of the body verticality. Contrary, older adults were unable to adjust their postural responses indicating that the challenging transition from standing to walking probably requires higher reliance on the visual input. The understanding of age-related differences in APAs may help to design training programs for the elderly specifically targeted to improve balance control in different sensory conditions, particularly during gait initiation.

The role of predictability of the magnitude of a perturbation in control of vertical posture when catching an object

The predictability of perturbation magnitude plays an important role in control of standing posture. The aim of the study was to examine anticipatory (APAs) and compensatory (CPAs) postural adjustments in response to catching objects of uncertain mass. Twenty adults caught the same object with either light or heavy weight placed in it. Electromyographic activity of eight trunk and leg muscles, displacements of the center of pressure, and angular displacement of the shoulder joint were recorded and analyzed during the APAs and CPAs intervals. When the subjects experienced repeated catching of the object with the same weight, they estimated the object mass beforehand and generated APAs more precisely. When the object mass changed unpredictably, they generated APAs based on the most recent catch and needed four to six trials to optimize APAs and CPAs. The muscle co-contraction was a primary pattern for catching the object of uncertain mass. The results of the study suggest that catching the object of uncertain mass is a challenging task that involves co-contraction of postural muscles to maintain balance.

Impact of chronic obstructive pulmonary disease on passive viscoelastic components of the musculoarticular system

Chronic obstructive pulmonary disease (COPD) produces skeletal muscle atrophy and weakness, leading to impairments of exercise performance. The mechanical work needed for movement execution is also provided by the passive tension developed by musculoarticular connective tissue. To verify whether COPD affects this component, the passive viscoelastic properties of the knee joint were evaluated in 11 patients with COPD and in 11 healthy individuals. The levels of stiffness and viscosity were assessed by means of the pendulum test, consisting in a series of passive leg oscillations. In addition, to explore the contribution of passive tension in the mechanical output of a simple motor task, voluntary leg flexion-extension movements were performed. Patients with COPD showed a statistically significant reduction in stiffness and viscosity compared to controls. Voluntary execution of flexion-extension movements revealed that the electromyographic activity of the Rectus Femoris and Biceps Femoris was lower in patients than in controls, and the low viscoelastic tension in the patients conditioned the performance of active movements. These results provide novel insights on the mechanism responsible for the movement impairments associated with COPD.