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Smith RE, Shelton AD, Sawicki GS, Franz JR. The effects of plantarflexor weakness and reduced tendon stiffness with aging on gait stability. PLoS One 2024; 19:e0302021. [PMID: 38625839 PMCID: PMC11020829 DOI: 10.1371/journal.pone.0302021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/26/2024] [Indexed: 04/18/2024] Open
Abstract
Falls among older adults are a costly public health concern. Such falls can be precipitated by balance disturbances, after which a recovery strategy requiring rapid, high force outputs is necessary. Sarcopenia among older adults likely diminishes their ability to produce the forces necessary to arrest gait instability. Age-related changes to tendon stiffness may also delay muscle stretch and afferent feedback and decrease force transmission, worsening fall outcomes. However, the association between muscle strength, tendon stiffness, and gait instability is not well established. Given the ankle's proximity to the onset of many walking balance disturbances, we examined the relation between both plantarflexor strength and Achilles tendon stiffness with walking-related instability during perturbed gait in older and younger adults-the latter quantified herein using margins of stability and whole-body angular momentum including the application of treadmill-induced slip perturbations. Older and younger adults did not differ in plantarflexor strength, but Achilles tendon stiffness was lower in older adults. Among older adults, plantarflexor weakness associated with greater whole-body angular momentum following treadmill-induced slip perturbations. Weaker older adults also appeared to walk and recover from treadmill-induced slip perturbations with more caution. This study highlights the role of plantarflexor strength and Achilles tendon stiffness in regulating lateral gait stability in older adults, which may be targets for training protocols seeking to minimize fall risk and injury severity.
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Affiliation(s)
- Ross E. Smith
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, North Carolina, United States of America
| | - Andrew D. Shelton
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, North Carolina, United States of America
| | - Gregory S. Sawicki
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Jason R. Franz
- Joint Dept. of Biomedical Engineering, UNC Chapel Hill and NC State University, Chapel Hill, North Carolina, United States of America
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Rasmussen CM, Mun S, Ouattas A, Walski A, Curtze C, Hunt NH. Curvilinear walking elevates fall risk and modulates slip and compensatory step attributes after unconstrained human slips. J Exp Biol 2024; 227:jeb246700. [PMID: 38456285 PMCID: PMC11006391 DOI: 10.1242/jeb.246700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
While much attention has been paid to understanding slip-related falls in humans, little has been focused on curvilinear paths despite their prevalence, distinct biomechanical demands and increased slipping threat. We determined the mechanics, compensatory stepping reactions and fall risk associated with slips during fixed-speed walking across ranges of path curvature, slipped foot and slip onset phase contexts possible in the community, which builds upon previous work by examining speed-independent effects of curvilinear walking. Twenty-one participants experienced 15 unconstrained slips induced by a wearable friction-reducing device as motion capture and harness load cell data were recorded. Falls were most likely after early stance slips to the inside foot and increased at tighter curvatures. Slip distance and peak velocity decreased as slips began later in stance phase, did not differ between feet, and accelerated on tighter paths. Slipping foot directions relative to heading transitioned from anterior (forward) to posterior (backward) as slips began later in stance, were ipsilateral (toward the slipping foot side) and contralateral (toward the opposite side) for the outside and inside foot, respectively, and became increasingly ipsilateral/contralateral on tighter curvatures. Compensatory steps were placed anteriorly and ipsilaterally after outside and inside foot slips, respectively, and lengthened at later onset phases for outside foot slips only. Our findings illustrate slip magnitude and fall risk relationships that suggest slip direction may influence the balance threat posed by a slip, imply that walking speed may modify slip likelihood, and indicate the most destabilizing curved walking contexts to target in future perturbation-based balance training approaches.
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Affiliation(s)
- Corbin M. Rasmussen
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Seongwoo Mun
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Abderrahman Ouattas
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Interdisciplinary Consortium on Advanced Motion Performance, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Andrew Walski
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Carolin Curtze
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Nathaniel H. Hunt
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
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Monaghan AS, Hooyman A, Dibble LE, Mehta SH, Peterson DS. Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease. J Neurol Phys Ther 2024:01253086-990000000-00061. [PMID: 38489661 DOI: 10.1097/npt.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND AND PURPOSE Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task. METHODS Twenty-five PwPD (70.52 years ± 7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps. RESULTS After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline (P < 0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months. DISCUSSION AND CONCLUSIONS These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465).
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Affiliation(s)
- Andrew S Monaghan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia (A.S.M.); School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona (A.H.); Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah (L.E.D.); Department of Neurology, Mayo Clinic, Scottsdale, Arizona (S.H.M.); College of Health Solutions, Arizona State University, Tempe, Arizona (D.S.P.); and Phoenix VA Health Care Center, Phoenix, Arizona (D.S.P.)
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Shelton AD, McTaggart EM, Allen JL, Mercer VS, Crenshaw JR, Franz JR. Does the effect of walking balance perturbations generalize across contexts? Hum Mov Sci 2024; 93:103158. [PMID: 38029635 PMCID: PMC10925841 DOI: 10.1016/j.humov.2023.103158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/15/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
Balance perturbations are used to study locomotor instability. However, these perturbations are designed to provoke a specific context of instability that may or may not generalize to a broader understanding of falls risk. The purpose of this study was to determine if the effect of balance perturbations on instability generalizes across contexts. 29 younger adults and 28 older adults completed four experimental trials, including unperturbed walking and walking while responding to three perturbation contexts: mediolateral optical flow, treadmill-induced slips, and lateral waist-pulls. We quantified the effect of perturbations as an absolute change in margin of stability from unperturbed walking. We found significant changes in mediolateral and anteroposterior margin of stability for all perturbations compared to unperturbed walking in both cohorts (p-values ≤ 0.042). In older adults, the mediolateral effects of lateral waist-pulls significantly correlated with those of optical flow perturbations and treadmill-induced slips (r ≥ 0.398, p-values ≤ 0.036). In younger adults but not in older adults, we found positive and significant correlations between the anteroposterior effect of waist-pull perturbations and optical flow perturbations, and the anteroposterior and mediolateral effect of treadmill-induced slips (r ≥ 0.428, p-values ≤ 0.021). We found no "goldilocks" perturbation paradigm to endorse that would support universal interpretations about locomotor instability. Building the most accurate patient profiles of instability likely requires a series of perturbation paradigms designed to emulate the variety of environmental contexts in which falls may occur.
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Affiliation(s)
- Andrew D Shelton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill & North Carolina State University, Chapel Hill, NC, USA
| | - Ellora M McTaggart
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill & North Carolina State University, Chapel Hill, NC, USA
| | - Jessica L Allen
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | - Vicki S Mercer
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeremy R Crenshaw
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill & North Carolina State University, Chapel Hill, NC, USA.
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Rieger MM, Papegaaij S, Steenbrink F, van Dieën JH, Pijnappels M. Effects of Perturbation-Based Treadmill Training on Balance Performance, Daily Life Gait, and Falls in Older Adults: REACT Randomized Controlled Trial. Phys Ther 2024; 104:pzad136. [PMID: 37805994 PMCID: PMC10802992 DOI: 10.1093/ptj/pzad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/01/2023] [Accepted: 08/04/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of perturbation-based treadmill training on gait quality in daily life, a predictor of fall risk that was used as the primary outcome. An additional aim was to evaluate the effects on secondary outcomes, including balance, gait performance, self-efficacy, daily life physical activity, and falls. METHODS Seventy community-dwelling older adults (mean age = 74.73 [SD = 5.69] years; 46 women) at risk of falling were randomized and received 4 weeks of dual-task treadmill training, either with or without treadmill perturbations. Balance, gait performance, self-efficacy, and daily life trunk accelerometry at baseline, after intervention, and at a 6-month follow-up were assessed and compared within group over time and between groups for each time point, and their change rates between groups over time were also assessed. RESULTS Both groups improved in their balance, gait performance, and self-efficacy; the experimental group showed a significantly larger decrease in concern of falling and an increase in physical performance than the controls. These training effects did not translate into significant improvements in daily life gait quality or physical activity. However, the number of daily life falls and the percentage of fallers decreased significantly more in the experimental group. CONCLUSION A 4-week perturbation-based dual-task treadmill training program can improve self-efficacy, balance, and gait performance in a controlled setting and reduce daily life falls, although not through changes in quantity or quality of daily life gait. IMPACT Perturbation-based treadmill training is a safe and efficient way to train older adults' balance recovery and gait performance, increase self-efficacy, and prevent falls.
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Affiliation(s)
- Markus M Rieger
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Motek Medical B.V., Houten, Amsterdam, The Netherlands
| | | | | | - Jaap H van Dieën
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Dieffenderfer J, Brewer A, Noonan MA, Smith M, Eichenlaub E, Haley KL, Jacks A, Lobaton E, Neupert SD, Hess TM, Franz JR, Ghosh SK, Misra V, Bozkurt A. A Wearable System for Continuous Monitoring and Assessment of Speech, Gait, and Cognitive Decline for Early Diagnosis of ADRD. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38082824 DOI: 10.1109/embc40787.2023.10339986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Early detection of cognitive decline is essential to study mild cognitive impairment and Alzheimer's Disease in order to develop targeted interventions and prevent or stop the progression of dementia. This requires continuous and longitudinal assessment and tracking of the related physiological and behavioral changes during daily life. In this paper, we present a low cost and low power wearable system custom designed to track the trends in speech, gait, and cognitive stress while also considering the important human factor needs such as privacy and compliance. In the form factors of a wristband and waist-patch, this multimodal, multi-sensor system measures inertial signals, sound, heart rate, electrodermal activity and pulse transit time. A total power consumption of 2.6 mW without any duty cycling allows for more than 3 weeks of run time between charges when 1500 mAh batteries are used.Clinical Relevance- Much earlier detection of Alzheimer's disease and related dementias may be possible by continuous monitoring of physiological and behavioral state using application specific wearable sensors during the activities of daily life.
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Eichenlaub EK, Urrego DD, Sapovadia S, Allen J, Mercer VS, Crenshaw JR, Franz JR. Susceptibility to walking balance perturbations in young adults is largely unaffected by anticipation. Hum Mov Sci 2023; 89:103070. [PMID: 36878025 PMCID: PMC10238661 DOI: 10.1016/j.humov.2023.103070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/30/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
Despite progress in understanding the mechanisms governing walking balance control, the number of falls in our older adult population is projected to increase. Falls prevention systems and strategies may benefit from understanding how anticipation of a balance perturbation affects the planning and execution of biomechanical responses to mitigate instability. However, the extent to which anticipation affects the proactive and reactive adjustments to perturbations has yet to be fully investigated, even in young adults. Our purpose was to investigate the effects of anticipation on susceptibility to two different mechanical balance perturbations - namely, treadmill-induced perturbations and impulsive waist-pull perturbations. Twenty young adults (mean ± standard deviation age: 22.8 ± 3.3 years) walked on a treadmill without perturbations and while responding to treadmill belt (200 ms, 6 m/s2) and waist-pull (100 ms, 6% body weight) perturbations delivered in the anterior and posterior directions. We used 3D motion capture to calculate susceptibility to perturbations during the perturbed and preceding strides via whole-body angular momentum (WBAM) and anterior-posterior margin of stability (MoSAP). Contrary to our hypotheses, anticipation did not affect young adults' susceptibility to walking balance challenges. Conversely, perturbation direction significantly affected walking instability. We also found that susceptibility to different perturbation contexts is dependent on the outcome measure chosen. We suggest that the absence of an effect of anticipation on susceptibility to walking balance perturbations in healthy young adults is a consequence of their having high confidence in their reactive balance integrity. These data provide a pivotal benchmark for the future identification of how anticipation of a balance challenge affects proactive and reactive balance control in populations at risk of falls.
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Affiliation(s)
- Emily K Eichenlaub
- Joint Department of Biomedical Engineering, University of North Carolina Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | | | | | - Jessica Allen
- Dept. of Mechanical and Aerospace Engineering, University of Florida, USA
| | - Vicki S Mercer
- Division of Physical Therapy, University of North Carolina Chapel Hill, USA
| | - Jeremy R Crenshaw
- Dept. of Kinesiology and Applied Physiology, University of Delaware, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina Chapel Hill and North Carolina State University, Chapel Hill, NC, USA.
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Siragy T, Russo Y, Young W, Lamb SE. Comparison of over-ground and treadmill perturbations for simulation of real-world slips and trips: A systematic review. Gait Posture 2023; 100:201-209. [PMID: 36603326 DOI: 10.1016/j.gaitpost.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/01/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Trips and slips increase fall risk for young and older adults. To examine recovery responses, studies utilized treadmill and/or over-ground methods to simulate real-world perturbations. However, differences in the recovery response between treadmill and over-ground perturbations remain unexamined. RESEARCH QUESTION To assess the current literature on the reactive recovery responses between over-ground- and split-belt treadmill trips and slips as well as the effect of aging on these responses. METHODS PubMed, Medline, Web of Science, SCOPUS, and Cochrane databases were searched for publications examining trips and slips in healthy young, healthy older adults, and older adults who fall. Included articles were in English, full-text accessible, and biomechanically quantified the reactive recovery responses for slips and trips during either over-ground or split-belt treadmill protocols. The initial database search yielded 1075 articles and 31 articles were included after title, abstract, and full-text screening. RESULTS For slips, 7 articles utilized lubricated surfaces while 5 articles used treadmills. Further, 3 studies examined differences between older and younger adults. For trips, 9 articles utilized obstacles and 7 used treadmills. Further, 4 articles examined differences between older and young adults and 1 article only examined older adults during over-ground trips. For both perturbations, treadmill and over-ground protocols demonstrated similar anteroposterior destabilization on the center of mass. In the mediolateral direction, over-ground slips consistently found a lateral destabilization while treadmill articles did not examine this direction. Foot placement recovery responses varied less for both perturbation directions on a treadmill compared to over-ground. SIGNIFICANCE Although treadmill and over-ground perturbations destabilize the center of mass similarly, the recovery response to these perturbations were different on treadmills. Specifically, recovery responses were more consistent for both slips and trips on treadmills. As older adults have difficulty in perturbation recovery scaling, treadmills may be limited in their ability to investigate the variety of aging impairments on perturbation recovery responses.
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Affiliation(s)
- Tarique Siragy
- University of Exeter, Department of Public Health & Sport Sciences, Exeter, UK; St. Pölten University of Applied Sciences Center of Digital Health and Social Innovation, St. Pölten, Austria.
| | - Yuri Russo
- University of Exeter, Department of Public Health & Sport Sciences, Exeter, UK.
| | - Will Young
- University of Exeter, Department of Public Health & Sport Sciences, Exeter, UK.
| | - Sallie E Lamb
- University of Exeter, Department of Public Health & Sport Sciences, Exeter, UK.
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Shih HT, Gregor R, Lee SP. Description, reliability and utility of a ground-reaction-force triggered protocol for precise delivery of unilateral trip-like perturbations during gait. PLoS One 2023; 18:e0284384. [PMID: 37098086 PMCID: PMC10128926 DOI: 10.1371/journal.pone.0284384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/24/2023] [Indexed: 04/26/2023] Open
Abstract
Tripping is a common cause of falls and a focus of many biomechanical investigations. Concerns regarding the precision of delivery of simulated-fall protocols reside in the current biomechanical methodology literature. This study aimed to develop a treadmill-based protocol that generated unanticipated trip-like perturbations during walking with high timing precision. The protocol utilized a side-by-side split-belt instrumented treadmill. Programmed treadmill belt acceleration profiles (two levels of perturbation magnitude) were triggered unilaterally at the instant the tripped leg bore 20% of the body weight. Test-retest reliability of fall responses was examined in 10 participants. Utility was examined as to whether the protocol could differentiate the fall recovery responses and likelihood of falls, estimated using peak trunk flexion angle after perturbation, between young and middle-aged adults (n = 10 per group). Results showed that the perturbations could be precisely and consistently delivered during early stance phases (10-45 milliseconds after initial contact). The protocol elicited excellent reliability of responses in both perturbation magnitudes (ICC = 0.944 and 0.911). Middle-aged adults exhibited significantly greater peak trunk flexion than young adults (p = 0.035), indicating that the current protocol can be utilized in differentiating individuals with different levels of fall risks. The main limitation of the protocol is that perturbations are delivered in stance rather swing phase. This protocol addressed some issues discussed in previous "simulated fall" protocols and may be useful for future fall research and subsequent clinical interventions.
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Affiliation(s)
- Hui-Ting Shih
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
- Baylor Scott & White Research Institute, Dallas, Texas, United States of America
| | - Robert Gregor
- School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
| | - Szu-Ping Lee
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
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Ferreira RN, Ribeiro NF, Figueiredo J, Santos CP. Provoking Artificial Slips and Trips towards Perturbation-Based Balance Training: A Narrative Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:9254. [PMID: 36501958 PMCID: PMC9740792 DOI: 10.3390/s22239254] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/29/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Humans' balance recovery responses to gait perturbations are negatively impacted with ageing. Slip and trip events, the main causes preceding falls during walking, are likely to produce severe injuries in older adults. While traditional exercise-based interventions produce inconsistent results in reducing patients' fall rates, perturbation-based balance training (PBT) emerges as a promising task-specific solution towards fall prevention. PBT improves patients' reactive stability and fall-resisting skills through the delivery of unexpected balance perturbations. The adopted perturbation conditions play an important role towards PBT's effectiveness and the acquisition of meaningful sensor data for studying human biomechanical reactions to loss of balance (LOB) events. Hence, this narrative review aims to survey the different methods employed in the scientific literature to provoke artificial slips and trips in healthy adults during treadmill and overground walking. For each type of perturbation, a comprehensive analysis was conducted to identify trends regarding the most adopted perturbation methods, gait phase perturbed, gait speed, perturbed leg, and sensor systems used for data collection. The reliable application of artificial perturbations to mimic real-life LOB events may reduce the gap between laboratory and real-life falls and potentially lead to fall-rate reduction among the elderly community.
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Affiliation(s)
- Rafael N. Ferreira
- Center for MicroElectroMechanical Systems, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
- LABBELS—Associate Laboratory, 4800-058 Guimarães, Portugal
| | - Nuno Ferrete Ribeiro
- Center for MicroElectroMechanical Systems, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
- LABBELS—Associate Laboratory, 4800-058 Guimarães, Portugal
- MIT Portugal Program, School of Engineering, University of Minho, 4800-058 Guimarães, Portugal
| | - Joana Figueiredo
- Center for MicroElectroMechanical Systems, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
- LABBELS—Associate Laboratory, 4800-058 Guimarães, Portugal
| | - Cristina P. Santos
- Center for MicroElectroMechanical Systems, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS—Associate Laboratory, 4710-057 Braga, Portugal
- LABBELS—Associate Laboratory, 4800-058 Guimarães, Portugal
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Hu X, Li Y, Chen G, Zhao Z, Qu X. Identification of balance recovery patterns after slips using hierarchical cluster analysis. J Biomech 2022; 143:111281. [PMID: 36095914 DOI: 10.1016/j.jbiomech.2022.111281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 11/26/2022]
Abstract
Accidental falls often result from loss of balance initiated by slips. People may adopt different balance recovery patterns after slips which could affect recovery outcomes. The present study aimed to identify balance recovery patterns after slips and to determine whether these balance recovery patterns could be associated with different levels of slip-induced fall likelihood. Sixty young (age 24.2 ± 2.1 years) participants were involved in an experimental study. They were instructed to walk on a linear walkway, where unexpected slips were induced when stepping onto a removable vinyl tile sheet covered with water-detergent mixture. One hundred and fifty slip trials were obtained, including 85 successful balance recovery trials and 65 failed balance recovery trials (i.e., fall trials). Hierarchical cluster analysis was used to classify balance recovery patterns based on the kinematic measures of both feet over the period from 100 to 300 ms after heel contact of the slipping foot. Three balance recovery patterns were identified, and these balance recovery patterns were found to be associated with different levels of slip-induced fall likelihood. Findings from the present study can contribute to better understanding of balance recovery mechanisms associated with slips, and guide developing and evaluating fall prevention interventions.
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Affiliation(s)
- Xinyao Hu
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China
| | - Yuting Li
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China
| | - Gengshu Chen
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China
| | - Zhong Zhao
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China
| | - Xingda Qu
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, China.
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Ma CZH, Bao T, DiCesare CA, Harris I, Chambers A, Shull PB, Zheng YP, Cham R, Sienko KH. Reducing Slip Risk: A Feasibility Study of Gait Training with Semi-Real-Time Feedback of Foot-Floor Contact Angle. SENSORS (BASEL, SWITZERLAND) 2022; 22:3641. [PMID: 35632054 PMCID: PMC9144019 DOI: 10.3390/s22103641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
Slip-induced falls, responsible for approximately 40% of falls, can lead to severe injuries and in extreme cases, death. A large foot-floor contact angle (FFCA) during the heel-strike event has been associated with an increased risk of slip-induced falls. The goals of this feasibility study were to design and assess a method for detecting FFCA and providing cues to the user to generate a compensatory FFCA response during a future heel-strike event. The long-term goal of this research is to train gait in order to minimize the likelihood of a slip event due to a large FFCA. An inertial measurement unit (IMU) was used to estimate FFCA, and a speaker provided auditory semi-real-time feedback when the FFCA was outside of a 10-20 degree target range following a heel-strike event. In addition to training with the FFCA feedback during a 10-min treadmill training period, the healthy young participants completed pre- and post-training overground walking trials. Results showed that training with FFCA feedback increased FFCA events within the target range by 16% for "high-risk" walkers (i.e., participants that walked with more than 75% of their FFCAs outside the target range) both during feedback treadmill trials and post-training overground trials without feedback, supporting the feasibility of training FFCA using a semi-real-time FFCA feedback system.
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Affiliation(s)
- Christina Zong-Hao Ma
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Tian Bao
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - Christopher A. DiCesare
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - Isaac Harris
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
| | - April Chambers
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.C.); (R.C.)
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Peter B. Shull
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Rakie Cham
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA; (A.C.); (R.C.)
| | - Kathleen H. Sienko
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA; (C.Z.-H.M.); (T.B.); (C.A.D.); (I.H.)
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13
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Betelli MT, de Oliveira JÁ, Coelho DB, Teixeira LA. Judokas Show Increased Resilience to Unpredictable Stance Perturbations. Percept Mot Skills 2022; 129:513-527. [PMID: 35379021 DOI: 10.1177/00315125221087581] [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: 11/16/2022]
Abstract
Combat sports are characterized by frequent large-scale stance perturbations that may lead to falls. In the present investigation, we compared compensatory arm and leg movements in response to unpredictable stance perturbations between judokas and other athletes whose sports present reduced balance demand, relative to combat sports. Specifically, we tested judokas (n = 9), and a group of swimmers and runners (n = 11, controls) in sudden support base displacements in the mediolateral direction, generated by a movable electronic platform, in the following modes: (a) rotation, (b) translation, and (c) combined rotation-translation. The platform was displaced to either side, in three peak velocities (cm/second or o/second) of 20 (low), 30 (moderate), or 40 (high), resulting in 18 distinct perturbations. We evaluated postural responses with a scale for analyzing the stability of compensatory arm and leg movements (CALM). Results showed that, in the most challenging perturbations, judokas had higher stability scores (arm, leg, and global) than did the comparison group. Higher scores for judokas reflected their increased rate of motionless arm and leg responses and absence of near-falls, compared to 30% falls in the most challenging perturbations for the swimmers and runners. As a practical application, judo training may help achieve stable compensatory limb movements in a way that parallels the benefits obtained from perturbation-based balance training in laboratory settings.
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Affiliation(s)
- Marina T Betelli
- Human Motor Systems Laboratory, School of Physical Education and Sport, 156416University of São Paulo, São Paulo, Brazil
| | - Julia Á de Oliveira
- Human Motor Systems Laboratory, School of Physical Education and Sport, 156416University of São Paulo, São Paulo, Brazil
| | - Daniel B Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, 156416University of São Paulo, São Paulo, Brazil.,Center for Engineering, Modeling and Applied Social Sciences (CECS), 74362Federal University of ABC, São Paulo, Brazil
| | - Luis A Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, 156416University of São Paulo, São Paulo, Brazil
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14
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Li J, Huang HJ. Small directional treadmill perturbations induce differential gait stability adaptation. J Neurophysiol 2022; 127:38-55. [PMID: 34851745 PMCID: PMC8721900 DOI: 10.1152/jn.00091.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introducing unexpected perturbations to challenge gait stability is an effective
approach to investigate balance control strategies. Little is known about the
extent to which people can respond to small perturbations during walking. This
study aimed to determine how subjects adapted gait stability to multidirectional
perturbations with small magnitudes applied on a stride-by-stride basis. Ten
healthy young subjects walked on a treadmill that either briefly decelerated
belt speed (“stick”), accelerated belt speed
(“slip”), or shifted the platform medial-laterally at right leg
mid-stance. We quantified gait stability adaptation in both anterior-posterior
and medial-lateral directions using margin of stability and its components, base
of support, and extrapolated center of mass. Gait stability was disrupted upon
initially experiencing the small perturbations as margin of stability decreased
in the stick, slip, and medial shift perturbations and increased in the lateral
shift perturbation. Gait stability metrics were generally disrupted more for
perturbations in the coincident direction. Subjects employed both feedback and
feedforward strategies in response to the small perturbations, but mostly used
feedback strategies during adaptation. Subjects primarily used base of support
(foot placement) control in the lateral shift perturbation and extrapolated
center of mass control in the slip and medial shift perturbations. These
findings provide new knowledge about the extent of gait stability adaptation to
small magnitude perturbations applied on a stride-by-stride basis and reveal
potential new approaches for balance training interventions to target foot
placement and center of mass control. NEW & NOTEWORTHY Little is known about if and how humans can
adapt to small magnitude perturbations experienced on a stride-by-stride basis
during walking. Here, we show that even small perturbations disrupted gait
stability and that subjects could still adapt their reactive balance control.
Depending on the perturbation direction, subjects might prefer adjusting their
foot placement over their center of mass and vice versa. These findings could
help potentially tune balance training to target specific aspects of
balance.
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Affiliation(s)
- Jinfeng Li
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, Florida
| | - Helen J Huang
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, Florida.,Disability, Aging, and Technology (DAT) Cluster, University of Central Florida, Orlando, Florida.,Bionic Materials, Implants, and Interfaces (Biionix) Cluster, University of Central Florida, Orlando, Florida
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15
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McCrum C, Vaes AW, Delbressine JM, Koopman M, Liu WY, Willems P, Meijer K, Spruit MA. A pilot study on the feasibility and effectiveness of treadmill-based perturbations for assessing and improving walking stability in chronic obstructive pulmonary disease. Clin Biomech (Bristol, Avon) 2022; 91:105538. [PMID: 34823220 DOI: 10.1016/j.clinbiomech.2021.105538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Falls risk is elevated in chronic obstructive pulmonary disease (COPD). However, there is a lack of evidence regarding the contributing factors. Here, we examined the feasibility of, and initial responses to, large walking perturbations in COPD, as well as the adaptation potential of people with COPD to repeated walking perturbations that might indicate potential for perturbation-based balance training in COPD. METHODS 12 participants with COPD undergoing inpatient pulmonary rehabilitation and 12 age-gender-matched healthy control participants walked on an instrumented treadmill and experienced repeated treadmill-belt acceleration perturbations (leading to a forward balance loss). Three-dimensional motion capture was used to quantify the stability of participants body position during perturbed walking. Feasibility, stability following the initial perturbations and adaptation to repeated perturbations were assessed. FINDINGS Using perturbations in this manner was feasible in this population (no harness assists and participants completed the minimum number of perturbations). No clear, specific deficit in reactive walking stability in COPD was found (no significant effects of participant group on stability or recovery step outcomes). There were mixed results for the adaptability outcomes which overall indicated some adaptability to repeated perturbations, but not to the same extent as the healthy control participants. INTERPRETATION Treadmill-based perturbations during walking are feasible in COPD. COPD does not appear to result in significant deficits in stability following sudden perturbations and patients do demonstrate some adaptability to repeated perturbations. Perturbation-based balance training may be considered for fall prevention in research and practice in people with COPD.
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Affiliation(s)
- Christopher McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Anouk W Vaes
- Research and Development, CIRO, Horn, the Netherlands
| | | | - Maud Koopman
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Wai-Yan Liu
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands; Research and Development, CIRO, Horn, the Netherlands; Department of Orthopaedic Surgery, Máxima Medical Center, Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Paul Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Martijn A Spruit
- Research and Development, CIRO, Horn, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
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16
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Vigor of reactive postural responses is set from feedback and feedforward processes. Behav Brain Sci 2021; 44:e134. [PMID: 34588050 DOI: 10.1017/s0140525x21000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
I explore a distinct perspective from that brought in the book by arguing that in postural control our organism selects the vigor of reactive responses guided by an optimization rule considering first the required postural response for balance recovery as indicated by afferent information from a myriad of sensory receptors, and second the history of previous responses to similar perturbations.
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17
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Van Liew C, Monaghan AS, Dibble LE, Foreman KB, MacKinnon DP, Peterson DS. Perturbation practice in multiple sclerosis: Assessing generalization from support surface translations to tether-release tasks. Mult Scler Relat Disord 2021; 56:103218. [PMID: 34454306 DOI: 10.1016/j.msard.2021.103218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/14/2021] [Accepted: 08/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether improvements in protective stepping experienced after repeated support surface translations generalize to a different balance challenge in people with multiple sclerosis (PwMS) BACKGROUND: MS affects almost 1 million people in the United States and impairs balance and mobility. Perturbation practice can improve aspects of protective stepping in PwMS, but whether these improvements generalize is unknown. METHODS Fourteen PwMS completed two visits, 24hrs apart. The balance tasks included tether-release trials and support surface translations on a treadmill eliciting backward protective stepping. Margin of stability, step length, and step latency were calculated. Generalization was assessed via multilevel mediation models (MLMM) with bootstrapping to produce percentile and bias corrected confidence intervals RESULTS: There were no mediated effects for margin of stability or step latency; however, mediation was observed for step length, indicating that participants increased step length throughout the treadmill trials, and this generalized to tether-release trials DISCUSSION: MLMM may be useful for evaluating generalization of motor training to novel balance situations, particularly in small sample sizes. Using these analyses, we observed PwMS generalized improvements in step length, suggesting that aspects of protective step training may translate to improvements in other reactive balance tasks in PwMS.
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Affiliation(s)
- Charles Van Liew
- Arizona State University, College of Health Solutions, AZ, United States
| | - Andrew S Monaghan
- Arizona State University, College of Health Solutions, AZ, United States
| | | | - K Bo Foreman
- University of Utah, College of Health, UT, United States
| | - David P MacKinnon
- Arizona State University, Department of Psychology, AZ, United States
| | - Daniel S Peterson
- Arizona State University, College of Health Solutions, AZ, United States; Phoenix VA Veterans Affairs Medical Center, AZ, United States.
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18
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Rasmussen CM, Hunt NH. Unconstrained slip mechanics and stepping reactions depend on slip onset timing. J Biomech 2021; 125:110572. [PMID: 34186292 PMCID: PMC8355080 DOI: 10.1016/j.jbiomech.2021.110572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
Slips can occur at any time during stance. Accordingly, time-dependent tangential ground reaction forces likely produce a diverse range of slipping foot mechanics when traction is lost, thus requiring flexible recovery strategies to prevent falls. However, previous research has focused on slip onset in early stance, often with experimental anteroposterior constraints on the slipping foot, despite the diversity of environmental slips and falls. This study aimed to determine the effects of slip onset time on slip direction, severity (distance and velocity), and compensatory stepping responses. Ten young adults received slipping perturbations at different times during the stance phase of walking via a wearable device that reduces available friction while allowing the slipping foot to slide freely within the horizontal plane. Slip direction, distance, and peak velocity, compensatory step direction and distance, and upper body angular momentum magnitude and plane of rotation were derived from kinematic data. All outcome measurements significantly correlated with the time of slip onset. Slip direction and the plane of rotation of angular momentum deviated widely from the sagittal plane, exhibiting laterally-directed components exceeding those in the anteroposterior direction. As slip onset occurred later in stance, slip severity decreased while compensatory steps became longer and progressed from a posterior to anterior placement. These results provide insight into critical times within stance when slips are most severe, and into the diversity of slipping mechanics caused by changes in slip onset time.
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Affiliation(s)
- Corbin M Rasmussen
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA.
| | - Nathaniel H Hunt
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
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19
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Lee A, Bhatt T, Liu X, Wang Y, Wang S, Pai YCC. Can Treadmill Slip-Perturbation Training Reduce Longer-Term Fall Risk Upon Overground Slip Exposure? J Appl Biomech 2020; 36:298-306. [PMID: 32843581 PMCID: PMC8344091 DOI: 10.1123/jab.2019-0211] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 04/23/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022]
Abstract
The purpose was to examine and compare the longer-term generalization between 2 different practice dosages for a single-session treadmill slip-perturbation training when reexposed to an overground slip 6 months later. A total of 45 older adults were conveniently assigned to either 24 or 40 slip-like treadmill perturbation trials or a third control group. Overground slips were given immediately after initial training, and at 6 months after initial training in order to examine immediate and longer-term effects. The performance (center of mass stability and vertical limb support) and fall percentage from the laboratory-induced overground slips (at initial posttraining and at 6 mo) were measured and compared between groups. Both treadmill slip-perturbation groups showed immediate generalization at the initial posttraining test and longer-term generalization at the 6-month retest. The higher-practice-dosage group performed significantly better than the control group (P < .05), with no difference between the lower-practice-dosage and the control groups at the 6-month retest (P > .05). A single session of treadmill slip-perturbation training showed a positive effect for reducing older adults' fall risk for laboratory-induced overground slips. A higher-practice dosage of treadmill slip perturbations could be more beneficial for further reducing fall risk.
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Affiliation(s)
- Anna Lee
- University of Illinois at Chicago
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20
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Liu X, Bhatt T, Wang Y, Wang S, Lee A, Pai YC. The retention of fall-resisting behavior derived from treadmill slip-perturbation training in community-dwelling older adults. GeroScience 2020; 43:913-926. [PMID: 32978705 PMCID: PMC8110680 DOI: 10.1007/s11357-020-00270-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/14/2020] [Indexed: 01/10/2023] Open
Abstract
The purpose of this study was to determine whether and to what extent the immediate generalization of treadmill slip-perturbation training could be retained over 6 months to resist overground slip-induced falls. Four protocols (Tc: treadmill control; Tt: treadmill slip-perturbation training; Oc: overground control; Ot: overground slip-perturbation training) from two randomized controlled trials were compared in which two training protocols were executed with single-session repeated slip-perturbation training on the treadmill or overground context, while two control protocols were executed without repeated training. A total of 152 community-dwelling older adults (≥ 65 years) who were trained by one of the four protocols and tested by an overground slip in the initial session attended a retest session 6 months later. Falls were detected by a load cell. Data collected from motion analysis system and force plates were used to calculate stability. Tt group had no significant change in fall incidence from initial post-training test to retest. Tt group had significantly lower fall incidence (p < 0.05) and higher reactive stability (p < 0.05) than Tc group in retest. Tt group had significantly higher fall incidence (p < 0.05) and lower reactive stability (p < 0.01) than Ot group. The generalization of a single session of treadmill slip-perturbation training to overground slip resulted in inferior outcomes compared with overground slip-perturbation training (absolute retention), although the training generalization could be retained over 6 months (relative retention). Thus, treadmill slip-perturbation training could be more convenient to use if future dose-response studies indicate better or equal efficacy to overground slip-perturbation training.
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Affiliation(s)
- Xuan Liu
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, 07052, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W. Taylor Street, Fourth Floor, Chicago, IL, 60612, USA
| | - Yiru Wang
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W. Taylor Street, Fourth Floor, Chicago, IL, 60612, USA
- Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois, Chicago, IL, 60612, USA
| | - Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W. Taylor Street, Fourth Floor, Chicago, IL, 60612, USA
| | - Anna Lee
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W. Taylor Street, Fourth Floor, Chicago, IL, 60612, USA
- Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois, Chicago, IL, 60612, USA
| | - Yi-Chung Pai
- Department of Physical Therapy, University of Illinois at Chicago, 1919 W. Taylor Street, Fourth Floor, Chicago, IL, 60612, USA.
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21
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Anticipatory control of human gait following simulated slip exposure. Sci Rep 2020; 10:9599. [PMID: 32541837 PMCID: PMC7295774 DOI: 10.1038/s41598-020-66305-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/15/2020] [Indexed: 01/10/2023] Open
Abstract
A cautious gait (CG), marked by wider and shorter steps, is typically employed to mitigate expected perturbations proactively. However, it is not well understood if and how CG is informed by the task requirements. Therefore, we assessed how CG is adjusted to these requirements. Three groups of ten healthy young adults were exposed to a single uninterrupted protocol of treadmill walking that consisted of three distinct phases. Spatiotemporal step characteristics and margins of stability of the unperturbed strides were compared when participants were (i) only warned of a perturbation, (ii) exposed to fifty unilateral (right) slip-like perturbations and (iii) kept unaware of perturbation removal. Only the perturbation intensity predictability differed between groups. This was either kept consistent or pseudo-randomly or randomly varied. Participants walked with wider and shorter steps following the perturbation warning. However, this extinguished in continuing perturbation absence. Next, during perturbation exposure, participants shortened the step of the perturbed but increased the step of the unperturbed leg. This did not differ between groups. Finally, participants persisted in displaying CG on perturbation removal, but this extinguished over time. Collectively, we show that CG is functionally adjusted to the task requirements. These findings may have practical implications for fall-prevention training.
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22
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Wang Y, Wang S, Bolton R, Kaur T, Bhatt T. Effects of task-specific obstacle-induced trip-perturbation training: proactive and reactive adaptation to reduce fall-risk in community-dwelling older adults. Aging Clin Exp Res 2020; 32:893-905. [PMID: 31321743 DOI: 10.1007/s40520-019-01268-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/01/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Trips account for over half of outdoor falls among community-dwelling older adults. AIMS To investigate to what extent obstacle-induced trip-perturbation training could reduce fall-risk among older adults and to see whether training effects could be retained short term. METHODS Forty community-dwelling older adults were exposed to 24 repeated trip-perturbations given in a "blocked-and-mixed" manner during over-ground gait. Another trip was given 30 min post-training. For each trip, recovery strategies and outcomes (fall versus no fall) were analyzed. Within-trial changes to proactive and reactive dynamic center of mass stability, pre-trip toe clearance and trunk angle, trunk angle at recovery completion, and recovery step length were analyzed. RESULTS 48% of participants fell on their novel trip. The fall rate decreased significantly for subsequent trips, with no falls on the last trip. The decreased fall incidence resulted from improved feedforward and feedback adjustments for controlling center of mass stability and body kinematics. Proactive adaptations included reduced forward center of mass velocity, which lessened forward instability, and larger toe clearance, which increased the likelihood of obstacle avoidance. Reactive adjustments included reduced forward instability and improved trunk control (reduced forward rotation) at recovery step completion. Post-training, training effects were retained in terms of fall incidence, with slight decay in toe clearance and reactive stability. CONCLUSIONS Older adults demonstrated appropriate locomotor-based proactive and reactive adaptations to repeated obstacle-induced trips with short-term retention similar to young adults, and thus could reduce their fall-risk through such training.
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Affiliation(s)
- Yiru Wang
- Department of Physical Therapy, College of Applied Health and Sciences, University of Illinois at Chicago, 1919 West Taylor Street (M/C 898), Chicago, IL, 60612, USA
- PhD Program in Rehabilitation Sciences, College of Applied Health and Sciences, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Shuaijie Wang
- Department of Physical Therapy, College of Applied Health and Sciences, University of Illinois at Chicago, 1919 West Taylor Street (M/C 898), Chicago, IL, 60612, USA
| | - Ryan Bolton
- College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Tanjeev Kaur
- College of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health and Sciences, University of Illinois at Chicago, 1919 West Taylor Street (M/C 898), Chicago, IL, 60612, USA.
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Nouredanesh M, Gordt K, Schwenk M, Tung J. Automated Detection of Multidirectional Compensatory Balance Reactions: A Step Towards Tracking Naturally Occurring Near Falls. IEEE Trans Neural Syst Rehabil Eng 2019; 28:478-487. [PMID: 31794400 DOI: 10.1109/tnsre.2019.2956487] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Falls are the leading cause of fatal and non-fatal injuries among seniors with serious and costly consequences. Laboratory evidence supports the view that impaired ability to execute compensatory balance reactions (CBRs) or near-falls is linked to an increased risk of falling. Therefore, as an alternative to the commonly used fall risk assessment methods examining spatial-temporal parameters of gait, this study focuses on the development of machine learning-based models to detect multidirectional CBRs using wearable inertial measurement units (IMUs). Random forest models were developed based upon the data captured by five wearable IMUs to 1) detect CBRs during normal gait, and 2) identify the type of CBR (eight different classes). A perturbation treadmill (PT) was employed to systematically elicit CBRs (i.e. PT-CBRs) during walking in different directions (e.g slip-like, trip-like, and medio-lateral) and amplitudes (e.g., low-, high-amplitude). We hypothesized that these PT-CBRs could simulate naturally-occurring CBRs (N-CBRs). Proof-of-concept testing in 9 young, healthy adults demonstrated accuracies of 96.60% and 80.64% for the PT-CBR detection and type identification models, respectively. Performance of the detection model was tested against a published dataset (IMUFD) simulating N-CBRs, including the most common types observed in older adults in long-term care facilities, which achieved sensitivity of 100%, but poor specificity. Adding normal gait data from IMUFD for training improved specificity, indicating treadmill walking alone is insufficient exemplar data. Perturbation treadmill combined with overground walking data is a suitable paradigm to collect training datasets of involuntary CBR events. These findings suggest that accurate detection of naturally-occurring CBRs is feasible, and supports further investigation of implementing a wearable sensor system to track naturally-occurring CBRs as a novel means of fall risk assessment.
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24
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Rasmussen CM, Hunt NH. A novel wearable device to deliver unconstrained, unpredictable slip perturbations during gait. J Neuroeng Rehabil 2019; 16:118. [PMID: 31623680 PMCID: PMC6798496 DOI: 10.1186/s12984-019-0602-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/30/2019] [Indexed: 01/14/2023] Open
Abstract
Background Task-specific perturbation training is a widely studied means of fall prevention, utilizing techniques that induce slips or slip-like perturbations during gait. Though effective, these methods only simulate narrow ranges within the larger space of possible slipping conditions encountered in daily life. Here we describe and test a novel, wearable apparatus designed to address these limitations and simulate a diverse range of slipping disturbances. Methods The device consists of wireless triggering and detachable outsole components that provide adequate friction with the floor when secured to the wearer’s foot, but suddenly create a low-friction surface underfoot upon release. “Benchtop” tests were carried out to quantify device triggering characteristics (i.e. cutting temperature, release delay) and the resulting friction reduction. The device was also tested on six healthy young adults (3 female, age 23 ± 2.4 years), who walked with and without the device to observe how gait kinematics and spatiotemporal parameters were influenced, then performed 12 walking trials ending with a slip delivered by the device. Each participant also completed a survey to obtain opinions on device safety, device comfort, slip realism, and slip difficulty. A linear mixed effects analysis was employed to compare subject spatiotemporal parameters with and without the apparatus, as well as correlation coefficients and root mean square errors (RMSE) to assess the impact of the device on lower limb gait kinematics. Slip onset phases, distances, directions, velocities, and recovery step locations were also calculated. Results This device rapidly diminishes available friction from static coefficients of 0.48 to 0.07, albeit after a substantial delay (0.482 ± 0.181 s) between signal reception and outsole release. Strong correlations (R > 0.93) and small RMSE between gait kinematics with and without the device indicate minimal effects on natural gait patterns, however some spatiotemporal parameters were significantly impacted. A diverse range of slip perturbations and recovery steps were successfully elicited by the device. Conclusions Our results highlight the efficacy and utility of a wearable slipping device to deliver diverse slip conditions. Such an apparatus enables the study of unconstrained slips administered across the gait cycle, as well as during different locomotor behaviors like turning, negotiating slopes, and level changes.
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Affiliation(s)
- Corbin M Rasmussen
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE, 68182, USA.
| | - Nathaniel H Hunt
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE, 68182, USA
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25
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Treadmill-gait slip training in community-dwelling older adults: mechanisms of immediate adaptation for a progressive ascending-mixed-intensity protocol. Exp Brain Res 2019; 237:2305-2317. [PMID: 31286173 DOI: 10.1007/s00221-019-05582-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022]
Abstract
The study purpose was to investigate whether older adults could improve their stability against a backward loss of balance (BLOB) after receiving repeated treadmill slips during walking and to see how such adaptive changes would be affected by practice dosage (combination of slip intensity and the number of slips at each intensity). Twenty-five healthy community-dwelling older adults received forty treadmill slips given over eleven blocks at five intensities (P1-P1-P2-P3-P4-P5-P4-P5-P5-P3-P1, larger number indicating higher intensity). Center of mass (COM) stability was calculated as the shortest distance of the instantaneous COM position and velocity relative to the base of support (BOS) from a theoretical threshold for BLOB (larger stability value indicated a better stability against BLOB). Stability, step length, and trunk angle were measured before and after slip onset to reflect proactive and reactive control, respectively. The first slips at each intensity block (i.e., P1, P3, P4, and P5) were compared with the first slips in the last blocks at those intensities to examine main effects of training dosage (intensity and repetition). Improvements in proactive and reactive stability were more pronounced for receiving more slips at larger intensities than fewer slips at smaller intensities. Older adults only demonstrated partial positive scaling effects to proactively, not reactively, establish a more stable initial COM state. The improved proactive stability was associated with an anterior shift of COM position relative to the BOS, resulting from a shorter pre-slip step length. The improved reactive stability was associated with an anterior shift of COM position, resulting from a larger compensatory step length and a faster COM velocity relative to the BOS. Our findings indicated that treadmill-gait slip perturbations elicited similar proactive and reactive control to that from over-ground slip perturbations, but greater slip intensity and repetition might yield more immediate adaptive improvements.
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Pigman J, Reisman DS, Pohlig RT, Wright TR, Crenshaw JR. The development and feasibility of treadmill-induced fall recovery training applied to individuals with chronic stroke. BMC Neurol 2019; 19:102. [PMID: 31128598 PMCID: PMC6534930 DOI: 10.1186/s12883-019-1320-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 04/29/2019] [Indexed: 12/03/2022] Open
Abstract
Background Exercise has failed to reduce falls in those with chronic stroke. A limitation of traditional exercise is that the motor responses needed to prevent a fall are not elicited (i.e. they lack processing specificity). Balance reactions often require compensatory steps. Therefore, interventions that target such steps have the potential to reduce falls. Computerized treadmills can deliver precise, repeatable, and challenging perturbations as part of a training protocol. The objective of this study was to develop and determine the feasibility of such training applied to those with chronic stroke. We developed the training to address specificity, appropriate duration and repetition, and progressive overloading and individualization. We hypothesized that our intervention would be acceptable, practical, safe, and demonstrate initial signs of efficacy. Methods In this single-arm study, thirteen individuals with chronic stroke (29–77 years old, 2–15 years post stroke) performed up to six training sessions using a computer-controlled treadmill. Each session had separate progressions focused on initial steps with the non-paretic or paretic limbs in response to anterior or posterior falls. Perturbation magnitudes were altered based on performance and tolerance. Acceptability was determined by adherence, or the number of sessions completed. Practicality was documented by the equipment, space, time, and personnel. Adverse events were documented to reflect safety. In order to determine the potential-efficacy of this training, we compared the proportion of successful recoveries and the highest perturbation magnitude achieved on the first and last sessions. Results The training was acceptable, as evident by 12/13 participants completing all 6 sessions. The protocol was practical, requiring one administrator, the treadmill, and a harness. The protocol was safe, as evident by no serious or unanticipated adverse events. The protocol demonstrated promising signs of efficacy. From the first to last sessions, participants had a higher proportion of successful recoveries and progressed to larger disturbances. Conclusions Using a computerized treadmill, we developed an approach to fall-recovery training in individuals with chronic stroke that was specific, considered duration and repetition, and incorporated progressive overloading and individualization. We demonstrated that this training was acceptable, practical, safe, and potentially beneficial for high-functioning individuals with chronic stroke. Trial registration Retrospectively registered at clinicaltrials.gov (NCT03638089) August 20, 2018.
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Affiliation(s)
- Jamie Pigman
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE, USA
| | - Tamara R Wright
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Jeremy R Crenshaw
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
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Perturbation-evoked lateral steps in older adults: Why take two steps when one will do? Clin Biomech (Bristol, Avon) 2019; 63:41-47. [PMID: 30825811 PMCID: PMC6501204 DOI: 10.1016/j.clinbiomech.2019.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/28/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip fractures in older adults often result from a fall in the lateral direction. While younger adults tend to recover balance from a lateral perturbation with a single lateral sidestep, older adults are prone to multistep responses which are associated with an increased fall risk. This study compared the stepping characteristics and stability of single and multistep responses to lateral perturbation in healthy older adults. METHODS Eighty-four older adults received lateral waist-pull perturbations to either side. Spatio-temporal stepping characteristics and balance stability were quantified. FINDINGS Fewer steps were taken to recover balance when the first step was a lateral sidestep. The stability margin of single lateral sidesteps was greater than medial sidesteps and cross-over steps to the back but not significantly different from single cross-over steps to the front at step termination. Single step responses were more stable than multistep responses at step termination and at step initiation for lateral sidesteps and cross-over steps to the front. The decreased stability of multistep responses was attributed to an increased center of mass velocity and a smaller distance between the center of mass and base-of-support at step termination. INTERPRETATION Although lateral sidesteps result in fewer steps than cross-over steps to the front, the stability margin was not significantly different at step termination. These results suggest difficulty terminating center of mass motion and/or inefficient center of mass control differentiates single and multistep responses. Future studies should investigate perturbation training and/or hip abductor muscle conditioning as a means of improving compensatory stepping reactions.
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Crenshaw JR, Bernhardt KA, Fortune E, Kaufman KR. The accuracy of rapid treadmill-belt movements as a means to deliver standing postural perturbations. Med Eng Phys 2019; 64:93-99. [PMID: 30635193 DOI: 10.1016/j.medengphy.2018.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/24/2018] [Accepted: 12/31/2018] [Indexed: 11/18/2022]
Abstract
Treadmill-induced postural perturbations are a promising tool in assessing and reducing the risk of falls. We evaluated the accuracy with which two treadmills (Simbex ActiveStep® and an AMTI instrumented treadmill) achieved commanded displacements, peak velocities, and average initial accelerations. To do so, we included a range of perturbation magnitudes (20, 30, and 40 cm displacements) applied in unweighted and weighted (body mass = 46-84 kg) conditions. Across treadmills and perturbation magnitudes, absolute errors in displacement (< 0.5 cm) and peak velocity (< 4 cm/s) were small (relative error < 5%). Between-treadmill differences in displacement and peak velocity were marginal (< 3%), regardless of the perturbation magnitude and participant body mass. Observed accelerations were more than 5% smaller than commanded values. The front, but not back, AMTI belt demonstrated less acceleration accuracy than the ActiveStep® (≈ 5% difference). In summary, both treadmills demonstrated a reasonable, consistent level of accuracy in delivering postural perturbations.
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Affiliation(s)
- Jeremy R Crenshaw
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | | | - Emma Fortune
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Wang Y, Bhatt T, Liu X, Wang S, Lee A, Wang E, Pai YCC. Can treadmill-slip perturbation training reduce immediate risk of over-ground-slip induced fall among community-dwelling older adults? J Biomech 2018; 84:58-66. [PMID: 30616984 DOI: 10.1016/j.jbiomech.2018.12.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to determine any potential falls-resistance benefits that might arise from treadmill-slip-perturbation training. One hundred sixty-six healthy community-dwelling older adults were randomly assigned to either the treadmill-slip-training group (Tt) or the treadmill-control group (Tc). Tt received 40 slip-like perturbations during treadmill walking. Tc received unperturbed treadmill walking for 30 min. Following their treadmill session, both groups were exposed to a novel slip during over-ground walking. Their responses to this novel slip were also compared to previously collected data from participants who received either over-ground-slip training (Ot) with 24 slips or over-ground walking (Oc) with no training before experiencing their novel over-ground slip. Fall rates and both proactive (pre-slip) and reactive (post-slip) stability were assessed and compared for the novel over-ground slip in groups Tt, Tc, and Oc, as well as for the 24th slip in Ot. Results showed Tt had fewer falls than Tc (9.6% versus 43.8%, p < 0.001) but more falls than Ot (9.6% versus 0%, p < 0.001). Tt also had greater proactive and reactive stability than Tc (Tt > Tc, p < 0.01), however, Tt's stabilities were lower than those of Ot (p < 0.01). There was no difference in fall-rate or reactive stability between Tc and Oc, though treadmill walking did improve the proactive stability control of the latter. While the treadmill-slip-training protocol could immediately reduce the numbers of falls from a novel laboratory-reproduced slip, such improvements were far less than that from the motor adaptation to the over-ground-slip-training protocol.
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Affiliation(s)
- Yiru Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA; PhD Program in Rehabilitation Science, College of Applied Health and Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Xuan Liu
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, USA
| | - Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Anna Lee
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA; PhD Program in Rehabilitation Science, College of Applied Health and Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Edward Wang
- Department of Biomedical and Health Information Sciences, College of Applied Health and Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Yi-Chung Clive Pai
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA.
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Chien JE, Hsu WL. Effects of Dynamic Perturbation-Based Training on Balance Control of Community-Dwelling Older Adults. Sci Rep 2018; 8:17231. [PMID: 30467355 PMCID: PMC6250668 DOI: 10.1038/s41598-018-35644-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/18/2018] [Indexed: 11/09/2022] Open
Abstract
Walking is one of the daily activities that may cause falling in older adults. We developed a novel dynamic balance training program using a perturbation-based training on a custom-made treadmill, which can generate forward, backward, and lateral sway perturbations during walking. The purpose of this study was to investigate the changes in the balance performance of community-dwelling older adults after 8-weeks of perturbation-based balance training. A three-dimensional motion analysis system was used to collect kinematic and kinetic data. Seventeen community-dwelling older adults performed quiet standing with and without the balance perturbation. Biomechanical parameters such as center of pressure (COP) and center of mass (COM) were calculated. A paired t-test was used to compare the difference in balance performance before and after the training. After training, the results showed that the COM control of the older adults was significantly improved during quiet standing with perturbation, while the COP control during quiet standing without perturbation was not changed. The perturbation-based balance training exerted a positive effect on dynamic balance control in older adults. This translational research offers a new paradigm of balance training and can be applied to patient populations who have a high risk of falling.
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Affiliation(s)
- Jo-En Chien
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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Day KA, Leech KA, Roemmich RT, Bastian AJ. Accelerating locomotor savings in learning: compressing four training days to one. J Neurophysiol 2018. [PMID: 29537915 DOI: 10.1152/jn.00903.2017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Acquiring new movements requires the capacity of the nervous system to remember previously experienced motor patterns. The phenomenon of faster relearning after initial learning is termed "savings." Here we studied how savings of a novel walking pattern develops over several days of practice and how this process can be accelerated. We introduced participants to a split-belt treadmill adaptation paradigm for 30 min for 5 consecutive days. By training day 5, participants were able to produce near-perfect performance when switching between split and tied-belt environments. We found that this was due to their ability to shift specific elements of their stepping pattern to account for the split treadmill speeds from day to day. We also applied a state-space model to further characterize multiday locomotor savings. We then explored methods of achieving comparable savings with less total training time. We studied people training only on day 1, with either one extended split-belt exposure or alternating four times between split-belt and tied-belt conditions rapidly in succession. Both of these single-day training groups were tested again on day 5. Experiencing four abbreviated exposures on day 1 improved the performance on day 5 compared with one extended exposure on day 1. Moreover, this abbreviated group performed similarly to the group that trained for 4 consecutive days before testing on day 5, despite only having one-quarter of the total training time. These results demonstrate that we can leverage training structure to achieve a high degree of performance while minimizing training sessions. NEW & NOTEWORTHY Learning a new movement requires repetition. Here, we demonstrate how to more efficiently train an adapted walking pattern. By compressing split-belt treadmill training delivered over 4 days to four abbreviated bouts of training delivered on the first day of training, we were able to induce equivalent savings over a 5-day span. These results suggest that we can manipulate the delivery of training to most efficiently drive multiday learning of a novel walking pattern.
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Affiliation(s)
- Kevin A Day
- Center for Movement Studies, The Kennedy Krieger Institute , Baltimore, Maryland.,Department of Biomedical Engineering, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Kristan A Leech
- Center for Movement Studies, The Kennedy Krieger Institute , Baltimore, Maryland.,Department of Neuroscience, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Ryan T Roemmich
- Center for Movement Studies, The Kennedy Krieger Institute , Baltimore, Maryland.,Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Amy J Bastian
- Center for Movement Studies, The Kennedy Krieger Institute , Baltimore, Maryland.,Department of Neuroscience, The Johns Hopkins University School of Medicine , Baltimore, Maryland
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Epro G, Mierau A, McCrum C, Leyendecker M, Brüggemann GP, Karamanidis K. Retention of gait stability improvements over 1.5 years in older adults: effects of perturbation exposure and triceps surae neuromuscular exercise. J Neurophysiol 2018. [PMID: 29537914 DOI: 10.1152/jn.00513.2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The plantarflexors play a crucial role in recovery from sudden disturbances to gait. The objective of this study was to investigate whether medium (months)- or long(years)-term exercise-induced enhancement of triceps surae (TS) neuromuscular capacities affects older adults' ability to retain improvements in reactive gait stability during perturbed walking acquired from perturbation training sessions. Thirty-four adult women (65 ± 7 yr) were recruited to a perturbation training group ( n = 13) or a group that additionally completed 14 wk of TS neuromuscular exercise ( n = 21), 12 of whom continued with the exercise for 1.5 yr. The margin of stability (MoS) was analyzed at touchdown of the perturbed step and the first recovery step following eight separate unexpected trip perturbations during treadmill walking. TS muscle-tendon unit mechanical properties and motor skill performance were assessed with ultrasonography and dynamometry. Two perturbation training sessions (baseline and after 14 wk) caused an improvement in the reactive gait stability to the perturbations (increased MoS) in both groups. The perturbation training group retained the reactive gait stability improvements acquired over 14 wk and over 1.5 yr, with a minor decay over time. Despite the improvements in TS capacities in the additional exercise group, no benefits for the reactive gait stability following perturbations were identified. Therefore, older adults' neuromotor system shows rapid plasticity to repeated unexpected perturbations and an ability to retain these adaptations in reactive gait stability over a long time period, but an additional exercise-related enhancement of TS capacities seems not to further improve these effects. NEW & NOTEWORTHY Older adults' neuromotor system shows rapid plasticity to repeated exposure to unexpected perturbations to gait and an ability to retain the majority of these adaptations in reactive recovery responses over a prolonged time period of 1.5 yr. However, an additional exercise-related enhancement of TS neuromuscular capacities is not necessarily transferred to the recovery behavior during unexpected perturbations to gait in older adults.
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Affiliation(s)
- G Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University , United Kingdom.,Institute of Biomechanics and Orthopaedics, German Sport University Cologne , Cologne , Germany
| | - A Mierau
- Institute of Movement and Neurosciences, German Sport University Cologne , Cologne , Germany.,Department of Exercise and Sport Science, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
| | - C McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ , Maastricht , The Netherlands.,Institute of Movement and Sport Gerontology, German Sport University Cologne , Cologne , Germany
| | - M Leyendecker
- Institute of Movement and Neurosciences, German Sport University Cologne , Cologne , Germany
| | - G-P Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne , Cologne , Germany.,Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne , Cologne , Germany
| | - K Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University , United Kingdom
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Lee A, Bhatt T, Liu X, Wang Y, Pai YC. Can higher training practice dosage with treadmill slip-perturbation necessarily reduce risk of falls following overground slip? Gait Posture 2018; 61:387-392. [PMID: 29453101 PMCID: PMC8312761 DOI: 10.1016/j.gaitpost.2018.01.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Perturbation training is an emerging paradigm to reduce idiopathic falls (without clinical signs or symptoms) in older adults. While a higher threat dosage (intensity) in motor learning often directly relates to greater adaptation, retention, and generalization, little is known whether increasing the practice dosage (repetition) of slip-perturbation training would necessarily improve its outcomes. RESEARCH QUESTION Can higher practice dosage of treadmill slip-perturbation training lead to greater generalization to an overground slip immediately after the training? METHODS Forty-five community-dwelling older adults (73.5 ± 5.6 years old) participated in the present study. They were conveniently assigned to three groups with equivalent treadmill walking duration: treadmill slip-perturbation training group with 40 practice dosage, 24 practice dosage, and zero practice dosage (without slip-perturbation). Later on during overground walking, all of them were exposed to the same generalization test (a novel slip on a walkway). Their recovery outcomes (fall, or no fall; balance loss, or no balance loss) and center of mass stability were compared. RESULTS Higher practice dosage did not show significantly less incidence of fall, balance loss, or greater stability in comparison to lower practice dosage (p > .05). The present study showed that there was no evidence of dose-response relationship when the practice dosage was set above the 24 trials of practice dosage in treadmill slip-perturbation training. SIGNIFICANCE Contrary to our hypothesis, increased practice dosage (40-slips) in treadmill slip-perturbation training from the commonly used threshold (24-slips) did not necessarily benefit immediate generalization from treadmill to overground walking among community-dwelling older adults.
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Affiliation(s)
- Anna Lee
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States,PhD Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Xuan Liu
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Yiru Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States,PhD Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Yi-Chung Pai
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States,Corresponding author. +1-708-819-7788. (Y.-C. Pai)
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Fujimoto M, Bair WN, Rogers MW. Single and multiple step balance recovery responses can be different at first step lift-off following lateral waist-pull perturbations in older adults. J Biomech 2017; 55:41-47. [PMID: 28285746 DOI: 10.1016/j.jbiomech.2017.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/11/2017] [Accepted: 02/11/2017] [Indexed: 11/25/2022]
Abstract
An inability to recover lateral balance with a single step is predictive of future falls in older adults. This study investigated if balance stability at first step lift-off (FSLO) would be different between multiple and single stepping responses to lateral perturbations. 54 healthy older adults received left and right waist-pulls at 5 different intensities (levels 1-5). Crossover stepping responses at and above intensity level 3 that induced both single and multiple steps were analyzed. Whole-body center of mass (COM) and center of pressure (COP) positions in the medio-lateral direction with respect to the base of support were calculated. An inverted pendulum model was used to define the lateral stability boundary, which was also adjusted using the COP position at FSLO (functional boundary). No significant differences were detected in the COP positions between the responses at FSLO (p≥0.075), indicating no difference in the functional boundaries between the responses. Significantly smaller stability margins were observed at first step landing for multiple steps at all levels (p≤0.024), while stability margins were also significantly smaller at FSLO for level 3 and 4 (p≤0.048). These findings indicate that although reduced stability at first foot contact would be associated with taking additional steps, stepping responses could also be attributable to the COM motion state as early as first step lift-off, preceding foot contact. Perturbation-based training interventions aimed at improving the reactive control of stability would reduce initial balance instability at first step lift-off and possibly the consequent need for multiple steps in response to balance perturbations.
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Affiliation(s)
- Masahiro Fujimoto
- College of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan
| | - Woei-Nan Bair
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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