Occlusion of the lower visual field when wearing a facial mask does not compromise gait control when stepping into a hole in older adults

Visual exproprioception obtained from the lower visual field (LVF) is used to control locomotion on uneven terrain. Wearing a facial mask obstructs the LVF and can compromise gait control. Therefore, this study aimed to investigate the effect of occluding the LVF when wearing a facial mask on gait control while walking and stepping into a hole in older adults. Fifteen older adults walked along a wooden walkway under two different surface conditions (without and with a hole [60 cm wide and long, with a depth of 9.5 cm] and three visual conditions (control, mask, and basketball goggles with an occluded LVF). We found that occlusion of the LVF with masks or goggles did not affect the adaptations necessary to step into a hole. Neither behavioral (gait speed, margin of stability, foot landing position) nor neuromuscular (EMG activation and co-activation) parameters were affected by either visual manipulation. Older adults used a downward head pitch strategy to compensate for visual obstruction and plan the anticipatory adjustments to step into the hole. The absence of lower limb visual exproprioception due to wearing a mask did not affect locomotion control when stepping into a hole in older adults. Older adults compensated for the obstruction of the LVF through head downward tilt, which allowed them to obtain visual information about the hole two steps ahead to make anticipatory locomotor adjustments.     

Gaze direction affects walking speed when using a self-paced treadmill with a virtual reality environment

BackgroundIn a previous study it was observed that participants increase their walking speed during a dual task while walking on a self-paced treadmill in a virtual reality (VR) environment (Gait Real time Analysis Interactive Lab (GRAIL)). This observation is in contrast with the limited resources hypothesis, which suggests walking speed of healthy persons to decrease when performing a cognitive dual task.AimThe aim of the present study was therefore to determine whether the cognitive demand of the task, an aroused feeling, discrepancy in optic flow or a change in gaze direction caused participants to walk faster in this computer assisted rehabilitation environment.MaterialsThe GRAIL included a self-paced treadmill, a motion-capture system and synchronized VR environments.MethodsThirteen healthy young adults (mean age 21.6 ± 2.5) were included in this study. Participants walked on the self-paced treadmill while seven different intervention conditions (IC) were offered. Prior to each IC, a control condition (CC) was used to determine the natural self-selected walking speed. Walking speed during the last 30 s of each IC was compared with the walking speed during the last 30 s of the preceding CC.ResultsResults show that the height on which a visual task was presented in the VR environment, influenced walking speed. Participants walked faster when gaze was directed above the focus of expansion.SignificanceThese findings contribute to a further understanding of the differences between walking in a real life environment or computer assisted rehabilitation environment. When analyzing gait on a self-paced treadmill in the future, one must be attentive where to place a visual stimulus in the VR environment.     

Age-related differences in head and trunk coordination during walking

The purpose of this study was to examine the effect of ageing on the pattern and structure of head and trunk accelerations during walking. Head and trunk accelerations of young (n=8; mean=23 years, SD=4 years) and elderly (n=8; mean=74 years, SD=3 years) individuals were measured using triaxial accelerometers while performing preferred speed walking. Accelerations were examined using power-spectral analysis and measures of signal smoothness, regularity and coupling. No differences in walking speed or signal regularity were detected between age groups. Compared to the young participants, the elderly had (1) a greater proportion of signal power above 6 Hz for the trunk, (2) a smaller difference in signal smoothness between the trunk and head, (3) less signal smoothness in the mediolateral direction, and (4) a greater degree of directional coupling for the head compared to the trunk. Overall these results suggest that the pattern of head accelerations was relatively unaffected by age, and that both age groups achieved similar levels of head stability despite differences in trunk acceleration characteristics. The manner in which head stability was achieved differed between age groups, with the elderly employing an upper body coordination strategy that enhanced coupling between acceleration directions of the head compared to the trunk. The findings of this study also suggest that an absence of age-related differences in signal complexity at one level of postural system, combined with differences at another level, may provide information about the way in which the motor system prioritises postural control during gait.     

How is gait visually regulated when the head is travelling faster than the legs?

Gait regulation patterns were examined under various visual conditions in order to determine whether speed information provided by peripheral vision is taken into account in gait adjustments. Nine subjects walking toward a visual target on the ground were required to place one foot exactly on it. peripheral vision was either restricted to a 12 degrees angle or decorrelated, corresponding to a moving speed greater than the actual walking speed. Decorrelation was obtained by placing the subject on a treadmill moving in the walking direction. The results show, by comparison with the control condition, that the restriction of peripheral visual information did not affect the accuracy of the foot positioning, whereas decorrelated conditions affected it significantly: we noted that the gait regulation was triggered early on and showed a very stable pattern so that the distance to the target was consistently underestimated. This suggest that, although visual speed information is not indispensable in this kind of task, it is nevertheless taken into account in stride adjustments when the whole visual field is available. The results are discussed, in the context of a time-based approach to locomotor activity, in relation to the possible visual methods that might be used in obtaining information about time to contact the target.     

Effects of visual focus and gait speed on walking balance in the frontal plane

We investigated how head position and gait speed influenced frontal plane balance responses to external perturbations during gait. Thirteen healthy participants walked on a treadmill at three different gait speeds. Visual conditions included either focus downward on lower extremities and walking surface only or focus forward on a stationary scene with horizontal and vertical lines. The treadmill was positioned on a platform that was stationary (non-perturbed) or moving in a pattern that appeared random to the subjects (perturbed). In non-perturbed walking, medial–lateral upper body motion was very similar between visual conditions. However, in perturbed walking, there was significantly less body motion when focus was on the stationary visual scene, suggesting visual feedback of stationary vertical and horizontal cues are particularly important when balance is challenged. Sensitivity of body motion to perturbations was significantly decreased by increasing gait speed, suggesting that faster walking was less sensitive to frontal plane perturbations. Finally, our use of external perturbations supported the idea that certain differences in balance control mechanisms can only be detected in more challenging situations, which is an important consideration for approaches to investigating sensory contribution to balance during gait.     

Head flexion and different walking speeds do not affect gait stability in older females

Head flexion is destabilizing in older individuals during quiet stance, yet the effect head flexion has on gait is not known. The study examined whether head flexion and gait parameters were altered when walking freely and fixed to a visual target, at different walking speeds. 15 young (23 ± 4 years) and 16 older (76 ± 6 years) healthy females walked at three different walking speeds (slow, comfortable, and fast) under two visual conditions (natural and fixed [focusing on a visual target set at eye level]). Head flexion was assessed using 2D video analysis, whilst gait parameters (step length, double support time, step time, and gait stability ratio) were recorded during a 9 m flat walkway. A mixed design ANOVA was performed for each variable, with age as the between-subject factor and, visual condition and walking speed as within-subject factors. When walking freely, older displayed a greater need for head flexion between walking speeds (P < 0.05) when compared to young. Walking under fixed condition reduced head flexion at all walking speeds in the older (P < 0.05), but had no effect on the young (P > 0.05). Walking at different speeds showed no difference in head flexion when walking under either visual condition and had no effect on gait stability for both groups. Despite older displaying differences in head flexion between visual conditions, there was no effect on gait parameters. Walking speed presented trivial difference in head flexion in older females, whilst overall gait stability was unaffected by different walking speeds.     

Effects of peripheral eccentricity and head orientation on gaze discrimination

Visual search tasks support a special role for direct gaze in human cognition, while classic gaze judgement tasks suggest the congruency between head orientation and gaze direction plays a central role in gaze perception. Moreover, whether gaze direction can be accurately discriminated in the periphery using covert attention is unknown. In the present study, individual faces in frontal and in deviated head orientations with a direct or an averted gaze were flashed for 150 ms across the visual field; participants focused on a centred fixation while judging the gaze direction. Gaze discrimination speed and accuracy varied with head orientation and eccentricity. The limit of accurate gaze discrimination was less than ±6° eccentricity. Response times suggested a processing facilitation for direct gaze in fovea, irrespective of head orientation, however, by ±3° eccentricity, head orientation started biasing gaze judgements, and this bias increased with eccentricity. Results also suggested a special processing of frontal heads with direct gaze in central vision, rather than a general congruency effect between eye and head cues. Thus, while both head and eye cues contribute to gaze discrimination, their role differs with eccentricity.     

Gaze behaviour during walking in young adults with developmental coordination disorder

BackgroundIndividuals with Developmental Coordination Disorder (DCD) experience difficulty with motor coordination and this affects their daily functioning. Research indicated inferior visuospatial processing and oculomotor control in DCD. As visual information is essential for locomotor control, more insight in the gaze behaviour of this population during walking is required and crucial for gaze training interventions as a possible means to improve daily functioning of children and adults with DCD.AimThis study explored differences and similarities in gaze behaviour during walking between typically developing young adults and those with DCD.Methods and proceduresTen young adults with DCD (age: 22.13 ± 0.64) and ten typically developing individuals (age: 22.00 ± 1.05) completed a walking task in which they had to place their feet on irregularly placed targets wearing eye tracking glasses.Outcomes and resultsIndividuals with DCD walked slower and demonstrated a different gaze strategy compared to their neurotypical peers as they fixated almost each and every target sequentially. Typically developing individuals, on the other hand, directed gaze further along the path and often fixated areas around the targets.Conclusions and implicationsDespite adequate walking performance in daily situations in young adults with DCD, fundamental control deficits persist into adulthood.What this paper adds?This paper is the first to demonstrate differences in gaze behaviour between young adults with DCD and typically developing individuals in a task that resembles a task of daily living, as previous research focused on laboratory tasks. This is a valuable finding as DCD has a clear impact on the daily life. Furthermore, this study demonstrated that the fundamental control deficits of DCD persist into adulthood despite frequent performance and practice of these daily tasks. Lastly, these findings might contribute to the therapeutic potential of gaze training interventions to improve the daily functioning of children and adults with DCD.     

Altered visual and somatosensory feedback affects gait stability in persons with multiple sclerosis

Persons with multiple sclerosis (PwMS) often report problems due to sensory loss and have an inability to appropriately reweight sensory information. Both of these issues can affect individual’s ability to maintain stability when walking under challenging conditions. The purpose of the current study was to determine how gait stability is adapted when walking under challenging sensory conditions where vision and somatosensation at the feet is manipulated. 25 healthy adults and 40 PwMS (15 fallers, 25 non-fallers) walked on a treadmill at their preferred normal walking speed under 3 conditions: normal walking, altered vision using goggles that shifted visual field laterally, and altered somatosensation using shoes with compliant foam soles. Inertial measurement united recorded acceleration at the lumbar and right ankle, and acceleration variability measures were calculated including root mean square (RMS), range, sample entropy (SaEn), and Lyapunov exponents (LyE). A gait stability index (GSI) was calculated using each of the four variability measures as the ratio of lumbar acceleration variability divided by foot acceleration variability in the frontal and sagittal planes. The sagittal and frontal GSI_RMS were larger in the somatosensory condition compared to the normal and visual conditions (p < 0.001). The frontal GSI_SaEn was greater in the visual condition compared to the somatosensory condition (p = 0.021). The frontal and sagittal GSI_LyE was greater in the somatosensory condition compared to the normal and visual conditions (p < 0.002). The current study showed that HC, MS non-fallers and MS fallers largely adapted to altered sensory feedback during walking in a similar manner. However, MS faller subjects may be more reliant on visual feedback compared to MS non-fallers and HC subjects.     

The organization of exploratory behaviors in infant locomotor planning

How do infants plan and guide locomotion under challenging conditions? This experiment investigated the real‐time process of visual and haptic exploration in 14‐month‐old infants as they decided whether and how to walk over challenging terrain – a series of bridges varying in width. Infants’ direction of gaze was recorded with a head‐mounted eye tracker and their haptic exploration and locomotor actions were captured on video. Infants’ exploration was an organized, efficient sequence of visual, haptic, and locomotor behaviors. They used visual exploration from a distance as an initial assessment on nearly every bridge. Visual information subsequently prompted gait modifications while approaching narrow bridges and haptic exploration at the edge of the bridge. Results confirm predictions about the sequential, ramping‐up process of exploration and the distinct roles of vision and touch. Exploration, however, was not a guarantee of adaptive decisions. With walking experience, exploratory behaviors became increasingly efficient and infants were better able to interpret the resulting perceptual information in terms of whether it was safe to walk.     

Spatial attentional distribution is modulated by head direction during eccentric gaze

Visual perception during eccentric gaze can be facilitated when a visual stimulus appears in front of the head direction. This study investigated the relative effects of gaze location and head direction on visual perception in central and peripheral vision. Participants identified the orientation of a T-shaped figure presented in the centre of a monitor and simultaneously localised a dot appearing in the periphery, while head direction relative to gaze location was to the left, right or centre. Effects of head direction were found only when the dot appeared far from the gaze fixation point, such that dot detection was superior when it appeared to the left (right) of fixation in the left (right) head direction. Experimental results indicated this was not due to a small shift of gaze location. Thus this study suggests that head direction influences visual perception particularly in peripheral vision where visual acuity decreases.     

The functional role of central and peripheral vision in the control of posture

Three experiments were conducted to investigate the role of central and peripheral vision (CV and PV) in postural control. In Experiment 1, either the central or peripheral visual field were selectively stimulated using a circular random dot pattern that was either static or alternated at 5 Hz. Center of foot pressure (CoP) was used to examine postural sway during quiet standing under both CV and PV conditions. The results showed that, when the visual stimulus was presented in the periphery, the CoP area decreased and more so in the anterior-posterior (AP) than in the medio-lateral (ML) direction, indicating a characteristic directional specificity. There was no significant difference between the static and dynamic (alternating) conditions. Experiment 2 investigated the directional specificity of body sway found in Experiment 1 by having the trunk either be faced toward the stimulus display or perpendicularly to it, with the head always facing the display. The results showed that the stabilizing effect of peripheral vision was present in the direction of stimulus observation (i.e., the head/gaze direction), irrespective of trunk orientation. This suggested that head/gaze direction toward the stimulus presentation, rather than a biomechanical factor like greater mobility of the ankle joint in AP direction than in ML direction, was essential to postural stability. Experiment 3 further examined whether the stabilizing effect of peripheral vision found in Experiments 1 and 2 was caused because more dots (500) were presented as visual cues to the peripheral visual field than to the central visual field (20 dots) by presenting the same number of dots (20) in both conditions. It was found that, in spite of the equal number of dots, the postural sway amplitudes were larger for the central vision conditions than for the peripheral vision conditions. In conclusion, the present study showed that peripheral rather than central vision contributes to maintaining a stable standing posture, with postural sway being influenced more in the direction of stimulus observation, or head/gaze direction, than in the direction of trunk orientation, which suggests that peripheral vision operates primarily in a viewer-centered frame of reference characterized by the head/gaze direction rather than in a body-centered frame of reference characterized by the anatomical planes of the body.     

Age-Related Differences in Locomotor Strategies During Adaptive Walking

Simultaneous control of lower limb stepping movements and trunk motion is important for skilled walking; adapting gait to environmental constraints requires frequent alternations in stepping and trunk motion. These alterations provide a window into the locomotor strategies adopted by the walker. The authors examined gait strategies in young and healthy older adults when manipulating step width. Anteroposterior (AP) and mediolateral (ML) smoothness (quantified by harmonic ratios) and stepping consistency (quantified by gait variability) were analyzed during narrow and wide walking while controlling cadence to preferred pace. Results indicated older adults preserved ML smoothness at the expense of AP smoothness, shortened their steps, and exhibited reduced stepping consistency. The authors conclude that older adults prioritized ML control over forward progression during adaptive walking challenges.     

Gait symmetric adaptation: Comparing effects of implicit visual distortion versus split-belt treadmill on aftereffects of adapted step length symmetry

Understanding gait adaptation is essential for rehabilitation, and visual feedback can be used during gait rehabilitation to develop effective gait training. We have previously shown that subjects can adapt spatial aspects of walking to an implicitly imposed distortion of visual feedback of step length. To further investigate the storage benefit of an implicit process engaged in visual feedback distortion, we compared the robustness of aftereffects acquired by visual feedback distortion, versus split-belt treadmill walking. For the visual distortion trial, we implicitly distorted the visual representation of subjects’ gait symmetry, whereas for the split-belt trial, the speed ratio of the two belts was gradually adjusted without visual feedback. After adaptation, the visual feedback or the split-belt perturbation was removed while subjects continued walking, and aftereffects of preserved asymmetric pattern were assessed. We found that subjects trained with visual distortion trial retained aftereffects longest. In response to the larger speed ratio of split-belt walking, the subjects showed an increase in the size of aftereffects compared to the smaller speed ratio, but it steeply decreased over time in all the speed ratios tested. In contrast, the visual distortion group showed much slower decreasing rate of aftereffects, which was evidence of longer storage of an adapted gait pattern. Visual distortion adaptation may involve the interaction and integration of the change in motor strategy and implicit process in sensorimotor adaptation. Although it should be clarified more clearly through further studies, the findings of this study suggest that gait control employs distinct adaptive processes during the visual distortion and split-belt walking and also the level of reliance of an implicit process may be greater in the visual distortion adaptation than the split-belt walking adaptation.     

Stability and variability may respond differently to changes in walking speed

In gait research it has often been assumed that variability and stability are negatively correlated, where increases in variability are assumed to equate with increases in instability. The purpose of this paper is to illustrate that variability does not always equate with stability. To proof this point, a method was developed to directly assess stability and variability during the application of a visual perturbation at different walking speeds. Walking variability was measured by using the average standard deviation of the knee joint angle across the gait cycle. Walking stability was measured by the recovery time of the knee joint angle trajectory from the distortion induced by a visual perturbation that was delivered at the beginning of the stance phase. Five participants were required to walk at six different velocities on a treadmill (0.67, 0.80, 0.94, 1.07, 1.21, and 1.34 m/s). The coefficients of intraclass correlations for the experiment were 83% and 80% for the calculated stability and variability, respectively. The calculated stabilities were not sensitive to changes in walking speed (p>0.98). The calculated variability however decreased with increases in walking speed (p=0.004). No significant correlation between variability and stability was observed (r=-0.002). We suggest that gait stability is independent of variability during locomotion and should thus be measured independently.     

Differences in influence between pitched-from-vertical lines and slanted-from-frontal horizontal lines on egocentric localization

The visual field exerts powerful effects on egocentric spatial localization along both horizontal and vertical dimensions. Thus, (1) prism-produced visual pitch and visual slant generate similar mislocalizations of visually perceived eye level (VPEL) and visually perceived straight ahead (VPSA) and (2) in darkness curare-produced extraocular muscle paresis under eccentric gaze generates similar mislocalizations in VPEL and VPSA that are essentially eliminated by introducing a normal visual field. In the present experiments, however, a search for influences of real visual slant on VPSA to correspond to the influences of visual pitch on VPEL failed to find one. Although the elevation corresponding to VPEL changes linearly with the pitch of a visual field consisting of two isolated 66.5°-long pitched-from-vertical lines, the corresponding manipulation of change in the slant of either a horizontal two-line or a horizontal four-line visual field on VPSA did not occur. The average slope of the VPEL-versus-pitch function across 5 subjects was +0.40 over a ±30° pitch range, but was indistinguishable from 0.00 for the VPSA-versus-slant function over a ±30° slant range. Possible contributions to the difference between susceptibility of VPEL and VPSA to visual influence from extraretinal eye position information, gravity, and several retinal gradients are discussed.     

Age and walking conditions differently affect domains of gait

IntroductionAnalysing gait in controlled conditions that resemble daily life walking could overcome the limitations associated with gait analysis in uncontrolled real-world conditions. Such analyses could potentially aid the identification of a walking condition that magnifies age-differences in gait. Therefore, the aim of the current study was to determine the effects of age and walking conditions on gait performance.MethodsTrunk accelerations of young (n = 27, age: 21.6) and older adults (n = 26, age: 68.9) were recorded for 3 min in four conditions: walking up and down a university hallway on a track of 10 m; walking on a specified path, including turns, in a university hallway; walking outside on a specified path on a pavement including turns; and walking on a treadmill. Factor analysis was used to reduce 27 computed gait measures to five independent gait domains. A multivariate analysis of variance was used to examine the effects of age and walking condition on these gait domains.ResultsFactor analysis yielded 5 gait domains: variability, pace, stability, time & frequency, complexity, explaining 64% of the variance in 27 gait outcomes. Walking conditions affected all gait domains (p < 0.01) but age only affected the time & frequency domain (p < 0.05). Age and walking conditions differently affected the domains variability, stability, time & frequency. The largest age-differences occurred mainly during straight walking in a hallway (variability: 31% higher in older adults), or during treadmill walking (stability: 224% higher, time&frequency: 120% lower in older adults).ConclusionWalking conditions affect all domains of gait independent of age. Treadmill walking and walking on a straight path in a hallway, were the most constrained walking conditions in terms of limited possibilities to adjust step characteristics. The age by condition interaction suggests that for the gait domains variability, stability, and time & frequency, the most constrained walking conditions seem to magnify the age-differences in gait.     

Gait,balance, mobility and muscle strength in people with anxiety compared to healthy individuals

BackgroundAnxiety disorders are the most common mental disorders. Changes in psychomotor behavior can be observed in gross motor skills, with gait disturbances thought to reflect defective brain functions in psychiatric conditions. While balance deficits are well documented in anxiety, only little is known about gait characteristics of people with anxiety.ObjectiveThis study wishes to examine the existence of differences in gait, balance, mobility and muscle strength between people with anxiety and healthy individuals, and to investigate the relationship between level of anxiety and motor characteristics.MethodsAn observational study was conducted in a psychiatric out-patient unit at a large Israeli general hospital. The sample consisted of 93 participants, ages 18–65: 48 of them (27 female, 21 male) categorized as having anxiety, and 45 (25 female, 20 male) without anxiety. Participants were divided into two groups of various ages and both genders, and completed two questionnaires and four physical tests: objective anxiety assessment (Hamilton Anxiety Rating Scale); spatiotemporal gait parameters (10-meter walking test); balance function (Unipedal Stance Test); muscle strength evaluation, and mobility (Time Up and Go Test). No attempt was made to correlate between the anxiety and control groups based on age and/or gender.ResultsParticipants with anxiety (both genders) were characterized by slower walking speed, shorter step length, and fewer steps per minute (p < 0.001), as well as balance deficiency and mobility dysfunction (p < 0.001), compared to the control group. Muscle strength in women with anxiety was found to be significantly lower than in healthy women.ConclusionsTo the best of our knowledge, this study is the first of its kind to examine spatiotemporal gait components in patients with anxiety. Based on the findings, there is room to consider implementing gait analysis into the physical examination of patients with anxiety, as well as muscle strength, balance, and mobility function. Correct assessment and proper treatment of these aspects might contribute to the well-being of patients with anxiety.     

Influence of cognitive and motor tasks using smartphone during gait: EMG and gait performance analysis – Dual-task study

Previous studies reported changes in spatiotemporal gait parameters during dual-task performance while walking using a smartphone compared to walking without a smartphone. However, studies that assess muscle activity while walking and simultaneously performing smartphone tasks are scarce. So, this study aimed to assess the effects of motor and cognitive tasks using a smartphone while simultaneously performing gait on muscle activity and gait spatiotemporal parameters in healthy young adults. Thirty young adults (22.83 ± 3.92 years) performed five tasks: walking without a smartphone (single-task, ST); typing on a smartphone keyboard in a sitting position (secondary motor single-task); performing a cognitive task on a smartphone in a sitting position (cognitive single-task); walking while typing on a smartphone keyboard (motor dual-task, mot-DT) and walking while performing a cognitive task on a smartphone (cognitive dual-task, cog-DT). Gait speed, stride length, stride width and cycle time were collected using an optical motion capture system coupled with two force plates. Muscle activity was recorded using surface electromyographic signals from bilateral biceps femoris, rectus femoris, tibialis anterior, gastrocnemius medialis, gastrocnemius lateralis, gluteus maximus and lumbar erector spinae. Results showed a decrease in stride length and gait speed from the single-task to cog-DT and mot-DT (p < 0.05). On the other hand, muscle activity increased in most muscles analyzed from single- to dual-task conditions (p < 0.05). In conclusion, performing a cognitive or motor task using a smartphone while walking promote a decline in spatiotemporal gait parameters performance and change muscle activity pattern compared to normal walking.