State-dependent corrective reactions for backward balance losses during human walking

We investigated corrective reactions for backward balance losses during walking. Several biomechanical studies have suggested that backward falling can be predicted from the horizontal position and velocity of the body center of mass (COM) related to the stance foot. Our hypothesis was that corrective reactions for backward balance losses depend on whether the body moves forward or backward after a perturbation. Using a split-belt treadmill, backward balance losses during walking were induced by rapid decreases of belt speed from 3.5 km/h to 2.5, 2.0, 1.5 and 1.0 km/h. We measured kinematic data and surface electromyography (EMG) during corrective reactions while walking on the treadmill. Phase portrait analysis of COM trajectories revealed that backward balance stability was decreased by the perturbations. When the perturbed belt speed was 1.0 km/h, the COM states at toe-off were significantly lower than the stability limit; a rapid touch-down of the swing foot posterior to the stance foot then occurred, and the gait rhythm was modulated so that the phase advanced. EMG recordings during perturbed steps revealed a bilateral response, including modulation of the swing leg during the recovery. For weaker perturbations, the swing foot placements were anterior to the stance foot and there was a phase delay. In contrast to the bilateral responses for stronger perturbations, unilateral EMG responses were observed for weaker perturbations. The differences in joint kinematics and EMG patterns in the unperturbed swing leg depended on the COM states at toe-off, suggesting the existence of different responses consisting of ongoing swing movements and rapid touch-down. Thus, we conclude that corrective reactions for backward balance losses are not only phase-dependent but also state-dependent. In addition, the control system for backward balance losses predicts the feasibility of forward progression and modulates swing movement and walking rhythm according to backward balance stability.     

Changes in lower limb co-contraction and stiffness by toddlers with Down syndrome and toddlers with typical development during the acquisition of independent gait

During gait acquisition, children learn to use their changing resources to meet the requirements of the task. Compared to typically developing toddlers (TD), toddlers with Down syndrome (DS) have functionally different musculoskeletal characteristics, such as hypotonia, and joint and ligament laxity, that could produce a reduced passive stiffness. The interplay between this inherently lower passive stiffness and the demands of walking may result in different strategies during gait acquisition. This study compared normalized global stiffness and lower limb's co-contraction indices (CCI) used by toddlers with TD (n=12) and with DS (n=12), during the early stages of gait acquisition. Stiffness and CCI were normalized by gravitational torque (mLg) in both phases of gait (stance, swing). Five longitudinal evaluations were conducted from the onset of locomotion until three months post-acquisition. All children were video taped and had electromyographic (EMG) recordings from muscle pairs of one leg, which were used to calculate CCI of hip, knee, ankle, and total leg CCI. Body and lower limb stiffness were calculated according to a hybrid pendulum resonance equation. Results from ANOVAs revealed no group differences on stiffness or on CCI's during stance but children with DS showed greater CCI during swing. Despite the structural musculoskeletal differences between toddlers with TD and with DS, the similarities observed in their processes of gait development suggest functional equivalences.     

Necessary condition for forward progression in ballistic walking

Ballistic walking requires an appropriate configuration of posture and velocity at toe-off to avoid backward falling. In this study, we investigated a determinant of the state of the body center of mass (COM) at the toe-off with regard to ballistic walking. We used an inverted pendulum model to represent ballistic trajectories and the necessary condition for forward progression by a simple relationship between the COM states (position and velocity) at toe-off. This condition was validated through a computer simulation of a 7-link musculoskeletal model and measurement experiments of human movements involving stepping and walking. The results of the model simulation were in good agreement with some of the results predicted by the inverted pendulum model. The measurement experiments of walking and stepping movements showed that most COM states at toe-off satisfied the condition for forward progression and the measured trajectories during single support phase were similar to the ballistic trajectories although humans are capable of walking in non-ballistic ways. These results suggested that the necessary condition for forward progression can predict the COM states at toe-off for efficient movement and for avoiding backward falling during single support phase.     

Modeling dynamic resource utilization in populations with unique constraints: preadolescents with and without Down syndrome

In this study we used a damped inverted pendulum and spring with an escapement function model to compare the global levels of stiffness and forcing used by 12 preadolescents with Down syndrome (DS) and 12 with typical development (TD). Participants walked overground at their self-selected speed and on a treadmill at speeds slower and faster than overground. Children with DS, who are characterized as hypotonic with reduced capacity for producing muscle force, exhibited significantly higher levels of stiffness and forcing (angular impulse) when walking on the treadmill and higher forcing but not stiffness overground, than children with TD. Both groups adapted to imposed speed increases similarly by increasing their global stiffness and angular impulse. We propose children with DS increased stiffness in order to overcome their hypotonia and joint laxity, thus, optimizing on stability, rather than metabolic efficiency. Higher angular impulse values for children with DS may reflect higher energy cost associated with increasing stiffness and their inherent biomechanical and physiological characteristics that reduce efficiency. We conclude that the inverted pendulum and spring with escapement function model is a useful tool for uncovering solutions to movement problems-solutions that reflect the dynamic resources of the individual and ones that are discovered, rather than prescribed.     

Gait training facilitates push-off and improves gait symmetry in children with cerebral palsy

BackgroundHuman walking involves a rapid and powerful contraction of ankle plantar flexors during push-off in late stance.ObjectiveHere we investigated whether impaired push-off force contributes to gait problems in children with cerebral palsy (CP) and whether it may be improved by intensive gait training.MethodsSixteen children with CP (6–15 years) and fourteen typically developing (TD) children (4–15 years) were recruited. Foot pressure was measured by insoles and gait kinematics were recorded by 3-dimensional video analysis during treadmill and overground walking. The peak derivative of ground reaction force at push off (dPF) was calculated from the foot pressure measurements. Maximal voluntary plantar flexion (MVC) was measured while seated. Measurements were performed before and after a control period and after 4 weeks of 30 minutes daily inclined treadmill training.ResultsdPF and MVC were significantly lower in children with CP on the most affected (MA) as compared to TD children (p < .001). dPF was lower on the MA leg as compared to the less affected (LA) leg in children with CP (p < .05). Following gait training, increases in dPF (p < .001) and MVC (p < .01) were observed for the MA leg. Following gait training children with CP showed similar timing of dPF and similar stance phase duration on both legs indicating improved symmetry of gait. These effects were also shown during overground walking.ConclusionImpaired ability to voluntarily activate ankle plantar flexors and produce a rapid and powerful push-off during late stance are of importance for impaired gait function in children with CP. Intensive treadmill training may facilitate the drive to ankle plantar flexors and reduce gait asymmetry during both treadmill and overground walking.     

Early stage of walking: development of control in mediolateral and anteroposterior directions

The authors examined the changes in bipedal gait of toddlers in the anteroposterior (AP) and mediolateral (ML) directions, as a set, at the onset of independent gait and 1 month after onset. Two groups with distinctly different dynamic resources were studied: 8 toddlers with typical development (TD) and 8 toddlers with Down syndrome (DS). Three-dimensional kinematic data were collected, and gait parameters, such as walking speed, stride length, and stride frequency, as well as the ratio of exchange between potential energy and kinetic energy of the center of mass (COM), were calculated. Displacement of the COM in the AP and ML directions were also analyzed. For some gait variables, toddlers with DS seemed to show more mature values at walking onset than their peers with TD. Those group differences reversed and increased by Visit 2. When the authors considered the motion of the COM of the system, it became clear that the qualitative differences between those groups were characterized primarily by constraints in the ML direction. The authors propose that establishment of coupling between AP and ML oscillations is a key component for the emergence of independent bipedal walking for both populations.     

Effects of toe length,foot arch length and toe joint axis on walking biomechanics

Toe joint articulation has been shown to affect gait mechanics, as evidenced by walking simulations, biped robots, and foot prostheses. However, it is not known how parameters such as toe length, foot arch length (i.e., heel-to-toe-joint length) or toe joint axis angle affect human walking. We utilized a previously developed adjustable ankle-toe prosthesis to systematically examine these three foot parameters. We tested ten able-bodied persons walking on a force instrumented-treadmill while wearing a pair of adjustable prostheses attached bilaterally below simulator boots (which fixated their biological ankles). We collected motion and ground reaction force data to compute lower-limb kinematics and kinetics as well as COM power and work. We observed that increasing the foot arch length by 60 mm (35%) increased COM Push-off work by ~5 J, due to increased energy storage and return by the ankle spring. Increasing the toe length by 40 mm (80%) and changing the toe joint axis by ±9° from a neutral angle resulted in negligible effects on COM mechanics and lower limb kinetics. This study provides further insights regarding toe joint function; knowledge which may benefit the design/integration of toe joints into prostheses, exoskeletons and legged robots.     

Changes in mechanical control of movement during the first 5 months of independent walking: a longitudinal study

Insight into neuromuscular control of movement is gained through an understanding of the mechanical causes of movement. Data on new walkers' net joint moments is scarce, however, although those moments can be considered the direct cause of movement. The authors' goal in this research project was to characterize net joint moments in toddlers (N = 10) during the first 5 months of independent walking and to discuss their role in mechanical control of walking. The authors modeled leg segments as oscillating pendulums fixed at the proximal joint and investigated the relationship between force and movement. Their investigation revealed that at the onset of independent gait, walking was primarily hip driven. Furthermore, the toddlers seemed to experience problems in uncoupling active and passive control around the joints. Changes in mechanical control of walking were observed after 3 to 4 months of independent walking. The changes were more obvious at the hip and the knee joint than at the ankle.     

Development of postural adjustment during gait initiation: kinematic and EMG analysis

The authors studied the development of postural adjustments associated with the initiation of gait in children by using kinematic and electromyographic (EMG) analysis. Participants (N = 28) included infants with 1-4 and 9-17 months of walking experience, children 4-5 years of age, and adults. Anticipatory postural adjustments (APA) were present in the youngest age groups, including a clear anticipatory lateral tilt of the pelvis and the stance leg, which enabled the child to unload the opposite leg shortly before its swing phase. An anticipatory activation of the hip abductor of the leg in stance phase prior to heel-off was found, suggesting pelvis stabilization. APA did not appear consistently until 4-5 years of age. A decrease in segmental oscillations occurred across the ages, indicating better control of intersegmental coordination in the frontal and sagittal planes during the postural phase of gait initiation. Young walkers presented APA involving movements of both the upper and the lower parts of the body, whereas, like adults, 4- to 5-year-olds were able to laterally shift only the pelvis and the stance leg. The oldest children and the adults also showed lower activation levels of hip and knee muscles but higher activation at the ankle level. Those kinematic and EMG results taken together suggest a clear developmental sequence from an en bloc operation of the body through an articulated operation with maturation, walking experience, or both.     

Development of Postural Adjustment During Gait Initiation: Kinematic and EMG Analysis

The authors studied the development of postural adjustments associated with the initiation of gait in children by using kinematic and electromyographic (EMG) analysis. Participants (N = 28) included infants with 1-4 and 9-17 months of walking experience, children 4-5 years of age, and adults. Anticipatory postural adjustments (APA) were present in the youngest age groups, including a clear anticipatory lateral tilt of the pelvis and the stance leg, which enabled the child to unload the opposite leg shortly before its swing phase. An anticipatory activation of the hip abductor of the leg in stance phase prior to heel-off was found, suggesting pelvis stabilization. APA did not appear consistently until 4-5 years of age. A decrease in segmental oscillations occurred across the ages, indicating better control of intersegmental coordination in the frontal and sagittal planes during the postural phase of gait initiation. Young walkers presented APA involving movements of both the upper and the lower parts of the body, whereas, like adults, 4- to 5-year-olds were able to laterally shift only the pelvis and the stance leg. The oldest children and the adults also showed lower activation levels of hip and knee muscles but higher activation at the ankle level. Those kinematic and EMG results taken together suggest a clear developmental sequence from an en bloc operation of the body through an articulated operation with maturation, walking experience, or both.     

What factors determine the preferred gait transition speed in humans? A review of the triggering mechanisms

Human locomotion is a fundamental skill that is required for daily living, yet it is not completely known how human gait is regulated in a manner that seems so effortless. Gait transitions have been analyzed to gain insight into the control mechanisms of human locomotion since there is a known change that occurs as the speed of locomotion changes. Specifically, as gait speed changes, there is a spontaneous transition between walking and running that occurs at a particular speed. Despite the growing body of research on the determinants of this preferred transition speed and thus the triggering mechanisms of human gait transitions, a clear consensus regarding the control mechanisms of gait is still lacking. Therefore, this article reviews the determinants of the preferred transition speed using concepts of the dynamic systems theory and how these determinants contribute to four proposed triggers (i.e. metabolic efficiency, mechanical efficiency, mechanical load and cognitive and perceptual) of human gait transitions. While individual anthropometric and strength characteristics influence the preferred transition speed, they do not act to trigger a gait transition. The research has more strongly supported the mechanical efficiency and mechanical load determinants as triggering mechanisms of human gait transitions. These mechanical determinants, combined with cognitive and perceptual processes may thus be used to regulate human gait patterns through proprioceptive and perceptual feedback as the speed of locomotion changes.     

Are transitions in human gait determined by mechanical,kinetic or energetic factors?

It is currently unclear whether it is the need to maintain metabolic efficiency, the need to keep skeletal loading below critical force levels, or simple mechanical factors that drive the walk-to-run (W-R) and run-to-walk (R-W) transitions in human gait. Eighteen adults (9 males and 9 females) locomoted on an instrumented treadmill using their preferred gait. Each completed 2 ascending (W-R) and 2 descending (R-W) series of trials under three levels of loading (0%, 15% and 30% body weight). For each trial, participants locomoted for 60 s at each of 9 different speeds--4 speeds both above and below their preferred transition speed (PTS) plus their PTS. Evidence was sought for critical levels of key kinetic (maximum vertical force, impulse, first peak force, time to first peak force and maximum loading rate), energetic (oxygen consumption, transport cost) and mechanical variables (limb lengths, strength) predictive of the gait transition. Analyses suggested the kinetic variables of time to first peak force and loading rate as the most likely determinants of the W-R and R-W transitions.     

Dynamic stability during running gait termination: Predictors for successful control of forward momentum in children and adults

Reported differences between children and adults with respect to COM horizontal and vertical position to maintain dynamic stability during running deceleration suggest that this relationship may not be as important in children. This study challenged the current dynamic stability paradigm by determining the features of whole body posture that predicted forward velocity and momentum of running gait termination in adults and children. Sixteen adults and 15 children ran as fast as possible and stopped at pre-determined location. Separate regression analyses determined whether COM posterior and vertical positions and functional limb length (distance between COM and stance foot) predicted velocity and momentum for adults and children. COM posterior position was the strongest predictor of forward velocity and momentum in both groups supporting the previously established relationship during slower tasks. COM vertical position also predicted momentum in children, not adults. Higher COM position in children was related to greater momentum; consistent with previously reported differences between children and adults in COM position across running deceleration. COM vertical position was related to momentum but not velocity in children suggesting that strategies used to terminate running may be driven by demands imposed not just by velocity, but also the mass being decelerated.     

Interlimb coordination in prosthetic walking: effects of asymmetry and walking velocity

The present study focuses on interlimb coordination in walking with an above-knee prosthesis using concepts and tools of dynamical systems theory (DST). Prosthetic walkers are an interesting group to investigate from this theory because their locomotory system is inherently asymmetric, while, according to DST, coordinative stability may be expected to be reduced as a function of the asymmetry of the oscillating components. Furthermore, previous work on locomotion motivated from DST has shown that the stability of interlimb coordination increases with walking velocity, leading to the additional expectation that the anticipated destabilizing effect of the prosthesis-induced asymmetry may be diminished at higher walking velocities. To examine these expectations, an experiment was conducted aimed at comparing interlimb coordination during treadmill walking between seven participants with an above-knee prosthesis and seven controls across a range of walking velocities. The observed gait patterns were analyzed in terms of standard gait measures (i.e., absolute and relative swing, stance and step times) and interlimb coordination measures (i.e., relative phase and frequency locking). As expected, the asymmetry brought about by the prosthesis led to a decrease in the stability of the coordination between the legs as compared to the control group, while coordinative stability increased with increasing walking velocity in both groups in the absence of a significant interaction. In addition, the 2:1 frequency coordination between arm and leg movements that is generally observed in healthy walkers at low walking velocities was absent in the prosthetic walkers. Collectively, these results suggest that both stability and adaptability of coordination are reduced in prosthetic walkers but may be enhanced by training them to walk at higher velocities.     

Biomechanics of normal and pathological gait: implications for understanding human locomotor control

The biomechanical (kinetic) analysis of human gait reveals the integrated and detailed motor patterns that are essential in pinpointing the abnormal patterns in pathological gait. In a similar manner, these motor patterns (moments, powers, and EMGs) can be used to identify synergies and to validate theories of CNS control. Based on kinetic and EMG patterns for a wide range of normal subjects and cadences, evidence is presented that both supports and negates the central pattern generator theory of locomotion. Adaptive motor patterns that are evident in peripheral gait pathologies reinforce a strong peripheral rather than a central control. Finally, a three-component subtask theory of human gait is presented and is supported by reference to the motor patterns seen in a normal gait. The identified subtasks are (a) support (against collapse during stance); (b) dynamic balance of the upper body, also during stance; and (c) feedforward control of the foot trajectory to achieve safe ground clearance and a gentle heel contact.     

Influence of swing leg movement on running stability

The aim of this study was to investigate the role of the swing leg movement on running stability. A simple model was used describing a forward hopping motion. The model consisted of two sub-models, namely a spring-mass system for the stance phase and a functional control model for the swing phase (represented by a passive or actively driven pendulum). To verify the main simulation results, an experimental study on treadmill running was performed. The results of the model indicated that for certain running speeds and pendulum lengths, the behavior of the mechanical system was stable. The following characteristic dependencies between the model parameters were observed. (1) Pendulum length and hip muscle activity determined running height and therefore swing duration. (2) Horizontal velocity was inversely related to leg angle of attack. Increased speed corresponded to flatter leg angles at touch-down, which is in agreement with experimental studies and previous predictions of spring-mass running. It was shown that a biologically motivated control approach with oscillating leg movements is well capable of generating stable hopping movements. Due to its simplicity, however, the monopedal model failed to explain more detailed mechanisms like the swing-leg to stance-leg interaction or the functional role of the leg segmentation. This simple model is therefore considered as a functional mechanical template for legged locomotion, which could help to build more elaborate models in the future.     

Errors in the ankle plantarflexor force production are related to the gait deficits of individuals with multiple sclerosis

BackgroundIndividuals with multiple sclerosis (MS) often have limited mobility that is thought to be due to the neuromuscular impairments of the ankle. Greater isometric motor control of the ankle has been associated with better standing postural balance but its relationship to mobility is less understood. The objectives of this investigation were to quantify the motor control of the ankle plantarflexors of individuals with MS during a dynamic isometric motor task, and explore the relationship between the ankle force control and gait alterations.MethodsFifteen individuals with MS and 15 healthy adults participated in both a dynamic isometric ankle plantarflexion force matching task and a biomechanical gait analysis.FindingsOur results displayed that the subjects with MS had a greater amount of error in their dynamic isometric force production, were weaker, walked with altered spatiotemporal kinematics, and had reduced maximal ankle moment at toe-off than the control group. The greater amount of error in the dynamic force production was related to the decreases in strength, step length, walking velocity, and maximal ankle moment during walking.InterpretationAltogether these results imply that errors in the ankle plantarflexion force production may be a limiting factor in the mobility of individuals with MS.     

Asymmetrical stabilization and mobilization exploited during static single leg stance and goal directed kicking

The motor control properties of the right and left legs are dependent on the stabilization and mobilization features of the motor tasks. The current investigation examined the right and left leg control differences – interlateral asymmetries – during static single leg stance and dynamic goal directed kicking with an emphasis of the asymmetrical stabilization and mobilization components of movements. Ten young, healthy, right-leg preferred individuals with minimal kicking experience completed both tests on each limb. During static single leg stance, participants were requested to stand as still as possible with one leg in contact with a force platform. Interlateral asymmetries of the standing leg were quantified using postural variability measures of the center of pressure (COP) standard deviation in the anterior-posterior (SD-COP_AP) and medial-lateral (SD-COP_ML) directions, resultant COP length and velocity, and 95% COP elliptical area. During dynamic goal directed kicking, participants stood on two adjacent force platforms in a side-by-side foot position and kicked a soccer ball toward three different directions as soon as they received an auditory cue of kicking. Three targets were located −30°, 0° or 30° in front and 3.05 m away from the participants’ midline. Participants kicked the ball toward the targets with each of their feet. The vertical ground reaction force (vGRF) of the kicking leg was used to define the preparation (from above two standard deviations of vGRF baseline to toe-off) and swing (from toe-off to toe-return) phases of dynamic kicking. To determine the presence of interlateral asymmetries during dynamic kicking, the magnitude and timing of the anticipatory postural adjustments (APA) during the preparation phase of kicking were quantified using the lateral net COP (COPnet-ML) time series derived from both force platforms. Postural variability measures of the support leg and the kinematic joint range of motion (JROM) trajectories of the kicking leg were also used to examined interlateral asymmetries. During static stance, no between-leg significance was identified for all dependent measures of COP variability suggesting symmetrical stabilization. During the preparation phase of kicking, both right and left leg kicking exhibited a similar level of APA magnitude, although the left leg kicking was shown to reach its maximum APA magnitude earlier than the right leg. In the support leg role, the right leg showed greater COP variability in the ML direction as compared to the left support leg and greater COP variability was observed when kicking in the ipsilateral direction compared to the center and contralateral directions. For mobilization control, the left kicking leg showed greater JROM displacements at the distal (knee and ankle) joints and reduced JROM primarily with hip frontal plane movements compared to the right kicking leg. The reported interlateral asymmetries during kicking may reflect a behavioral adaptation that results in differential stabilization between the right and left legs. Overall, the findings suggest that novel tasks, such as dynamic goal directed kicking, appear to be more sensitive than static balance in identifying interlateral asymmetries.     

Postural sway and joint kinematics during quiet standing are affected by lumbar extensor fatigue

The purpose of this study was to investigate changes in postural sway and strategy elicited by lumbar extensor muscle fatigue. Specifically, changes in center of mass (COM), center of pressure (COP), and joint kinematics during quiet standing were determined, as well as selected cross correlations between these variables that are indicative of movement strategy. Twelve healthy male participants stood quietly both before and after exercises that fatigued the lumbar extensors. Whole-body movement and ground reaction force data were recorded and used to calculate mean body posture and variability of COM, COP, and joint kinematics during quiet standing. Three main findings emerged. First, participants adopted a slight forward lean post-fatigue as evidenced by an anterior shift of the COM and COP. Second, post-fatigue increases in joint angle variability were observed at multiple joints including joints distal to the fatigued musculature. Despite these increases, anterior-posterior (AP) ankle angle correlated well with AP COM position, suggesting the body still behaved similar to an inverted pendulum. Third, global measures of sway based on COM and COP were not necessarily indicative of changes in individual joint kinematics. Thus, in trying to advance our understanding of how localized fatigue affects movement patterns and the postural control system, it appears that joint kinematics and/or multivariate measures of postural sway are necessary.     

Multisensory postural control in adults: Variation in visual,haptic, and proprioceptive inputs

Maintaining balance is fundamentally a multisensory process, with visual, haptic, and proprioceptive information all playing an important role in postural control. The current project examined the interaction between such sensory inputs, manipulating visual (presence versus absence), haptic (presence versus absence of contact with a stable or unstable finger support surface), and proprioceptive (varying stance widths, including shoulder width stance, Chaplin [heels together, feet splayed at approximately 60°] stance, feet together stance, and tandem stance) information. Analyses of mean velocity of the Centre of Pressure (CoP) revealed significant interactions between these factors, with stability gains observed as a function of increasing sensory information (e.g., visual, haptic, visual + haptic), although the nature of these gains was modulated by the proprioceptive information and the reliability of the haptic support surface (i.e., unstable versus stable finger supports). Subsequent analyses on individual difference parameters (e.g., height, leg length, weight, and areas of base of support) revealed that these variables were significantly related to postural measures across experimental conditions. These findings are discussed relative to their implications for multisensory postural control, and with respect to inverted pendulum models of balance. (185 words).