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.     

Age effects on the control of dynamic balance during step adjustments under temporal constraints

This study investigated the age effects on the control of dynamic balance during step adjustments under temporal constraints. Fifteen young adults and 14 older adults avoided a virtual white planar obstacle by lengthening or shortening their steps under free or constrained conditions. In the anterior–posterior direction, older adults demonstrated significantly decreased center of mass velocity at the swing foot contact under temporal constraints. Additionally, the distances between the ‘extrapolated center of mass’ position and base of support at the swing foot contact were greater in older adults than young adults. In the mediolateral direction, center of mass displacement was significantly increased in older adults compared with young adults. Consequently, older adults showed a significantly increased step width at the swing foot contact in the constraint condition. Overall, these data suggest that older adults demonstrate a conservative strategy to maintain anterior–posterior stability. By contrast, although older adults are able to modulate their step width to maintain mediolateral dynamic balance, age-related changes in mediolateral balance control under temporal constraints may increase the risk of falls in the lateral direction during obstacle negotiation.     

The 'extrapolated center of mass' concept suggests a simple control of balance in walking

Next to position x and velocity v of the whole body center of mass (CoM) the 'extrapolated center of mass' (XcoM) can be introduced: xi = chi + nu/omega 0, where omega 0 is a constant related to stature. Based on the inverted pendulum model of balance, the XcoM enables to formulate the requirements for stable walking in a relatively simple form. In a very simple walking model, with the effects of foot roll-over neglected, the trajectory of the XcoM is a succession of straight lines, directed in the line from center of pressure (CoP) to the XcoM at the time of foot contact. The CoM follows the XcoM in a more sinusoidal trajectory. A simple rule is sufficient for stable walking: at foot placement the CoP should be placed at a certain distance behind and outward of the XcoM at the time of foot contact. In practice this means that a disturbance which results in a CoM velocity change Deltav can be compensated by a change in foot position (CoP) equal to Deltav/omega 0 in the same direction. Similar simple rules could be formulated for starting and stopping and for making a turn.     

Horizontal plane head stabilization during locomotor tasks

Frequency characteristics of head stabilization were examined during locomotor tasks in healthy young adults(N = 8) who performed normal walking and 3 walking tasks designed to produce perturbations primarily in the horizontal plane. In the 3 walking tasks, the arms moved in phase with leg movement, with abnormally large amplitude, and at twice the frequency of leg movement. Head-in-space angular velocity was examined at the predominant frequencies of trunk motion. Head movements in space occurred at low frequencies (< 4.0 Hz) in all conditions and at higher frequencies (> 4.0 Hz) when the arms moved at twice the frequency of the legs. Head stabilization strategies were determined from head-on-trunk with respect to trunk frequency profiles derived from angular velocity data. During natural walking at low frequencies (< 3.0 Hz), head-on-trunk movement was less than trunk movement. At frequencies 3.0 Hz or greater, equal and opposite compensatory movement ensured head stability. When arm swing was altered, compensatory movement guaranteed head stability at all frequencies. Head stabilization was successful for frequencies up to 10.0 Hz during locomotor tasks. Maintaining head stability at high frequencies during voluntary tasks suggests that participants used feedforward mechanisms to coordinate head and trunk movements. Maintenance of head stability during dynamic tasks allows optimal conditions for vestibulo-ocular reflex function.     

Saccade-stepping interactions revise the motor plan for obstacle avoidance

The authors used a stimulus-response compatibility paradigm to assess the effect of changing the estimated time to obstacle contact. A limb-selection cue was presented in different phases of gait to young (n = 5) and to older (n = 4) adults while they were moving toward a foam obstacle in the walking path. A downward saccade was initiated after the cue; the saccade typically occurred during the stance phase of the target limb (the foot cued to lead the step over the obstacle). The mean saccade-step latency after the cue was on the order of -500 ms in both young and elderly participants. On reaching the obstacle, both groups generated an upward saccade approximately -300 ms before target footlift in both groups. Saccades following the limb-selection cue appeared to direct the gaze toward footfall targets just beyond the obstacle, whereas saccades generated just before obstacle footlift moved the gaze to the forward-looking direction. The elderly had significantly longer saccade-trailing-footlift latencies and prolonged gaze-fixation times than did the younger adults. Transient disruptions in optical flow appeared to be necessary for successful obstacle-avoidance behavior when there was an unexpected change in the estimated time to obstacle contact.     

Advanced age brings a greater reliance on visual feedback to maintain balance during walking

We implemented a virtual reality system to quantify differences in the use of visual feedback to maintain balance during walking between healthy young (n = 12, mean age: 24 years) and healthy old (n = 11, 71 years) adults. Subjects walked on a treadmill while watching a speed-matched, virtual hallway with and without mediolateral visual perturbations. A motion capture system tracked center of mass (CoM) motion and foot kinematics. Spectral analysis, detrended fluctuation analysis, and local divergence exponents quantified old and young adults’ dynamic response to visual perturbations. Old and young adults walked normally with comparable CoM spectral characteristics, lateral step placement temporal persistence, and local divergence exponents. Perturbed visual flow induced significantly larger changes in mediolateral CoM motion in old vs. young adults. Moreover, visual perturbations disrupted the control of lateral step placement and compromised local dynamic stability more significantly in old than young adults. Advanced age induces a greater reliance on visual feedback to maintain balance during waking, an effect that may compensate for degradations in somatosensation. Our findings are relevant to the early diagnosis of sensory-induced balance impairments and also point to the potential use of virtual reality to evaluate sensory rehabilitation and balance training programs for old adults.     

Horizontal Plane Head Stabilization During Locomotor Tasks

Frequency characteristics of head stabilization were examined during locomotor tasks in healthy young adults (N = 8) who performed normal walking and 3 walking tasks designed to produce perturbations primarily in the horizontal plane. In the 3 walking tasks, the arms moved in phase with leg movement, with abnormally large amplitude, and at twice the frequency of leg movement. Head-in-space angular velocity was examined at the predominant frequencies of trunk motion. Head movements in space occurred at low frequencies (< 4.0 Hz) in all conditions and at higher frequencies (> 4.0 Hz) when the arms moved at twice the frequency of the legs. Head stabilization strategies were determined from head-on-trunk with respect to trunk frequency profiles derived from angular velocity data. During natural walking at low frequencies (< 3.0 Hz), head-on-trunk movement was less than trunk movement. At frequencies 3.0 Hz or greater, equal and opposite compensatory movement ensured head stability. When arm swing was altered, compensatory movement guaranteed head stability at all frequencies. Head stabilization was successful for frequencies up to 10.0 Hz during locomotor tasks Maintaining head stability at high frequencies during voluntary tasks suggests that participants used feedforward mechanisms to coordinate head and trunk movements. Maintenance of head stability during dynamic tasks allows optimal conditions for vestibulo-ocular reflex function.     

Saccade-Stepping Interactions Revise the Motor Plan for Obstacle Avoidance

The authors used a stimulus-response compatibility paradigm to assess the effect of changing the estimated time to obstacle contact. A limb-selection cue was presented in different phases of gait to young (n = 5) and to older (n = 4) adults while they were moving toward a foam obstacle in the walking path. A downward saccade was initiated after the cue; the saccade typically occurred during the stance phase of the target limb (the foot cued to lead the step over the obstacle). The mean saccade-step latency after the cue was on the order of ?500 ms in both young and elderly participants. On reaching the obstacle, both groups generated an upward saccade approximately ?300 ms before target footlift in both groups. Saccades following the limb-selection cue appeared to direct the gaze toward footfall targets just beyond the obstacle, whereas saccades generated just before obstacle footlift moved the gaze to the forward-looking direction. The elderly had significantly longer saccade-trailing-footlift latencies and prolonged gaze-fixation times than did the younger adults. Transient disruptions in optical flow appeared to be necessary for successful obstacle-avoidance behavior when there was an unexpected change in the estimated time to obstacle contact.     

Changes of Gait Kinematics in Different Simulators of Reduced Gravity

Gravity reduction affects the energetics and natural speed of walking and running. But, it is less clear how segmental coordination is altered. Various devices have been developed in the past to study locomotion in simulated reduced gravity. However, most of these devices unload only the body center of mass. The authors reduced the effective gravity acting on the stance or swing leg to 0.16g using different simulators. Locomotion under these conditions was associated with a reduction in the foot velocity and significant changes in angular motion. Moreover, when simulated reduced gravity directly affected the swing limb, it resulted in significantly slower swing and longer foot excursions, suggesting an important role of the swing phase dynamics in shaping locomotor patterns.     

Gait adjustments in response to an obstacle are faster than voluntary reactions

It has been reported that obstacle avoidance reactions during gait have very short latencies. This raises the question whether the cortex can be involved, as it is in voluntary reactions. In this study, latencies of obstacle avoidance (OA) reactions were determined and related to latencies of voluntary stride modifications and simple reaction times (SRT) of hand and foot. Twenty-five healthy young adults participated in this study. While they were walking on the treadmill, an obstacle suddenly fell in front of their left leg. The first reaction to the obstacle was the moment at which the differentiated acceleration curve of the foot deviated from the control signal. Latencies of OA reactions were 122 ms (SD 14 ms) on average. Two very different avoidance reactions (lengthening and shortening of the stride) were noticed, but there was no avoidance strategy effect on OA latencies. OA latencies were significantly shorter as compared to latencies of voluntary stride modifications and simple reaction times of hand and foot. The short OA latencies could not only be explained from the dynamic nature of the task. It is suggested that subcortical pathways might be involved in obstacle avoidance.     

The effect of shoe and floor characteristics on walking kinematics

It is common sense that walking on sand poses challenges to postural control. However, there are no studies quantifying the kinematics of sand walking compared to other types of postural perturbations such as unstable shoes. The aim of the study was to investigate differences in walking kinematics during walking on solid ground, in unstable shoes and on unstable surfaces. Nineteen healthy young adults (23.5 ± 1.5 years) performed three different walking tasks: 1) walking at preferred speed while wearing regular shoes; 2) Walking at preferred speed wearing Masai Barefoot Technology shoes and 3) barefoot walking at preferred speed on a large sand grave. Full-body kinematics were recorded during all conditions using an inertial motion capture system. Basic gait parameters (walking speed, stride length and duration), relative vertical center-of-mass position (rvCOM), and ankle, knee and hip joint angles in the sagittal plane were compared across the tasks through statistical parametric mapping over the course of full walking cycles. Participants presented similar walking speed, as well as stride length and duration across different conditions (p > 0.05). However, walking on sand reduced the rvCOM (p < 0.05), while also requiring greater ankle plantarflexion during stance phase (p < 0.05), as well as greater knee and hip flexion during leg swing and initial contact when compared to the other conditions (p < 0.05). It was concluded that walking on sand substantially changes walking kinematics, and may cause greater postural instability than unstable shoes. Therefore, walking on sand can be an alternative to improve postural control in patients undergoing walking rehabilitation.     

Generation of forward angular impulse with different initial conditions

Generation of angular impulse during foot contact is regulated by controlling the relative orientation between the total body center of mass (CoM) and the reaction force (RF) applied to the feet. Between-task differences in initial CoM horizontal momentum were hypothesized to alter how forward angular impulse was generated during two forward translating tasks. Five skilled athletes performed standing (SFS) and running (RFS) forward somersaulting dives. Sagittal plane kinematics and RFs were obtained during the take-off phase of both tasks. The initial CoM momentum differences resulted in significant differences in control of the CoM relative to the RF, RF generation mechanisms, and knee and hip net joint moments (NJMs). During the RFS, angular impulse was generated by positioning the feet anterior to the CoM at initial contact so that the RF passed posterior to the CoM throughout the take-off phase. During the SFS, angular impulse was generated by positioning the CoM anterior to the feet prior to the push interval so that the RF passed posterior to the CoM. Task-specific differences in segment kinematics and RF direction contributed to the redistribution of knee and hip NJMs. These results suggest that initial conditions influence strategies the nervous system uses to satisfy task objectives.     

Multi-tasking deteriorates trunk movement control during and after obstacle avoidance

Dynamic and cognitive multi-tasking might affect balance and walking negatively and increase risk of falling. Trunk movement control is critical for balance maintenance and fall-prevention. The impact of multi-tasking on trunk movement control has not been thoroughly studied. In a challenging dynamic multi-tasking condition such as walking and obstacle avoidance, presence of a cognitive task not only increases risk of tripping but also may increase risk of falling by deteriorating trunk control. Our objective was to investigate the impacts of a challenging dynamic and cognitive multi-tasking condition (walking + obstacle avoidance + cognitive task) on trunk kinematics and kinetics and compare those with other joints/segments. Trunk, pelvis, hip, knee, and ankle kinematics and kinetics of 12 young adults were compared between joints/segments and conditions. During walking and obstacle avoidance (dynamic multi-tasking), the trunk had the largest normalized increase in peak flexion angle and extension torque compared to walking, among the other joints/segments. The presence of a cognitive task during walking and obstacle avoidance (dynamic and cognitive multi-tasking) did not impact any of the joints/segments biomechanics except the trunk peak extension torque that was increased. Furthermore, trunk kinematics showed the largest residual differences (post-effects) in 3 cycles after obstacle avoidance compared to walking. The presence of a cognitive task (dynamic and cognitive multi-tasking) did not impact the post-effects of obstacle avoidance on any joints/segments except the trunk with its residual difference from normal walking further increased. These results suggest that a cognitive task deteriorates trunk control and interferes with the ability to regain normal trunk biomechanics after obstacle avoidance. In summary, the trunk requires the largest biomechanical adjustments in a challenging dynamic and cognitive multi-tasking condition where there is a risk of falling. Our study provides baseline results suggesting that trunk control demands more attention and is more negatively affected by dynamic and cognitive multi-tasking. Our results raise a concern for elderly population as their trunk control is already impaired and common daily multi-tasking could further deteriorate their trunk control and increase fall risk.     

Evaluating the Acute Contributions of Dopaminergic Replacement to Gait With Obstacles in Parkinson's Disease

The influence of dopaminergic replacement (DR) on gait in people with Parkinson's disease (PD) is well documented. However, little is known about the acute effects of dopamine on more complex locomotor tasks that require visual guidance to avoid obstacles during gait. The authors investigated the influence of DR on locomotor behavior in a task where movement planning and control might be challenged by the height of the obstacle. The PD group included patients diagnosed with idiopathic PD (n = 12), as well as healthy controls (n = 12). Patients walked and stepped over obstacles of different heights before (OFF) and after (ON) levodopa intake. Spatial adjustments were not modulated by DR, but the step time to perform these anticipatory gait adjustments was longer only in PD-OFF (compared with healthy controls) when approaching the highest obstacle, but not PD-ON. During the crossing phase, trail limb toe clearance of PD patients was shorter than healthy controls only during the OFF state. ON-OFF comparisons were significantly different only for the time to reach the lead foot clearance over the highest obstacle. In summary, DR partially improved movement slowness but did not directly affect movement amplitude of lower limb regulation in this gait task.     

Repeated exposure to tripping like perturbations elicits more precise control and lower toe clearance of the swinging foot during steady walking

Controlling minimum toe clearance (MTC) is considered an important factor in preventing tripping. In the current study, we investigated modifications of neuro-muscular control underlying toe clearance during steady locomotion induced by repeated exposure to tripping-like perturbations of the right swing foot. Fourteen healthy young adults (mean age 26.4 ± 3.1 years) participated in the study. The experimental protocol consisted of three identical trials, each involving three phases: steady walking (baseline), perturbation, and steady walking (post-perturbation). During the perturbation, participants experienced 30 tripping-like perturbations at unexpected timing delivered by a custom-made mechatronic perturbation device. The temporal parameters (cadence and stance phase_%), mean, and standard deviation of MTC were computed across approximately 90 strides collected during both baseline and post-perturbation phases, for all trials. The effects of trial (three levels), phase (two levels: baseline and post-perturbation) and foot (two levels: right and left) on the outcome variables were analyzed using a three-way repeated measures analysis of variance. The results revealed that exposure to repeated trip-like perturbations modified MTC toward more precise control and lower toe clearance of the swinging foot, which appeared to reflect both the expectation of potential forthcoming perturbations and a quicker compensatory response in cases of a lack of balance. Moreover, locomotion control enabled subjects to maintain symmetric rhythmic features during post-perturbation steady walking. Finally, the effects of exposure to perturbation quickly disappeared among consecutive trials.     

Coupling of postural and manual tasks in expert performers

The purpose of this study was to investigate the integration of bimanual rhythmic movements and posture in expert marching percussionists. Participants (N = 11) performed three rhythmic manual tasks [1:1, 2:3, and 2:3-F (2:3 rhythm played faster at a self-selected tempo)] in one of three postures: sitting, standing on one foot, and standing on two feet. Discrete relative phase, postural time-to-contact, and coherence analysis were used to analyze the performance of the manual task, postural control, and the integration between postural and manual performance. Across all three rhythms, discrete relative phase mean and variability results showed no effects of posture on rhythmic performance. The complexity of the manual task (1:1 vs. 2:3) had no effect on postural time-to-contact. However, increasing the tempo of the manual task (2:3 vs. 2:3-F) did result in a decreased postural time-to-contact in the two-footed posture. Coherence analysis revealed that the coupling between the postural and manual task significantly decreased as a function of postural difficulty (going from a two-footed to a one-footed posture) and rhythmic complexity (1:1 vs. 2:3). Taken together, these results demonstrate that expert marching percussionists systematically decouple postural and manual fluctuations in order to preserve the performance of the rhythmic movement task.     

Distraction Affects the Performance of Obstacle Avoidance During Walking

In this study, dual-task interference in obstacle-avoidance tasks during human walking was examined. Ten healthy young adults participated in the experiment. While they were walking on a treadmill, an obstacle suddenly fell on the treadmill in front of their left leg during either midswing, early stance, or late stance of the ipsilateral leg. Participants were instructed to avoid the obstacle, both as a single task and while they were concurrently performing a cognitive secondary task (dual task). Rates of failure, avoidance strategy, and a number of kinematic parameters were studied under both task conditions. When only a short response time was available, rates of failure on the avoidance task were larger during the dual task than during the single task. Smaller crossing swing velocities were found during the dual task as compared with those observed in the single task. The difference in crossing swing velocities was attributable to increased stiffness of the crossing swing limb. The results of the present study indicated that divided attention affects young and healthy individuals' obstacle-avoidance performance during walking.     

Distraction affects the performance of obstacle avoidance during walking

In this study, dual-task interference in obstacle-avoidance tasks during human walking was examined. Ten healthy young adults participated in the experiment. While they were walking on a treadmill, an obstacle suddenly fell on the treadmill in front of their left leg during either midswing, early stance, or late stance of the ipsilateral leg. Participants were instructed to avoid the obstacle, both as a single task and while they were concurrently performing a cognitive secondary task (dual task). Rates of failure, avoidance strategy, and a number of kinematic parameters were studied under both task conditions. When only a short response time was available, rates of failure on the avoidance task were larger during the dual task than during the single task. Smaller crossing swing velocities were found during the dual task as compared with those observed in the single task. The difference in crossing swing velocities was attributable to increased stiffness of the crossing swing limb. The results of the present study indicated that divided attention affects young and healthy individuals' obstacle-avoidance performance during walking.     

Intentional compensation for selective loading affecting human gait phases

The locomotor strategies used by 12 subjects, instructed to hold their walking speed constant, were examined under various dynamic conditions in order to determine the means by which subjects can act upon their basic locomotor synergy. The dynamic conditions were modified either by adding a load or applying an impeding force. These modifications were designed to selectively affect either the stance phase or the swing phase. The results show that (a) subjects were able to rapidly calibrate their efforts to hold their walking speed constant, (b) in all conditions, the same walking speed was achieved with the same stride lengths and durations, and (c) at the within-cycle level, a change in duration synergically affected both phases and not just the perturbed one. The above results are discussed in terms of intentionally controlled parameters. Because cadence is closely linked to walking speed, it can be used as feedback; the control of walking speed in our experiments may thus be achieved simply by increasing the exerted force until the same cadence is produced.     

Prediction of foot clearance parameters as a precursor to forecasting the risk of tripping and falling

Tripping and falling is a serious health problem for older citizens due to the high medical costs incurred and the high mortality rates precipitated mostly by hip fractures that do not heal well. Current falls prevention technology encompasses a broad range of interventions; both passive (e.g., safer environments, hip protectors) and active (e.g., sensor-based fall detectors) which attempt to reduce the effects of tripping and falling. However the majority of these interventions minimizes the impact of falls and do not directly reduce the risk of falling. This paper investigates the prediction of gait parameters related to foot-to-ground clearance height during the leg swing phase which have been physically associated with tripping and falling risk in the elderly. The objective is to predict parameters of foot trajectory several walking cycles in advance so that anticipated low foot clearance could be addressed early with more volitional countermeasures, e.g., slowing down or stopping. In this primer study, foot kinematics was recorded with a highly accurate motion capture system for 10 healthy adults (25-32 years) and 11 older adults (65-82 years) with a history of falls who each performed treadmill walking for at least 10 min. Vertical foot displacement during the swing phase has three characteristic inflection points and we used these peak values and their normalized time as the target prediction values. These target variables were paired with features extracted from the corresponding foot acceleration signal (obtained through double differentiation). A generalized regression neural network (GRNN) was used to independently predict the gait variables over a prediction horizon (number of gait cycles ahead) of 1-10 gait cycles. It was found that the GRNN attained 0.32-1.10 cm prediction errors in the peak variables and 2-8% errors in the prediction of normalized peak times, with slightly better accuracies in the healthy group compared to elderly fallers. Prediction accuracy decreased linearly (best fit) at a slow rate with increasing prediction horizon ranging from 0.03 to 0.11 cm per step for peak displacement variables and 0.34 × 10(-3) - 1.81 × 10(-3)% per step for normalized peak time variables. Further time series analysis of the target gait variable revealed high autocorrelations in the faller group indicating the presence of cyclic patterns in elderly walking strategies compared to almost random walking patterns in the healthy group. The results are promising because the technique can be extended to portable sensor-based devices which measure foot accelerations to predict the onset of risky foot clearance, thus leading to a more effective falls prevention technology.