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.     

Effects of plantar cutaneo-muscular and tendon vibration on posture and balance during quiet and perturbed stance

Modulation of lower limb somatosensory information by tendon or plantar vibration produces directionally specific, vibration-induced falling reactions that depend on the tendon or the region of the sole that is vibrated. This study characterized the effects of different patterns of plantar cutaneo-muscular vibration and bilateral Achilles tendon vibration (ATV) on the postural strategies observed during quiet and perturbed stance. Twelve healthy young participants stood barefooted, with their vision blocked, on two sets of plantar vibrators placed on two AMTI force plates embedded in a moveable support surface. Two other vibrators were positioned over the Achilles tendons. Participants were randomly exposed to different patterns of plantar cutaneo-muscular and ATV. Tilts of the support surface in the toes-up (TU) and toes-down (TD) directions were given 5-8 s after the beginning of vibration. Body kinematics in 3D and ground reaction forces were recorded. Bilateral ATV applied with or without rearfoot vibration (RFV) during quiet stance resulted in a whole-body backward leaning accompanied by an increase in trunk extension and hip and knee flexion. RFV alone produced a forward whole-body tilt with increased flexion in trunk, hip, and ankle. When stance was perturbed by TU tilts, the center of mass (CoM) and center of pressure (CoP) displacements were larger in the presence of RFV or ATV and associated with increased peak trunk flexion. TD tilts with or without ATV resulted in no significant difference in CoM and CoP displacements, while larger trunk extension and smaller distal angular displacements were observed during ATV. RFV altered the magnitude of the balance reactions, as observed by an increase in CoP displacements and variable response in trunk displacement. Significant interactions between ATV and RFV were obtained for the peak angular excursions for both directions of perturbations, where ATV either enhanced (for TU tilts) or attenuated (for TD tilts) the influence of RFV. Manipulating somatosensory information from the plantar cutaneo-muscular and muscle spindle Ia afferents thus results in altered and widespread postural responses, as shown by profound changes in body kinematics and CoM and CoP displacements. This suggests that the CNS uses plantar cutaneo-muscular and ankle spindle afferent inputs to build an appropriate reference of verticality that influences the control of equilibrium during quiet and perturbed stance.     

Older adults exhibit variable responses in stepping behaviour following unexpected forward perturbations during gait initiation

With the socioeconomic burden associated with falls expected to rise as the average age of the Canadian population increases, research is needed to elucidate the nature of postural responses generated by older adults (OA) following a posture-destabilizing event. This knowledge is even more imperative for novel and difficult tasks, such as gait initiation (GI), a task known to pose a postural threat to stability for OA. A common technique to regain stability following an unexpected perturbation is reactive stepping. A deficiency in the execution of a reactive control strategy following a destabilizing event may be the cause of many unexpected falls in OA. The purpose of this study is to explore age related changes in the nature of these responses during a challenging GI task combined with an unexpected forward perturbation of the support surface. A total of 18 young adults (YA) and 16 OA performed 36 trials containing 20 unexpected perturbations. We calculated step width, length, time and COM velocity in the first unperturbed step and the second perturbed step. Results revealed that, during unperturbed GI, OA had a reduced forward velocity and took shorter, faster steps. Following forward perturbations, OA altered stepping patterns, perhaps to reduce single support duration, via reduced base of support and shorter step length compared to YA. Additionally, OA executed both forward and backwards directed steps however YA only generated forward steps. Regression analyses revealed that reduced forward velocity was predictive of step direction; which is possibly an unfavorable motor control strategy as OA who walk slower generated a posterior directed step immediately following the perturbation. This strategy is of concern as rapid responses by the trail limb are required to recover successfully, and these alterations may be associated with an elevated risk of falls.     

Postural fluctuations during pointing from a unilateral or bilateral stance

An experiment was conducted to compare the effects of bilateral and unilateral stance on postural fluctuations and intralimb coordination during active balance control. Fifteen participants stood bilaterally and unilaterally while conducting a pointing task with an outstretched arm. Excursion of center of foot pressure (CoP) and limb movements were recorded with a force plate and eight dual-axis accelerometers, respectively. Compared to bilateral stance, unilateral stance resulted in wider CoP trajectories and greater postural fluctuations, especially in the lower limbs. The limb-dependent postural fluctuations during unilateral stance were associated with an increased coupling between the upper limb segments and a decreased coupling between the segments of the stance leg. Unilateral stance further resulted in greater regularity and spectral changes in postural fluctuations of the trunk and lower limb due to increased central oscillations (8-15 Hz). The observed structural differences in postural fluctuations between unilateral and bilateral stance strongly suggested that the postural control system modulates joint stiffness in a stance-dependent manner. Probably, in unilateral stance, attentive control was shifted to the stance leg at the expense of increasing arm stiffness to reduce movement redundancy.     

Standing Posture on Land and at Sea

We studied the influence of ship motion on postural activity during stance, varying stance width (the distance between the feet in side-by-side stance) and the difficulty of visual tasks. Participants (experienced crewmembers) were tested on land and then on successive days on a ship at sea in mild sea states. On land, we replicated classical effects of stance width and visual task on the magnitude of postural movement. The magnitude of forces used in postural control was greater at sea than on land. Visual performance at sea was comparable to performance on land. Both stance width and visual task difficulty influenced postural activity at sea. In addition, postural activity changed over days at sea. We conclude that experienced crewmembers modulated standing posture in support of the performance of visual tasks and that such effects occurred even in mild sea states. The overall pattern of effects is compatible with the hypothesis that postural activity is modulated, in part, in support of the performance of suprapostural tasks.     

Effects of dual task difficulty in motor and cognitive performance: Differences between adults and adolescents

In the present study our aim was to compare dual-task performance in thirteen adolescents and fifteen young adults while concurrently performing a cognitive and a motor task. The postural control variables were obtained under three different conditions: i) bipedal stance, ii) tandem stance and iii) unipedal stance. The cognitive task consisted of a backward digit span test in which the participants were asked to memorize a sequence of numbers and then repeat the number in reverse order at three different difficulty levels (i.e. with 3, 4 and 5 digits). The difficulty of the cognitive task was seen to have different effects on adolescents and young adults. Adolescents seem to prioritize postural control during high difficulty postural conditions while a cross-domain competition model appeared in easy postural conditions.     

Stepping Responses in Young and Older Adults Following a Perturbation to the Support Surface During Gait

The objective of this work was to investigate the influence perturbation direction has on postural responses during overground gait, and whether these responses are age related. Differences in stepping patterns following perturbations of the support surface were examined in the frontal and sagittal planes during forward walking. Eleven young and 10 older adults completed Mini BESTest, hip strength tests, and 45 perturbed walking trials, triggered on heel contact. Lateral perturbations were more challenging to postural stability for both groups. Step length measures showed young adults recovered in the step proceeding the perturbation, while older adults needed additional steps to regain balance. Young adults arrested center of mass movement by producing larger step widths than older adults following the support surface perturbation.     

The precision demands of viewing distance modulate postural coordination and control

There are contrasting views on the role of vision in modifying postural organization (information-driven and postural facilitation) and limited direct tests of the underlying postural mechanisms. Here, we examined whether the distinction between the two views is appropriate given that both are interrelated parts of task constraints modulating postural coordination and control. The study investigated whether changes in the organization of the postural system are a function of the visual precision demands of a task and, in addition, whether such organization could be described as reflecting an intermittent controller. Sixteen participants were instructed to maintain quiet postural stance while fixating a point at different viewing distances (25, 50, 135, 220, 305 cm) or standing with eyes closed. The 25-cm condition showed the lowest standard deviation of the center of pressure (COP) and the highest correlation dimension (CD) in the anterior posterior direction. Analyses revealed that, contrary to the intermittent controller hypothesis, adaptations in the continuous COP and center of mass (COM) coupling characterized the observed changes in CD. The findings show that the natural act of looking to the same feature in the environment as a function of visual viewing distance can lead to quantitative and qualitative changes in the dynamics of posture. This is consistent with the view that postural facilitation and information availability are integrated in the perceptual-motor dynamics.     

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).     

Transitions in Visual Proprioception: A Cross-Sectional Developmental Study of the Effect of Visual Flow on Postural Control

In the present study, a moving room paradigm was used that characterized the developmental progression of the effects of visual perturbations on stance control in subjects (N = 39) from 5 months to 10 years of age. Kinematic (probability of recording sway, magnitude of sway response) and electromyographic (probability and patterns of muscle activation, muscle onset latencies) data were found that suggested that visual flow simulating sway activates organized postural muscle responses and results in subsequent sway in standing infants as young as 5 months of age, well before they are able to stand independently. In new walkers, there was an increase in the magnitude of the effect of the visual perturbation, suggesting a possible increase in reliance on visual information. The magnitude of sway decreased to very low levels in older children and adults. The large-amplitude responses observed in the youngest age groups may indicate an inability to switch from an unreliable to a reliable source of perceptual information or an inability to modulate the responses produced following the perturbations. With increasing age and experience, the ability to resolve the conflict increased, with adult subjects demonstrating little sway response.     

A concurrent attention-demanding task did not interfere with balance recovery function in standing and walking among young adults – An explorative laboratory study

This study aimed to explore the ability to overcome unannounced surface perturbations of different magnitudes during standing and walking under single-task and dual-task conditions. Balance recovery abilities during perturbed walking and concurrently performing cognitive tasks has rarely been investigated although it provides more ecological information in regard to real-life situations than perturbations during single-task conditions (i.e., just walking). Thirteen young adults were asked to perform: 1) a cognitive task while sitting; 2) perturbed standing; 3) a concurrent cognitive task during perturbed standing; 4) perturbed walking; and 5) a concurrent cognitive task during perturbed walking. The cognitive task was to perform number subtractions by seven. The participants were instructed to “try to avoid a fall” during the perturbation trials. Step threshold, cognitive task performance, and 3D kinematic analysis of the first recovery step, i.e., the spatiotemporal characteristics, were compared between all conditions. Step threshold and the spatiotemporal parameters of the first recovery stepping responses were similar between all task conditions. Cognitive performance was also unaffected by the postural challenges in all task conditions. These results suggest that the first balance recovery stepping response among young adults is automatic. Furthermore, young adults seem to have sufficient motor-cognitive resources to perform concurrently both balance recovery and cognitive tasks with no interference effects.     

Upward perturbations trigger a stumbling effect

BackgroundVertical perturbations are one major cause of falling. Incidentally, while conducting a comprehensive study comparing effects of vertical versus horizontal perturbations, we commonly observed a stumbling-like response induced by upward perturbations. The present study describes and characterizes this stumbling effect.MethodsFourteen individuals (10 male; 27 ± 4 yr) walked self-paced on a treadmill embedded in a moveable platform and synchronized to a virtual reality system. Participants experienced 36 perturbations (12 types). Here, we report only on upward perturbations. We determined stumbling based on visual inspection of recorded videos, and calculated stride time and anteroposterior, whole-body center of mass (COM) distance relative to the heel, i.e., COM-to-heel distance, extrapolated COM (xCOM) and margin of stability (MOS) before and after perturbation.ResultsFrom 68 upward perturbations across 14 participants, 75% provoked stumbling. During the first gait cycle post-perturbation, stride time decreased in the perturbed foot and the unperturbed foot (perturbed = 1.004 s vs. baseline = 1.119 s and unperturbed = 1.017 s vs. baseline = 1.125 s, p < 0.001). In the perturbed foot, the difference was larger in stumbling-provoking perturbations (stumbling: 0.15 s vs. non-stumbling: 0.020 s, p = 0.004). In addition, the COM-to-heel distance decreased during the first and second gait cycles after perturbation in both feet (first cycle: 0.58 m, second cycle: 0.665 m vs. baseline: 0.72 m, p-values<0.001). During the first gait cycle, COM-to-heel distance was larger in the perturbed foot compared to the unperturbed foot (perturbed foot: 0.61 m vs. unperturbed foot: 0.55 m, p < 0.001). MOS decreased during the first gait cycle, whereas the xCOM increased during the second through fourth gait cycles post-perturbation (maximal xCOM at baseline: 0.5 m, second cycle: 0.63 m, third cycle: 0.66 m, fourth cycle: 0.64 m, p < 0.001).ConclusionsOur results show that upward perturbations can induce a stumbling effect, which – with further testing – has the potential to be translated into balance training to reduce fall risk, and for method standardization in research and clinical practice.     

Evaluating feedback time delay during perturbed and unperturbed balance in handstand

Feedback delays in balance are often assessed using muscle activity onset latencies in response to discrete perturbations. The purpose of the study was to calculate EMG latencies in perturbed handstand, and determine if delays are different to unperturbed handstand. Twelve national level gymnasts completed 12 perturbed and 10 unperturbed (five eyes open and five closed) handstands. Forearm EMG latencies during perturbed handstands were assessed against delay estimates calculated via: cross correlations of wrist torque and COM displacement, a proportional and derivative model of wrist torque and COM displacement and velocity (PD model), and a PD model incorporating a passive stiffness component (PS-PD model). Delays from the PD model (161 ± 14 ms) and PS-PD model (188 ± 14 ms) were in agreement with EMG latencies (165 ± 14 ms). Cross correlations of COM displacement and wrist torque provided unrealistically low estimates (5 ± 9 ms). Delays were significantly lower during perturbed (188 ± 14 ms) compared to unperturbed handstand (eyes open: 207 ± 12 ms; eyes closed: 220 ± 19 ms). Significant differences in delays and model parameters between perturbed and unperturbed handstand support the view that balance measures in perturbed testing should not be generalised to unperturbed balance.     

Interaction between the development of postural control and the executive function of attention

The authors examined the interaction between the development of postural control and the development of the executive function of attention in 13 children and 6 adults in dual-task conditions. Participants performed an attentionally demanding cognitive task and a postural task simultaneously. The authors equalized the attentional load of the cognitive task across age groups. Comparative changes in the center of pressure in dual- and single-task conditions indicated that dual tasks interfered with postural performance in the wide stance (WS) and the modified Romberg stance (RS). Children at 4-6 years of age (but not children at ages 7-12 years of age or adults) experienced postural control interference in both stance positions, but interference was greater in the RS (p = .018). For all participants, cognitive task performance in RS was unchanged from that in WS. The knowledge gained from the results of this study will contribute to the design and implementation of academic and preacademic programming for young children. Their performance of an intentionally demanding cognitive task would be enhanced by the provision of appropriately sized desks and chairs or their use of an alternate, less demanding position.     

Modulations of muscle modes in automatic postural responses induced by external surface translations

The authors applied principal component analysis to investigate muscle activation patterns (M-modes) involved in the automatic postural responses induced by external surface perturbations. They focused on M-mode modulations as responses to the effects of practice, stability of the conditions and perturbed directions. While peak center of mass velocity reduced with practice, M-modes were similar with practice and across stability conditions. In contrast, atypical sway mode coactivations that combined proximal trunk muscles with distal muscles of the opposite lower extremity of the ventral-dorsal side were observed under the unstable conditions in both forward and backward perturbations after practice. In addition, M-modes in the forward translations were characterized by increased cocontraction patterns. Results suggest that compositions of the underlying M-modes show minor differences in each perturbed direction, but practice enhances coactivation patterns combining proximal muscles with distal muscles, and with accompanying cocontraction patterns, under more challenging conditions.     

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.     

Interaction Between the Development of Postural Control and the Executive Function of Attention

The authors examined the interaction between the development of postural control and the development of the executive function of attention in 13 children and 6 adults in dual-task conditions. Participants performed an attentionally demanding cognitive task and a postural task simultaneously. The authors equalized the attentional load of the cognitive task across age groups. Comparative changes in the center of pressure in dual- and single-task conditions indicated that dual tasks interfered with postural performance in the wide stance (WS) and the modified Romberg stance (RS). Children at 4-6 years of age (but not children at ages 7-12 years of age or adults) experienced postural control interference in both stance positions, but interference was greater in the RS (p = .018). For all participants, cognitive task performance in RS was unchanged from that in WS. The knowledge gained from the results of this study will contribute to the design and implementation of academic and preacademic programming for young children. Their performance of an intentionally demanding cognitive task would be enhanced by the provision of appropriately sized desks and chairs or their use of an alternate, less demanding position.     

Effects of Visual Tasks and Conversational Partner on Personal and Interpersonal Postural Activity

The control of stance is influenced by activities that are engaged in during stance. We investigated simultaneous constraints imposed by individual-specific factors (such as the distance of visual targets) and of interpersonal factors arising from dyadic conversation. Each member of participant pairs looked at targets (drawings) that were similar to, but differed from, that of a conversational partner. Conversational partners conversed to identify the differing elements. In Experiments 1 and 2, members of each dyad conversed with each other or separately conversed with a confederate (an experimenter). We varied the distance of targets (Experiment 1) and their size (Experiment 2). In Experiment 3, target size could be the same for both members of a dyad (i.e., small-small, large-large) or could differ (i.e., small-large, large-small). Interpersonal postural coordination was stronger when members of dyads conversed with each other, replicating earlier studies, but this manipulation also influenced parameters of individual sway. In Experiment 3, interpersonal postural coordination also was influenced by variation in the size of the partner's target. Analysis of the sway of individuals revealed influences of target distance and size, replicating previous effects; however, these manipulations also influenced interpersonal postural coordination. Overall, the results indicate that postural activity was modulated simultaneously with respect to individual and dyadic parameters of the task situation. We argue that it may be useful, both theoretically and empirically, to interpret the effects of conversation on postural activity within the broader context of relations between postural control and the performance of suprapostural tasks.     

Harnessing the Power of a Novel Program for Dynamic Balance Perturbation with Supported Body Weight

Abstract

Self-initiated postural adjustments commonly occur in daily life. To accessibly measure this type of dynamic balance, we developed a simple computer program to induce virtual perturbations and combined it with a commercially available balance board and portable EMG system to measure resulting self-initiated postural adjustments. When performing perturbed balance tests, safety harness with body weight support (BWS) is often used. However, influences of these harnesses on postural reactions are not well known. This study investigated the sensitivity of our assessment tool under different BWS conditions and muscle responses during postural adjustments following perturbation at different directions. Fifteen neurologically intact participants performed self-initiated postural adjustments under conditions with: (1) no harness; (2) harness with no BWS; and (3) harness with 10% BWS. Postural adjustment time and muscle activities of the lower leg were measured. We observed significant increases in postural adjustment time in the harness with no BWS condition and differneces in lower leg muscles response to virtual perturbation. Our findings suggest that the combination of our customized program with EMG is a sensitive and convenient tool to measure postural adjustments that approximate real-world scenarios. This method can be used with light body weight support to ensure safety without influencing muscle synergies.     

Slip and Trip Perturbations During an Object Transport Task Requiring a Lateral Change in Support

The ability to counteract destabilizing external forces while simultaneously executing a complex task presents a novel way to ascertain one's ability to generate adaptive postural control responses to avoid a potential fall. In this study, participants performed an upper limb object transport task requiring a lateral change in support on a robotic platform that could remain fixed in space or translated (mimicking a slip or trip perturbation). No significant stability differences were observed at initial recovery step between slip and trip perturbations. Variability measures were greatest during the trip perturbations; though stability was at its greatest level preceding these perturbations. These results will aid in the design of future studies that will investigate adaptive postural control responses generated by older adults when executing similar, ongoing complex upper body tasks interrupted by a destabilizing support surface perturbation.