Upward perturbations trigger a stumbling effect |
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| Institution: | 1. Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel;2. Brightlands Institute for Smart Society-BISS, Maastricht University, Maastricht, the Netherlands;3. Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA;4. Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel;5. Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;6. Department of Neurological Rehabilitation, Sheba Medical Center, Ramat Gan, Israel;7. Department of Physical and Rehabilitation Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;8. School of Health Professions, Ono Academic College, Kiryat Ono, Israel;9. Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;1. Département des sciences de l''activité physique, Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, QC G8Z 4M3, Canada;2. École de kinésiologie et des sciences de l''activité physique de la Faculté de médecine, Université de Montréal, 2100 Edouard Montpetit Blvd. #6219, Montreal, QC H3T 1J4, Canada;3. Centre de recherche du CHU Sainte-Justine, 5858 Côte-des-Neiges Rd, Montreal, QC H3S 1Z1, Canada;4. Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Rd, Montreal, QC H3S 1Z1, Canada;5. Human Kinetics Department, St Francis Xavier University, 4130 University Ave, Antigonish, NS B2G 2W5, Canada;6. Département de kinésiologie, Université Laval, 2300, rue de la Terrasse, Quebec, QC G1V 0A6, Canada;7. Département de Pédiatrique, Faculté de médecine, Université de Montréal, 3175, chemin Côte Sainte-Catherine, Montréal, QC H3T 1C5, Canada;1. TUM School of Computation, Information and Technology, Human-centered Assistive Robotics, Technical University of Munich, Karlstraße 45, 80333 Munich, Germany;3. TUM Department of Sport and Health Sciences, Human Movement Science, Technical University of Munich, Munich 80992, Germany;4. Institute of Computer Technology, Autonomous Systems, Technische Universität Wien, Vienna 1040, Austria;5. Institute of Robotics and Mechatronics, German Aerospace Center (DLR), 82234 Wessling, Germany;1. The Polytechnic School, Arizona State University, Mesa, AZ, USA;2. School for Engineering of Matter, Transport & Energy, Arizona State University, Tempe, AZ, USA;1. Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Taiwan;2. Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan;3. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan;4. Center of Parkinson''s Disease, Kaohsiung Chang Gung Memorial Hospital, Taiwan;5. Center for Mitochondrial Research and Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan;6. Department of Physical Education, National Kaohsiung Normal University, Taiwan |
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| Abstract: | 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. |
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