Effects of aging on hip abductor-adductor neuromuscular and mechanical performance during the weight transfer phase of lateral protective stepping.

Aging brings about challenges in the ability to recover balance through protective stepping, especially in the lateral direction. Previous work has suggested that lateral protective stepping during weight transfer may be affected by impaired muscle composition and performance of the hip abductors (AB) in older adults. Hence, this study investigated the influence of hip abductor-adductor (AB-AD) neuromuscular performance on the weight transfer phase of lateral protective stepping in younger and older adults. Healthy younger (n = 15) and older adults (n = 15) performed hip AB-AD isometric maximal voluntary contractions (IMVC). Lateral balance perturbations were applied via motorized waist-pulls. Participants were instructed to recover their balance using a single lateral step. Kinetic, kinematic and electromyographic (EMG) data were analyzed during the weight transfer phase. In the hip IMVC task, older adults showed reduced peak AB-AD torque, AB rate of torque development and AB-AD rate of EMG neuromuscular activation (RActv). During the lateral balance perturbations, older individuals had a lower incidence of lateral steps, reduced hip AB-AD RActv and delayed weight transfer. However, several outcomes were larger in the older group, such as, center of mass momentum at step onset, step-side peak rate of vertical force development, hip AB net joint torque, and power. Although older adults had greater hip muscular output during the weight transfer phase, their lateral balance recovery was still impaired. The reduced maximal hip AB-AD capacity, especially RActv, may have been a greater contributor to this impairment, as it affects the ability to generate rapid force, crucial for balance recovery.

Low-dose hip abductor-adductor power training improves neuromechanical weight-transfer control during lateral balance recovery in older adults.

BACKGROUND: Age-related neuromuscular changes in the hip abductor-adductor muscles lead to reduced performance, especially in the rate of force development and power production. These alterations may impair weight transfer control and lateral balance recovery through protective stepping. This study compared the effects of eight weeks of low-dose hip abductor-adductor power and strength training on the performance of isometric maximal voluntary contractions, and lateral balance recovery at different initial weight-bearing conditions in older individuals. METHODS: Eighteen healthy older adults (71.3 (0.9) years) underwent eight weeks of low-dose hip abductor-adductor exercise training involving either power training (n = 10) or lower velocity strength training (n = 8). Outcomes were assessed for hip abductor-adductor isometric maximal voluntary contractions and lateral waist-pull balance perturbations with three initial stepping limb-load conditions (50%, 65%, or 80% body mass). FINDINGS: Power training increased isometric maximal voluntary contractions abductor-adductor peak torque (14%-18%, p < 0.05), rate of torque development (31%-39%, p < 0.05) and rate of neuromuscular activation (37%-81%, p < 0.05). During lateral balance recovery, power training increased the incidence of stabilizing single lateral steps at 80% body mass pre-load (by 43%, p < 0.05), reduced step lift-off time by 27 ms at 50% body mass (p < 0.05) and decreased downward momentum of the body center of mass at 80% body mass (32%, p < 0.05). Power training also increased in task hip abductor net joint torque (49%-61%, p < 0.05), power (21%-54%, p < 0.05), and abductor-adductor rate of neuromuscular activation (17%-62%, p < 0.05). INTERPRETATION: Low-dose hip abductor-adductor power training was more effective than strength training at eliciting improvements in maximal neuromuscular performance and enhanced medio-lateral balance recovery.

The role of vestibular and somatosensory systems in intersegmental control of upright stance.

Upright stance was perturbed using sinusoidal platform rotations to see how vestibular and somatosensory information are used to control segment and intersegmental dynamics in subjects with bilateral vestibular loss (BVL) and healthy controls (C). Subjects stood with eyes closed on a rotating platform (+/-1.2 degrees) for frequencies ranging from 0.01-0.4 Hz in the presence and absence of light fingertip touch. Trunk movement relative to the platform of BVLs was higher than Cs at higher platform frequencies whereas leg movement relative to the platform was similar for both groups. With the addition of light touch, both groups showed similar trunk and leg segment movement relative to the platform. Trunk-leg coordination was in-phase for frequencies below 1 Hz and anti-phase above 1 Hz. Interestingly, BVLs showed evidence of a "legs-leading-trunk" relationship in the shift from in-phase to anti-phase around 1 Hz. Controls showed no preference for either segment to lead the coordinative shift from in- to anti-phase. The results suggest that the balance instability of BVL subjects stems from high variability of the trunk, rather than the legs. The high trunk variability may emerge from the "legs-leading" intersegmental relationship upon which BVLs rely. Because BVLs derive information about self-orientation primarily from the support surface when their eyes are closed, the legs initiate the shift to anti-phase trunk-leg coordination that is necessary for stable upright stance control. Higher trunk variability suggests that this strategy results in lower overall postural stability. Light touch substitutes for vestibular information, leading to lower trunk variability along with a trunk-leg phase shift similar to controls, without a preference for either segment to lead the shift. The results suggest that vestibulospinal control acts primarily to stabilize the trunk in space and to facilitate intersegmental dynamics.

Limited control strategies with the loss of vestibular function.

When subjects stand on an unstable or compliant support surface, rather than a stable one, vestibular information becomes more important for the control of posture. We investigated how subjects with bilateral vestibular loss (BVL) controlled their upright posture, with and without light-touch contact at the fingertip, while standing on a support surface, sinusoidally rotating at different frequencies. Subjects stood with eyes closed on a platform that rotated +/-1.2 degrees around an axis directly beneath the midline of the ankle for frequencies ranging from 0.01 to 0.4 Hz for two sensory conditions: (1) with light, nonsupportive touch (less than 1 N vertical force) on a stationary surface; or (2) with the fingertip held in a position directly above the contact surface (no contact). Gain, phase, and variability of the center of mass (CoM) and the finger were analyzed to compare BVL subjects with healthy controls in the no-touch and light-touch conditions. Three important results were observed: First, CoM gain and variability of BVL subjects was distinctly higher than control subjects with no-touch contact, particularly at the higher platform frequencies. Second, with light-touch contact, BVL and control subjects showed equivalent gain, variability, and phase. Third, multiple relationships between the finger and the CoM were observed in control subjects, whereas BVL subjects implemented a single finger/CoM control scheme. The results are explained in terms of three interacting factors: the transfer function of the vestibular system, a sensory reweighting mechanism, and the inertial properties of the body. Moreover, multiple control strategies observed in control subjects suggest a more flexible control system than that of individuals with severely diminished vestibular function.