The Effects of Optical Flow Perturbations on Standing Balance in People With Multiple Sclerosis.

Multiple sclerosis is a neurodegenerative disease that causes balance deficits, even in early stages. Evidence suggests that people with multiple sclerosis (PwMS) rely more on vision to maintain balance, and challenging balance with optical flow perturbations may be a practical screening for balance deficits. Whether these perturbations affect standing balance in PwMS is unknown. Therefore, the purpose of this study was to examine how optical flow perturbations affect standing balance in PwMS. We hypothesized that perturbations would cause higher variability in PwMS compared with matched controls during standing and that standing balance would be more susceptible to anterior-posterior (A-P) perturbations than medial-lateral (M-L) perturbations. Thirteen PwMS and 13 controls stood under 3 conditions: unperturbed, M-L perturbation, and A-P perturbations. A-P perturbations caused significantly higher A-P trunk sway variability in PwMS than controls, although both groups had similar center-of-pressure variability. Both perturbations increased variability in A-P trunk sway and center of pressure. Trunk variability data supported the hypothesis that PwMS were more susceptible to optical flow perturbations than controls. However, the hypothesis that A-P perturbations would affect balance more than M-L perturbations was partially supported. These results suggest potential for optical flow perturbations to identify balance deficits in PwMS.

Can optical flow perturbations detect walking balance impairment in people with multiple sclerosis?

People with multiple sclerosis (PwMS) who exhibit minimal to no disability are still over twice as likely to fall as the general population and many of these falls occur during walking. There is a need for more effective ways to detect preclinical walking balance deficits in PwMS. Therefore, the purpose of this study was to investigate the effects of optical flow perturbations applied using virtual reality on walking balance in PwMS compared to age-matched controls. We hypothesized that susceptibility to perturbations-especially those in the mediolateral direction-would be larger in PwMS compared to controls. Fourteen PwMS and fourteen age-matched controls walked on a treadmill while viewing a virtual hallway with and without optical flow perturbations in the mediolateral or anterior-posterior directions. We quantified foot placement kinematics, gait variability, lateral margin of stability and, in a separate session, performance on the standing sensory organization test (SOT). We found only modest differences between groups during normal, unperturbed walking. These differences were larger and more pervasive in the presence of mediolateral perturbations, evidenced by higher variability in step width, sacrum position, and margin of stability at heel-strike in PwMS than controls. PwMS also performed worse than controls on the SOT, and there was a modest correlation between step width variability during perturbed gait and SOT visual score. In conclusion, mediolateral optical flow perturbations revealed differences in walking balance in PwMS that went undetected during normal, unperturbed walking. Targeting this difference may be a promising approach to more effectively detect preclinical walking balance deficits in PwMS.

Effects of aging and target location on reaction time and accuracy of lateral precision stepping during walking.

Older adults have poorer lateral balance and deficits in precision stepping accuracy, but the way these deficits manifest with lateral step distance is unclear. The purpose of this study was to investigate aging effects on lateral precision stepping performance in reaction to near and distant foot placement targets during treadmill walking. We hypothesized that older adults would step to targets later and less accurately than young adults, and that these difference would be more pronounced for distant targets. During the study, young and older adults stepped on lateral targets projected onto the surface of a treadmill one stride prior to their targeting step. We measured stepping accuracy to the target, the time when the swing foot diverged from its normal swing trajectory, and swing phase gluteus medius activity. Both groups had similar performance stepping to near targets, suggesting that giving older subjects a full stride to react to target location mitigates visuomotor processing delays that have contributed to deficits in stepping performance in prior studies. However, when stepping to distant targets, older adults had larger errors and later divergence times than young adults. This suggests that age-related deficits other than those in visuomotor processing contribute to poorer performance for more difficult stepping tasks. Furthermore, while young adults increased early swing gluteus medius activity with lateral target distance, older adults did not. This is the first study to show a potential neuromuscular basis for precision stepping deficits in older adults.

Time-dependent tuning of balance control and aftereffects following optical flow perturbation training in older adults.

BACKGROUND: Walking balance in older adults is disproportionately susceptible to lateral instability provoked by optical flow perturbations. The prolonged exposure to these perturbations could promote reactive balance control and increased balance confidence in older adults, but this scientific premise has yet to be investigated. This proof of concept study was designed to investigate the propensity for time-dependent tuning of walking balance control and the presence of aftereffects in older adults following a single session of optical flow perturbation training. METHODS: Thirteen older adults participated in a randomized, crossover design performed on different days that included 10 min of treadmill walking with (experimental session) and without (control session) optical flow perturbations. We used electromyographic recordings of leg muscle activity and 3D motion capture to quantify foot placement kinematics, lateral margin of stability, and antagonist coactivation during normal walking (baseline), early (min 1) and late (min 10) responses to perturbations, and aftereffects immediately following perturbation cessation (post). RESULTS: At their onset, perturbations elicited 17% wider and 7% shorter steps, higher step width and length variability (+171% and +132%, respectively), larger and more variable margins of stability (MoS), and roughly twice the antagonist leg muscle coactivation (p-values<0.05). Despite continued perturbations, most outcomes returned to values observed during normal, unperturbed walking by the end of prolonged exposure. After 10 min of perturbation training and their subsequent cessation, older adults walked with longer and more narrow steps, modest increases in foot placement variability, and roughly half the MoS variability and antagonist lower leg muscle coactivation as they did before training. CONCLUSIONS: Findings suggest that older adults: (i) respond to the onset of perturbations using generalized anticipatory balance control, (ii) deprioritize that strategy following prolonged exposure to perturbations, and (iii) upon removal of perturbations, exhibit short-term aftereffects that indicate a lessening of anticipatory control, an increase in reactive control, and/or increased balance confidence. We consider this an early, proof-of-concept study into the clinical utility of prolonged exposure to optical flow perturbations as a training tool for corrective motor adjustments relevant to walking balance integrity toward reinforcing task-specific, reactive control and/or improving balance confidence in older adults. TRIAL REGISTRATION: clinicaltrials.gov ( NCT03341728 ). Registered 14 November 2017.

Development and Assessment of a Low-Cost Clinical Gait Analysis System.

Clinically, measuring gait kinematics and ground reaction force (GRF) is useful to determine the effectiveness of treatment. However, it is inconvenient and expensive to maintain a laboratory-grade gait analysis system in most clinics. The purpose of this study was to validate a Wii Balance Board, Kinovea motion-tracking software, and a video camera as a portable, low-cost system, and overground gait analysis system. We validated this low-cost system against a multicamera Vicon system and research-grade force platform (Advanced Mechanical Technology, Inc). After validation trials with known weights and angles, 5 subjects walked across an instrumented walkway for multiple times (n = 8/subject). We collected vertical GRF and segment angles. Average GRF data from the 2 systems were similar, with peak GRF errors below 3.5%BW. However, variability in the balance board's sampling rate led to large GRF errors early and late in stance, when the GRF changed rapidly. The thigh, shank, and foot angle measurements were similar between the single and multicamera, but the pelvis angle was far less accurate. The proposed system has the potential to provide accurate segment angles and peak GRF at low cost but does not match the accuracy of the multicamera system and force platform, in part because of the Wii Balance Board's variable sampling rate.

Changes in mechanical work during neural adaptation to asymmetric locomotion.

Minimizing whole-body metabolic cost has been suggested to drive the neural processes of locomotor adaptation. Mechanical work performed by the legs should dictate the major changes in whole-body metabolic cost of walking while providing greater insight into temporal and spatial mechanisms of adaptation. We hypothesized that changes in mechanical work by the legs during an asymmetric split-belt walking adaptation task could explain previously observed changes in whole-body metabolic cost. We predicted that subjects would immediately increase mechanical work performed by the legs when first exposed to split-belt walking, followed by a gradual decrease throughout adaptation. Fourteen subjects walked on a dual-belt instrumented treadmill. Baseline trials were followed by a 10-min split-belt adaptation condition with one belt running three times faster than the other. A post-adaptation trial with both belts moving at 0.5 m s-1 demonstrated neural adaptation. As predicted, summed mechanical work from both legs initially increased abruptly and gradually decreased over the adaptation period. The initial increase in work was primarily due to increased positive work by the leg on the fast belt during the pendular phase of the gait cycle. Neural adaptation in asymmetric split-belt walking reflected the reduction of pendular phase work in favor of more economical step-to-step transition work. This may represent a generalizable framework for how humans initially and chronically learn new walking patterns.

Two biomechanical strategies for locomotor adaptation to split-belt treadmill walking in subjects with and without transtibial amputation.

Locomotor adaptation is commonly studied using split-belt treadmill walking, in which each foot is placed on a belt moving at a different speed. As subjects adapt to split-belt walking, they reduce metabolic power, but the biomechanical mechanism behind this improved efficiency is unknown. Analyzing mechanical work performed by the legs and joints during split-belt adaptation could reveal this mechanism. Because ankle work in the step-to-step transition is more efficient than hip work, we hypothesized that control subjects would reduce hip work on the fast belt and increase ankle work during the step-to-step transition as they adapted. We further hypothesized that subjects with unilateral, trans-tibial amputation would instead increase propulsive work from their intact leg on the slow belt. Control subjects reduced hip work and shifted more ankle work to the step-to-step transition, supporting our hypothesis. Contrary to our second hypothesis, intact leg work, ankle work and hip work in amputees were unchanged during adaptation. Furthermore, all subjects increased collisional energy loss on the fast belt, but did not increase propulsive work. This was possible because subjects moved further backward during fast leg single support in late adaptation than in early adaptation, compensating by reducing backward movement in slow leg single support. In summary, subjects used two strategies to improve mechanical efficiency in split-belt walking adaptation: a CoM displacement strategy that allows for less forward propulsion on the fast belt; and, an ankle timing strategy that allows efficient ankle work in the step-to-step transition to increase while reducing inefficient hip work.

Locomotor control of limb force switches from minimal intervention principle in early adaptation to noise reduction in late adaptation.

During movement, errors are typically corrected only if they hinder performance. Preferential correction of task-relevant deviations is described by the minimal intervention principle but has not been demonstrated in the joints during locomotor adaptation. We studied hopping as a tractable model of locomotor adaptation of the joints within the context of a limb-force-specific task space. Subjects hopped while adapting to shifted visual feedback that induced them to increase peak ground reaction force (GRF). We hypothesized subjects would preferentially reduce task-relevant joint torque deviations over task-irrelevant deviations to increase peak GRF. We employed a modified uncontrolled manifold analysis to quantify task-relevant and task-irrelevant joint torque deviations for each individual hop cycle. As would be expected by the explicit goal of the task, peak GRF errors decreased in early adaptation before reaching steady state during late adaptation. Interestingly, during the early adaptation performance improvement phase, subjects reduced GRF errors by decreasing only the task-relevant joint torque deviations. In contrast, during the late adaption performance maintenance phase, all torque deviations decreased in unison regardless of task relevance. In deadaptation, when the shift in visual feedback was removed, all torque deviations decreased in unison, possibly because performance improvement was too rapid to detect changes in only the task-relevant dimension. We conclude that limb force adaptation in hopping switches from a minimal intervention strategy during performance improvement to a noise reduction strategy during performance maintenance, which may represent a general control strategy for locomotor adaptation of limb force in other bouncing gaits, such as running.

Motor noise removal for determining gait events over treadmill walking using wavelet filter.

The conventional method for filtering force plate data, low-pass filtering, does not always give accurate results when applied to force data from a custom-made, instrumented treadmill. Therefore, this study compares low-pass filtered data to the same data passed through a wavelet filter. We collected data with the treadmill running. However these include motor noise with ground reaction force at two force plates. We found that he proposed wavelet method eliminated motor noise to result in more accurate force plate data than the conventional low-pass filter, particularly at high speed motor operation. In this study we suggested the convolution wavelet (CNW) which was compared to that of a low-pass filter. The CNW showed better performance as compared to band-pass filtering particularly for low signal-to-noise ratios, and a lower computational load.