Vestibular input modulates stepping balance reactions early in the pre-step phase through to post-recovery.

Compensatory stepping reactions to recover balance are frequently performed, however, the role of sensory feedback in regulating these responses is not fully understood. Specifically, it is unknown whether vestibular input influences compensatory stepping. Here, we aimed to assess whether step responses utilize vestibular input by combining medio-lateral galvanic vestibular stimulation (GVS) with step-inducing balance perturbations via unpredictable anterior-posterior platform translations. Step responses were assessed for any lateral differences due to the illusory sense of left (LGVS) or rightward (RGVS) postural motion in terms of pre-step weight-shifts, center of mass (COM) motion and step-placement as well as lateral stability when recovering balance. GVS evoked clear differences from the pre-step phase onwards, in an asymmetrical pattern depending on the GVS direction relative to the right step-leg side. RGVS induced a leftwards postural shift to create a larger stability margin to the right (p < 0.0007), opposing the illusory motion and reducing the fall towards the unsupported side during the step; however, RGVS caused no change in step-width. Conversely, LGVS evoked a leftward step placement (p < 0.0001) in the direction of the mis-sensed motion, but without any rightward shift in postural motion. This asymmetry is consistent with vestibular input predictively modulating pre-step lateral weight-shifts and foot-placement in accordance with step mechanics, specifically in controlling frontal plane stability when lifting the foot to step.

The Influence of Countermovements on Inter-Segmental Coordination and Mechanical Energy Transfer during Vertical Jumping.

Inter-segmental coordination patterns and mechanical energy transfer were compared between vertical jumping tasks which possess different countermovement characteristics. Thirteen participants completed squat (SJ), countermovement (CMJ) and drop (DVJ) vertical jumps. Inter-segmental coordination patterns became more out-of-phase with increases in countermovement velocity (DVJ > CMJ > SJ), at the ankle, hip and lumbar spine (all p < 0.05), but not at the knee. With countermovements, more inter-segmental energy transfer occurred at all joints (p < 0.05), but increasing the countermovement velocity (DVJ compared to CMJ) did not always increase energy transfer (p < 0.001 for the hip and knee, p > 0.05 for the ankle and lumbar spine). The relationship between mechanical energy transfer and inter-segmental coordination patterns during vertical jumping is not straightforward since the responses to these varying countermovement demands were not consistent across all joints.

Altered Arm-Body Coordination with Triggered Pointing Responses as Influenced by Task Predictability.

Reaching movements generate reaction forces that affect postural stability, requiring sophisticated coordination between body and arm movement to maintain balance. In voluntary movement, this coordination involves feedforward shifts of posture, and such anticipatory postural muscle activity also accompanies the rapid modulation of an ongoing point to suddenly a shifting target (double-step). However, it is unknown if this early postural activity depends on target-shift predictability and whether arm and body motion are similar coordinated to voluntary movement. Body and arm motion coordination during double-step pointing movements from standing were done under differing conditions of target-shift predictability. In a proportion of trials, the pointing target was displaced, with the predictability of target-shift direction varied between two peripheral targets (target-shift direction known) and two central targets (target-shift direction uncertain). The target jump evoked an adjustment in the arm then body response, opposite to the pointing responses to the initial target. The triggered arm-then-body ordering was consistent across target-shift predictability, although known target-shift direction resulted in closer timing of arm and body onsets. The altered coordination in triggered corrections suggests that the body component in triggered reactions depend on response predictability, showing an altered control of arm and body motion.

Older adults exhibit altered motor coordination during an upper limb object transport task requiring a lateral change in support.

Investigating an ecologically relevant upper limb task, such as manually transporting an object with a concurrent lateral change in support (sidestepping alongside a kitchen counter), may provide greater insight into potential deficits in postural stability, variability and motor coordination in older adults. Nine healthy young and eleven older, community dwelling adults executed an upper limb object transport task requiring a lateral change in support in two directions at two self-selected speeds, self-paced and fast-paced. Dynamic postural stability and movement variability was quantified via whole-body center of mass motion. The onset of lead lower limb movement in relation to object movement onset was quantified as a measure of motor coordination. Older adults demonstrated similar levels of stability and variability as their younger counterparts, but at slower peak movement velocity and increased task duration. Furthermore, older adults demonstrated asymmetrical motor coordination between left and right task directions, while younger adults remained consistent regardless of task direction. Thus, older adults significantly modulated movement speed and motor coordination to maintain similar levels of stability and variability compared to their younger counterparts.

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.

Simultaneous Turn and Step Task for Investigating Control Strategies in Healthy Young and Community Dwelling Older Adults.

A simultaneous turn and step motion is a vital component of many complex movements and may provide insight into age related balance and stability deficits during a weight transfer task. In this study, nine young adults and ten healthy, community dwelling older adults performed a simultaneous "turn and step" task from a quiet standing position under two self-selected speeds, self-paced and as quickly and efficiently as possible. Whole-body center of mass was estimated to investigate stability, segmental coordination, and variability. Older adults performed the task with greater variability, however they were unable to alter stability nor segmental coordination across the self-selected speeds; absence of this modulation portrays a trade-off between stability and manoeuvrability. An increase in variability with no observed directional differences suggests that the simultaneous turn and step task may be a sensitive discriminatory motor task helpful in elucidating the adoption of altered control strategies used by elderly populations.

Effect of aging on dynamic postural stability and variability during a multi-directional lean and reach object transportation task.

A "reach and transport object" task that represents common activities of daily living may provide improved insight into dynamic postural stability and movement variability deficits in older adults compared to previous lean to reach and functional reach tests. Healthy young and older, community dwelling adults performed three same elevation object transport tasks and two multiple elevation object transport tasks under two self-selected speeds, self-paced and fast-paced. Dynamic postural stability and movement variability was quantified by whole-body center of mass motion. Older adults demonstrated significant decrements in frontal plane stability during the multiple elevation tasks while exhibiting the same movement variability as their younger counterparts, regardless of task speed. Interestingly, older adults did not exhibit a tradeoff in maneuverability in favour of maintaining stability throughout the tasks, as has previously been reported. In conclusion, the multi-planar, ecologically relevant tasks employed in the current study were specific enough to elucidate decrements in dynamic stability, and thus may be useful for assessing fall risk in older adults with suspected postural instability.

Effects of temporal and spatial cueing on anticipatory postural control in a rapid interceptive task.

Balance disruptions induced by voluntary focal arm actions are accommodated via anticipatory postural adjustments, but how this coordinated control is organized by the central nervous system remains unclear: either as combined or separate streams of postural-focal motor commands. For example, a focal arm task that dictates extremely tight temporal constraints may induce a focal response in absence of an anticipatory postural adjustment, providing evidence for separate focal-postural control streams. This study sought to probe the organization of focal-postural control via an interceptive task with very little available response time, and to determine whether focal-postural coordination depends on temporal and/or spatial foreknowledge of the task. Ten healthy young adults (5 males and 5 females; 20-29 years) reacted to catch a ball when standing under four conditions of temporal and spatial foreknowledge. Response onset was characterized by muscle activity from both postural and focal arm muscles. The catching task resulted in rapid muscle responses, but there was no difference between the fastest focal and postural muscle onsets. As expected, temporal cuing resulted in faster focal and postural onsets compared to spatial and control cuing trials. The accompaniment and time-locking of focal and postural muscle onsets, suggests that postural-focal coupling remains intact even under external time constraints and provides evidence for a single combined command stream of postural and focal control under such circumstances.

Experimentally induced central sensitization in the cervical spine evokes postural stiffening strategies in healthy young adults.

Dysequilibrium of cervicogenic origin can result from pain and injury to cervical paraspinal tissues post-whiplash; however, the specific physiological mechanisms still remain unclear. Central sensitization is a neuradaptive process which has been clinically associated with conditions of chronic pain and hypersensitivity. Strong links have been demonstrated between pain hypersensitivity and postural deficits post-whiplash; however, the precise mechanisms are still poorly understood. The purpose of this study was to explore the mechanisms of cervicogenic disequilibrium by investigating the effect of experimentally induced central sensitization in the cervical spine on postural stability in young healthy adults. Sixteen healthy young adults (7 males (22.6±1.13 years) and 9 females (22±2.69 years)) performed 30-s full-tandem stance trials on an AMTI force plate under normal and centrally sensitized conditions. The primary outcome variables included the standard deviation of the center of pressure (COP) position in medio-lateral (M-L) and antero-posterior (A-P) directions; sway range of the COP in M-L and A-P directions and the mean power frequency (MPF) of the COP and horizontal ground shear forces. Variability and sway range of the COP decreased with experimental induction of central sensitization, accompanied by an increase in MPF of COP displacement in both M-L and A-P directions, suggesting an increase in postural stiffening post-sensitization versus non-sensitized controls. Future studies need to further explore this relationship in clinical (whiplash, chronic pain) populations.

Determinants and consequences for standing balance of spontaneous weight-bearing on the paretic side among individuals with chronic stroke.

Hemiparetic stroke patients commonly bear more weight on the non-paretic side which seems intuitively linked to unilateral control deficits. However, there is evidence that some post-stroke favour weighting the paretic side, which may be problematic given altered capacity of the paretic limb to contribute to the control of upright posture. This study explores the prevalence and clinical determinants of stance asymmetry, and the relationship between stance asymmetry and postural control among chronic stroke patients. Subjects (n=147; >6 months post-stroke) stood on two force plates in eyes-open and eyes-closed conditions; 59 were symmetric, 18 had paretic asymmetry (PA), and 70 had non-paretic asymmetry (NPA). Root mean square (RMS) of antero-posterior and medio-lateral centre-of-pressure under each limb and both limbs combined were compared. RMS of total medio-lateral centre-of-pressure was greater for both asymmetric groups compared with the symmetric group. PA subjects relied less on the loaded limb for control than NPA subjects and relied more on visual information for postural control than those who were symmetric. There were no differences in the characteristics of individuals between the PA and NPA groups. The loading of the paretic limb was not related to impaired postural control during stationary standing which was attributable, in part, to individuals relying on control from the non-paretic limb, in spite of lower vertical load, and a greater dependence on visual contributions. There was no evidence that greater loading on the paretic limb was related to persisting dyscontrol but may rather reflect a learned strategy.

Reducing fall risk by improving balance control: development, evaluation and knowledge-translation of new approaches.

PROBLEM: Falling is a leading cause of serious injury, loss of independence, and nursing-home admission in older adults. Impaired balance control is a major contributing factor. METHODS: Results from our balance-control studies have been applied in the development of new and improved interventions and assessment tools. Initiatives to facilitate knowledge-translation of this work include setting up a new network of balance clinics, a research-user network and a research-user advisory board. RESULTS: Our findings support the efficacy of the developed balance-training methods, balance-enhancing footwear, neuro-prosthesis, walker design, handrail-cueing system, and handrail-design recommendations in improving specific aspects of balance control. IMPACT ON KNOWLEDGE USERS: A new balance-assessment tool has been implemented in the first new balance clinic, a new balance-enhancing insole is available through pharmacies and other commercial outlets, and handrail design recommendations have been incorporated into 10 Canadian and American building codes. Work in progress is expected to have further impact.

Stepping to recover balance in complex environments: is online visual control of the foot motion necessary or sufficient?

Rapid step reactions evoked by balance perturbation must accommodate constraints on limb motion imposed by obstacles and other environmental features. Recent results suggest that the required visuospatial information (VSI) is acquired and stored "proactively", prior to perturbation onset (PO); however, the extent to which "online" (post-PO) visual feedback can contribute is not known. To study this, we used large unpredictable platform perturbations to evoke rapid step reactions, while subjects wore liquid crystal goggles that occluded vision: (1) prior to PO (forcing use of online-VSI), (2) after PO (forcing use of stored-VSI), or (3) not at all (normal-VSI). Subjects stood behind a barrier in which the location of a narrow slot, through which the foot had to be moved during forward step reactions, was varied unpredictably between trials. Within subjects who were able to do the task (6 of 8 young adults tested), responses in stored-VSI and normal-VSI trials were very similar. However, in online-VSI trials, the foot-off time for the step through the slot was delayed (by approximately 50 ms, on average). Presumably, this delay allowed more time to acquire and process online-VSI regarding the required foot trajectory, yet subjects were still more likely to select the "wrong" foot (contralateral to the slot location) and to contact the barrier while moving the foot through the slot, in online-VSI trials. These results suggest a critical role for stored-VSI during the earliest phase of the step, in selecting the step limb and planning the initial trajectory. Online acquisition and processing of the required VSI may be too slow to allow effective control of this early phase, particularly in situations where the demands for accurate foot motion are high.

Gaze behavior of older adults during rapid balance-recovery reactions.

BACKGROUND: Rapid stepping reactions are a prevalent response to sudden loss of balance and play a crucial role in preventing falls. A previous study indicated that young adults are able to guide these stepping reactions amid challenging environmental constraints using "stored" visuospatial information. This study addressed whether healthy older adults also use "stored" visuospatial information in this manner, or are more dependent on "online" visual control. METHODS: Gaze behavior was recorded during rapid forward-stepping reactions evoked by unpredictable platform perturbation, as participants performed a concurrent task demanding visual attention. Challenging obstacles and/or step targets were used to increase demands for accurate foot motion. Twelve healthy older adults (61-73 years) were compared to 12 young adults (22-29 years) tested in a previous study. RESULTS: Similar to young adults, older participants seldom redirected gaze downward in response to the perturbation (11% of trials), yet were commonly able to clear the obstacle (74% of trials) or land on the target (41% of trials) while stepping to recover balance. The threat posed by the obstacle apparently prompted older adults to initiate early downward saccades during a small proportion (18%) of obstacle trials; however, this did not improve ability to clear the obstacle. CONCLUSION: Aging did not alter the predominant visual-control strategy used to guide the stepping reactions. Both young and older persons typically used stored visuospatial information, thereby allowing vision/attention to be switched to other demands during the stepping reaction and minimizing head/eye movements that could exacerbate the destabilizing effect of the balance perturbation.

Effect of competing attentional demands on perturbation-evoked stepping reactions and associated gaze behavior in young and older adults.

BACKGROUND: Rapid stepping reactions are a prevalent response to sudden loss of balance and are thought to play a crucial role in preventing falls. Previous dual-task studies, involving concurrent performance of step reactions and a visuomotor tracking task, indicated that online visual attention was not required to guide the step, even when nearby objects increased demands for accurate foot movement. However, the planning and execution of the step apparently required attentional resources initially allotted to the tracking task. Reallocation of these resources ("attention switching") was delayed in older adults. The present study examined the influence of the competition for attentional resources by comparing trials performed with and without the concurrent task. METHODS: Unpredictable platform perturbations were used to evoke rapid forward stepping reactions in healthy young and older adults. Challenging obstacles and/or step targets increased demands for accurate foot motion in some trials. A concurrent tracking task was performed in half of the trials. RESULTS: Although participants looked down more frequently in the absence of the tracking task, the ability to clear the obstacle or land on the step target and other spatiotemporal features of the stepping reactions were largely unaffected. There was, however, one notable exception: In older adults, the duration and amplitude of the "anticipatory postural adjustment" that preceded foot lift were reduced in tracking trials, resulting in increased lateral center-of-mass motion. CONCLUSION: Impaired attention switching apparently compromised the control of lateral stability during stepping reactions in older adults, and may be an important contributor to increased risk of falling.

Gaze behavior governing balance recovery in an unfamiliar and complex environment.

Visuospatial information regarding obstacles and other environmental constraints on limb movement is essential for the successful planning and execution of stepping movements. Visuospatial control strategies used during gait and volitional stepping have been studied extensively; however, the visuospatial strategies that are used when stepping rapidly to recover balance in response to sudden postural perturbation are not well established. To study this, rapid forward stepping reactions were evoked by unpredictable support-surface acceleration while subjects stood amid multiple obstacles that moved intermittently and unpredictably prior to perturbation onset (PO). To prevent predictive control, subjects performed only one trial (their very first exposure to the perturbation and environment). Visual scanning of the obstacles and surroundings occurred prior to PO in all subjects; however, gaze was never redirected at the obstacles, step foot or landing site in response to the perturbation. Surprisingly, the point of gaze at time of foot-contact was consistently and substantially anterior to the step-landing site. Despite the apparent absence of 'online' visual feedback related to the foot movement, the compensatory step avoided obstacle contact in 10 of 12 young adults and 9 of 10 older subjects. The results indicate that the balance-recovery reaction was typically modulated on the basis of visuospatial environmental information that was acquired and continually updated prior to perturbation, as opposed to a strategy based on 'online' visual control. The capacity to do this was not adversely affected by aging, despite a tendency for older subjects to look downward less frequently than young adults.

Redirection of gaze and switching of attention during rapid stepping reactions evoked by unpredictable postural perturbation.

In many situations successful execution of a balance-recovery reaction requires visual information about the environment. In particular, reactions that involve rapid limb movements, such as stepping, must be controlled to avoid obstacles and accommodate other constraints on limb trajectory. However, it is unknown whether the central nervous system can acquire the necessary visuospatial information prior to perturbation onset or must, instead, redirect gaze at the floor during the execution of the stepping reaction. To study this we examined gaze behaviour, during rapid forward-directed stepping reactions triggered by unpredictable platform perturbation, in 12 healthy young adults. We also monitored switching of attention, as inferred from onset of significant error in performing a concurrent visuomotor tracking task. Obstacles and/or step targets were used as constraints, to increase demands for accurate foot movement. Downward gaze shifts towards the floor almost never occurred during stepping reactions when foot motion was unconstrained but did occur more frequently as the demands for accurate foot movement increased. Nonetheless, even in the most challenging condition (target plus obstacle), downward redirection of gaze occurred in less than 40% of the trials, and subjects were commonly well able to clear the obstacle and land the foot on the target without redirecting their gaze towards the floor. An apparent switching of attention, subsequent to perturbation onset, occurred frequently (>80% of trials) in all task conditions, independent of the gaze shifts. The findings indicate that visual fixation of the foot or floor was not essential for accurate control of the foot movement, nor was the apparent switching of attention that followed perturbation onset linked, in any consistent way, to overt changes in visual fixation. Spatial features of the support surface were apparently "remembered" prior to perturbation onset, thereby allowing both vision and attention to be directed to other demands during the execution of the balance reaction.

Environmental constraints on foot trajectory reveal the capacity for modulation of anticipatory postural adjustments during rapid triggered stepping reactions.

This study used environmental restrictions on foot movement to challenge the capacity of the central nervous system (CNS) to counter the lateral instability that arises after foot-lift during rapid triggered stepping reactions evoked by unpredictable postural perturbation. The objective was to determine the extent to which lateral stability could be regulated via modulation of the mediolateral (m-l) anticipatory postural adjustment (APA) that precedes foot-lift. A high frontal obstacle was used to double the required swing duration, and thereby increase the potential for the center of mass (COM) to fall laterally toward the unsupported side, during forward-step reactions. The capacity to use lateral step placement to recover lateral stability was restricted by means of lateral barriers. Six healthy young adults were tested. In obstacle-only trials, the APA was insufficient to prevent increased lateral COM motion during the prolonged swing phase; hence, lateral step placement was necessitated. However, when lateral stepping was obstructed, the CNS was able to upregulate the APA amplitude so as to prevent this increase in lateral COM motion. The swing foot was placed medially, with no detriment to clearing the frontal obstacle or recovering equilibrium. There was no change in step timing or anteroposterior (a-p) COM motion. While previous studies have suggested that the a-p COM progression may determine the extent to which the m-l APA is expressed or truncated during triggered stepping reactions evoked by unpredictable perturbation, the present findings demonstrate that prior knowledge of environmental demands can lead to predictive efforts to modulate the APA during such reactions. An apparent preference to underscale anticipatory efforts when lateral step placement is permitted suggests that the CNS may be acting to avoid some potential risk or cost associated with the execution of a large APA.

Can stabilizing features of rapid triggered stepping reactions be modulated to meet environmental constraints?

This study examined whether the stabilizing features of rapid triggered compensatory stepping reactions can be modulated to accommodate an environmental constraint, in the form of an obstacle placed in front of the subject. The compensatory stepping reactions were evoked, in 11 healthy young adults, by unpredictable multidirectional platform translation; the forward-step reactions evoked by large backward translations were analyzed. Clearance of the obstacle required a doubling of the usual (no obstacle) swing duration and therein presented significant challenges to both anteroposterior (a-p) and lateral stability, yet the central nervous system (CNS) was able to decelerate and stabilize the body's center of mass (COM) without taking additional steps. Findings that the response was modulated successfully without prior practice or exposure to the perturbation suggest that the CNS automatically incorporates exteroceptive information into the control of compensatory stepping. Control of a-p stability appeared primarily to involve an increase in forward step distance. Surprisingly, the control of lateral stability involved both an anticipatory postural adjustment (APA) and lateral step placement. By including a much larger APA prior to foot-lift (137% increase in amplitude and 50% increase in duration versus no-obstacle trials), the COM was propelled to a more stable position prior to swing phase. This was achieved with minimal (32 ms) delay in foot-lift, due, in part, to more rapid initiation and execution of limb unloading. In contrast to previous findings that APAs are commonly absent or severely reduced during compensatory stepping, the present results demonstrate that large APAs can be incorporated into these reactions when demanded by task conditions. However, these large APAs were still insufficient to counter the increased tendency of the COM to fall during the prolonged swing phase. The fact that the APA was included at all may indicate a hybrid control, in which predictive control (via APA) is used to reduce the anticipated lateral instability, and reactive control of the final foot placement, governed by sensory discharge related to the actual COM motion, provides any additional stabilization required.