Gait characteristics during inadvertent obstacle contacts in young, middle-aged and older adults.

BACKGROUND: When stepping over obstacles, analyses have focused on the successful trials to understand adaptive gait. However, examination of the inadvertent trips that occasionally occur in the laboratory can provide a rich source of information regarding the gait characteristics underlying trip-related falls. RESEARCH QUESTION: What gait variables during obstacle crossing are associated with inadvertent obstacle contacts, and are these variables different across the lifespan? METHODS: Three age groups included: young adults (20-35 years, N = 20), middle-aged adults (50-64 years, N = 15), and older adults (65-79 years, N = 19). A stationary, visible obstacle (26 cm tall) was placed in the middle of a walkway. Foot trajectories and head angles were compared between contact and non-contact trials. RESULTS: Twelve participants contacted the obstacle: seven young adults (3.5% of young adult trials), two middle-aged adults (1.3%), and three older adults (1.6%). Young and middle-aged adults contacted primarily with the trail limb, while older adults contacted primarily with the lead limb. Contacts occurred for different reasons: Most young adult contact trials had appropriate foot placement, but inadequate elevation; middle-aged and older adults demonstrated inappropriate foot placement before the obstacle, leading to foot contact during the swing phase. SIGNIFICANCE: Lower contact rates in the middle-aged and older adults indicates that the cautious strategies adopted during obstacle crossing are effective. Higher contact rates in young adults may indicate trial-and-error exploratory behavior. Inappropriate foot placement in the middle-aged and older adults may indicate impaired ability to gather obstacle position information during the approach phase.

Changes in the control of obstacle crossing in middle age become evident as gait task difficulty increases.

BACKGROUND: Age-associated physiological changes result in modified gait, such as slower speed, for older adults. Identifying the onset of age-related gait changes will provide insight into the role of aging on locomotor control. It is expected that a more challenging gait task (obstacle crossing) puts more demands on physiological systems, and may reveal gait modifications in a middle-aged group that are not evident in an easier gait task (level walking). RESEARCH QUESTION: To identify the effect of advancing age on gait as a function of increasing locomotor challenge during an obstacle crossing task. METHODS: Three age groups (young, middle-aged, and older adults) stepped over an obstacle placed in a 15 m walkway. Task challenge ranged from low to high in four conditions: unobstructed gait, 3, 10, and 26 cm obstacles. Gait measures were calculated during the approach and crossing steps. RESULTS: Significant interactions were observed for gait speed (age by height by step, p < 0.01), foot placement variability (age by step, p < 0.01) and foot clearance (age by height, p = 0.05). Relative to young adults, older adults walked slower in all conditions and had higher foot clearances for the 10 and 26 cm obstacles. Middle-aged adults walked with speeds and foot clearances that were not different from young adults in the lower gait challenge conditions, and changed to values that were not different from older adults in the highest gait challenge conditions. Foot placement variability was greater for the middle-aged and older groups, but only in the last two steps before the obstacle. SIGNIFICANCE: Multiple gait changes were observed as early as middle-age, and changes in speed and foot clearance became more evident as task difficulty increased. The increased gait challenge placed more demands on the neuromuscular system, revealing age-related gait modifications that were not evident in the level walking gait task.

Coupling of postural and manual tasks in expert performers.

The purpose of this study was to investigate the integration of bimanual rhythmic movements and posture in expert marching percussionists. Participants (N=11) performed three rhythmic manual tasks [1:1, 2:3, and 2:3-F (2:3 rhythm played faster at a self-selected tempo)] in one of three postures: sitting, standing on one foot, and standing on two feet. Discrete relative phase, postural time-to-contact, and coherence analysis were used to analyze the performance of the manual task, postural control, and the integration between postural and manual performance. Across all three rhythms, discrete relative phase mean and variability results showed no effects of posture on rhythmic performance. The complexity of the manual task (1:1 vs. 2:3) had no effect on postural time-to-contact. However, increasing the tempo of the manual task (2:3 vs. 2:3-F) did result in a decreased postural time-to-contact in the two-footed posture. Coherence analysis revealed that the coupling between the postural and manual task significantly decreased as a function of postural difficulty (going from a two-footed to a one-footed posture) and rhythmic complexity (1:1 vs. 2:3). Taken together, these results demonstrate that expert marching percussionists systematically decouple postural and manual fluctuations in order to preserve the performance of the rhythmic movement task.

Prospective dynamic balance control during the swing phase of walking: stability boundaries and time-to-contact analysis.

This study examined the prospective control of the swing phase in young healthy adults while walking at preferred speed over unobstructed ground and during obstacle clearance. Three aspects of swing were examined: (1) the relation of the body Center of Mass (CoM) to the stability boundaries at the base of support; (2) a dynamic time-to-contact analysis of the CoM and swing foot to these boundaries; and (3) the role of head movements in the prospective control of gait and field of view assessment. The time-to-contact analysis of CoM and swing foot showed less stable swing dynamics in the trail foot compared to the lead foot in the approach to the unstable equilibrium, with the CoM leading the swing foot and crossing the anterior stability boundary before the swing foot. Compensations in temporal coupling occurred in the trail limb during the late swing phase. Time-to-contact analysis of head movement showed stronger prospective control of the lead foot, while fixation of the field of view occurred earlier in swing and was closer to the body in the obstacle condition compared to unobstructed walking. The dynamic time-to-contact analysis offers a new approach to assessing the unstable swing phase of walking in different populations.

Effect of head orientation on postural control during upright stance and forward lean.

Sensory feedback from the vestibular system and neck muscle stretch receptors is critical for the regulation of postural control. The postural relationship of the head to the trunk is a major factor determining the integration of sensory feedback and can be interfered with by varying head orientation. This study assessed how 60-s of standing with the head neutral, flexed, or extended impacted postural stability during upright stance and during forward lean in 13 healthy participants (26 ±5 years old). During both quiet upright stance and maximal forward lean, head extension increased postural center of pressure (COP) velocity and decreased the COP time-to-contact the anterior stability boundary compared with the head neutral condition. Head flexion did not differ from head neutral for either of the stance conditions. This study demonstrates that interfering with the head-trunk relationship by adopting extended, but not flexed, head orientations interferes with postural control that may impact postural stability during both quiet upright stance and maximal forward lean conditions.

Postural control in women with multiple sclerosis: effects of task, vision and symptomatic fatigue.

People with multiple sclerosis (MS) often report problems with balance, which may be most apparent during challenging postural tasks such as leaning or reaching, and when relying on non-visual sensory systems. An additional obstacle facing people with MS is a high incidence of symptomatic fatigue (>70%). The purpose of this study was to investigate the changes in balance during upright stance in individuals with mild-to-moderate disability due to MS under normal and restricted vision and different levels of self-reported fatigue. Limb loading asymmetry, sway and magnitude of postural shift in center of pressure, and time-to-contact the stability boundary of the center of mass and center of pressure were assessed during quiet standing and maximal lean and reach tasks. Compared to controls, people with MS displayed greater postural sway, greater loading asymmetry, and shorter time-to-contact during quiet standing. In the postural perturbation tasks the MS group had smaller postural shifts and reduced stability compared to controls in the direction perpendicular to the lean and reach. Limiting vision increased loading asymmetry during quiet standing and postural instability during backward lean in the MS group. Inducing additional fatigue in the MS group did affect postural control in the more challenging balance conditions but had no impact during quiet upright standing. The results of this study indicate subtle changes in postural control during standing in people with mild-to-moderate impairments due to MS.

Age-related changes in upper body adaptation to walking speed in human locomotion.

Assessments of changes in gait stability due to aging and disease are predominantly based on lower extremity kinematic and kinetic data. These gait changes are also often based on comparisons at preferred speed only. The purpose of this experiment was to: (1) examine age-related changes in range of motion and coordination of segments of the upper body during locomotion; and (2) investigate the effects of a systematic walking velocity manipulation on rotational motion and coordination. Participants (n=30) walked on a motor driven treadmill at speeds ranging from 0.2 to 1.8m/s and were divided into three groups with mean ages of 23.3, 49.3 and 72.6 years, respectively. Seven high-speed infrared cameras were used to record three-dimensional kinematics of the pelvis, trunk and head. Dependent variables were amplitude of segmental and joint rotations, as well as relative phase to assess coordination between segments. Although no differences in stride parameters were found between the groups, age-related changes in movement amplitude in response to speed manipulations were observed for all segments and joints. Pelvic rotations in sagittal, frontal and transverse planes of motion were systematically reduced with age. Older individuals showed reduced trunk flexion-extension in the sagittal plane and increased trunk axial rotation in the transverse plane. Coordination analysis showed reduced compensatory movement between pelvis and trunk in older individuals. These findings support the importance of systematic manipulation of walking velocity and three-dimensional upper body kinematics in assessing age-related changes in locomotor stability and adaptability.

Postural orientation: age-related changes in variability and time-to-boundary.

The relation between age-specific postural instability and the detection of stability boundaries was examined. Balance control was investigated under different visual conditions (eyes open/closed) and postural orientations (forward/backward lean) while standing on a force platform. Dependent variables included center of pressure variability and the time-to-contact of the center of pressure with the stability boundaries around the feet (i.e., time-to-boundary). While leaning maximally, older individuals (ages 55-69) showed increased center of pressure variability compared to no lean, while younger subjects (ages 24-38) showed a decrease. These significant differences were found only in anterior-posterior direction. No significant age-specific differences were found between eyes open and eyes closed conditions. Time-to-boundary analysis revealed reduced spatio-temporal stability margins in older individuals in both anterior-posterior and medio-lateral directions. Time-to-boundary variability, however, was not significantly different between the groups in both medio-lateral and anterior-posterior direction. These results show the importance of boundary relevant center of pressure measures in the study of postural control, especially concerning the lateral instability often observed in older adults.

Rigidity decreases resting tremor intensity in Parkinson's disease: A [(123)I]beta-CIT SPECT study in early, nonmedicated patients.

Tremor is one of the clinical hallmarks of Parkinson's disease (PD). Although it is accepted that other classic symptoms of PD such as rigidity and bradykinesia result from a degeneration of the nigrostriatal system and subsequent reduction in striatal dopamine, the pathophysiology of resting tremor remains unclear. The majority of recent single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies, using various radioligands, demonstrated significant correlation between striatal radioligand bindings and the degree of parkinsonian symptoms such as rigidity and bradykinesia, but not tremor. We investigate the relationship between the degeneration of the nigrostriatal pathway and the appearance of resting tremor, taking into account the possible interference of rigidity with the resting tremor. Thirty early and drug-naïve PD patients were examined. Tremor and rigidity of the arms were assessed using UPDRS, and the power of tremor was estimated using spectral analysis of tremor peaks. [(123)I]beta-CIT SPECT was used to assess degeneration of the dopaminergic system in PD patients. A comparison between asymmetry indices showed that in terms of both tremor and rigidity, the most affected arm corresponded significantly with the contralateral striatum, having the largest reduction in radioligand binding. Furthermore, tremor power accounted for a significant part of variance in the contralateral striatum, suggesting a relationship between this PD symptom and the degeneration of the dopaminergic system. Further, the degree of tremor was reduced with increasing rigidity. However, correcting for the influence of rigidity, the significant contribution of tremor in the variance in the contralateral striatal [(123)I]beta-CIT binding disappeared. When the confounding influence of rigidity is taken into account, no significant direct relationship between dopaminergic degeneration and the degree of tremor could be found. Other pathophysiological mechanisms should be similarly investigated in order to further our understanding of the origin of resting tremor in PD.

Stability boundaries and lateral postural control in parkinson's disease.

Postural instability is a major problem in patients with Parkinson's disease (PD). We examined balance control in PD by using center of pressure (CP) variability and time-to-contact to investigate boundary relevant postural control behavior under quiet stance leaning conditions. Postural orientation was manipulated by having patients (n = 10) and healthy older controls (n = 7) lean forward and backward with varying degrees of lean on a force platform. The subjects were instructed to lean forward or backward (either halfway or as far as possible) without bending their hips or lifting their heels or toes off the ground. Time-to-contact of the CP with the geometric stability boundary defined by the feet as well as CP position and variability were analyzed. Medio-lateral CP variability was increased in the patients with PD. Medio-lateral average time-to-contact was decreased in the patients but not so in the anterior-posterior direction. In contrast to the CP variability, the medio-lateral variability of time-to-contact was lower in the patients. Patients as well as healthy older controls responded to lean manipulations with an increase in CP variability. Boundary relevant CP measures thus show clear changes in control strategies and confirm the role of lateral instability in PD.

The swing phase of human walking is not a passive movement.

Many studies have assumed that the swing phase of human walking at preferred velocity is largely passive and thus highly analogous to the swing of an unforced pendulum. In other words, while swing-phase joint moments are generally nonzero during swing, it was assumed that they were either zero or at least negligibly small compared to gravity. While neglect of joint moments does not invalidate a study by default, it remains that the limitations of such an assumption have not been explored thoroughly. This paper makes five arguments that the swing phase cannot be passive, using both original data and the literature: (1) Computer simulations of the swing phase require muscular control to be accurate. (2) Swing-phase joint moments, while smaller than those during stance, are still greater than those due to gravity. (3) Gravity accounts for a minority of the total kinetics of a swing phase. (4) The kinetics due to gravity do not have the pattern needed to develop a normal swing phase. (5) There is no correlation between pendular swing times and human walking periods in overground walking. The conclusion of this paper is that the swing phase must be an actively controlled process, and should be assumed to be passive only when a study does not require a quantitative result. This conclusion has significant implications for many areas of gait research, including clinical study, control theory, and mechanical modeling.

Resonant frequencies of arms and legs identify different walking patterns.

The present study is aimed at investigating changes in the coordination of arm and leg movements in young healthy subjects. It was hypothesized that with changes in walking velocity there is a change in frequency and phase coupling between the arms and the legs. In addition, it was hypothesized that the preferred frequencies of the different coordination patterns can be predicted on the basis of the resonant frequencies of arms and legs with a simple pendulum model. The kinematics of arms and legs during treadmill walking in seven healthy subjects were recorded with accelerometers in the sagittal plane at a wide range of different velocities (i.e., 0.3-1. 3m/s). Power spectral analyses revealed a statistically significant change in the frequency relation between arms and legs, i.e., within the velocity range 0.3-0.7m/s arm movement frequencies were dominantly synchronized with the step frequency, whereas from 0.8m/s onwards arm frequencies were locked onto stride frequency. Significant effects of walking speed on mean relative phase between leg and arm movements were found. All limb pairs showed a significantly more stable coordination pattern from 0.8 to 1.0m/s onwards. Results from the pendulum modelling demonstrated that for most subjects at low-velocity preferred movement frequencies of the arms are predicted by the resonant frequencies of individual arms (about 0.98Hz), whereas at higher velocities these are predicted on the basis of the resonant frequencies of the individual legs (about 0.85Hz). The results support the above-mentioned hypotheses, and suggest that different patterns of coordination, as shown by changes in frequency coupling and phase relations, can exist within the human walking mode.

A dynamical systems approach to lower extremity running injuries.

UNLABELLED: In this paper, we are presenting an alternative approach to the investigation of lower extremity coupling referred to as a dynamical systems approach. In this approach, we calculate the phase angle of each segment and joint angle. Pairing the key segment/joint motions, we use phase angles to determine the continuous relative phase and the variability of the continuous relative phase. Data from two studies illustrate the efficacy of the dynamical systems approach. Individuals who were asymptomatic, even though they may have anatomical aberrant structural problems (i.e. high Q-angle vs low Q-angle) showed no differences in the pattern of the continuous relative phase or in the variability of the continuous phase. However, differences in the variability of the continuous relative phase were apparent in comparing individuals who were symptomatic with patellofemoral pain with non-injured individuals. Patellofemoral pain individuals showed less variability in the continuous relative phase of the lower extremity couplings than did the healthy subjects. We hypothesize that the lower variability of the couplings in the symptomatic individuals indicates repeatable joint actions within a very narrow range. RELEVANCE: We claim that the traditional view of the variability of disordered movement is not tenable and suggest that there is a functional role for variability in lower extremity segment coupling during locomotion. While the methods described in this paper cannot determine a cause of the injury, they may be useful in the detection and treatment of running injuries.

Q-angle influences on the variability of lower extremity coordination during running.

UNLABELLED: The quadriceps angle (Q-angle) has received attention as a possible predictor of patellofemoral pain (PFP). It has been suggested that an excessive Q-angle alters the patellofemoral tracking, thereby leading to PFP. Traditional methods used to evaluate alterations in lower extremity angular kinematics have not confirmed this thought. A dynamical systems approach involving segment couplings may provide additional insight by addressing the variability of the intersegmental coordination. METHODS: Thirty-two healthy pain-free subjects with varying Q-angles were examined and divided into groups based on gender and Q-angle. Subjects ran overground for 10 trials while three-dimensional kinematic data were collected from the thigh, leg, and foot. The kinematic data were digitized and filtered before a direct linear transformation was employed to calculate three-dimensional segment angles and angular velocities. The variability of the continuous relative phase (CRP) of segment couplings was used to assess between-trial consistency at specific stance phase intervals. RESULTS: No differences in CRP variability were found among subjects with varying Q-angles. Significant differences were present between the specific intervals of the couplings with the greatest variability during initial stance (P < 0.05). CONCLUSIONS: A difference in CRP variability does not appear to exist in the lower extremity between individuals with and without abnormal Q-angles. The significant differences among the stance phase intervals of running suggest the inherent presence of coordination pattern variability. The importance of the increased pattern variability during initial stance may be associated with maintaining external stability.

Identification of axial rigidity during locomotion in Parkinson disease.

OBJECTIVES: To identify coordination changes and stability in the movements of the trunk during locomotion in Parkinson disease (PD) as a function of walking velocity. STUDY DESIGN: Comparison of treadmill locomotion with an opto-electronic tracking device. PATIENTS: Newly diagnosed patients with PD (n = 27) and a group of healthy control subjects (n = 11). RESULTS: Coordination between transversal pelvic and thoracic rotations showed significantly smaller changes in mean relative phase (p < .0001) and lower variability in relative phase (p < .0001) in the PD group. No significant differences were found in stride duration and variability in stride duration. CONCLUSIONS: The relative phase data contradict traditional notions of increased variability in motor control in PD and pinpoint the importance of the trunk in identifying axial rigidity. This discrepancy may be due to lack of control for walking velocity in earlier studies. It is concluded that systematic manipulation of walking velocity can identify coordination deficits and rigidity in trunk movement. This coordination of trunk movement can also be a sensitive measure for (early) diagnosis and the assessment of movement and pharmacological therapy in PD.

Effects of walking velocity on relative phase dynamics in the trunk in human walking.

The nature of coordination changes and stability features in the relative phase dynamics of the trunk were examined in seven healthy subjects, while walking velocity on a treadmill was gradually increased and decreased. Predictions from Schöner et al (J. Theor. Biol. 142, 359-391, 1990) regarding transition mechanisms in quadrupedal walking generalized to pelvis-thorax phase relations in bipedal walking, in that more continuous transitions with and without loss of stability were observed when walking velocity was manipulated as a control parameter. Relative phase changed from more in-phase (about 25 degrees) at lower velocities to more out-of-phase (about 110 degrees) at higher velocities. Stability analysis of relative phase demonstrated the existence of more than one stable coordination pattern ('multistability'). Total ranges of motion in pelvis, thorax, and trunk, as well as stride length were larger at the decreasing velocity range was compared to the increasing velocity range, showing dependence on direction of control parameter manipulation ('hysteresis effect'). The nature of these transitions identifies phase relations in the trunk in human walking as lower symmetry dynamics, a finding consistent with the proposed dynamics of the quadrupedal walking mode. These results suggest the existence of different coordination patterns (multistability) in the human bipedal walking mode and question traditional distinctions in only two modes (walking and running) in human gait.

Facial stereotypic movements and tardive dyskinesia in a mentally retarded population.

The facial stereotypies of adults diagnosed as having mental retardation and tardive dyskinesia were examined through a kinematic analysis of video-taped lip and tongue motions. A control group of healthy adult subjects without mental retardation was also examined in the production of preferred rates of lip and tongue oscillatory motions to provide a basis to assess the degree of movement variability in the stereotypies. The inter- and intraindividual variability of the movement form characteristics of the lip and tongue stereotypic motions was higher in the subjects with mental retardation. Results suggest that the low variability of discrete properties of movement kinematics may not be a defining feature of stereotypies. The concept of invariance in stereotypies may relate only to the topological kinematic properties of the movement sequence that provide the basis to infer that the same stereotypic movement sequence was reproduced from observation to observation.

Quantification of postural sway patterns in tardive dyskinesia.

An assessment was made of the orientation and variability in postural center of pressure patterns in individuals with tardive dyskinesia (TD) and/or developmental disability during quiet standing. Postural patterns were compared and contrasted between four groups of individuals: those with (a) TD and developmentally disabled (severely and profoundly retarded); (b) developmental disability only; (c) TD but of normal intelligence; and (d) a healthy control group. The center of pressure displacements were derived from the lateral, vertical, and anterior-posterior force and moment components of force platform measurements. Analyses demonstrated that individuals with TD in combination with developmental disability had a different center of pressure orientation and variability compared to healthy individuals and individuals suffering only from developmental disability or TD. The center of pressure pattern in the developmentally disabled TD group was characterized by a more prominent lateral orientation, whereas in the other three groups, it had a more predominant anterior-posterior orientation. In addition, the variability in these orientation components was much smaller in the developmentally disabled TD group, indicating a more regular pattern of sway in the center of pressure during quiet standing in these individuals. These findings show that assessments of postural center of pressure profile orientation and variability may be useful indicators for investigating TD, especially in distinguishing between developmental disability and TD.

Arm tremor, tardive dyskinesia, and mental retardation.

The arm tremor of adults diagnosed as having mental retardation and/or tardive dyskinesia was examined through an analysis of the acceleration properties of several arm postures. The degree of arm acceleration was increased in all groups compared to a control group without mental retardation. The tardive dyskinesia and/or mentally retarded groups also showed a shift to a lower modal frequency of physiological tremor. Results showed that both time domain and frequency properties of the tremor acceleration signal are necessary to distinguish between groups. The neuroleptic medication appears to engender a dual and opposing influence on performance in the arm tremor task for the mentally retarded group. The medication reduces behavioral variability as indexed by analyses of arm acceleration over time (time domain) but lowers the modal frequency of physiological tremor.