Can we use peripheral vision to create a visuospatial map for compensatory reach-to-grasp reactions?

Perturbation-induced reach-to-grasp reactions are dependent on vision to capture environmental features of potential support surfaces. Previous research proposed the use of an intrinsic visuospatial map of the environment to reduce delays in motor responses (e.g., stepping, grasping a handrail). Forming such a map from foveal vision would be challenging during movement as it would require constant foveal scanning. The objective of this study was to determine if compensatory reach-to-grasp reactions could be successfully executed while relying on a visuospatial map acquired using peripheral vision. Subjects were instructed to respond to a perturbation by grasping a handle randomly located at 0°, 20° or 40° in their field of view under three visual conditions: full vision throughout the entire trial (FV), vision available prior to perturbation only (MAP), and vision available post-perturbation only (ONLINE). Electromyography was used to determine reaction time and kinematic data were collected to determine initial reach angle. Overall, participants were successful in arresting whole-body motion across all visual conditions and handle locations. Initial reach angles were target specific when vision was available prior to perturbation onset (FV and MAP). However, the 40° handle location produced a greater initial reach angle in MAP, suggesting some limitations for mapping in the further visual periphery. These findings suggest that peripheral vision contributes to the ability to spatially locate targets by building an a priori visuospatial map, which benefits the control of rapid compensatory reach-to-grasp reactions evoked in the response to unpredictable events of instability.

Exploring the role of applied force eccentricity after foot-contact in managing anterior instability among older adults during compensatory stepping responses.

BACKGROUND: The specific mechanisms responsible for age-related decline in forward stability control remain unclear. Previous work has suggested reactive control of net ground reaction force (GRFnet) eccentricity may be responsible for age-related challenges in mediolateral stability control during the restabilisation phase of forward compensatory stepping responses. RESEARCH QUESTIONS: Does reactive control of GRFnet eccentricity play a role in managing forward stability control during the restabilisation phase of a forward stepping response to external balance perturbation? METHODS: Healthy younger (YA) (n = 20) and older adults (OA) (n = 20) were tethered to a rigid frame, via adjustable cable. Participants were released from a standardised initial forward lean and regained their balance using a single step. Whole-body motion analysis and four force platforms were utilised for data acquisition. Forward instability was quantified as centre of mass (COM) incongruity - the difference between the first local peak and final stable anterior COM positions. The extent of GRFnet eccentricity was quantified as the sagittal-plane angle of divergence of the line of action of the GRFnet relative to the COM. Two discrete points during restabilisation were examined (P1 and P2), which have been suggested to be indicative of proactive and reactive COM control, respectively. Age-related differences in magnitude, timing and trial-to-trial variability of kinematic and kinetic outcome variables were analysed using two-factor ANOVAs with repeated-measures. RESULTS: OA exhibited greater COM incongruity magnitude and variability - both were reduced with trial-repetition. There were no age-related differences in the magnitude or timing of P2. Instead, OA exhibited a reduced magnitude of GRFnet eccentricity at P1. There was a positive correlation between AP COM incongruity magnitude and P1 magnitude. SIGNIFICANCE: Different from mediolateral stability control, the present results suggest that OA may experience forward stability control challenges as a function of insufficient preparatory lower limb muscle activation prior to foot-contact.

Local dynamic stability of the lower extremity in novice and trained runners while running intraditional and minimal footwear.

BACKGROUND: Understanding how footwear cushioning influences movement stability may be helpful in reducing injuries related to repetitive loading. RESEARCH QUESTION: The purpose of this study was to identify the relationship between running experience and midsole cushioning on local dynamic stability of the ankle, knee and hip. METHODS: Twenty-four trained and novice runners were recruited to run on a treadmill for five minutes at the same relative intensity. Midsole thickness (thick/thin) and stiffness (soft / hard) were manipulated yielding four unique conditions. Lyapunov exponents were estimated using the Wolf algorithm from sagittal ankle, knee and hip kinematics. RESULTS: Trained runners had increased movement stability in all shoe conditions compared to their novice counterparts. Midsole thickness and stiffness, overall, did not affect movement stability within each of the running groups. Novice runners displayed decreased movement stability at the hip while running in the thick/soft running shoes. It was found that running experience has a greater influence on movement stability in the lower limbs compared to the midsole characteristics that were manipulated in this experiment. The hip was most stable followed by the knee and the ankle highlighting decreased stability in distal joints. CONCLUSIONS: It appears that midsole design within current design ranges do not have the ability to influence movement stability.

Age-related challenges in reactive control of mediolateral stability during compensatory stepping: A focus on the dynamics of restabilisation.

Age-related mediolateral instability during forward stepping reactions evoked by whole-body perturbation is believed to occur independent of the initial temporospatial parameters prior to step-contact. Recent research is beginning to explore the restabilisation phase, following step-contact, as the origin of such instability. This work sought to uncover potential mechanisms underlying age-related mediolateral instability during restabilisation by examining whole-body centre of mass (COM) kinematics and the orientation of the net ground reaction force relative to the COM. Healthy younger (n=20) and older adults (n=20) were anchored to a rigid frame, via adjustable cable. After establishing a standardised initial forward lean, cable release occurred with pseudorandom timing. Participants regained their balance using a single self-selected step. The potential for lateral instability was quantified by COM kinematics. The angle of divergence of the line of action of the net ground reaction force relative to the COM was quantified and examined at three discrete points during restabilisation, as indices of COM control. Age-related differences in magnitude and trial-to-trial variability were analysed. Older adults exhibited increased ML COM incongruity and trial-to-trial variability, which were reduced with trial repetition. Older adults required an increased time to reorient the net ground reaction force, which was correlated with the increased lateral COM displacement during restabilisation. The present results support the idea that age-related mediolateral instability occurs during restabilisation and may be linked to the reactive control of the orientation of the net ground reaction force with respect to the centre of mass.

Control of standing balance while using constructions stilts: comparison of expert and novice users.

This study examined the control of standing balance while wearing construction stilts. Motion capture data were collected from nine expert stilt users and nine novices. Three standing conditions were analysed: ground, 60 cm stilts and an elevated platform. Each task was also performed with the head extended as a vestibular perturbation. Both expert and novice groups exhibited lower displacement of the whole body centre of mass and centre of pressure on construction stilts. Differences between the groups were only noted in the elevated condition with no stilts, where the expert group had lower levels of medial-lateral displacement of the centre of pressure. The postural manipulation revealed that the expert group had superior balance to the novice group. Conditions where stilts were worn showed lower levels of correspondence to the inverted pendulum model. Under normal conditions, both expert and novice groups were able to control their balance while wearing construction stilts. PRACTITIONER SUMMARY: This work investigated the effects of experience on the control of balance while using construction stilts. Under normal conditions, expert and novice stilt users were able to control their balance while wearing construction stilts. Differences between the expert and novice users were revealed when the balance task was made more difficult, with the experts showing superior balance in these situations.

Kinetic measures of restabilisation during volitional stepping reveal age-related alterations in the control of mediolateral dynamic stability.

Research examining age-related changes in dynamic stability during stepping has recognised the importance of the restabilisation phase, subsequent to foot-contact. While regulation of the net ground reaction force (GRFnet) line of action is believed to influence dynamic stability during steady-state locomotion, such control during restabilisation remains unknown. This work explored the origins of age-related decline in mediolateral dynamic stability by examining the line of action of GRFnet relative to the centre of mass (COM) during restabilisation following voluntary stepping. Healthy younger and older adults (n=20 per group) performed three single-step tasks (varying speed and step placement), altering the challenge to stability control. Age-related differences in magnitude and intertrial variability of the angle of divergence of GRFnet line of action relative to the COM were quantified, along with the peak mediolateral and vertical GRFnet components. The angle of divergence was further examined at discrete points during restabilisation, to uncover events of potential importance to stability control. Older adults exhibited a reduced angle of divergence throughout restabilisation. Temporal and spatial constraints on stepping increased the magnitude and intertrial variability of the angle of divergence, although not differentially among the older adults. Analysis of the time-varying angle of divergence revealed age-related reductions in magnitude, with increases in timing and intertrial timing variability during the later phase of restabilisation. This work further supports the idea that age-related challenges in lateral stability control emerge during restabilisation. Age-related alterations during the later phase of restabilisation may signify challenges with reactive control.

The influence of ankle muscle activation on postural sway during quiet stance.

Although balance during quiet standing is postulated to be influenced by multiple factors, including ankle stiffness, it is unclear how different mechanisms underlying increases in stiffness affect balance control. Accordingly, this study examined the influence of muscle activation and passive ankle stiffness increases on the magnitude and frequency of postural sway. Sixteen young adults participated in six quiet stance conditions including: relaxed standing, four muscle active conditions (10%, 20%, 30% and 40% maximum voluntary contraction (MVC)), and one passive condition wearing an ankle foot orthotic (AFO). Kinetics were collected from a force plate, while whole-body kinematics were collected with a 12-sensor motion capture system. Bilateral electromyographic signals were recorded from the tibialis anterior and medial gastrocnemius muscles. Quiet stance sway amplitude (range and root mean square) and frequency (mean frequency and velocity) in the sagittal plane were calculated from time-varying centre of gravity (COG) and centre of pressure (COP) data. Compared to the relaxed standing condition, metrics of sway amplitude were significantly increased (between 37.5 and 63.2%) at muscle activation levels of 30% and 40% MVC. Similarly, frequency measures increased between 30.5 and 154.2% in the 20-40% MVC conditions. In contrast, passive ankle stiffness, induced through the AFO, significantly decreased sway amplitude (by 23-26%), decreased COG velocity by 13.8%, and increased mean COP frequency by 24.9%. These results demonstrate that active co-contraction of ankle musculature (common in Parkinson's Disease patients) may have differential effects on quiet stance balance control compared to the use of an ankle foot orthotic (common for those recovering from stroke).

Age-related changes in mediolateral dynamic stability control during volitional stepping.

The control of mediolateral dynamic stability during stepping can be particularly challenging for older adults and appears to be related to falls and hip fracture. The specific mechanisms or control challenges that lead to mediolateral instability, however, are not fully understood. This work focussed on the restabilisation phase of volitional forward stepping, subsequent to foot contact, which we believe to be a principal determinant of mediolateral dynamic stability. Twenty younger (age 24±5 years; 50% women) and 20 older participants (age 71±5 years; 50% women) performed three different single-step tasks of various speed and step placement, which varied the challenge to dynamic stability. The trajectory of the total body centre of mass (COM) was quantified. Mediolateral COM incongruity, defined as the difference between the peak lateral and final COM position, and trial-to-trial variability of incongruity were calculated as indicators of dynamic stability. Older adults exhibited increased instability compared to young adults, as reflected by larger COM incongruity and trial-to-trial variability. Such increases among older adults occurred despite alterations in COM kinematics during the step initiation and swing phases, which should have led to increased stability. Task related increases in instability were observed as increased incongruity magnitude and trial-to-trial variability during the two rapid stepping conditions, relative to preferred speed stepping. Our findings suggest that increased COM incongruity and trial-to-trial variability among older adults signify a reduction in dynamic stability, which may arise from difficulty in reactive control during the restabilisation phase.

Dynamic stability control during volitional stepping: a focus on the restabilisation phase at movement termination.

This work sought to advance the understanding of dynamic stability control during stepping. The specific intention was to better understand the control of the centre of mass during voluntary stepping, by characterizing its trajectory and intertrial variability. Young participants (n=10) performed five different stepping tasks to vary the challenge to COM control: (1) preferred step, (2) long step, (3) wide step, (4) long and wide step and (5) rapid step. The trajectory of the total body COM during the restabilisation phase was assessed by quantifying the magnitude of incongruity between the peak and final COM position. The intertrial variability of incongruity and the extent to which incongruity was reduced with trial repetition were also evaluated. Interestingly, incongruity was typical during preferred stepping, with a strong bias toward overshoot. In the frontal plane, the magnitude of incongruity and the incidence of overshoot were greater in trials with increased step width. The variability of incongruity did not vary by condition nor was there evidence of adaptive changes. Together, these results suggest that overshoots may represent a strategy linked to gait initiation or to the simplification of reactive control during the restabilisation phase. Further insight into these mechanisms will be gained by examining the kinetic determinants of dynamic stability control.

Locomotor strategies in response to altered lower limb segmental mechanical properties.

The present study sought to use stilt walking as a model to uncover modifications to gait dynamics caused by changes in lower limb anthropometrics. We examined 10 novice and 10 expert stilt walkers, each walking with and without stilts, to determine the specific adaptations brought about by experience. Three-dimensional kinematics and force platform data were used to calculate the intersegmental forces, net joint moments and moment powers at the ankle, knee and hip. Spatio-temporal data were computed to aid the interpretation of these data. Non-dimensional scaling was used to facilitate comparison between stilt- and normal-walking. In general, the stilts induced largely the same alterations in the locomotor patterns of both novices and experts, which did not allow for the conclusion that the experts employed locomotor dynamics that were better suited to the challenges imposed by alterations to limb length, mass and mass moment of inertia induced by the stilts. Nevertheless, the experts exhibited a lesser reduction in dimensionless stride length and velocity and generated larger concentric knee flexor and hip extensor powers, relative to the novices, which may be indicative of enhanced dynamic stability control.

Intersegmental coordination while walking up inclined surfaces: age and ramp angle effects.

The lower-limb segment elevation angles during human locomotion have been shown to co-vary in a manner such that they approximate a plane when plotted against each other over a gait cycle. This relationship has been described as the Planar Co-Variation Law and has been shown to be consistent across various modes of locomotion on level ground. The goal of this study is to determine whether the Planar Co-Variation Law will hold in situations where the orientation of the walking surface is altered and if aging will have an effect on this intersegmental coordination during these locomotor tasks. Nine healthy young females (mean age = 21.4), and nine older adult females (mean age = 73.3) were asked to complete walking trials on level ground, and walking up ramps with inclines of 3 degrees , 6 degrees , 9 degrees and 12 degrees while the kinematics of their lower limbs were measured. It was found that the Planar Co-Variation Law was held across all ramp incline conditions by both the young adult and older adult groups. It was found that the changes in intersegmental coordination required to walk up the ramp resulted in a unique orientation of the co-variation plane for both groups when walking up a particular incline. The results of this study indicate that the Planar Co-Variation Law will include situations where the walking surface is not level and provides further support to models of motor control that have been proposed where walking patterns for different modes of gait can be predicted based on the orientation of the co-variation plane.

Postural responses following a rotational support surface perturbation, following knee joint replacement: frontal plane rotations.

Total knee arthroplasty (TKA) is associated with altered sensory and motor functions of the knee which may impair balance control when standing and walking. This study examined the organization of electromyographic and kinematic postural responses to frontal plane support surface rotations, after TKA. Eight TKA patients and nine control participants volunteered. Patients demonstrated changes in onset latency of rectus femoris and gluteus medius, and in amplitude of muscle activity in tibialis anterior, gastrocnemius, rectus femoris, and gluteus medius, for both perturbation directions, and for both the surgical and sound limbs. Peak knee joint angular velocity was reduced among the patients for both perturbation directions and both the surgical and sound limbs, and patients demonstrated greater peak center of mass displacement. The CNS appears to alter the response to postural perturbation of both lower limbs, based on the reduced capacities of the surgical limb. Impaired detection of the valgus-varus loading of the knee joints may lead to the changes in muscle activity and resultant kinematics. Clinically, these findings are relevant in understanding that fully recovered TKA patients may continue to demonstrate balance impairments, and that balance training during physical rehabilitation may be advantageous to these patients.

Organization of postural responses following a rotational support surface perturbation, after TKA: sagittal plane rotations.

Proprioceptive dysfunction, related to osteoarthritis and total knee arthroplasty (TKA) may be related to changes in gait, and may result in balance impairment. This study examined the organization of postural responses to rotational support surface perturbations after TKA. Eight TKA patients and nine control participants volunteered. EMG was collected bilaterally from lower limb muscles. Kinematic data were collected using an OPTOTRAK system. The temporal pattern of muscle activation was preserved in both the surgical and sound limbs of the patient groups, while muscle activation amplitude was reduced. Knee joint angular displacement was reduced in both limbs among patients. COM displacement was not different. Patients demonstrated a different method in recovering posture control following a postural perturbation. Bilateral changes appear to reflect a simplification in the organization of the motor response, in response to the needs of the injured, or previously injured limb.

Adaptation to unilateral change in lower limb mechanical properties during human walking.

To produce successful and safe walking movements, the locomotor control system must have a detailed awareness of the mechanical properties of the lower limbs. Flexibility of this control comes from an ability to identify and accommodate any changes in limb mechanics by updating its internal representation of the lower limb. To explore the ability of the locomotor control system to tune its representation of the lower limb, eight participants performed three 5 min trials (PRE, WEIGHT and POST) of treadmill walking. During the middle trial the participants wore a 2 kg mass around the leg segment of the left lower limb. Joint kinematics and kinetics were determined to assess changes in the walking movements. The modification of limb inertia by adding mass to the limbs (WEIGHT) required a substantive period of adaptation, which lasted between 45 and 50 strides, before individuals fully adjusted to their new lower limb mechanics to achieve steady-state joint kinematics. These movements were caused in part from an increase in hip flexor and knee extensor activity in early swing followed by an increase in hip extensors and knee flexor activity in late swing. Following the removal of the mass (POST), ankle, knee and hip flexion all increased above the levels that were observed in the PRE condition and returned the baseline levels within 20, 70 and 70 strides, respectively. The removal of the mass appeared to cause a greater disruption to walking than the addition of mass to the limb despite a quick return of the joint moments to the PRE condition. Both the changes following the addition of the mass and its subsequent removal may embody a recalibration of the internal limb representation. These changes were characterized by an integrated response consisting of primary recalibration to the modified mechanical parameters and secondary actions to main the integrity of locomotor objectives such as propulsion, balance, support and safe foot trajectories. These recalibration responses were similar to those demonstrated in upper limb movements in response to altered force environments. Understanding this recalibration process will have implications for the prevention of trips and falls as individuals encounter different movement environments or changes to mechanical properties of their limbs, especially for individuals with decreased proprioception or other neural challenges.

Locomotor adaptations for changes in the slope of the walking surface.

The goal of this study was to examine the transition of walking from a level surface onto different inclined surfaces. Kinematic data of limb and trunk segments were recorded from individuals as they approached and stepped onto four different ramped surfaces (slopes= 3 degrees , 6 degrees , 9 degrees , 12 degrees ). This transition introduced significant adaptations to the swing limb trajectory that were evident in even the lowest ramp condition and appear to be scaled to the ramp inclination although the nature of this scaling seemed to change between the 6 degrees and 9 degrees conditions. An increased forward pitch of the trunk orientation during all ramp conditions was initiated early on during the preceding stance phase on level ground. The swing limb modification essentially consisted of a two-stage response. The initial response of the limb trajectory changes was not specific to the degree of inclination but later changes were dependent on the ramp condition. The initial response is to ensure a safe toe clearance as the foot approaches the edge of the ramp and then later modifications provide the appropriate positioning of the limb to prepare for an elevated foot contact. Early changes were actively produced through an increased pull-off by the hip flexors and an elevation of the swing limb by the active muscle control of the stance limb. Ankle dorsiflexion also appears to have a supporting role increasing toe clearance. Absorption at the hip and knee during later swing contribute to control and position the limb in preparation for foot contact. These strategies were similar to those adopted for step changes in the level of the walking surface where there are similar demands of the quickly moving the limb forward and upward, however, the positioning of the limb for new angled landing surface requires further adaptations.

Swing phase kinetics and kinematics of knee replacement patients during obstacle avoidance.

Proper knee joint function is essential for safe and effective mobility within a complex environment. Following knee joint replacement, joint structure and function are altered, often requiring individuals to adjust normal movement patterns in order to adapt to these changes. Such adaptations may either improve function or lead to movement patterns that may potentially be unsafe for individuals. To investigate this issue, a group of individuals who had undergone knee replacement was examined while performing an obstacle avoidance task. Their performance was compared with that of healthy age-matched controls. Participants walked along a 10 m walkway a total 48 times. Trials were divided equally between unobstructed walking and clearing a 6 or 18 cm obstacle during both right and left limb lead. Lead limb kinetic and kinematic variables were examined and revealed that members of the surgical group exhibited decreased active surgical knee flexion and diminished surgical knee flexor work. In order to maintain toe clearance at control levels, patients were observed to increase hip hiking and hip flexor work, in addition to laterally displacing the surgical toe during swing over the obstacle. Despite allowing individuals to maintain adequate toe clearance, these compensatory strategies may lead to an increased instability and pose a threat to safety in this population. In addition, an increased demand placed on the hip joint of the surgical limb may be undesirable in this population. Research aimed at determining how to best maximize surgical knee function must continue if these potential negative sequela are to be minimized.

Bilateral lower limb strategies used during a step-up task in individuals who have undergone unilateral total knee arthroplasty.

OBJECTIVE: The purpose of this study was to determine how bilateral lower limb joint function is altered by the combined effects of osteoarthritis and its treatment by total knee arthroplasty. DESIGN: Lower limb joint work of age-matched healthy, control participants was compared to surgical and non-surgical limb work in individuals who had undergone total knee arthroplasty. BACKGROUND: Research investigating outcomes following total knee arthroplasty has focussed primarily on the surgical knee, identifying deficits in surgical knee function. The existence of additional lower limb deficits and adjustments made by unaffected joints to complement these deficits, has yet to be examined. METHODS: Joint moments, power and work were calculated using bilateral lower limb force and kinematic data collected during a step-up to heights of 11.25 and 20 cm. RESULTS: Fifty percent of patients were unable to step onto the 20 cm step. At both step heights, when the surgical limb led the step-up, surgical knee work was less than controls. When the non-surgical limb led, deficits in non-surgical lead knee work were observed. In both cases, lead hip work increased. CONCLUSIONS: Work done by both surgical and non-surgical knees in a step-up task was lower than that done by healthy controls. This deficit was balanced by increased lead hip extensor work. RELEVANCE: These findings highlight the importance of including exercises that optimize bilateral knee and hip function in rehabilitation programs used following knee replacement. Clinicians working with this population can use this information to assist in the design of evidenced based treatment programs.