"Posture first": Interaction between posture and locomotion in people with low back pain during unexpectedly cued modification of gait initiation motor command.

The ability to adapt anticipatory postural adjustments (APAs) in response to perturbations during single-joint movements is altered in people with chronic low back pain (LBP), but a comprehensive analysis during functional motor tasks is still missing. This study aimed to compare APAs and stepping characteristics during gait initiation between people with LBP and healthy controls, both in normal (without cue occurrence) condition and when an unexpected visual cue required to switch the stepping limb. Fourteen individuals with LPB and 10 healthy controls performed gait initiation in normal and switch conditions. The postural responses were evaluated through the analysis of center of pressure, propulsive ground reaction forces, trunk and whole-body kinematics, and activation onsets of leg and back muscles. During normal gait initiation, participants with LBP exhibited similar APAs and stepping characteristics to healthy controls. In the switch condition, individuals with LBP were characterized by greater mediolateral postural stability but decreased forward body motion and propulsion before stepping. The thorax motion was associated with forward propulsion parameters in both task conditions in people with LBP but not healthy controls. No between-group differences were found in muscle activation onsets. The results suggest that postural stability is prioritized over forward locomotion in individuals with LBP. Furthermore, the condition-invariant coupling between thorax and whole-body forward propulsion in LBP suggests an adaptation in the functional use of the thorax within the postural strategy, even in poor balance conditions.

Comparison of over-ground and treadmill perturbations for simulation of real-world slips and trips: A systematic review.

BACKGROUND: Trips and slips increase fall risk for young and older adults. To examine recovery responses, studies utilized treadmill and/or over-ground methods to simulate real-world perturbations. However, differences in the recovery response between treadmill and over-ground perturbations remain unexamined. RESEARCH QUESTION: To assess the current literature on the reactive recovery responses between over-ground- and split-belt treadmill trips and slips as well as the effect of aging on these responses. METHODS: PubMed, Medline, Web of Science, SCOPUS, and Cochrane databases were searched for publications examining trips and slips in healthy young, healthy older adults, and older adults who fall. Included articles were in English, full-text accessible, and biomechanically quantified the reactive recovery responses for slips and trips during either over-ground or split-belt treadmill protocols. The initial database search yielded 1075 articles and 31 articles were included after title, abstract, and full-text screening. RESULTS: For slips, 7 articles utilized lubricated surfaces while 5 articles used treadmills. Further, 3 studies examined differences between older and younger adults. For trips, 9 articles utilized obstacles and 7 used treadmills. Further, 4 articles examined differences between older and young adults and 1 article only examined older adults during over-ground trips. For both perturbations, treadmill and over-ground protocols demonstrated similar anteroposterior destabilization on the center of mass. In the mediolateral direction, over-ground slips consistently found a lateral destabilization while treadmill articles did not examine this direction. Foot placement recovery responses varied less for both perturbation directions on a treadmill compared to over-ground. SIGNIFICANCE: Although treadmill and over-ground perturbations destabilize the center of mass similarly, the recovery response to these perturbations were different on treadmills. Specifically, recovery responses were more consistent for both slips and trips on treadmills. As older adults have difficulty in perturbation recovery scaling, treadmills may be limited in their ability to investigate the variety of aging impairments on perturbation recovery responses.

Does visual cueing improve gait initiation in people with Parkinson's disease?

Anticipatory postural adjustments (APAs) prior to gait initiation are impaired in people with Parkinson's disease (PD), particularly in those who report Freezing of Gait (FOG). External cues can improve gait parameters in people with PD, but the effects of visual cues on gait initiation are poorly known. The study aimed to (i) assess differences, during gait initiation, between people with PD with (FOG+) and without FOG (FOG-) and healthy controls (HC), (ii) explore the effect of disease severity on gait initiation and (iii) investigate the acute effect of visual cueing on gait initiation and straight-ahead gait. Twenty FOG- and twenty FOG+, and eighteen HC participated in this study. Participants were asked to perform self-initiated gait with and without visual cues presented as transverse taped lines on the floor. Gait initiation and gait were characterized with wireless inertial measurement units. Results showed that FOG+ had smaller APAs than HC and FOG-; although no differences were detected between FOG+ and FOG- when taking into account disease severity. Significant correlations between MDS-UPDRS III scores and gait initiation/straight-ahead gait variables confirmed that differences between FOG+ and FOG- were driven by disease severity. In gait initiation, visual cues elicited different behaviors in people with and without PD. Particularly, people with PD showed smaller and longer APAs, whereas HC showed longer first step durations, compared to baseline. However, the adopted visual cues improved gait speed and stride length in all individuals. These results suggest that people with PD, despite the presence of FOG, utilize different motor strategies, compared to HC, to adapt to the new biomechanical requirements of gait initiation dictated by the visual cues.

Characterization of Anticipatory Postural Adjustments in Lateral Stepping: Impact of Footwear and Lower Limb Preference.

Lateral stepping is a motor task that is widely used in everyday life to modify the base of support, change direction, and avoid obstacles. Anticipatory Postural Adjustments (APAs) are often analyzed to describe postural preparation prior to forward stepping, however, little is known about lateral stepping. The aim of the study is to characterize APAs preceding lateral steps and to investigate how these are affected by footwear and lower limb preference. Twenty-two healthy young participants performed a lateral step using both their preferred and non-preferred leg in both barefoot and shod conditions. APA spatiotemporal parameters (size, duration, and speed) along both the anteroposterior and mediolateral axes were obtained through force plate data. APAs preceding lateral stepping showed typical patterns both along the anteroposterior and mediolateral axis. RM-ANOVA highlighted a significant effect of footwear only on medio-lateral APAs amplitude (p = 0.008) and velocity (p = 0.037). No differences were found for the limb preference. APAs in lateral stepping presented consistent features in the sagittal component, regardless of limb/shoe factors. Interestingly, the study observed that footwear induced an increase in the medio-lateral APAs size and velocity, highlighting the importance of including this factor when studying lateral stepping.

Anticipatory postural adjustments in forward and backward single stepping: Task variability and effects of footwear.

A single step is usually preceded by the so-named anticipatory postural adjustments (APAs). These are normally described through the observation of the trajectory of the center of pressure (CoP). Even though, external factors such as stepping direction and footwear are known to modify APAs, quantitative investigations regarding their relevant effects are understudied in the literature. Therefore, this study aims at characterizing APAs patterns prior to forward and backward stepping when performed either in barefoot or shod condition and explores their variability. Twenty-eight young healthy volunteers participated in the study. CoP trajectories were recorded using a force plate and relevant spatio-temporal parameters extracted (i.e. duration, amplitude, and mean speed). Results showed distinct effects of both direction of the step and footwear on APAs: the first mainly induces variations of APAs along the anteroposterior direction, whereas the latter in the mediolateral direction. In addition, variability indices exhibited lower values for the APAs along the mediolateral axis which was affected by neither footwear nor direction of the step. This study extends previous literature by revealing significant direction X footwear interactions on APAs. Furthermore, regardless of these factors, the medio-lateral strategy is still well preserved, highlighting the prioritization of balance control over motor performance. In conclusion, both direction and footwear have a major effect on postural preparation therefore both factors should be included when evaluating APAs in real-life condition.

Stepping forward, stepping backward: a movement-related cortical potential study unveils distinctive brain activities.

Human locomotion is the product of complex dynamic systems, which rely on physical capacities as well as cognitive functions. In our daily life, we mostly experience forward walking, but also backward stepping can occur, as in protective stepping. In this work, we investigated the electroencephalographic (EEG) correlates of cognitive processing underpinning step initiation by means of movement-related cortical potentials (MRCPs) analysis and force-plates recordings. Healthy young volunteers (N = 11) performed self-paced forward- and backward-oriented steps on two force platforms, which were synchronized to simultaneous EEG recordings. MRCPs and their source localization analyses were computed. Results demonstrate the involvement of cognitive processing during step preparation and execution, as showed by the prefrontal activity, which was enhanced in backward stepping. Further, the parietal activity was larger in forward than backward stepping, while motor-related regions were involved in both step directions. Thus, the neural timing and sources of forward and backward stepping suggest a functional distinction of these two actions, which undergo different cortical organizations. Backward stepping requires enhanced cognitive control and can be regarded as an avoidance behavior, while forward stepping would be assimilated to an oriented-to-action behavior mainly localized over parietal areas. In conclusion, preparing body locomotion involves high cognitive processing, with step direction showing different cortical organization and functional specialization.

How do different movement references influence ERP related to gait initiation? A comparative methods' assessment.

BACKGROUND: Movement-Related Cortical Potentials (MRCPs) are widely used in studying brain dynamics of motor control. However, limited information is available on complex tasks such as locomotion for which the appropriate identification of gait initiation trigger is still a technical challenge. Thus, it is conceivable that recorded brain activity may vary due to the instrument used to provide the temporal trigger. Therefore, a comparative assessment was performed to determine whether and how trigger identification techniques affect the MRCP in gait initiation. NEW METHOD: Eleven able-bodied young participants performed 200 forward- and 200 backward-oriented self-initiated steps. Brain activity was recorded through 64-channel electroencephalography. Four different triggering techniques were tested based on measurements of surface electromyography, stereophotogrammetry and forceplates. RESULTS: Repeated-Measures ANOVAs on the mean amplitude of the Bereitschaftspotential and on both peak amplitude and latency of the motor potential showed a main effect of the triggering technique (p < 0.003). Specifically, force plates signal amplitude (-11.56 ±â€¯1.4 µV) was larger than stereophotogrammetry (-5.0±0.5 µV and -6.5 ±â€¯1 µV) and electromyography (-7.2 ±â€¯0.9 µV). COMPARISON WITH EXISTING METHOD(S): Considering the gait initiation task, no previous study has performed a comparison between the MRCPs observed by triggering the same signal with different approaches. CONCLUSION: Different instruments identify triggers that vary in terms of time delay, resulting in different amplitudes and timing of the MRCPs. The comparative analysis indicates that forceplate allows to obtain the best MRCP trigger to study gait initiation, in terms of signal strength, cost and set up time.