Muscle co-contractions are greater in older adults during walking at self-selected speeds over uneven compared to even surfaces.

Falls in the aging population are a major public health concern. Outdoor falls in community-dwelling older adults are often triggered by uneven pedestrian walkways. Our understanding of the motor control adaptations to walk over an uneven surface, and the effects of aging on these adaptations is sparse. Here, we study changes in muscle co-contraction, a clinically accepted measure of motor control, due to changes in walking surfaces typically encountered in the outdoor built environment. We address the following research questions: 1) are there walking surface and sex-based differences in muscle co-contractions between young and older adults? and 2) is muscle co-contraction associated with age? We calculated muscle co-contractions from 13 young and 17 older adults during walking at self-selected speeds over even and uneven brick walkways. Muscle co-contraction at the ankle joint was determined from the tibialis anterior and lateral gastrocnemius muscle pair, and at the knee joint from the rectus femoris and semitendinosus muscle pair. Older adults displayed 8-13% greater ankle muscle co-contractions during walking over uneven compared to even surfaces. We found 55-61% (entire gait) and 73-75% (stance phase) greater ankle muscle co-contractions in older females compared to older males during walking over even and uneven surfaces. We found 31-43% greater knee muscle co-contractions in older females compared to older males during the swing phase of walking over even and uneven surfaces. This study underscores the need for determining muscle co-contractions from even and uneven surfaces for quantifying motor control deficits due to aging or neuromuscular disorders.

Knee muscle co-contractions are greater in old compared to young adults during walking and stair use.

BACKGROUND: Muscle co-contraction is an accepted clinical measure to quantify the effects of aging on neuromuscular control and movement efficiency. However, evidence of increased muscle co-contraction in old compared to young adults remains inconclusive. RESEARCH QUESTION: Are there differences in lower-limb agonist/antagonist muscle co-contractions in young and old adults, and males and females, during walking and stair use? METHODS: In a retrospective study, we analyzed data from 20 healthy young and 19 healthy old adults during walking, stair ascent, and stair descent at self-selected speeds, including marker trajectories, ground reaction force, and electromyography activity. We calculated muscle co-contraction at the knee (vastus lateralis vs. biceps femoris) and ankle (tibialis anterior vs. medial gastrocnemius) using the ratio of the common area under a muscle pairs' filtered and normalized electromyography curves to the sum of the areas under each muscle in that pair. RESULTS: Old compared to young adults displayed 18%-22% greater knee muscle co-contractions during the entire cycle of stair use activities. We found greater (17%-29%) knee muscle co-contractions in old compared to young adults during the swing phase of walking and stair use. We found no difference in ankle muscle co-contractions between the two age groups during all three activities. We found no difference in muscle co-contraction between males and females at the knee and ankle joints for all three activities. SIGNIFICANCE: Based on our findings, we recommend clinical evaluation to quantify the effects of aging through muscle co-contraction to include the knee joint during dynamic activities like walking and stair use, and independent evaluation of the stance and swing phases.

Late-cueing of gait tasks on an uneven brick surface impacts coordination and center of mass control in older adults.

BACKGROUND: Changing directions while walking (turning gait), often with little planning time, is essential to navigating irregular surfaces in the built-environment. It is unclear how older adults reorient their bodies under these constraints and whether adaptations are related to declines in physiological characteristics. RESEARCH QUESTION: The aims of this study were to (1) investigate whether surface irregularity, late-cueing, and age negatively affect coordination, kinematics, and center of mass (COM) movement during 90° turning gait and (2) determine if adaptations correlate with declines in strength, balance, and reaction-time. METHODS: Eighteen young (18-35 years) and sixteen older (65+ years) healthy adults participated in the study. Retro-reflective marker and trunk-accelerometry data were used to compute upper-body segmental reorientation timing, upper-body kinematics, and COM movement characteristics. Balance scores, lower-limb strength, and choice-reaction-times were also recorded. RESULTS: Young and older adults maintained a cranial-caudal (head, shoulders, pelvis) reorientation sequence (p ≤ 0.018), lowered head pitch (uneven surface; young p = 0.035 and old p < 0.001), increased maximum COM acceleration (uneven surface and late-cueing; p ≤ 0.002), and decreased COM smoothness (uneven surface; p < 0.001). Young adults increased shoulder roll (uneven surface and late-cueing; p ≤ 0.008). Reduced stride regularity (late-cueing) was observed in older (p < 0.001), compared to young (p = 0.017), adults. Declines in strength (p ≤ 0.040) and balance (p = 0.018) were correlated with gait adaptations of older adults. SIGNIFICANCE: Late-cueing on an uneven surface is challenging for older adults. These challenges are exacerbated by strength and balance deficits.

Biomechanical Effects of Stiffness in Parallel With the Knee Joint During Walking.

The human knee behaves similarly to a linear torsional spring during the stance phase of walking with a stiffness referred to as the knee quasi-stiffness. The spring-like behavior of the knee joint led us to hypothesize that we might partially replace the knee joint contribution during stance by utilizing an external spring acting in parallel with the knee joint. We investigated the validity of this hypothesis using a pair of experimental robotic knee exoskeletons that provided an external stiffness in parallel with the knee joints in the stance phase. We conducted a series of experiments involving walking with the exoskeletons with four levels of stiffness, including 0%, 33%, 66%, and 100% of the estimated human knee quasi-stiffness, and a pair of joint-less replicas. The results indicated that the ankle and hip joints tend to retain relatively invariant moment and angle patterns under the effects of the exoskeleton mass, articulation, and stiffness. The results also showed that the knee joint responds in a way such that the moment and quasi-stiffness of the knee complex (knee joint and exoskeleton) remains mostly invariant. A careful analysis of the knee moment profile indicated that the knee moment could fully adapt to the assistive moment; whereas, the knee quasi-stiffness fully adapts to values of the assistive stiffness only up to ∼80%. Above this value, we found biarticular consequences emerge at the hip joint.

Use of body armor protection with fighting load impacts soldier performance and kinematics.

The purpose of this evaluation was to examine how increasing body armor protection with and without a fighting load impacted soldiers' performance and mobility. Thirteen male soldiers performed one performance (repeated 30-m rushing) and three mobility tasks (walk, walk over and walk under) with three different body armor configurations and an anterior fighting load. Increasing body armor protection, decreased soldier performance, as individual and total 30-m rush times were significantly longer with greater protection. While increasing body armor protection had no impact on mobility, i.e. significant effect on trunk and lower limb biomechanics, during the walk and walk over tasks, greater protection did significantly decrease maximum trunk flexion during the walk under task. Adding fighting load may negatively impact soldier mobility, as greater maximum trunk extension was evident during the walk and walk over tasks, and decreased maximum trunk flexion exhibited during the walk under task with the fighting load.

Soldier-relevant loads impact lower limb biomechanics during anticipated and unanticipated single-leg cutting movements.

This study quantified how body borne load impacts hip and knee biomechanics during anticipated and unanticipated single-leg cutting maneuvers. Fifteen male military personnel performed a series of single-leg cutting maneuvers with three different load configurations (light, ~6 kg, medium, ~20 kg, and heavy, ~40 kg). Subject-based means of the specific lower limb biomechanical variables were submitted to repeated measures ANOVA to test the main and interaction effects of body borne load and movement type. With body borne load, stance time (P<0.001) increased, while larger hip (P=0.027) and knee flexion (P=0.004), and hip adduction (P<0.001) moments, and decreased hip (P=0.002) and knee flexion (P<0.001), and hip adduction (P=0.003) postures were evident. Further, the hip (P<0.001) and ankle (P=0.024) increased energy absorption, while the knee (P=0.020) increased energy generation with body borne load. During the unanticipated maneuvers, the hip (P=0.009) and knee (P=0.032) increased energy generation, and peak hip flexion moment (P=0.002) increased relative to the anticipated movements. With the body borne load, participants adopted biomechanical patterns that decreased their locomotive ability including larger moments and reduced flexion postures of the lower limb. During the single-leg cut, participants used greater energy absorption from the large, proximal muscles of the hip and greater energy generation from the knee with the addition of load. Participant's performance when carrying a range of loads was not compromised by anticipation, as they did not exhibit the hip and knee kinetic and kinematic adaptations previously demonstrated when reacting to an unplanned stimulus.

Design and evaluation of a quasi-passive knee exoskeleton for investigation of motor adaptation in lower extremity joints.

In this study, we describe the mechanical design and control scheme of a quasi-passive knee exoskeleton intended to investigate the biomechanical behavior of the knee joint during interaction with externally applied impedances. As the human knee behaves much like a linear spring during the stance phase of normal walking gait, the exoskeleton implements a spring across the knee in the weight acceptance (WA) phase of the gait while allowing free motion throughout the rest of the gait cycle, accomplished via an electromechanical clutch. The stiffness of the device is able to be varied by swapping springs, and the timing of engagement/disengagement changed to accommodate different loading profiles. After describing the design and control, we validate the mechanical performance and reliability of the exoskeleton through cyclic testing on a mechanical knee simulator. We then describe a preliminary experiment on three healthy adults to evaluate the functionality of the device on both left and right legs. The kinetic and kinematic analyses of these subjects show that the exoskeleton assistance can partially/fully replace the function of the knee joint and obtain nearly invariant moment and angle profiles for the hip and ankle joints, and the overall knee joint and exoskeleton complex under the applied moments of the exoskeleton versus the control condition, implying that the subjects undergo a considerable amount of motor adaptation in their lower extremities to the exoskeletal impedances, and encouraging more in-depth future experiments with the device.

Effects of a lower-body exoskeleton device on metabolic cost and gait biomechanics during load carriage.

This study investigated the effects on metabolic cost and gait biomechanics of using a prototype lower-body exoskeleton (EXO) to carry loads. Nine US Army participants walked at 1.34 m/s on a 0% grade for 8 min carrying military loads of 20 kg, 40 kg and 55 kg with and without the EXO. Mean oxygen consumption (VO(2)) scaled to body mass and scaled to total mass were significantly higher, by 60% and 41% respectively, when the EXO was worn, compared with the control condition. Mean VO(2) and mean VO(2) scaled to body mass significantly increased with load. The kinematic and kinetic data revealed significant differences between EXO and control conditions, such as walking with a more flexed posture and braking with higher ground reaction force at heel strike when wearing the EXO. Study findings demonstrate that the EXO increased users' metabolic cost while carrying various loads and altered their gait biomechanics compared with conventional load carriage. STATEMENT OF RELEVANCE: An EXO designed to assist in load bearing was found to raise energy expenditure substantially when tested by soldiers carrying military loads. EXO weight, weight distribution and design elements that altered users' walking biomechanics contributed to the high energy cost. To realise the potential of EXOs, focus on the user must accompany engineering advances.

Nonlinear analysis of gait kinematics to track changes in oxygen consumption in prolonged load carriage walking: a pilot study.

Linking human mechanical work to physiological work for the purpose of developing a model of physical fatigue is a complex problem that cannot be solved easily by conventional biomechanical analysis. The purpose of the study was to determine if two nonlinear analysis methods can address the fundamental issue of utilizing kinematic data to track oxygen consumption from a prolonged walking trial: we evaluated the effectiveness of dynamical systems and fractal analysis in this study. Further, we selected, oxygen consumption as a measure to represent the underlying physiological measure of fatigue. Three male US Army Soldier volunteers (means: 23.3 yr; 1.80 m; 77.3 kg) walked for 120 min at 1.34 m/s with a 40-kg load on a level treadmill. Gait kinematic data and oxygen consumption (VO(2)) data were collected over the 120-min period. For the fractal analysis, utilizing stride interval data, we calculated fractal dimension. For the dynamical systems analysis, kinematic angle time series were used to estimate phase space warping based features at uniform time intervals: smooth orthogonal decomposition (SOD) was used to extract slowly time-varying trends from these features. Estimated fractal dimensions showed no apparent trend or correlation with independently measured VO(2). While inter-individual difference did exist in the VO(2) data, dominant SOD time trends tracked and correlated with the VO(2) for all volunteers. Thus, dynamical systems analysis using gait kinematics may be suitable to develop a model to predict physiologic fatigue based on biomechanical work.

The effects of a lower body exoskeleton load carriage assistive device on limits of stability and postural sway.

The study investigated the effects of using a lower body prototype exoskeleton (EXO) on static limits of stability and postural sway. Measurements were taken with participants, 10 US Army enlisted men, standing on a force platform. The men were tested with and without the EXO (15 kg) while carrying military loads of 20, 40 and 55 kg. Body lean to the left and right was significantly less and postural sway excursions and maximal range of movement were significantly reduced when the EXO was used. Hurst values indicated that body sway was less random over short-term time intervals and more random over long-term intervals with the EXO than without it. Feedback to the user's balance control mechanisms most likely was changed with the EXO. The reduced sway and relatively small changes in sway with increasing load weights suggest that the EXO structure may have functioned to provide a bracing effect on the body.

Discrete bandwidth visual feedback increases structure of output as compared to continuous visual feedback in isometric force control tasks.

BACKGROUND: Performance variability measures provide a partial picture of force control ability. Nonlinear analyses can reveal important information related to the randomness and complexity of the data, providing a more complete picture of the physiological process. METHODS: We investigated the effects of visual feedback on the structure and performance of the force output from isometric force control tasks. Twelve young volunteers completed isometric force control tasks using two types of visual feedback: discrete bandwidth (+/-4% maximal voluntary contraction) and continuous line matching. We determined force signal variability (standard deviation), self-similarity (fractal dimension), and complexity (approximate entropy). Analyses of variance (feedback x muscle group x force level) were conducted and P values less than 0.05 were considered significant. FINDINGS: The force signal in discrete bandwidth feedback, compared to continuous line matching, had significantly a higher standard deviation (P=.000): 2.18 Nm (SD 1.98) vs. 0.99 Nm (SD 0.91); lower fractal dimension (P=.000): 1.07 (SD 0.04) vs. 1.16 (SD 0.04); and lower approximate entropy (P=.000): 0.12 (SD 0.07) vs. 0.26 (SD 0.09). INTERPRETATION: The greater self-similarity (lower fractal dimension) and greater regularity (lower approximate entropy) of the discrete bandwidth, compared to the continuous line matching, may indicate a process that required more kinesthetic (intrinsic) feedback to modulate force. Clinicians may choose to employ visual feedback paradigms that target the use of intrinsic feedback during rehabilitation. Discrete bandwidth feedback may be useful for delineating impairments in motor skill and measuring outcomes of intervention programs.

Effects of carried weight on random motion and traditional measures of postural sway.

The purpose of the study was to investigate the effects of load weight carried by soldiers upon postural sway. Fourteen US Army enlisted men participated. Postural sway and muscle activity were measured while participants stood on a force plate. The load weight conditions, comprised of Army clothing and load-carriage equipment were 6, 16, and 40 kg. With an increase in load weight, stabilogram-diffusion analysis revealed that random movement of postural sway decreased. Also, with an increase in load weight, center of pressure excursions increased linearly but muscle activity changed minimally. In short, increasing load weight challenged the load carriers' stability, reduced the randomness of postural sway and required the load carriers to exert greater control of the load in order to maintain balance.

Effects of step length on stepping responses used to arrest a forward fall.

This study investigated effects of step length on the stepping response used to arrest an impending forward fall. Twelve healthy young (mean age 22, S.D. 3.3 years) males participated by recovering balance with a single step following a forward lean-and-release. Participants were instructed to step to one of three floor targets representing small, natural, and large step lengths. The effect of step length was examined on the primary outcome variables: pushoff time, liftoff and landing time, swing duration, balance recovery time, landing impulse, and center of mass (COM) characteristics. Pushoff and liftoff times were not affected by step length, although swing phase duration, landing and recovery times and the anterior-posterior (AP) impulse at landing increased with increasing step length. The results support the idea of an invariant step preparation phase. Given that our participants naturally chose not to utilize a step as short as they were capable of employing, healthy young individuals do not minimize recovery time nor strength requirements when selecting their step length.