Upward perturbations trigger a stumbling effect.


Journal

Human movement science
ISSN: 1872-7646
Titre abrégé: Hum Mov Sci
Pays: Netherlands
ID NLM: 8300127

Informations de publication

Date de publication:
Apr 2023
Historique:
received: 21 04 2022
revised: 06 02 2023
accepted: 09 02 2023
pubmed: 6 3 2023
medline: 15 3 2023
entrez: 5 3 2023
Statut: ppublish

Résumé

Vertical perturbations are one major cause of falling. Incidentally, while conducting a comprehensive study comparing effects of vertical versus horizontal perturbations, we commonly observed a stumbling-like response induced by upward perturbations. The present study describes and characterizes this stumbling effect. Fourteen individuals (10 male; 27 ± 4 yr) walked self-paced on a treadmill embedded in a moveable platform and synchronized to a virtual reality system. Participants experienced 36 perturbations (12 types). Here, we report only on upward perturbations. We determined stumbling based on visual inspection of recorded videos, and calculated stride time and anteroposterior, whole-body center of mass (COM) distance relative to the heel, i.e., COM-to-heel distance, extrapolated COM (xCOM) and margin of stability (MOS) before and after perturbation. From 68 upward perturbations across 14 participants, 75% provoked stumbling. During the first gait cycle post-perturbation, stride time decreased in the perturbed foot and the unperturbed foot (perturbed = 1.004 s vs. baseline = 1.119 s and unperturbed = 1.017 s vs. baseline = 1.125 s, p < 0.001). In the perturbed foot, the difference was larger in stumbling-provoking perturbations (stumbling: 0.15 s vs. non-stumbling: 0.020 s, p = 0.004). In addition, the COM-to-heel distance decreased during the first and second gait cycles after perturbation in both feet (first cycle: 0.58 m, second cycle: 0.665 m vs. baseline: 0.72 m, p-values<0.001). During the first gait cycle, COM-to-heel distance was larger in the perturbed foot compared to the unperturbed foot (perturbed foot: 0.61 m vs. unperturbed foot: 0.55 m, p < 0.001). MOS decreased during the first gait cycle, whereas the xCOM increased during the second through fourth gait cycles post-perturbation (maximal xCOM at baseline: 0.5 m, second cycle: 0.63 m, third cycle: 0.66 m, fourth cycle: 0.64 m, p < 0.001). Our results show that upward perturbations can induce a stumbling effect, which - with further testing - has the potential to be translated into balance training to reduce fall risk, and for method standardization in research and clinical practice.

Sections du résumé

BACKGROUND BACKGROUND
Vertical perturbations are one major cause of falling. Incidentally, while conducting a comprehensive study comparing effects of vertical versus horizontal perturbations, we commonly observed a stumbling-like response induced by upward perturbations. The present study describes and characterizes this stumbling effect.
METHODS METHODS
Fourteen individuals (10 male; 27 ± 4 yr) walked self-paced on a treadmill embedded in a moveable platform and synchronized to a virtual reality system. Participants experienced 36 perturbations (12 types). Here, we report only on upward perturbations. We determined stumbling based on visual inspection of recorded videos, and calculated stride time and anteroposterior, whole-body center of mass (COM) distance relative to the heel, i.e., COM-to-heel distance, extrapolated COM (xCOM) and margin of stability (MOS) before and after perturbation.
RESULTS RESULTS
From 68 upward perturbations across 14 participants, 75% provoked stumbling. During the first gait cycle post-perturbation, stride time decreased in the perturbed foot and the unperturbed foot (perturbed = 1.004 s vs. baseline = 1.119 s and unperturbed = 1.017 s vs. baseline = 1.125 s, p < 0.001). In the perturbed foot, the difference was larger in stumbling-provoking perturbations (stumbling: 0.15 s vs. non-stumbling: 0.020 s, p = 0.004). In addition, the COM-to-heel distance decreased during the first and second gait cycles after perturbation in both feet (first cycle: 0.58 m, second cycle: 0.665 m vs. baseline: 0.72 m, p-values<0.001). During the first gait cycle, COM-to-heel distance was larger in the perturbed foot compared to the unperturbed foot (perturbed foot: 0.61 m vs. unperturbed foot: 0.55 m, p < 0.001). MOS decreased during the first gait cycle, whereas the xCOM increased during the second through fourth gait cycles post-perturbation (maximal xCOM at baseline: 0.5 m, second cycle: 0.63 m, third cycle: 0.66 m, fourth cycle: 0.64 m, p < 0.001).
CONCLUSIONS CONCLUSIONS
Our results show that upward perturbations can induce a stumbling effect, which - with further testing - has the potential to be translated into balance training to reduce fall risk, and for method standardization in research and clinical practice.

Identifiants

pubmed: 36871477
pii: S0167-9457(23)00015-5
doi: 10.1016/j.humov.2023.103069
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

103069

Informations de copyright

Copyright © 2023. Published by Elsevier B.V.

Auteurs

Desiderio Cano Porras (D)

Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; Brightlands Institute for Smart Society-BISS, Maastricht University, Maastricht, the Netherlands.

Benedetta Heimler (B)

Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel.

Jesse V Jacobs (JV)

Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA.

Shani Kimel Naor (SK)

Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel.

Rivka Inzelberg (R)

Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Gabriel Zeilig (G)

Department of Neurological Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; Department of Physical and Rehabilitation Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; School of Health Professions, Ono Academic College, Kiryat Ono, Israel.

Meir Plotnik (M)

Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: meir.plotnik@sheba.health.gov.il.

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