physical activity might increase fall risk due to an increase in exposure. This may explain the ineffectiveness of fall prevention programs for stroke survivors. 5 Before the exposure is increased by stimulating daily walking activities, training may be necessary to improve gait stability in fall
Michiel Punt, Sjoerd M. Bruijn, Ingrid G. van de Port, Ilona J.M. de Rooij, Harriet Wittink and Jaap H. van Dieën
Ronita L. Cromwell and Roberta A. Newton
Age-related adaptations during walking create a more stable walking pattern, which is less effective for forward progression and might be related to balance deficiencies. This study determined the relationship between walking stability and measures of balance in older adults. Seventeen older and 20 young adults performed the Berg Balance Test (BBT) and walked 10 m. Walking velocity (WV) and cadence were measured, and a gait-stability ratio (GSR) was calculated. Higher GSR indicated that a greater portion of the gait cycle was spent in double-limb support. Age-group comparisons established declines in BBT scores and WV and increases in GSR with age. Significant relationships were identified for BBT Item 12 (alternate stepping on a stool) with WV (r = .58, r 2 = .34) and GSR (r = −.74, r 2 = .54). The correlation of BBT Item 12 with GSR was stronger than with WV (p < .05). Results indicated a strong relationship between increased gait stability and decreased balance for a dynamic weight-shifting task. Therefore, GSR is a better indicator of balance deficits during walking than is WV alone.
Timothy D. Coleman, Haley J. Lawrence and W. Lee Childers
This research tested a reproducible uneven walkway designed to destabilize human gait. Ten participants walked 30 times over even and uneven (7.3 × .08 m, sequentially-placed wooden blocks in a rotating pattern, 1-cm thick rubber mat) walkways. A full-body marker set and 8-camera motion capture system recorded limb kinematics. MatLab 2013b was used to calculate measures of gait stability: angular momentum, margin of stability, step width variability, CoM height, toe clearance, lateral arm swing. The minimum number of strides necessary to minimize intraparticipant variability was calculated via the interquartile range/median ratio (IMR) at 25% and 10% thresholds for each measure. A paired t test tested for significance between terrains (P < .05). The uneven walkway significantly destabilized gait as seen by increases in: coronal and sagittal plane angular momentum, step width variability, and toe clearance. We found no significant difference with the margin of stability between the 2 terrains possibly due to compensatory strategies (eg, lateral arm swing, trunk sway, step width). Recording a minimum of 10 strides per subject will keep each variable between the 25% and 10% IMR thresholds. In conclusion, the uneven walkway design significantly destabilizes human gait and at least 10 strides should be collected per subject.
Daniel Hamacher, Dennis Hamacher, Roy Müller, Lutz Schega and Astrid Zech
, W. R. ( 2011 ). Kinematic measures for assessing gait stability in elderly individuals: A systematic review . Journal of the Royal Society, 8 ( 65 ), 1682 – 1698 . doi:10.1098/rsif.2011.0416 Mariani , B. , Hoskovec , C. , Rochat , S. , Büla , C. , Penders , J. , & Aminian , K
Richard E.A. van Emmerik, Stephanie L. Jones, Michael A. Busa and Jennifer L. Baird
Postural instability, falls, and fear of falling that accompany frailty with aging and disease form major impediments to physical activity. In this article we present a theoretical framework that may help researchers and practitioners in the development and delivery of intervention programs aimed at reducing falls and improving postural stability and locomotion in older individuals and in those with disability due to disease. Based on a review of the dynamical and complex systems perspectives of movement coordination and control, we show that 1) central to developing a movement-based intervention program aimed at fall reduction and prevention is the notion that variability can play a functional role and facilitate movement adaptability, 2) intervention programs aimed at fall reduction should focus more on coordination and stability boundary measures instead of traditional gait and posture outcome variables, and 3) noise-based intervention techniques using stochastic resonance may offer external aids to improve dynamic balance control.
Jebb G. Remelius and Richard E.A. van Emmerik
This study investigated timing and coordination during the swing phase of swing leg, body center of mass (CoM) and head during walking people with multiple sclerosis (MS; n = 19) and controls (n = 19). The MS group showed differences in swing phase timing at all speeds. At imposed but not preferred speeds, the MS group had less time to prepare for entry into the unstable equilibrium, as the CoM entered this phase of swing earlier. Time-to-contact coupling, quantifying the coordination between the CoM and the swing foot, was not different between groups. The projection of head motion on the ground occurred earlier after toeoff and was positioned closer to the body in the MS group, illustrating increased reliance on visual exproprioception in which vision of the body in relation to the surface of support is established. Finally, prospective control, linking head movements to the swing foot time-to-contact and next step landing area, was impaired in the MS group at higher gait speeds.
Hitoshi Koda, Yoshihiro Kai, Shin Murata, Hironori Osugi, Kunihiko Anami, Takahiko Fukumoto and Hidetaka Imagita
significant correlation between toe grip strength asymmetry and body sway while walking and that a toe grip strength asymmetry surpassing 23.5% causes an increase in body sway. For older adults, toe grip strength asymmetry may be a target for improving gait stability. In the future, we intend to continue our
Christopher McCrum, Katrin Eysel-Gosepath, Gaspar Epro, Kenneth Meijer, Hans H.C.M. Savelberg, Gert-Peter Brüggemann and Kiros Karamanidis
Posturography is used to assess balance in clinical settings, but its relationship to gait stability is unclear. We assessed if dynamic gait stability is associated with standing balance in 12 patients with unilateral vestibulopathy. Participants were unexpectedly tripped during treadmill walking and the change in the margin of stability (MoSchange) and base of support (BoSchange) relative to nonperturbed walking was calculated for the perturbed and first recovery steps. The center of pressure (COP) path during 30-s stance with eyes open and closed, and the distance between the most anterior point of the COP and the anterior BoS boundary during forward leaning (ADist), were assessed using a force plate. Pearson correlations were conducted between the static and dynamic variables. The perturbation caused a large decrease in the BoS, leading to a decrease in MoS. One of 12 correlations was significant (MoSchange at the perturbed step and ADist; r = −.595, P = .041; nonsignificant correlations: .068 ≤ P ≤ .995). The results suggest that different control mechanisms may be involved in stance and gait stability, as a consistent relationship was not found. Therefore, posturography may be of limited use in predicting stability in dynamic situations.
Ahmadreza Nematollahi, Fahimeh Kamali, Ali Ghanbari, Zahra Etminan and Sobhan Sobhani
The aim of this study was to examine and compare the effects of conventional, multisensory, and dual-task exercises on balance ability in a group of older community dwellers over a four-week period. Forty-four older people were randomly assigned to one of the three training groups. The score on the Fullerton Advanced Balance (FAB) scale, gait stability ratio, and walking speed were evaluated at baseline and after four weeks of training. All three groups showed significant (p < .001) improvement in the FAB scores following the three training programs (on average, 3 points for the conventional and multisensory groups and 3.8 points for the dual-task group). The improvements were comparable across the three intervention groups (p = .23). There were no statistically significant differences, neither within nor between groups, in the gait stability ratio and walking speed across the three training groups. In a four-week period, all the training modes were effective in improving balance of older adults, with no significant superiority of one mode of training over another.
Bryan C. Heiderscheit
The purpose of this paper is to discuss the role of variability in human movement, with emphasis on locomotion variability. Based on the assessment of stride characteristics, movement variability has been associated with reduced gait stability and unsteadiness. However, based on the measure of joint coordination during locomotion, variability has been suggested to provide a source of adaptation. Therefore, it would appear that the assessment of movement coordination from either the task outcome (i.e., stride characteristics) or the joint coordination patterns provide distinctly opposing views of variability. This paper will discuss the use of the variability measures, specifically joint coordination variability, from a clinical perspective. Investigations will be presented in which a reduction in joint coordination variability has been associated with pathology. Finally, the clinical implications of these measures as well as treatment suggestions are discussed.