Obstacle avoidance in Down syndrome

IntroductionThe ability to avoid obstacles requires to represent the properties of the obstacle, represent the location of the obstacle relative to the body and update these representations as the body moves. Individuals with Down syndrome (DS) often have trouble avoiding obstacles, leading to increased frequency of trips and falling. The aim of the present study was to deeply analyze obstacle avoidance strategies in normally developed young adults (N) and in young adults with DS, at different levels of obstacle heights, with particular attention to the strategies used for clearing the obstacle and to how the walking pattern was modified by obstacle perception.Methods10 DS and 16 age-matched N walked along a walkway in three conditions: plain walking, walking with obstacle at ground level, walking with obstacle at 10% of the subject’s height. Spatiotemporal parameters were analyzed.ResultsThere was evidence for a different avoidance strategy in DS, and for a difficulty in regulating gait parameters when challenged with a complex situation as the presence of an obstacle. This may lead to an increased risk of fall. The results in addition suggested a lack in anticipatory movement adjustments in DS and provided further evidence of the presence of difficulties in perceptual–motor coupling in DS.     

Adaptive control of center of mass (global) motion and its joint (local) origin in gait

Dynamic gait stability can be quantified by the relationship of the motion state (i.e. the position and velocity) between the body center of mass (COM) and its base of support (BOS). Humans learn how to adaptively control stability by regulating the absolute COM motion state (i.e. its position and velocity) and/or by controlling the BOS (through stepping) in a predictable manner, or by doing both simultaneously following an external perturbation that disrupts their regular relationship. Post repeated-slip perturbation training, for instance, older adults learned to forward shift their COM position while walking with a reduced step length, hence reduced their likelihood of slip-induced falls. How and to what extent each individual joint influences such adaptive alterations is mostly unknown. A three-dimensional individualized human kinematic model was established. Based on the human model, sensitivity analysis was used to systematically quantify the influence of each lower limb joint on the COM position relative to the BOS and the step length during gait. It was found that the leading foot had the greatest effect on regulating the COM position relative to the BOS; and both hips bear the most influence on the step length. These findings could guide cost-effective but efficient fall-reduction training paradigm among older population.     

Deficient limb support is a major contributor to age differences in falling

Older adults are more likely than young to fall upon a loss of balance, yet the factors responsible for this difference are not well understood. This study investigated whether age-related differences in movement stability, limb support, and protective stepping contribute to the greater likelihood of falling among older adults. Sixty young and 41 older, safety-harnessed, healthy adults were exposed to a novel and unexpected forward slip during a sit-to-stand task. More older than young adults fell (76% vs. 30%). Falls in both age groups were related to lesser stability and lower hip height at first step touchdown, with 97.1% of slip outcomes correctly classified based on these variables. Decreases in hip height at touchdown had over 20 times greater effect on the odds of falling than equivalent decreases in stability. Three age differences placed older adults at greater risk of falling: older adults had lower and more slowly rising hips at slip onset, they were less likely to respond to slipping with ample limb support, and they placed their stepping foot less posterior to their center of mass. The first two differences, each associated with deficient limb support, reduced hip ascent and increased hip descent. The third difference resulted in lesser stability at step touchdown. These results suggest that deficient limb support in normal movement patterns and in the reactive response to a perturbation is a major contributor to the high incidence of falls in older adults. Improving proactive and reactive limb support should be a focus of fall prevention efforts.     

Age-related reduction in sagittal plane center of mass motion during obstacle crossing

Accidental falls are a leading cause of injury and death in the growing elderly population. Traumatic falls are frequent, costly, and debilitating. Control of balance during locomotion is critical for safe ambulation, but relatively little is known about the natural effect of aging on dynamic balance control. Samples of healthy young (n = 13) and elderly (n = 13) subjects were compared in the interactive measures of center of mass (COM) and center of pressure (COP) during level walking and obstacle crossing conditions. Obstacle heights were normalized to individual body height (2.5%, 5%, 10%, and 15%). Temporal-distance (T-D) variables of gait were also compared. Statistical analyses were conducted using a two-way ANOVA for subject group and obstacle height. T-D parameters were not significantly different between groups; nor were frontal plane COM and COP parameters. Significant age differences did exist for antero-posterior (A/P) motion of the COM (decreased motion in the elderly), and its relationship with the COP (reduced separation between the two variables in the elderly). Anterior COM velocities were also significantly lower in the elderly group. The results confirm the ability of healthy elderly adults to maintain dynamic balance control in the frontal plane during locomotion. Reduced A/P distances between the COM and COP indicate a conservative reduction of the mechanical load on joints of the supporting limb. This conservative strategy may be related to a reduction in muscle strength as it occurs in the natural aging process.     

Control of center of mass motion state through cuing and decoupling of spontaneous gait parameters in level walking

Can the center of mass (COM) motion state, i.e., its position and velocity relative to the base of support (BOS), which dictate gait stability, be predictably controlled by the global gait parameters of step length and gait speed, or by extension, cadence? The precise relationships among step length and gait speed, and the COM motion state are unknown, partially due to the interdependence between step length and gait speed and the difficulty in independent control of both parameters during spontaneous level walking. The purposes of this study were to utilize simultaneous audio-visual cuing to independently manipulate step length and gait speed, and to determine the extent to which the COM position and velocity can be subsequently controlled. Fifty-six young adults were trained at one of the three gait patterns in which both the step length and gait speed were targeted simultaneously. The results showed that the cuing could successfully “decouple” gait speed from step length. Although this approach did yield reliable control of the COM velocity through manipulation of gait speed (R²=0.97), the manipulation of step length yielded less precise control of COM position (R²=0.60). This latter control appears to require manipulation of an additional degree-of-freedom at the local segment level, such that the inclusion of trunk inclination with step length improved the prediction of COM position (R²=0.80).     

Reactive gait and postural adjustments following the first exposures to (un)expected stepdown

This study evaluated the reactive biomechanical strategies associated with both upper- and lower-body (lead and trail limbs) following the first exposures to (un)expected stepdown at comfortable (1.22 ± 0.08 m/s) and fast (1.71 ± 0.11 m/s) walking velocities. Eleven healthy adults completed 34 trails per walking velocity over an 8-m, custom-built track with two forceplates embedded in its center. For the expected stepdown, the track was lowered by 0-, −10- and −20-cm from the site of the second forceplate, whereas the unexpected stepdown was created by camouflaging the second forceplate (−10-cm). Two-way repeated-measurement ANOVAs detected no velocity-related effects of stepdown on kinematic and kinetic parameters during lead limb stance-phase, and on the trail limb stepping kinematics. However, analyses of significant interactions revealed greater peak flexion angles across the trunk and the trail limb joints (hip, knee and ankle) in unexpected versus expected stepdown conditions at a faster walking velocity. The −10-cm unexpected stepdown (main effect) had a greater influence on locomotor behavior compared to expected conditions due mainly to the absence of predictive adjustments, reflected by a significant decrease in peak knee flexion, contact time and vertical impulse during stance-phase. Walking faster (main effect) was associated with an increase in hip peak flexion and net anteroposterior impulse, and a decrease in contact time and vertical impulse during stepdown. The trail limb, in response, swung forward faster, generating a larger and faster recovery step. However, such reactive stepping following unexpected stepdown was yet a sparse compensation for an unstable body configuration, assessed by significantly smaller step width and anteroposterior margin-of-stability at foot-contact in the first-recovery-step compared with expected conditions. These findings depict the impact of the expectedness of stepdown onset on modulation of global dynamic postural control for a successful accommodation of (un)expected surface elevation changes in young, healthy adults.     

Alteration in community-dwelling older adults' level walking following perturbation training

While perturbation training is promising in reducing fall-risk among older adults, its impact on altering their spontaneous gait pattern has not been investigated. The purpose of this study was to determine to what extent older adults' gait pattern would be affected by exposure to repeated slips. Seventy-three community-dwelling older adults (age: 72.6±5.4 years) underwent 24 repeated-slip exposure induced by unannounced unlocking and relocking of low-friction sections of a 7-m pathway upon which they walked. Full body kinematics and kinetics were recorded during the training. The gait parameters and the center of mass (COM) stability against backward balance loss were compared before and after the training. The results revealed that the training reduced fall incidence from 43.8% upon the novel slip to 0 at the end of training. After the training, subjects significantly improved gait stability by forward positioning of their COM relative to the base of support without altering gait speed. This forward COM shift resulted from a shortened step at the end of single stance and forward trunk leaning during double stance. They also adopted flat foot landing with knee flexed at touchdown (with an average change of 6.9 and 4.1 degrees, respectively). The perturbation training did alter community-dwelling older adults' spontaneous gait pattern. These changes enabled them to improve their volitional control of stability and their resistance to unpredictable and unpreventable slip-related postural disturbance.     

Predicted threshold against backward balance loss following a slip in gait

The purpose of this study was to use a 7-link, moment-actuated human model to predict, at liftoff of the trailing foot in gait, the threshold of the center of mass (COM) velocity relative to the base of support (BOS) required to prevent backward balance loss during single stance recovery from a slip. Five dynamic optimization problems were solved to find the minimum COM velocities that would allow the simulation to terminate with the COM above the BOS when the COM started 0.25, 0.5, 0.75, 1.0, and 1.25 foot lengths behind the heel of the stance foot (i.e., behind the BOS). The initial joint angles of the model were based on averaged data from experimental trials. Foot-ground contact was modeled using 16 visco-elastic springs distributed under the stance foot. Slipping was modeled by setting the sliding coefficient of friction of these springs to 0.02. The forward velocity of the COM necessary to avoid a backward balance loss is nearly two times larger under slip conditions under non-slip conditions. The predicted threshold for backward balance loss following a slip agreed well with experimental data collected from 99 young adults in response to 927 slips during walking. In all trials in which a subject's COM had a velocity below the predicted threshold, the subject's recovery foot landed posterior to the slipping foot as predicted. Finally, combining experimental data with optimization, we verified that the 7-link model could more accurately predict gait stability than a 2-link model.     

Interactions between cognitive and sensory load while planning and controlling complex gait adaptations in Parkinson’s disease

Background

Recent research has argued that removal of relevant sensory information during the planning and control of simple, self-paced walking can result in increased demand on central processing resources in Parkinson’s disease (PD). However, little is known about more complex gait tasks that require planning of gait adaptations to cross over an obstacle in PD.

Methods

In order to understand the interaction between availability of visual information relevant for self-motion and cognitive load, the current study evaluated PD participants and healthy controls while walking toward and stepping over an obstacle in three visual feedback conditions: (i) no visual restrictions; (ii) vision of the obstacle and their lower limbs while in complete darkness; (iii) vision of the obstacle only while in complete darkness; as well as two conditions including a cognitive load (with a dual task versus without a dual task). Each walk trial was divided into an early and late phase to examine changes associated with planning of step adjustments when approaching the obstacle.

Results

Interactions between visual feedback and dual task conditions during the obstacle approach were not significant. Patients with PD had greater deceleration and step time variability in the late phase of the obstacle approach phase while walking in both dark conditions compared to control participants. Additionally, participants with PD had a greater number of obstacle contacts when vision of their lower limbs was not available specifically during the dual task condition. Dual task performance was worse in PD compared to healthy control participants, but notably only while walking in the dark regardless of visual feedback.

Conclusions

These results suggest that reducing visual feedback while approaching an obstacle shifts processing to somatosensory feedback to guide movement which imposes a greater demand on planning resources. These results are key to fully understanding why trips and falls occur in those with PD.

     

Adaptive recovery responses to repeated forward loss of balance in older adults

Experiments designed to assess balance recovery in older adults often involve exposing participants to repeated loss of balance. The purpose of this study was to investigate the adaptive balance recovery response exhibited by older adults following repeated exposure to forward loss of balance induced by releasing participants from a static forward lean angle. Fifty-eight healthy, community-dwelling older adults, aged 65-80 years, participated in the study. Participants were instructed to attempt to recover with a single step and performed four trials at each of three lean angles. Adaptive recovery responses at four events (cable release, toe-off of the stepping foot, foot contact and maximum knee flexion angle following landing in the stepping leg) were quantified for trials performed at the intermediate lean angle using the concept of margin of stability. The antero-posterior and medio-lateral margin of stability were computed as the difference between the velocity-adjusted position of the whole body centre of mass and the corresponding anterior or lateral boundary of the base of support. Across repeated trials adaptations in reactive stepping responses were detected that resulted in improved antero-posterior stability at foot contact and maximum knee flexion angle. Improved antero-posterior stability following repeated trials was explained by more effective control of the whole body centre of mass during the reactive stepping response and not by adjustments in step timing or base of support. The observed adaptations occurred within a single testing session and need to be considered in the design of balance recovery experiments.     

American Society of Biomechanics Journal of Biomechanics Award 2018: Adaptive motor planning of center-of-mass trajectory during goal-directed walking in novel environments

To aid in the successful execution of goal-directed walking (discrete movement from a start location to an end target) the central nervous system forms a predictive motor plan. For the motor plan to be effective, it must be adapted in response to environmental changes. Despite motor planning being inherent to goal-directed walking, it is not understood how the nervous system adapts these plans to interact with changing environments. Our objective was to understand how people adapt motor plans of center of mass (COM) trajectory during goal-directed walking in response to a consistent change in environmental dynamics. Participants preformed a series of goal-directed walking trials in a novel environment created by a cable robot that applied a lateral force field to their COM. We hypothesized that participants would adapt to the environment by forming an internal model of their COM trajectory within the force field. Our findings support this hypothesis. Initially, we found COM trajectory significantly deviated in the same direction as the applied field, relative to baseline (no field) (p = 0.002). However, with practice in the field, COM trajectory adapted back to the baseline (p = 0.6). When we unexpectedly removed the field, participants demonstrated after-effects, COM trajectory deviated in the direction opposite of the field relative to baseline (p < 0.001). Our findings suggest that when performing a goal-directed walking task, people adapt a motor plan that predicts the COM trajectory that will emerge from the interaction between a specific set of motor commands and the external environment.     

Influence of gait speed on the control of mediolateral dynamic stability during gait initiation

This study investigated the influence of gait speed on the control of mediolateral dynamic stability during gait initiation. Thirteen healthy young adults initiated gait at three self-selected speeds: Slow, Normal and Fast. The results indicated that the duration of anticipatory postural adjustments (APA) decreased from Slow to Fast, i.e. the time allocated to propel the centre of mass (COM) towards the stance-leg side was shortened. Likely as an attempt at compensation, the peak of the anticipatory centre of pressure (COP) shift increased. However, COP compensation was not fully efficient since the results indicated that the mediolateral COM shift towards the stance-leg side at swing foot-off decreased with gait speed. Consequently, the COM shift towards the swing-leg side at swing heel-contact increased from Slow to Fast, indicating that the mediolateral COM fall during step execution increased as gait speed rose. However, this increased COM fall was compensated by greater step width so that the margin of stability (the distance between the base-of-support boundary and the mediolateral component of the “extrapolated centre of mass”) at heel-contact remained unchanged across the speed conditions. Furthermore, a positive correlation between the mediolateral extrapolated COM position at heel-contact and step width was found, indicating that the greater the mediolateral COM fall, the greater the step width. Globally, these results suggest that mediolateral APA and step width are modulated with gait speed so as to maintain equivalent mediolateral dynamical stability at the time of swing heel-contact.     

Postural Instability Detection: Aging and the Complexity of Spatial-Temporal Distributional Patterns for Virtually Contacting the Stability Boundary in Human Stance

Falls among the older population can severely restrict their functional mobility and even cause death. Therefore, it is crucial to understand the mechanisms and conditions that cause falls, for which it is important to develop a predictive model of falls. One critical quantity for postural instability detection and prediction is the instantaneous stability of quiet upright stance based on motion data. However, well-established measures in the field of motor control that quantify overall postural stability using center-of-pressure (COP) or center-of-mass (COM) fluctuations are inadequate predictors of instantaneous stability. For this reason, 2D COP/COM virtual-time-to-contact (VTC) is investigated to detect the postural stability deficits of healthy older people compared to young adults. VTC predicts the temporal safety margin to the functional stability boundary ( =  limits of the region of feasible COP or COM displacement) and, therefore, provides an index of the risk of losing postural stability. The spatial directions with increased instability were also determined using quantities of VTC that have not previously been considered. Further, Lempel-Ziv-Complexity (LZC), a measure suitable for on-line monitoring of stability/instability, was applied to explore the temporal structure or complexity of VTC and the predictability of future postural instability based on previous behavior. These features were examined as a function of age, vision and different load weighting on the legs. The primary findings showed that for old adults the stability boundary was contracted and VTC reduced. Furthermore, the complexity decreased with aging and the direction with highest postural instability also changed in aging compared to the young adults. The findings reveal the sensitivity of the time dependent properties of 2D VTC to the detection of postural instability in aging, availability of visual information and postural stance and potential applicability as a predictive model of postural instability during upright stance.     

The threshold trip duration for which recovery is no longer possible is associated with strength and reaction time

The recovery of young adults from trips of increasing severity was studied. Our null hypothesis was that lower extremity strength, and reaction time, step time, step distance and step velocity measured in a volitional stepping task would not explain a significant portion of the variance in the magnitude of the threshold trip duration for which recovery is no longer possible. Ten males and 11 females (average age 26.8 and 28.4 years old, respectively) were subjected to trips of increasing duration until recovery was no longer possible with a single step. The average threshold trip duration for which subjects were no longer able to recover with a single step was 681+/-169ms. The threshold trip duration significantly increased as lower extremity strength increased and volitional reaction time decreased (multiple stepwise linear regression: R(2)=0.52, p=0.001). The other volitional step parameters and the subject characteristics were not significantly associated with the magnitude of the threshold trip duration. These results suggest that some trip-related falls may be due to slower reaction times and/or reduced lower extremity strengths.     

Thresholds for step initiation induced by support-surface translation: a dynamic center-of-mass model provides much better prediction than a static model

The need to initiate a step in order to recover balance could, in theory, be predicted by a static model based solely on displacement of the center of mass (COM) with respect to the base of support (BOS), or by a dynamic model based on the interaction between COM displacement and velocity. The purpose of this study was to determine whether the dynamic model provides better prediction than the static model regarding the need to step in response to moving-platform perturbation. The COM phase plane trajectories were determined for 10 healthy young adults for trials where the supporting platform was translated at three different acceleration levels in anterior and posterior directions. These trajectories were compared with the thresholds for step initiation predicted by the static and dynamic COM models. A single-link-plus-foot biomechanical model was employed to mathematically simulate termination of the COM movement, without stepping, using the measured platform acceleration as the input. An optimization routine was used to determine the stability boundaries in COM state space so as to establish the dynamic thresholds where a compensatory step must be initiated in order to recover balance. In the static model, the threshold for step initiation was reached if the COM was displaced beyond the BOS limits. The dynamic model showed substantially better accuracy than the static model in predicting the need to step in order to recover balance: 71% of all stepping responses predicted correctly by the dynamic model versus only 11% by the static model. These results support the proposition that the central nervous system must react to and control dynamic effects, i.e. COM velocity, as well as COM displacement in order to maintain stability with respect to the existing BOS without stepping.     

Mechanisms of adaptation from a multiple to a single step recovery strategy following repeated exposure to forward loss of balance in older adults

When released from an initial, static, forward lean angle and instructed to recover with a single step, some older adults are able to meet the task requirements, whereas others either stumble or fall. The purpose of the present study was to use the concept of margin of stability (MoS) to investigate balance recovery responses in the anterior-posterior direction exhibited by older single steppers, multiple steppers and those that are able to adapt from multiple to single steps following exposure to repeated forward loss of balance. One hundred and fifty-one healthy, community dwelling, older adults, aged 65-80 years, participated in the study. Participants performed four trials of the balance recovery task from each of three initial lean angles. Balance recovery responses in the anterior-posterior direction were quantified at three events; cable release (CR), toe-off (TO) and foot contact (FC), for trials performed at the intermediate lean angle. MoS was computed as the anterior-posterior distance between the forward boundary of the Base of Support (BoS) and the vertical projection of the velocity adjusted centre of mass position (XCoM). Approximately one-third of participants adapted from a multiple to a single step recovery strategy following repeated exposure to the task. MoS at FC for the single and multiple step trials in the adaptation group were intermediate between the exclusively single step group and the exclusively multiple step group, with the single step trials having a significant, 3.7 times higher MoS at FC than the multiple step trials. Consistent with differences between single and multiple steppers, adaptation from multiple to single steps was attributed to an increased BoS at FC, a reduced XCoM at FC and an increased rate of BoS displacement from TO to FC. Adaptations occurred within a single test session and suggest older adults that are close to the threshold of successful recovery can rapidly improve dynamic stability following repeated exposure to a forward loss of balance.     

Does the margin of stability measure predict medio-lateral stability of gait with a constrained-width base of support?

This study aimed to determine the validity of the centre of mass position (COM) position and extrapolated COM (XCOM), relative to the base of support, for predicting medio-lateral stability during a walking task where the base of support width is limited. Nine young healthy participants walked on a narrow beam. Three-dimensional motion capture was used to calculate the COM and XCOM relative to the base of support. Steps were classified as having either the COM or XCOM inside or outside the base of support, and were classified as successful (stable – foot placed on the beam) or failed (unstable – foot stepped off the beam). If the COM or XCOM are valid measures of stability, they should be within the base of support for successful steps and outside the base of support for failed steps. Classifying the COM and XCOM inside or outside the base of support correctly predicted successful or failed steps in 69% and 58% of cases, respectively. When the COM or XCOM were outside the base of support, walking faster seemed to help participants to maintain stability. The further the COM or XCOM were outside the base of support during a successful step, the more likely participants were to fail on a subsequent step. The results of this study suggest that both COM and XCOM are valid measures of stability during a beam walking task, but that classifying COM and XCOM as inside or outside the base of support may be over-simplistic.     

Required coefficient of friction during turning at self-selected slow,normal, and fast walking speeds

This study investigated the relationship of required coefficient of friction to gait speed, obstacle height, and turning strategy as participants walked around obstacles of various heights. Ten healthy, young adults performed 90° turns around corner pylons of four different heights at their self selected normal, slow, and fast walking speeds using both step and spin turning strategies. Kinetic data was captured using force plates. Results showed peak required coefficient of friction (RCOF) at push off increased with increased speed (slow μ=0.38, normal μ=0.45, and fast μ=0.54). Obstacle height had no effect on RCOF values. The average peak RCOF for fast turning exceeded the OSHA safety guideline for static COF of μ>0.50, suggesting further research is needed into the minimum static COF to prevent slips and falls, especially around corners.     

Can treadmill-slip perturbation training reduce immediate risk of over-ground-slip induced fall among community-dwelling older adults?

The purpose of this study was to determine any potential falls-resistance benefits that might arise from treadmill-slip-perturbation training. One hundred sixty-six healthy community-dwelling older adults were randomly assigned to either the treadmill-slip-training group (Tt) or the treadmill-control group (Tc). Tt received 40 slip-like perturbations during treadmill walking. Tc received unperturbed treadmill walking for 30 min. Following their treadmill session, both groups were exposed to a novel slip during over-ground walking. Their responses to this novel slip were also compared to previously collected data from participants who received either over-ground-slip training (Ot) with 24 slips or over-ground walking (Oc) with no training before experiencing their novel over-ground slip. Fall rates and both proactive (pre-slip) and reactive (post-slip) stability were assessed and compared for the novel over-ground slip in groups Tt, Tc, and Oc, as well as for the 24th slip in Ot. Results showed Tt had fewer falls than Tc (9.6% versus 43.8%, p < 0.001) but more falls than Ot (9.6% versus 0%, p < 0.001). Tt also had greater proactive and reactive stability than Tc (Tt > Tc, p < 0.01), however, Tt’s stabilities were lower than those of Ot (p < 0.01). There was no difference in fall-rate or reactive stability between Tc and Oc, though treadmill walking did improve the proactive stability control of the latter. While the treadmill-slip-training protocol could immediately reduce the numbers of falls from a novel laboratory-reproduced slip, such improvements were far less than that from the motor adaptation to the over-ground-slip-training protocol.