THE INFLUENCE OF DECREASED AMBIENT LIGHTING ON REACTIVE BALANCE MECHANISMS IN YOUNG ADULTS

Introduction: Balance recovery/reactive balance prevents falls by restabilizing the center of mass (COM) when instability occurs. Dim lighting is a risk factor for falling, although limited research has examined how lighting conditions affect the ability to recover from losses of balance. The purpose of this thesis was to examine the effect of lighting conditions on reactive balance mechanisms. Methods: 20 young adults (23.3(4.4) y) completed forward lean-and-release perturbations in two lighting conditions: 1) Light: ~800 Lux; 2) Dark: 0 Lux. Optical motion capture and surface electromyography were used to quantify stepping/angular kinematics, COM control, and the timing, activation, and coordination of lower-limb neuromuscular responses. Differences between lighting conditions were analyzed with paired sample t-tests (alpha=0.05). Results: In darkness, individuals showed modified stepping (increased step length, knee flexion/extension velocity, and hip flexion velocity (pDiscussion:Balance recovery in dark environments can result in modified stepping responses and decreased COM control, which could prevent successful balance recovery in real-world environments and populations. Evidence-based lighting standards could minimize fall risk in built environments and public spaces

Virtual reality obstacle crossing: adaptation, retention and transfer to the physical world

Virtual reality (VR) paradigms are increasingly being used in movement and exercise sciences with the aim to enhance motor function and stimulate motor adaptation in healthy and pathological conditions. Locomotor training based in VR may be promising for motor skill learning, with transfer of VR skills to the physical world in turn required to benefit functional activities of daily life. This PhD project aims to examine locomotor adaptations to repeated VR obstacle crossing in healthy young adults as well as transfers to the untrained limb and the physical world, and retention potential of the learned skills. For these reasons, the current thesis comprises three studies using controlled VR obstacle crossing interventions during treadmill walking. In the first and second studies we investigated adaptation to crossing unexpectedly appearing virtual obstacles, with and without feedback about crossing performance, and its transfer to the untrained leg. In the third study we investigated transfer of virtual obstacle crossing to physical obstacles of similar size to the virtual ones, that appeared at the same time point within the gait cycle. We also investigated whether the learned skills can be retained in each of the environments over one week. In all studies participants were asked to walk on a treadmill while wearing a VR headset that represented their body as an avatar via real-time synchronised optical motion capture. Participants had to cross virtual and/or physical obstacles with and without feedback about their crossing performance. If applicable, feedback was provided based on motion capture immediately after virtual obstacle crossing. Toe clearance, margin of stability, and lower extremity joint angles in the sagittal plane were calculated for the crossing legs to analyse adaptation, transfer, and retention of obstacle crossing performance. The main outcomes of the first and second studies were that crossing multiple virtual obstacles increased participants’ dynamic stability and led to a nonlinear adaptation of toe clearance that was enhanced by visual feedback about crossing performance. However, independent of the use of feedback, no transfer to the untrained leg was detected. Moreover, despite significant and rapid adaptive changes in locomotor kinematics with repeated VR obstacle crossing, results of the third study revealed limited transfer of learned skills from virtual to physical obstacles. Lastly, despite full retention over one week in the virtual environment we found only partial retention when crossing a physical obstacle while walking on the treadmill. In summary, the findings of this PhD project confirmed that repeated VR obstacle perturbations can effectively stimulate locomotor skill adaptations. However, these are not transferable to the untrained limb irrespective of enhanced awareness and feedback. Moreover, the current data provide evidence that, despite significant adaptive changes in locomotion kinematics with repeated practice of obstacle crossing under VR conditions, transfer to and retention in the physical environment is limited. It may be that perception-action coupling in the virtual environment, and thus sensorimotor coordination, differs from the physical world, potentially inhibiting retained transfer between those two conditions. Accordingly, VR-based locomotor skill training paradigms need to be considered carefully if they are to replace training in the physical world

A Qualitative Review of Balance and Strength Performance in Healthy Older Adults: Impact for Testing and Training

A continuously greying society is confronted with specific age-related health problems (e.g., increased fall incidence/injury rate) that threaten both the quality of life of fall-prone individuals as well as the long-term sustainability of the public health care system due to high treatment costs of fall-related injuries (e.g., femoral neck fracture). Thus, intense research efforts are needed from interdisciplinary fields (e.g., geriatrics, neurology, and exercise science) to (a) elucidate neuromuscular fall-risk factors, (b) develop and apply adequate fall-risk assessment tools that can be administered in clinical practice, and (c) develop and design effective intervention programs that have the potential to counteract a large number of fall-risk factors by ultimately reducing the number of falls in the healthy elderly. This paper makes an effort to present the above-raised research topics in order to provide clinicians, therapists, and practitioners with the current state-of-the-art information

SLIP-RELATED MUSCLE ACTIVATION PATTERNS OF THE STANCE LEG DURING GAIT

Falls precipitated by slipping are a major cause of injury, death and disability in the elderly. This research focused on muscle activation patterns generated in response to slipping and anticipation of slippery surfaces. The goal was to identify the muscle activation patterns of the stance leg in response to an unexpected slip (reactive strategies) and investigate muscle activity when anticipating slippery floors during gait on dry surfaces (proactive strategies). Additionally, age-related differences were examined. Electromyographic recordings were made from the Vastus Lateralis, Medial Hamstring, Tibialis Anterior and Medial Gastrocnemius of eleven young and nine older adults. Participants walked during the following conditions: (1) baseline dry (subjects knew the floor was dry); (2) unexpected slip (contaminant was applied to floor without subjects' knowledge); (3) alert dry (subjects were uncertain of the floor's condition). Reactive strategies, which were similar among young and older adults, consisted of activation of the Medial Hamstring at around 21% stance (~ 175 ms) followed by the Vastus Lateralis at around 29% stance (~ 240 ms). Corrective responses were scaled to slip severity with more severe slip reactions consisting of longer, higher magnitude responses. Delayed Vastus Lateralis latency and Medial Hamstring cessation were associated with an increased slip severity as quantified by peak slip velocity. Additionally, when experiencing a severe slip, young adults demonstrated a longer, more powerful response compared to older adults. Anticipation of a slippery surface resulted in increased magnitude of activation (48% increase) and ankle/knee co-contraction (30% increase), as well as earlier onsets and longer durations of posterior muscles. Young adults demonstrated earlier onsets (3% stance, 24 ms) and longer durations (10% stance, 83 ms) than older adults reducing their slip potential. Finally, adults with baseline gait on dry floors characterized by greater ankle co-contraction at heel contact and delayed Tibialis Anterior onset were predisposed to experience less severe slips when encountering an unexpected slippery floor. Older adults' natural gait predisposes them to experience a less hazardous slip. However, once a slip occurs, older adults cannot react with the long, powerful response needed to prevent balance loss whereas young adults are capable of this response

The Slippery Slope Between Falling And Recovering: An Examination Of Sensory And Somatic Factors Influencing Recovery After A Slip

Background: Slips and falls account for large rates of injury and mortality in multiple populations. During an unexpected slip, sensory mechanisms are responsible for signaling the slip to the central nervous system, and a series of corrective responses is generated to arrest the slip and prevent a fall. While previous research has examined the corrective responses elicited, the answer of how these systems break down during a fall remains elusive. Purpose: To examine differences in postural control (slip detection), lower extremity corrective responses (slip recovery), and cortical control of the slip recovery response between individuals who fall and those who recover. Methods: One hundred participants were recruited for this study (50 males & 50 females). Participant’s gait kinematics and kinetics were collected during normal gait (NG) and an unexpected slip (US). The slip was classified as a fall or recovery, and by slip severity. Once classified, postural control, reaction times, corrective moments, and cortical contribution were examined between groups using ANOVAs and independent t-tests. Additionally, prediction equations for slip outcome, and slip severity were created using a binary logistic regression model. Slip Detection Results: Postural sway when the proprioceptive (OR = 0.02, CI: 0.01-1.34) and vestibular (OR = 0.60, CI: 0.26-1.39) systems are stressed were negatively associated with odds of falling. While postural sway when the visual system was stressed (OR = 3.18, CI: 0.887-11.445) was positively associated with odds of falling. Slip Recovery Results: Increased time to peak hip extension (OR = 1.006, CI: 1.00-1.01) and ankle dorsiflexion (OR = 1.005, CI: 1.00-1.01) moments increased the odds of falling. While the average ankle moment was negatively associated with falling (OR = 0.001, CI: 0.001-0.005). Cortical Contribution Results: Spectral power in the Piper frequency band was increased in US trials compared to NG. Further, fallers exhibited an increase in cortical activity compared to those who recovered. Conclusions: Rapid lower extremity corrective responses appear critical in arresting the slip and preventing a fall, and the temporal nature of this response may depend on slip detection and subsequent response selection. Moreover, our results suggest that more severe slips may require increased activation of higher centers of the motor cortex

A biomechanical approach to prevent falls in ergonomic settings

Introduction: Fall-related injuries are exceptionally prevalent in occupational settings. While endangering the workers’ health, falls cause poor productivity and increased economic burden in the workplace. Hence, identifying these threats and training workers to achieve proper postural control is crucial. Purpose: Study 1: To investigate the ankle joint kinematics in unexpected and expected trip responses during single-tasking (ST), dual-tasking (DT), and triple-tasking (TT), before and after a physically fatiguing exercise. Study 2: To investigate the impact of virtual heights, DT, and training on static postural stability and cognitive processing. Methods: Study 1: Twenty collegiate volunteers (10 males and females, one left leg dominant, age 20.35 plus-minus 1.04 years, height 174.83 plus-minus 9.03 cm, mass 73.88 plus-minus 15.55 kg) were recruited. Ankle joint kinematics were recorded while treadmill walking during normal gait (NG), unexpected trip (UT), and expected trip (ET) perturbations with DT and physical fatigue. Study 2: Twenty-eight collegiate volunteers (14 males and females; all right leg dominant; age 20.48 plus-minus 1.26 years; height 172.67 plus-minus 6.66 cm; mass 69.52 plus-minus 13.78 kg; body mass index 23.32 plus-minus 3.54 kg/m2) were recruited. They were exposed to different virtual environments (VEs) over three days with and without DT. Postural sway parameters, lower extremity muscle activity, heart rate, and subjective anxiety parameters were collected. Results: Study 1: Greater maximum ankle angles were observed during UT compared to NG, MDT compared to ST, and TT compared to ST, while greater minimum ankle angles were observed during ET compared to NG and during post-fatigue compared to pre-fatigue. Study 2: Greater postural decrements and poor cognitive processing were observed in high altitudes and DT. Discussion & conclusions: Study 1: Trip recovery responses are different between during DT, TT, and fatigue. Study 2: Static postural stability deteriorates at higher virtual altitudes and with DT, while it improves with a two-day training. Virtual height exposure reduces cognitive performance. Importance: The findings of these studies will provide insights into the biomechanics of falls in ergonomic settings and aid in designing functional and convenient fall prevention programs

The Feedforward and Feedback Controls on Gait in Adults with Diabetes

There are nearly 26 million people with diabetes mellitus (DM) in the US, and half of chronic DMs develop somatosensory deficits due to diabetic polyneuropathy or diabetic peripheral neuropathy (DPN). The absence or impaired somatosensory feedback (e.g. touch sensation or joint proprioception) resulted from the damage of large nerve fiber, and motor deficits such as attenuated muscle strength and abnormal plantar pressure of lower extremity have been identified in DPN, and these sensorimotor impairments lead to an increased number of falls. To reduce the risk of falling, a well-coordinated and adapted limb movement driven by the feedforward (anticipatory) and feedback (reactive) control movement strategies are required to deal with forthcoming and instantaneous perturbations during walking respectively. The top-down feedforward control communicates with the central nervous system (CNS) and forms the basis for computing necessary motor output by simultaneously predicting or correcting errors of event information from the bottom-up feedback control. The altered spatiotemporal gait pattern in DM can either be the compensation of somatosensory feedback deficits or the compromised CNS-driven motor command. Exploring the feedforward and feedback controls not only illustrates the potential cause of the DM’s altered gait pattern but also offer the future opportunity to design prospective clinical intervention for DM’s safety and wellness. The overall objective of this study unveiled the impacts of feedforward and feedback control on DM/DPN’s dynamic balance during walking. This dissertation adopted a virtual reality-based obstacle crossing task to examine our central hypothesis of potential altered sensory and CNS-driven motor command of DPN would be manifested through the adjustment of spatiotemporal gait characteristics compared with healthy controls. In addition, we investigated how the visual guidance played a role to the on-line adjustment of these altered gait measures as the compensation. In results, DM demonstrated the compromised feedback control by lowering their maximal toe elevation during crossing and increasing their step width after crossing; while DPN presented the both compromised feedforward and feedback controls by decreasing the toe elevation during crossing and increasing stride/stance time after crossing of obstacle. Besides, the adjustment of the altered spatiotemporal gait characteristics were observed through the visual guidance. With the combination of virtual obstacle crossing task design with the guidance of visual information, the future virtual obstacle crossing training paradigm can be implemented for training diabetes population to reduce the risk of falling

Effects of aging and dual tasking on step adjustments to perturbations in visually cued walking

Making step adjustments is an essential component of walking. However, the ability to make step adjustments may be compromised when the walker's attentional capacity is limited. This study compared the effects of aging and dual tasking on step adjustments in response to stepping-target perturbations during visually cued treadmill walking. Fifteen older adults (69.4 ± 5.0 years; mean ± SD) and fifteen young adults (25.4 ± 3.0 years) walked at a speed of 3 km/h on a treadmill. Both groups performed visually cued step adjustments in response to unpredictable shifts of projected stepping targets in forward (FW), backward (BW) or sideward (SW) directions, at different levels of task difficulty [which increased as the available response distance (ARD) decreased], and with and without dual tasking (auditory Stroop task). In both groups, step adjustments were smaller than required. For FW and BW shifts, older adults undershot more under dual-task conditions. For these shifts, ARD affected the age groups differentially. For SW shifts, larger errors were found for older adults, dual tasking and the most difficult ARD. Stroop task performance did not differ between groups in all conditions. Older adults have more difficulty than young adults to make corrective step adjustments while walking, especially under dual-tasking conditions. Furthermore, they seemed to prioritize the cognitive task over the step adjustment task, a strategy that may pose aging populations at a greater fall risk. For comparable task difficulty, the older adults performed considerably worse than the young adults, indicating a decreased ability to adjust steps under time pressure

Adaptive Postural Strategies: Impact of Aging

Falls threaten the quality of life of older adults and are associated with tremendous economic costs. Slips and trips are the two major causes of falls during locomotion and each requires a different postural response to prevent falling. However, a critical requirement in maintaining balance in either is the ability to generate proactive postural adjustments. Older adults have been shown to adopt proactive postural adjustments through repeated exposure to novel perturbations. However, the extent to which such learning abilities applied to perturbed and novel gait was unknown. This dissertation investigated reducing the incidence of falls in older adults through learning to better recover from perturbed gait based on a systems model theory. Potential associations between aging and anticipatory postural strategies when repeatedly exposed to forward slips were studied. Forward vs. backward walking slips were also compared to examine the impact of gait novelty on the ability to generate proactive adjustments. We also desired to know whether knowledge of the type of perturbation impacts the ability to generate proactive adjustments and whether such adjustments change with experience and when the nature of the perturbation is unknown. Subjects were exposed to multiple slip and trip perturbations to investigate these differences and to compare how young and older adults optimize their proactive adjustments. As anticipatory behavior improves perturbation recovery outcomes, changes in measures of severity with increased exposure were also analyzed. This study found young and older adults capable of adopting optimal proactive postural adjustments when repeatedly exposed to forward slips and their central nervous system was able to make internal representations applicable to a novel task. Awareness of a perturbation proved sufficient to induce proactive adaptations and with experience, adaptations became perturbation specific to reduce slip and trip risk in both age groups. Perturbation recovery improved with multiple exposures in both age groups as decreases in severity measures were observed. This study opens the door to studies evaluating the retention of postural control motor skills adapted through training and prior experiences and sheds light on the benefits of a systems model theory based fall intervention program for slips and trips