Use of the margin of stability to quantify stability in pathologic gait - a qualitative systematic review

BACKGROUND: The Margin of Stability (MoS) is a widely used objective measure of dynamic stability during gait. Increasingly, researchers are using the MoS to assess the stability of pathological populations to gauge their stability capabilities and coping strategies, or as an objective marker of outcome, response to treatment or disease progression. The objectives are; to describe the types of pathological gait that are assessed using the MoS, to examine the methods used to assess MoS and to examine the way the MoS data is presented and interpreted. METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) in the following databases: Web of Science, PubMed, UCL Library Explore, Cochrane Library, Scopus. All articles measured the MoS of a pathologically affected adult human population whilst walking in a straight line. Extracted data were collected per a prospectively defined list, which included: population type, method of data analysis and model building, walking tasks undertaken, and interpretation of the MoS. RESULTS: Thirty-one studies were included in the final review. More than 15 different clinical populations were studied, most commonly post-stroke and unilateral transtibial amputee populations. Most participants were assessed in a gait laboratory using motion capture technology, whilst 2 studies used instrumented shoes. A variety of centre of mass, base of support and MoS definitions and calculations were described. CONCLUSIONS: This is the first systematic review to assess use of the MoS and the first to consider its clinical application. Findings suggest the MoS has potential to be a helpful, objective measurement in a variety of clinically affected populations. Unfortunately, the methodology and interpretation varies, which hinders subsequent study comparisons. A lack of baseline results from large studies mean direct comparison between studies is difficult and strong conclusions are hard to make. Further work from the biomechanics community to develop reporting guidelines for MoS calculation methodology and a commitment to larger baseline studies for each pathology is welcomed

The direction of postural threat alters balance control when standing at virtual elevation

This is the author accepted manuscript. The final version is available from Springer via the DOI in this recordAvailability of Data and Material: All data are available here: https://github.com/keithlohse/Gait_VR/tree/master/standing_balanceCode availability: All analysis code are available here: https://github.com/keithlohse/Gait_VR/tree/master/standing_balanceAnxiogenic settings lead to reduced postural sway while standing, but anxiety-related balance may be influenced by the location of postural threat in the environment. We predicted that the direction of threat would elicit a parallel controlled manifold relative to the standing surface, and an orthogonal uncontrolled manifold during standing. Altogether, 14 healthy participants (8 women, mean age = 27.5 yrs, SD = 8.2) wore a virtual reality (VR) headset and stood on a matched real-world walkway (2m x 40cm x 2cm) for 30s at ground level and simulated heights (elevated 15m) in two positions: (1) parallel to walkway, lateral threat; and (2) perpendicular to walkway, anteroposterior threat. Inertial sensors measured postural sway acceleration (e.g., 95% ellipse, root mean square (RMS) of acceleration), and a wrist-worn monitor measured heart rate coefficient of variation (HR CV). Fully factorial linear-mixed effect regressions (LMER) determined the effects of height and position. HR CV moderately increased from low to high height (p = 0.050, g = 0.397). The Height x Position interaction approached significance for sway area (95% ellipse; ß = -0.018, p = 0.062) and was significant for RMS (ß = -0.022, p = 0.007). Post-hoc analyses revealed that frontal plane sway accelerations and RMS increased from low to high elevation in parallel standing, but decreased when facing the threat during perpendicular standing. Postural response to threat varies depending on the direction of threat, suggesting that the control strategies used during standing are sensitive to the direction of threat.National Institutes of Health (NIH

The feasibility of using virtual reality to induce mobility-related anxiety during turning

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordThe fear of falling, or mobility-related anxiety, profoundly affects gait, but is challenging to study without risk to participants. Purpose: To determine the efficacy of using virtual reality (VR) to manipulate illusions of height and consequently, elevated mobility-related anxiety when turning. Moreover, we examined if mobility-related anxiety effects decline across time in VR environments as participants habituate. Methods: Altogether, 10 healthy participants (five women, mean (standard deviation) age = 28.5 (8.5) years) turned at self-selected and fast speeds on a 2.2 m walkway under two simulated environments: (1) ground elevation; and (2) high elevation (15 m above ground). Peak turning velocity was recorded using inertial sensors and participants rated their cognitive (i.e., worry) and somatic (i.e., tension) anxiety, confidence, and mental effort. Results: A significant Height × Speed × Trial interaction (p =  0.013) was detected for peak turning velocity. On average, the virtual height illusion decreased peak turning velocity, especially at fast speeds. At low elevation, participants decreased speed across trials, but not significantly (p =  0.381), but at high elevation, they significantly increased speed across trials (p =  0.001). At self-selected speeds, no effects were revealed (all p >  0.188) and only effects for Height were observed for fast speeds (p <  0.001). After turning at high elevation, participants reported greater cognitive (p =  0.008) and somatic anxiety (p =  0.007), reduced confidence (p = 0.021), and greater mental effort (p <  0.001) compared to the low elevation. Conclusion: VR can safely induce mobility-related anxiety during dynamic motor tasks, and habituation effects from repeated exposure should be carefully considered in experimental designs and analysis