Increased use of stepping strategy in response to medio-lateral perturbations in the elderly relates to altered reactive tibialis anterior activity

Background The influence of aging on reactive control of balance during walking has been mainly investigated in the sagittal plane, whereas balance control in response to frontal plane perturbations is largely unexplored in the elderly. This is remarkable, given that walking mainly requires active control in the frontal plane. An extensive gait perturbation protocol was used to test whether reactive control of walking balance changes with aging and whether these changes are more pronounced in the frontal than in the sagittal plane. Research question Do alterations in reactive muscle activity cause an age-related shift in stepping strategy in response to perturbations in the frontal and sagittal planes during walking? Method A treadmill-based perturbation protocol imposed frontal and sagittal plane perturbations of different magnitudes during different phases of the gait cycle. Motion capture and electromyography measured the response to the different perturbations in a group of eighteen young and ten older adults. Results Only for a small subset of the perturbations, reactive muscle activity and kinematic strategies differed between young and older subjects. When perturbation magnitude increased, the older adults relied more on a stepping strategy for inward directed frontal plane perturbations and for sagittal plane perturbation just before heelstrike. Tibialis anterior activity increased less in the older compared to the young subjects. Using simulations, we related tibialis anterior activity to backward and outward movement of the center of pressure in the stance foot and confirmed its contribution to the ankle strategy. We concluded that deficient tibialis anterior activity predisposes elderly to use stepping rather than lateral ankle strategies to control balance. Significance Rehabilitation targets for fall prevention in elderly need to also focus on ankle muscle reactivit

Insights into muscle metabolic energetics: Modelling muscle-tendon mechanics and metabolic rates during walking across speeds

Prior studies have produced models to predict metabolic rates based on experimental observations of isolated muscle contraction from various species. Such models can provide reliable predictions of metabolic rates in humans if muscle properties and control are accurately modeled. This study aimed to examine how muscle-tendon model calibration and metabolic energy models influenced estimation of muscle-tendon states and time-series metabolic rates, to evaluate the agreement with empirical data, and to provide predictions of the metabolic rate of muscle groups and gait phases across walking speeds. Three-dimensional musculoskeletal simulations with prescribed kinematics and dynamics were performed. An optimal control formulation was used to compute muscle-tendon states with four levels of individualization, ranging from a scaled generic model and muscle controls based on minimal activations, to calibration of passive muscle forces, personalization of Achilles and quadriceps tendon stiffnesses, to finally informing muscle controls with electromyography. We computed metabolic rates based on existing models. Simulations with calibrated passive forces and personalized tendon stiffness most accurately estimate muscle excitations and fiber lengths. Interestingly, the inclusion of electromyography did not improve our estimates. The whole-body average metabolic cost was better estimated using Bhargava et al. 2004 and Umberger 2010 models. We estimated metabolic rate peaks near early stance, pre-swing, and initial swing at all walking speeds. Plantarflexors accounted for the highest cost among muscle groups at the preferred speed and was similar to the cost of hip adductors and abductors combined. Also, the swing phase accounted for slightly more than one-quarter of the total cost in a gait cycle, and its relative cost decreased with walking speed.Comment: 33 pages, 7 figure

Modulation of gluteus medius activity reflects the potential of the muscle to meet the mechanical demands during perturbed walking

Mediolateral stability during walking can be controlled by adjustment of foot placement. Reactive activity of gluteus medius (GM) is modulated during the gait cycle. However, the mechanisms behind the modulation are yet unclear. We measured reactive GM activity and kinematics in response to a mediolateral platform translation during different phases of the gait cycle. Forward simulations of perturbed walking were used to evaluate the isolated effect of the perturbation and the GM response on gait stability. We showed that the potential of GM to adjust lateral foot placement and prevent collisions during swing varies during the gait cycle and explains the observed modulation. The observed increase in stance, swing or combined GM activity causes an outward foot placement and therefore compensates for the loss of stability caused by a perturbation early in the gait cycle. GM activity of the swing leg in response to a platform translation late in the gait cycle counteracts foot placement, but prevents collision of the swing foot with the stance leg. This study provides insights in the neuromechanics of reactive control of gait stability and proposes a novel method to distinguish between the effect of perturbation force and reactive muscle activity on gait stability

Adaptations in Reactive Balance Strategies in Healthy Older Adults After a 3-Week Perturbation Training Program and After a 12-Week Resistance Training Program

Both resistance training (RT) and perturbation-based training (PBT) have been proposed and applied as interventions to improve reactive balance performance in older adults. PBT is a promising approach but the adaptations in underlying balance-correcting mechanisms through which PBT improves reactive balance performance are not well-understood. Besides it is unclear whether PBT induces adaptations that generalize to movement tasks that were not part of the training and whether those potential improvements would be larger than improvements induced by RT. We performed two training interventions with two groups of healthy older adults: a traditional 12-week RT program and a 3-week PBT program consisting of support-surface perturbations of standing balance. Reactive balance performance during standing and walking as well as a set of neuro-muscular properties to quantify muscle strength, sensory and motor acuity, were assessed pre- and post-intervention. We found that both PBT and RT induced training specific improvements, i.e., standing PBT improved reactive balance during perturbed standing and RT increased strength, but neither intervention affected reactive balance performance during perturbed treadmill walking. Analysis of the reliance on different balance-correcting strategies indicated that specific improvements in the PBT group during reactive standing balance were due to adaptations in the stepping threshold. Our findings indicate that the strong specificity of PBT can present a challenge to transfer improvements to fall prevention and should be considered in the design of an intervention. Next, we found that lack of improvement in muscle strength did not limit improving reactive balance in healthy older adults. For improving our understanding of generalizability of specific PBT in future research, we suggest performing an analysis of the reliance on the different balance-correcting strategies during both the training and assessment tasks

The Influence of age-related changes on non-stepping balance control: a simulation study

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Increased sensory noise explains age-related changes in postural resposnes to perturbations of standing

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Increased use of stepping strategy in response to medio-lateral perturbations in the elderly relates to altered reactive tibialis anterior activity

Background: The influence of aging on reactive control of balance during walking has been mainly investigated in the sagittal plane, whereas balance control in response to frontal plane perturbations is largely unexplored in the elderly. This is remarkable, given that walking mainly requires active control in the frontal plane. An extensive gait perturbation protocol was used to test whether reactive control of walking balance changes with aging and whether these changes are more pronounced in the frontal than in the sagittal plane. Research question: We hypothesize that alterations in reactive muscle activity cause an age-related shift from lateral ankle to stepping strategy in response to perturbations in the frontal and sagittal plane, and that the alterations in the frontal plane will be larger than the alterations in the sagittal plane. Method: A treadmill-based perturbation protocol imposed frontal and sagittal plane perturbations of different magnitudes during different phases of the gait cycle. Motion capture and electromyography measured the response to the different perturbations in a group of eighteen young and ten older adults. Results: Only for a small subset of the perturbations, reactive muscle activity and kinematic strategies differed between young and older subjects. When perturbation magnitude increased, the older adults relied more on a stepping strategy for inward directed frontal plane perturbations and for sagittal plane perturbation just before heelstrike. Tibialis anterior activity increased less in the older compared to the young subjects. Using simulations, we related tibialis anterior activity to backward and outward movement of the center of pressure in the stance foot and confirmed its contribution to the ankle strategy. We concluded that deficient tibialis anterior activity predisposes elderly to use stepping rather than lateral ankle strategies to control balance. Significance: Rehabilitation targets for fall prevention in elderly need to also focus on ankle muscle reactivity.status: publishe

Effort minimization predicts ankle over hip strategie

Experimental studies showed that a continuum of ankle and hip strategies is used to restore posture. Postural responses can be modeled by feedback control, with feedback gains that optimize a specific objective [1]. On the one hand, feedback gains that minimize effort have been used to predict muscle activity during perturbed standing. On the other hand, hip and ankle strategies have been predicted by minimizing postural instability and deviation from upright posture. It remains unclear however whether and how effort minimization influences the selection of a specific postural response. We hypothesize that the relative importance of minimizing mechanical effort versus postural instability influences the strategy used to restore upright posture. Experiments and predictive simulations of the postural response following a backward support surface translation were used to test this hypothesis. The posture of 10 healthy adults was perturbed. Full body kinematics and ground reaction forces were measured and analyzed in OpenSim. Significant correlations were found between the measured hip range of motion, characterizing a hip strategy, and the experimentally determined mechanical effort, metabolic work and muscle activity (R=0.81, R=0.71, R= 0.7, p<0.001). Predictive simulations were used to establish a cause effect relationship between the relative importance of minimizing mechanical effort and the postural response. Therefore, the response of a double inverted pendulum model to the backward surface translation was optimized to minimize an objective function consisting of a weighted sum of (1) postural instability and (2) mechanical work. Ankle strategies were predicted when the minimizing postural instability whereas hip strategies were predicted when minimizing mechanical work (figure 1). Furthermore, there was a significant positive correlation between the relative weight that predicts the measured postural response best and the measured hip range of motion (R=0.70, p<0.001). This shows that the trade-off between effort and postural instability minimization can explain the selection of a specific postural response in the continuum of potential ankle and hip strategies.status: publishe