The GARS-M is a reliable and valid measure for documenting gait features associated with an increased risk of falling among community-dwelling, frail older persons and may provide a clinically useful alternative to established quantitative gait-assessment methods.
The aim of this study was to discuss the influence of age, gender, obesity status, joint laxity, and the W-sitting habit on flatfoot in preschool-aged children. A total of 1,598 children (833 boys and 765 girls) between 3 and 6 years of age from kindergartens in the central area of Taiwan were studied. The children were divided into a normal group (n = 733), a unilateral flatfoot group (n = 266), and a bilateral flatfoot group (n = 599), and a multinomial logistic regression model was used to analyze the data. The prevalence of flatfoot decreased significantly with increasing age: 54.5% of 3-year-old but only 21% for 6-year-old children had bilateral flatfoot. In the bilateral flatfoot group, the risk decreased with increased age, increased with increasing weight beyond the normal range, and was higher for boys than girls. Age and obesity status were not significantly influential in the unilateral flatfoot group. Children with higher joint laxity and a habit of W-sitting also experienced higher risk in both flatfoot groups. In conclusion, this study demonstrates a significant association of age, gender, obesity status, joint laxity, and the W-sitting habit with the bilateral flatfoot in preschool-aged children. Children with unilateral flatfoot differ from those with normal feet and bilateral flatfoot. It is suggested that the unilateral flatfoot deserves special attention in future studies.
Although important differences exist between learning a new motor skill and adapting a well-learned skill to new environmental constraints, studies of force field adaptation have been used frequently in recent years to identify processes underlying learning. Most of these studies have been of reaching tasks that were each hand position was specified by a unique combination of joint angles. At the same time, evidence has been provided from a variety of tasks that the central nervous system takes advantage of the redundancy available to it when planning and executing functional movements. The current study attempted to determine whether a change in the use of joint motion redundancy is associated with the adaptation process. Both experimental and control subjects performed 160 trials of reaching in each of four adaptation phases, while holding the handle of a robot manipulandum. During the first and last adaptation phases, the robot motors were turned off. During phases 2 and 3 the motors produced a velocity-dependent force field to which experimental subjects had to adapt to regain relatively straight line hand movements during reaching to a target, while the motors remained off for the control group. The uncontrolled manifold (UCM) method was used to partition the variance of planar clavicle-scapular, shoulder, elbow and wrist joint movements into two orthogonal components, one (V UCM ) that reflected combinations of joint angles that were equivalent with respect to achieving the average hand path and another (V ORT ) that took the hand away from its average path. There was no change in either variance component for the control group performing 640 nonperturbed reaches across four 'pseudo-adaptation' phases. The experimental group showed adaptation to reaching in the force field that was accompanied initially by an increase in both components of variance, followed by a smaller decrease of V UCM than V ORT during 320 practice reaches in the force field. After initial re-adaptation to reaching to the null field, V UCM was higher in experimental than in control subjects after performing a comparable number of reaches. V UCM was also larger in the experimental group after re-adaptation when compared to the 160 null field reaching trials performed prior to initial force field introduction. The results suggest that the central nervous system makes use of kinematic redundancy, or flexibility of motor patterns, to adapt reaching performance to unusual force fields, a fact that has implications for the hypothesis that motor adaptation requires learning of formal models of limb and environmental dynamics.
Stabilization of the center of mass (CM) is an important goal of the postural control system. Coordination of several joints along the human "pendulum" is required to achieve this goal. We studied the coordination among body segments with respect to horizontal CM stabilization during a quiet stance task and the effects of vision on CM stability. Subjects were asked to stand quietly on a narrow wooden block supporting only the mid-foot, with either open (EO) or closed (EC) eyes on separate trials. Instant equilibrium points (IEPs) in the center of pressure (CP) trajectory were determined when the horizontal component of the ground reaction force was zero and the CP data were decomposed into their rambling and trembling components. The joint angle, CM and CP data were divided into short cycles (time-normalized to 100 data points) or longer segments (time-normalized to 1000 data points) of equal length beginning and ending in an IEP. Motor abundance with respect to patterns of joint coordination was evaluated using the uncontrolled manifold (UCM) approach. Here, a UCM is a subspace spanning all joint combinations resulting in a given CM position. All combinations of joint angles that lie within this subspace are equivalent with respect to that CM position while joint angle combinations lying in a subspace orthogonal to the UCM lead to deviation from that CM position. UCM analysis was performed on data organized either across time within longer segments or at each point in time across multiple segments or across multiple cycles. Regardless of method of analysis, most of the variance in joint space was constrained to be within the UCM, preserving the mean CM position in both the EO and EC conditions. Joint configuration variance was significantly higher in the EC than in the EO condition although this increase occurred primarily within the UCM rather than in the orthogonal subspace that would have led to variation of the CM position. These results demonstrate the ability of the control system to selectively "channel" motor variability into directions in joint space that stabilize the CM position. This effect was enhanced when the task was made more challenging in the absence of vision. There was also a significant relationship between joint variance that led to a change in the CM position and, in particular, the rambling component of the CP path, lending some support to the idea that the CNS prescribes a certain stable trajectory of the CP during quiet stance that leads to a small controlled movement of the CM.
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