Dynamic stability during increased walking speeds is related to balance confidence of older adults: a pilot study

Kongsuk, Jutaluk; Brown, David A.; Hurt, Christopher P.

doi:10.1016/j.gaitpost.2019.06.018

Cited by 19 publications

(19 citation statements)

References 31 publications

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“…Some studies did report perturbing participants at specific time intervals regardless of gait cycle and reported decreased CoP motion [ 38 ], decreased CoM sway [ 9 ], and decreased MoS and dynamic stability [ 22 ]. These results contradict previous literature as well as other studies in the review; while inconsistencies of methods are abundant, the timing of perturbation onset should not be discounted as having an influence on the results [ 21 , 26 , 35 , 51 , 52 , 53 ]. In addition to this, perturbation at heel strike was performed using split belt and single belt treadmills, providing contradicting motivation and intention of the perturbation.…”

Section: Discussioncontrasting

confidence: 81%

Perturbations during Gait: A Systematic Review of Methodologies and Outcomes

Taylor

Walsh

Hawkins

et al. 2022

Sensors

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Background: Despite extensive literature regarding laboratory-based balance perturbations, there is no up-to-date systematic review of methods. This systematic review aimed to assess current perturbation methods and outcome variables used to report participant biomechanical responses during walking. Methods: Web of Science, CINAHL, and PubMed online databases were searched, for records from 2015, the last search was on 30th of May 2022. Studies were included where participants were 18+ years, with or without clinical conditions, conducted in non-hospital settings. Reviews were excluded. Participant descriptive, perturbation method, outcome variables and results were extracted and summarised. Bias was assessed using the Appraisal tool for Cross-sectional Studies risk of bias assessment tool. Qualitative analysis was performed as the review aimed to investigate methods used to apply perturbations. Results: 644 records were identified and 33 studies were included, totaling 779 participants. The most frequent method of balance perturbation during gait was by means of a treadmill translation. The most frequent outcome variable collected was participant step width, closely followed by step length. Most studies reported at least one spatiotemporal outcome variable. All included studies showed some risk of bias, generally related to reporting of sampling approaches. Large variations in perturbation type, duration and intensity and outcome variables were reported. Conclusions: This review shows the wide variety of published laboratory perturbation methods. Moreover, it demonstrates the significant impact on outcome measures of a study based on the type of perturbation used. Registration: PROSPERO ID: CRD42020211876.

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Section: Discussioncontrasting

confidence: 81%

Perturbations during Gait: A Systematic Review of Methodologies and Outcomes

Taylor

Walsh

Hawkins

et al. 2022

Sensors

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“…The MOS of older adults who stopped early was larger for MOS AP and MOS ML compared to young adults. Given the relationship between walking speed and MOS AP in this finding is not surprising, however, for MOS ML there is no consensus on the relationship between MOS ML and walking speed [7,27], although our results suggest that older adults who stopped earlier appeared to prioritize a larger MOS in both AP and ML directions. We did not find any statistical difference of MOS variability at FSA for MOS AP and MOS ML .…”

Section: Margin Stability and Walking At Faster Speedscontrasting

confidence: 63%

“…For some older adults, walking at a comfortable speed is less automatic perhaps due to increased attentional demands to walk safely at a comfortable speed [9,16], and thus, walking at a faster, more challenging speed may be even more attentionally demanding [5,11,[13][14][15]. Some studies of older adults have reported a positive relationship between advancing age and instability while walking [2,7]. Reduced dynamic stability while walking suggests reduced control of the kinematics of the center of mass (COM) relative to a base of support (BOS) [17,18].…”

Section: Introductionmentioning

confidence: 99%

Increased Attentional Focus on Walking by Older Adults Limits Maximum Speed and Is Related to Dynamic Stability

et al. 2021

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Background and Purpose: Older adults with lower balance confidence demonstrate a reduced willingness to experience instability as the task of walking becomes more challenging (i.e., walking with a faster speed). However, the specific reason why is not known. The purpose of this study was to investigate the extent to which capacity of increasing walking speeds relates to the attentional requirements (i.e., automaticity) of walking. Methods: Sixteen young (31 ± 5.85 years) and 15 older participants (69 ± 3.04 years) began walking on a treadmill at 0.4 m/s, and speed was increased by 0.2 m/s until the participant either chose to stop or reached a speed of 2.0 m/s. Sixty steps were collected at steady-state speed for each walking trial. Kinematic data were collected, and the margin of stability in the anterior direction (MOSAP) at heelstrike was quantified for each step. The timed up and go (TUG) and TUG dual (TUGdual) task were performed, from which an automaticity index (TUG/TUGdual × 100) was calculated. Older individuals were grouped based on whether they did or did not complete all walking speeds (i.e., completers [n = 9] or noncompleters [n = 6]). The fastest walking speed attempted (FSA), automaticity index, and MOSAP were compared, and correlations were assessed between the FSA/MOSAP and the automaticity index. Results: A significant difference was identified in an average MOSAP at heelstrike between older completer and noncompleter groups (p < 0.001). Further, older adults with lower automaticity index choose to stop walking at lower speeds (p = 0.001). The FSA was positively correlated with the automaticity index (ρ = 0.81, p < 0.001). Finally, the average MOSAP at FSA and the automaticity index were also negatively correlated (r = −0.85, p < 0.001). Conclusion: Older adults with lower automaticity of walking choose to stop walking at speeds before they completed all walking speeds, which may relate with increased attentional demands required to maintain dynamic stability at higher walking speeds. Given that these were otherwise healthy adults, the combination of FSA and an automaticity of walking may help to identify individuals who should be considered for an assessment to identify walking problems.

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“…In previous studies, it had been observed that in some cases, loss of balance confidence appears independent of experiencing falling [36]; this suggests that balance confidence could relate to a perception of instability as opposed to actual instability. Older adults who reported lower balance confidence were less willing to attempt faster walking speeds, even though no fall had occurred [32]. In our study, it is a possibility that because of the relatively short training duration, the participants were unable to "test" their balance ability doing various activities denoted in the ABC Scale to observe a change, even though there was an actual change in their abilities as observed by the BESS.…”

Section: Discussionmentioning

confidence: 67%

“…Rosén et al [31] identified significant positive correlations between falls self-efficacy and clinical measures of balance. Other clinical measures of balance (e.g., walking speed, Berg Balance Scale (BBS), and Timed Up and Go Test) have been related to balance confidence, whereby better balance performance equates to higher balance confidence [32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Investigating Relationships between Balance Confidence and Balance Ability in Older Adults

Thompson

Badache

Brusamolin

et al. 2021

Journal of Aging Research

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Increasing balance confidence in older individuals is important towards improving their quality of life and reducing activity avoidance. Here, we investigated if balance confidence (perceived ability) and balance performance (ability) in older adults were related to one another and would improve after balance training. The relationship of balance confidence in conjunction with balance performance for varied conditions (such as limiting vision, modifying somatosensory cues, and also base of support) was explored. We sought to determine if balance confidence and ability, as well as their relationship, could change after several weeks of training. Twenty-seven healthy participants were trained for several weeks during standing and walking exercises. In addition, seven participants with a higher risk of imbalance leading to falls (survivors of stroke) were also trained. Prior to and after training, balance ability and confidence were assessed via the Balance Error Scoring System (BESS) and Activities Specific Balance Confidence (ABC) Scale, respectively. Both groups showed improvements in balance abilities (i.e., BESS errors significantly decreased after training). Balance confidence was significantly higher in the healthy group than in the stroke group; however, ABC results reflected that balance confidence did not significantly increase after training for each. The correlations between balance ability and balance confidence were explored. Encouragingly, healthy participants displayed a negative correlation between BESS errors and ABC (i.e., enhancements in balance confidence (increases in ABC Scale results) were related to improvements in balance ability (decreases in BESS errors)). For the stroke participants, despite improvements in balance ability, our results showed that there was no relation to balance confidence (i.e., no correlation between BESS errors and ABC) in this group.

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Dynamic stability during increased walking speeds is related to balance confidence of older adults: a pilot study

Cited by 19 publications

References 31 publications

Perturbations during Gait: A Systematic Review of Methodologies and Outcomes

Perturbations during Gait: A Systematic Review of Methodologies and Outcomes

Increased Attentional Focus on Walking by Older Adults Limits Maximum Speed and Is Related to Dynamic Stability

Investigating Relationships between Balance Confidence and Balance Ability in Older Adults

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