Effect of arm motion on postural stability when recovering from a slip perturbation

Gholizadeh, Hossein; Hill, Allen; Nantel, Julie

doi:10.1016/j.jbiomech.2019.07.013

Cited by 15 publications

(8 citation statements)

References 31 publications

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“…Alternatively, split-belt treadmills have been used to simulate FFSs by increasing the posterior velocity of one belt, causing a forward falling loss of balance (Lurie et al, 2013;Ilmane et al, 2015;Sloot et al, 2015;Madehkhaksar et al, 2018;Roeles et al, 2018;Gholizadeh et al, 2019). These studies provided insights on balance recovery, kinematics, muscular activity and the use of treadmills to build fall-prevention interventions.…”

Section: Introductionmentioning

confidence: 99%

Recovery From a Forward Falling Slip: Measurement of Dynamic Stability and Strength Requirements Using a Split-Belt Instrumented Treadmill

Debelle

Harkness-Armstrong

Hadwin

et al. 2020

Front. Sports Act. Living

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Aim: Falls commonly occur from trips and slips while walking. Recovery strategies from trips and backward falling slips have been extensively studied. However, until recently, forward falling slips (FFSs) have been considered less dangerous and have been understudied. This study aimed first to create an application to realistically simulate FFSs using a split-belt instrumented treadmill and then to understand the biomechanical requirements for young adults to recover from an FFS. Methods: We developed a semi-automatic custom-made application on D-Flow that triggered FFSs by briefly and unexpectedly increasing the speed (a = 5 m•s −2) of the right belt during stance. To validate the protocol, we tested against criteria defined for an ecologically and experimentally valid FFS: unexpected occurrence of the slip, increased foot velocity, forward loss of balance during the slip and consistent perturbation timing. We evaluated the recovery strategies of 17 young adults by measuring dynamic stability, joint moments and ground reaction force (GRF) vector angles before, during and on 15 steps following the FFS. Results: The application successfully triggered FFSs, according to the criteria we defined. Participants' balance returned to normal for a minimum of three consecutive steps in 10.9 (7.0) steps. Recovery from the FFSs was characterised by larger hip flexor and knee extensor moments to support the centre of mass during the slip, and a longer first recovery step with large hip extensor moments to arrest the fall followed by large knee extensor moments to raise and advance the centre of mass into the next step (p < 0.001 compared with normal gait). Subsequent steps progressively returned to normal. Conclusion: This is the first study to experimentally simulate FFSs meeting the aforementioned criteria, and to measure their effects on the dynamic balance and kinetic parameters. The split-belt instrumented treadmill proved a promising tool to better study the mechanisms of falls and recovery. The required large hip and knee joint moments generally agree with findings on trips and backward falling slips and provide an indication of the functional capacities that should be targeted in fall-prevention interventions. These findings should be used to better understand and target the mechanisms of balance loss and falls in older adults following FFSs.

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Section: Introductionmentioning

confidence: 99%

Recovery From a Forward Falling Slip: Measurement of Dynamic Stability and Strength Requirements Using a Split-Belt Instrumented Treadmill

Debelle

Harkness-Armstrong

Hadwin

et al. 2020

Front. Sports Act. Living

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“…The impaired ability to recover from an unexpected lateral loss of balance is especially relevant to falls among older adults. When balance is lost unexpectedly to the right or left, arm lift [ 4 ] and trunk movements [ 5 ] are used to decelerate the center of mass (CoM) motion and preserve balance at minor perturbation magnitudes. A lateral recovery step is used at higher perturbation magnitudes, and the foot is placed more to the right or left to preserve balance during locomotion [ 6 – 9 ] and during standing [ 10 – 12 ] to adequately regulate the relationship between the body’s CoM and the base of support (BoS) provided by the feet to prevent a fall.…”

Section: Introductionmentioning

confidence: 99%

The kinematics and strategies of recovery steps during lateral losses of balance in standing at different perturbation magnitudes in older adults with varying history of falls

et al. 2020

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Background Step-recovery responses are critical in preventing falls when balance is lost unexpectedly. We investigated the kinematics and strategies of balance recovery in older adults with a varying history of falls. Methods In a laboratory study, 51 non-fallers (NFs), 20 one-time fallers (OFs), and 12 recurrent-fallers (RFs) were exposed to random right/left unannounced underfoot perturbations in standing of increasing magnitude. The stepping strategies and kinematics across an increasing magnitude of perturbations and the single- and multiple-step threshold trials, i.e., the lowest perturbation magnitude to evoke single step and multiple steps, respectively, were analyzed. Fall efficacy (FES) and self-reported lower-extremity function were also assessed. Results OFs had significantly lower single- and multiple-step threshold levels than NFs; the recovery-step kinematics were similar. Surprisingly, RFs did not differ from NFs in either threshold. The kinematics in the single-step threshold trial in RFs, however, showed a significant delay in step initiation duration, longer step duration, and larger center of mass (CoM) displacement compared with NFs and OFs. In the multiple-step threshold trial, the RFs exhibited larger CoM displacements and longer time to fully recover from balance loss. Interestingly, in the single-stepping trials, 45% of the step-recovery strategies used by RFs were the loaded-leg strategy, about two times more than OFs and NFs (22.5 and 24.2%, respectively). During the multiple-stepping trials, 27.3% of the first-step recovery strategies used by RFs were the loaded-leg strategy about two times more than OFs and NFs (11.9 and 16.4%, respectively), the crossover stepping strategy was the dominated response in all 3 groups (about 50%). In addition, RFs reported a lower low-extremity function compared with NFs, and higher FES in the OFs. Conclusions RFs had impaired kinematics during both single-step and multiple-step recovery responses which was associated with greater leg dysfunction. OFs and NFs had similar recovery-step kinematics, but OFs were more likely to step at lower perturbation magnitudes suggesting a more “responsive” over-reactive step response related from their higher fear of falling and not due to impaired balance abilities. These data provide insight into how a varying history of falls might affect balance recovery to a lateral postural perturbation. Trial registration This study was registered prospectively on November 9th, 2011 at clinicaltrials.gov ( NCT01439451 ).

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“…Such findings might be explained by participation limitations, as individuals with greater upper-limb involvement may have greater disability [ 35 ] resulting in reduced exposure to higher-risk activities [ 30 ]. It is also possible that individuals with AMC who have limited upper-limb movement from birth (due to extensive upper-limb involvement) compensate by reducing their whole body angular momentum range as a strategy to maintain postural stability during external perturbations; such perturbations require quick control of the body’s angular momentum to prevent a fall [ 37 ]. Evaluation of slips and trips in controlled environments (e.g., motion analysis laboratories), may enhance our understanding of how upper-limb involvement impacts postural stability (and may be related to falls) in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Falls and Associated Factors among Adolescents and Young Adults with Arthrogryposis Multiplex Congenita

Sions

Donohoe

Beisheim

et al. 2021

Int J Rare Dis Disord

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Background: Falls research among individuals with arthrogryposis multiplex congenita (AMC), a group of congenital conditions characterized by joint contractures in two or more body regions, is sparse. The primary objectives of this study were to estimate the prevalence of single, multiple, and injurious falls among adolescents and adults with AMC and identify factors associated with multiple and injurious falls.Methods: Individuals, aged 10-50 years, with a diagnosis of AMC completed questionnaires obtaining demographic and AMC-specific information, falls history (e.g., number, injurious/non-injurious), markers of bone health, orthopedic surgical history, and mobility aid use, as well as the Gillette Functional Assessment Questionnaire and the Saltin-Grimby Physical Activity Level Scale. Falls were defined as "any body part above the ankle coming to rest on the ground, floor, or a lower level". Falling was defined as ≥ 1 fall, while multiple falls were defined as ≥ 2 falls in the past year.Differences in falling, multiple falls, and injurious falls rates between adolescents (10-17 years) and adults (aged 18-50 years) were evaluated. Using univariate binary logistic regression models, associations between participant characteristics and multiple falls, as well as injurious falls, were evaluated, while considering age as a covariate (p ≤ 0.050); odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.Results: Adolescents (N = 28; median age = 14 years) and adults (N = 40; median age = 32 years) with AMC had similar falling, i.e., 89.3% versus 70.0%, and injurious fall rates, i.e., 32.1% versus 27.5%, respectively (p > 0.050).Adolescents with AMC, however, were more likely to report multiple falls in the past year, i.e., 89.3%, when compared to adults with AMC, i.e., 57.5% (p = 0.005). Beyond age, multiple falls were associated with a greater number of lowerlimb surgeries [p = 0.036, OR (95%CI): 1.18 (1.01-1.39)], ability to transfer floor-to-stand with support [p = 0.002, OR (95%CI): 8.98 (2.30-35.06)], and increased mobility per the Gillette Functional Assessment Questionnaire [p = 0.004, OR (95%CI): 1.48 (1.13-1.92)]. Factors associated with a reduced odds of multiple falls were spinal involvement [p = 0.025, OR (95%CI): 0.23 (0.07-0.84)], history of spinal surgery [p = 0.018, OR (95%CI: 0.18 (0.04-0.74)], greater upper extremity involvement [OR (95%CI): 0.65 (0.44-0.95)], home assistive device use [p = 0.010, OR (95%CI): 0.15 (0.03-0.63)], and community wheelchair use [p = 0.006, OR (95%CI): 0.16 (0.04-0.59)]. None of the explored characteristics were associated with injurious falls in the past year (p > 0.050). Conclusion:Falls are exceedingly common among adolescents and adults with AMC; potential risk and protective factors for multiple falls are identified for future prospective falls research.

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Effect of arm motion on postural stability when recovering from a slip perturbation

Cited by 15 publications

References 31 publications

Recovery From a Forward Falling Slip: Measurement of Dynamic Stability and Strength Requirements Using a Split-Belt Instrumented Treadmill

Recovery From a Forward Falling Slip: Measurement of Dynamic Stability and Strength Requirements Using a Split-Belt Instrumented Treadmill

The kinematics and strategies of recovery steps during lateral losses of balance in standing at different perturbation magnitudes in older adults with varying history of falls

Falls and Associated Factors among Adolescents and Young Adults with Arthrogryposis Multiplex Congenita

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