Is There an Optimal Recovery Step Landing Zone Against Slip-Induced Backward Falls During Walking?

Wang, Shuaijie; Pai, Yi–Chung; Bhatt, Tanvi

doi:10.1007/s10439-020-02482-4

Cited by 16 publications

(31 citation statements)

References 41 publications

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“…Previous studies indicated that the step length was related to the stability and could affect the risk of slip-induced falls (Espy et al, 2010 ; Wang et al, 2020 ). The step length was calculated by subtracting the heel position of the stepping foot from the heel position of the stance foot in the AP direction at RTD.…”

Section: Methodsmentioning

confidence: 99%

“…A larger MOS indicates better stability against slip perturbation but a greater forward instability against trip perturbation; conversely, a smaller MOS indicates better stability against trip perturbation but a greater backward instability against slip perturbation. Previous studies indicated that the step length was related to the stability and could affect the risk of slip-induced falls (Espy et al, 2010;Wang et al, 2020). The step length was calculated by subtracting the heel position of the stepping foot from the heel position of the stance foot in the AP direction at RTD.…”

Section: Outcome Variablesmentioning

confidence: 99%

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Perturbation Training for Fall-Risk Reduction in Healthy Older Adults: Interference and Generalization to Opposing Novel Perturbations Post Intervention

Bhatt

Wang

et al. 2021

Front. Sports Act. Living

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This study examined the effects of perturbation training on the contextual interference and generalization of encountering a novel opposing perturbation. One hundred and sixty-nine community-dwelling healthy older adults (69.6 ± 6.4 years) were randomly assigned to one of the three groups: slip-perturbation training (St, n = 67) group received 24 slips, trip-perturbation training (Tt, n = 67) group received 24 trips, and control (Ctrl: n = 31) group received only non-perturbed walking trials (ClinicalTrials.gov NCT03199729; https://clinicaltrials.gov/ct2/show/NCT03199729). After training, all groups had 30 min of rest and three post-training non-perturbed walking trials, followed by a reslip and a novel trip trial for St, a retrip and a novel slip trial for Tt, and randomized novel slip and trip trials for Ctrl. The margin of stability (MOS), step length, and toe clearance of post-training walking trials were compared among three groups to examine interferences in proactive adjustment. Falls, MOS at the instant of recovery foot touchdown, and hip height of post-training perturbation trials were investigated to detect interferences and generalization in reactive responses. Results indicated that prior adaptation to slip perturbation training, resulting in walking with a greater MOS (more anterior) and a shorter step length (p < 0.01) than that of the Ctrl group, would be associated with a greater likelihood to forward balance loss if encountered with a trip. The trip adaptation training mainly induced a higher toe clearance during walking (p < 0.01) than the Ctrl group, which could lead to reduced effectiveness of the reactive response when encountered with a novel slip. However, there was no difference in the reactive MOS, limb support, and falls between the control group and the slip and trip training groups on their respective opposing novel perturbation post-training (MOS, limb support, and falls for novel slip: Tt = Ctrl; for the novel trip: St = Ctrl, both p > 0.05). Current findings suggested that, although perturbation training results in proactive adjustments that could worsen the reactive response (interference) when exposed to an unexpected opposing perturbation, older adults demonstrated the ability to immediately generalize the training-induced adaptive reactive control to maintain MOS, to preserve limb support control, and to reduce fall risk.

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Section: Methodsmentioning

confidence: 99%

Section: Outcome Variablesmentioning

confidence: 99%

Perturbation Training for Fall-Risk Reduction in Healthy Older Adults: Interference and Generalization to Opposing Novel Perturbations Post Intervention

Bhatt

Wang

et al. 2021

Front. Sports Act. Living

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“…Depending on the perturbation type, the control of stability and limb support is achieved via changes in kinematic parameters such as recovery step length, trunk angle and velocity resulting from changes in neuromuscular output (Epro et al, 2018a, Wang et al, 2020a, Wang et al, 2020b.…”

Section: What Are the Mechanisms For Pbt Improving Fall-resisting Ski...mentioning

confidence: 99%

Perturbation-based Balance Training: Principles, Mechanisms and Implementation in Clinical Practice

McCrum¹,

Bhatt²,

Gerards³

et al. 2022

Preprint

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Since the mid-2000s, perturbation-based balance training has been gaining interest as an efficient and effective way to prevent falls in older adults. It has been suggested that this task-specific training approach may present a paradigm shift in fall prevention. In this review, we discuss key concepts and common issues and questions regarding perturbation-based balance training. In doing so, we aim to provide a comprehensive synthesis of the current evidence on the mechanisms, feasibility and efficacy of perturbation-based balance training for researchers and practitioners. We address this in two sections: “Principles and Mechanisms” and “Implementation in Practice”. In the first section, definitions, task-specificity, adaptation and retention mechanisms and the dose-response relationship are discussed. In the second section, issues related to safety, anxiety, evidence in clinical populations (e.g., Parkinson’s disease, stroke), technology and training devices are discussed. Perturbation-based balance training is a promising approach to fall prevention. However, several fundamental and applied aspects of the approach need to be further investigated before it can be widely implemented in clinical practice.

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“…The loss of equilibrium is generally followed by recovery stepping. Increased rates of falls are considerably associated with a lack of ability to regain one’s balance by taking restorative steps [ 7 ]. Humans can quickly regain stability and maintain balance from the same type of perturbation [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, quantifying the gait performance of recovery steps is intuitively critical following an unexpected slipping or stumbling perturbation. Successful stepping strategies could provide additional limb support to maintain the CoM within an effective base of support (BoS), thereby reducing the likelihood of falls [7]. This typically needs the successful application of dynamic stability control mechanisms, including modulation of stepping [16][17][18], activation of muscle moments around ankle [19] and changing the angular momentum around the hip [20,21] and so on.…”

Section: Introductionmentioning

confidence: 99%

Lower extremity joint compensatory effects during the first recovery step following slipping and stumbling perturbations in young and older subjects

et al. 2022

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Background The lower extremity may play a crucial role in compensating for gait perturbations. The study aimed to explore the mechanism of perturbation compensation by investigating the gait characteristics and lower extremity joint moment effects in young (YS) and older subjects (OS) during the first recovery gait following slipping (slipping_Rec1) and stumbling (stumbling_Rec1). Method An automatic perturbation-triggered program was developed using D-Flow software based on the Gait Real-time Analysis Interactive Lab to induce the two aforementioned perturbations. Marker trajectories and ground reaction forces were recorded from 15 healthy YS (age: 26.53 ± 3.04 years; body height: 1.73 ± 0.07 m; body mass: 66.81 ± 11.44 kg) and 15 healthy OS (age: 68.33 ± 3.29 years; body height: 1.76 ± 0.10 m; body mass: 81.13 ± 13.99 kg). The Human Body Model was used to compute the variables of interest. One-way analysis of variance and independent samples t-test statistical analyses were performed. Results In slipping_Rec1 and stumbling_Rec1, the change in gait pattern was mainly reflected in a significant increase in step width, no alterations in step length and stance/swing ratio were revealed. Based on perturbed task specificity, lower extremity joint moments increased or decreased at specific phases of the gait cycle in both YS and OS in slipping_Rec1 and stumbling_Rec1 compared to normal gait. The two perturbed gaits reflected the respective compensatory requirements for the lower extremity joints, with both sagittal and frontal joint moments producing compensatory effects. The aging effect was not reflected in the gait pattern, but rather in the hip extension moment during the initial stance of slipping_Rec1. Conclusions Slipping appears to be more demanding for gait recovery than stumbling. Gait perturbation compensatory mechanisms for OS should concentrate on ankle strategy in the frontal plane and counter-rotation strategy around the hip.

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Is There an Optimal Recovery Step Landing Zone Against Slip-Induced Backward Falls During Walking?

Cited by 16 publications

References 41 publications

Perturbation Training for Fall-Risk Reduction in Healthy Older Adults: Interference and Generalization to Opposing Novel Perturbations Post Intervention

Perturbation Training for Fall-Risk Reduction in Healthy Older Adults: Interference and Generalization to Opposing Novel Perturbations Post Intervention

Perturbation-based Balance Training: Principles, Mechanisms and Implementation in Clinical Practice

Lower extremity joint compensatory effects during the first recovery step following slipping and stumbling perturbations in young and older subjects

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