Reactive stepping after a forward fall in people living with incomplete spinal cord injury or disease

Chan, Katherine; Lee, Jae Woung; Unger, Janelle; Yoo, Jaeeun; Masani, Kei; Musselman, Kristin E.

doi:10.1038/s41393-019-0332-y

Cited by 17 publications

(8 citation statements)

References 48 publications

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“…The significant increase in VL activity at footoff aligns with its role in pushing off during reactive and volitional stepping (Chvatal et al, 2011;Wang et al, 2016;Winter and Yack, 1987). The peak difference in muscle activity immediately following foot contact aligns with previous literature that highlights the role of VL in braking during perturbed walking, running, and stance (Chan et al, 2020;Ellis et al, 2014;Graham et al, 2017). Therefore, it appears that increased TA and VL activity prior to, and during foot-off facilitated faster and stronger push offs from the stepping limb.…”

Section: The Modulation Of Anterior Muscle Activity For Foot-off Timesupporting

confidence: 83%

The effect of perturbation magnitude on lower limb muscle activity during reactive stepping using functional data analysis

Saumur

Nestico

Mochizuki

et al. 2020

Preprint

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This study aimed to determine the effect of perturbation magnitude on stance and stepping limb muscle activation during reactive stepping using functional data analysis. Nineteen healthy, young adults responded to 6 small and 6 large perturbations using an anterior lean-and-release system, evoking a single reactive step. Muscle activity from surface electromyography was compared between the two conditions for medial gastrocnemius, biceps femoris, tibialis anterior, and vastus lateralis of the stance and stepping limb using functional data analysis. Stance limb medial gastrocnemius and biceps femoris activation increased in the large compared to small perturbation condition immediately prior to foot-off and at foot contact. In the stepping limb, significant increases in medial gastrocnemius, biceps femoris, and tibialis anterior activity occurred immediately prior to foot-off during the large perturbations. Similar to the stance limb, medial gastrocnemius and biceps femoris activity significantly increased during and following foot contact in the large, compared to small, perturbation condition. Lastly, vastus lateralis activity significantly increased for large, compared to small, perturbations during foot-off and immediately following foot contact. These findings highlight lower limb muscle activity modulation associated with perturbation magnitude throughout reactive stepping and the additional benefit of implementing functional data analysis to study reactive balance control.

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Section: The Modulation Of Anterior Muscle Activity For Foot-off Timesupporting

confidence: 83%

The effect of perturbation magnitude on lower limb muscle activity during reactive stepping using functional data analysis

Saumur

Nestico

Mochizuki

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In addition, electromyography (EMG) was used to determine muscle reaction time. Following SENIAM recommendations [ 45 ], EMG electrodes were placed bilaterally on the muscle bellies of four major leg muscles: medial gastrocnemius (MG), tibialis anterior (TA), bicep femoris (BF), and rectus femoris (RF) after standard skin preparation procedures [ 46 ]. EMG signals from these muscles were sampled at 1500 Hz (Noraxon U.S.A. Inc., Scottsdale, AZ, USA) and was filtered by a bandpass filter (fourth-order, zero-lag Butterworth) in the range of 10–500 Hz to remove the low frequency movement artefact and high frequency noises.…”

Section: Methodsmentioning

confidence: 99%

Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial

Junata

Cheng

Man

et al. 2021

J NeuroEngineering Rehabil

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Background Falls are more prevalent in stroke survivors than age-matched healthy older adults because of their functional impairment. Rapid balance recovery reaction with adequate range-of-motion and fast response and movement time are crucial to minimize fall risk and prevent serious injurious falls when postural disturbances occur. A Kinect-based Rapid Movement Training (RMT) program was developed to provide real-time feedback to promote faster and larger arm reaching and leg stepping distances toward targets in 22 different directions. Objective To evaluate the effectiveness of the interactive RMT and Conventional Balance Training (CBT) on chronic stroke survivors’ overall balance and balance recovery reaction. Methods In this assessor-blinded randomized controlled trial, chronic stroke survivors were randomized to receive twenty training sessions (60-min each) of either RMT or CBT. Pre- and post-training assessments included clinical tests, as well as kinematic measurements and electromyography during simulated forward fall through a “lean-and-release” perturbation system. Results Thirty participants were recruited (RMT = 16, CBT = 14). RMT led to significant improvement in balance control (Berg Balance Scale: pre = 49.13, post = 52.75; P = .001), gait control (Timed-Up-and-Go Test: pre = 14.66 s, post = 12.62 s; P = .011), and motor functions (Fugl-Meyer Assessment of Motor Recovery: pre = 60.63, post = 65.19; P = .015), which matched the effectiveness of CBT. Both groups preferred to use their non-paretic leg to take the initial step to restore stability, and their stepping leg’s rectus femoris reacted significantly faster post-training (P = .036). Conclusion The RMT was as effective as conventional balance training to provide beneficial effects on chronic stroke survivors’ overall balance, motor function and improving balance recovery with faster muscle response. Trial registration: The study was registered at Clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT03183635, NCT03183635) on 12 June 2017.

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“…The data used in this study were previously collected in another work by Chan et al 28 , 29 and Unger et al 30 . Specific inclusion criteria are presented in the Supplemental Methods .…”

Section: Methodsmentioning

confidence: 99%

Co-contraction of ankle muscle activity during quiet standing in individuals with incomplete spinal cord injury is associated with postural instability

Fok

Lee

Unger

et al. 2021

Sci Rep

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Previous findings indicate that co-contractions of plantarflexors and dorsiflexors during quiet standing increase the ankle mechanical joint stiffness, resulting in increased postural sway. Balance impairments in individuals with incomplete spinal cord injury (iSCI) may be due to co-contractions like in other individuals with reduced balance ability. Here we investigated the effect of co-contraction between plantar- and dorsiflexors on postural balance in individuals with iSCI (iSCI-group) and able-bodied individuals (AB-group). Thirteen able-bodied individuals and 13 individuals with iSCI were asked to perform quiet standing with their eyes open (EO) and eyes closed (EC). Kinetics and electromyograms from the tibialis anterior (TA), soleus and medial gastrocnemius were collected bilaterally. The iSCI-group exhibited more co-contractions than the AB-group (EO: 0.208% vs. 75.163%, p = 0.004; EC: 1.767% vs. 92.373%, p = 0.016). Furthermore, postural sway was larger during co-contractions than during no co-contraction in the iSCI-group (EO: 1.405 cm/s2 vs. 0.867 cm/s2, p = 0.023; EC: 1.831 cm/s2 vs. 1.179 cm/s2, p = 0.030), but no differences were found for the AB-group (EO: 0.393 cm/s2 vs. 0.499 cm/s2, p = 1.00; EC: 0.686 cm/s2 vs. 0.654 cm/s2, p = 1.00). To investigate the mechanism, we performed a computational simulation study using an inverted pendulum model and linear controllers. An increase of mechanical stiffness in the simulated iSCI-group resulted in increased postural sway (EO: 2.520 cm/s2 vs. 1.174 cm/s2, p < 0.001; EC: 4.226 cm/s2 vs. 1.836 cm/s2, p < 0.001), but not for the simulated AB-group (EO: 0.658 cm/s2 vs. 0.658 cm/s2, p = 1.00; EC: 0.943 cm/s2 vs. 0.926 cm/s2, p = 0.190). Thus, we demonstrated that co-contractions may be a compensatory strategy for individuals with iSCI to accommodate for decreased motor function, but co-contractions may result in increased ankle mechanical joint stiffness and consequently postural sway.

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Reactive stepping after a forward fall in people living with incomplete spinal cord injury or disease

Cited by 17 publications

References 48 publications

The effect of perturbation magnitude on lower limb muscle activity during reactive stepping using functional data analysis

The effect of perturbation magnitude on lower limb muscle activity during reactive stepping using functional data analysis

Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial

Co-contraction of ankle muscle activity during quiet standing in individuals with incomplete spinal cord injury is associated with postural instability

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