The coordination of upper and lower limb movements during gait in healthy and stroke individuals

Most falls in older adults occur when walking, specifically following a trip. This study investigated the short- and longer term responses of young ( n = 24, 27.6 ± 4.5 yr) and older adults ( n = 18, 69.1 ± 4.2 yr) to a trip during gait at comfortable speed and the role of interlimb coordination in recovery from tripping. Subjects walked on a self-paced treadmill when forward movement of their dominant leg was unexpectedly arrested for 250 ms. Recovery of center of mass (COM) movements and of double-support duration following perturbation was determined. In addition, the disruption and recovery of interlimb coordination of the arms and legs was evaluated. Although young and older subjects used similar lower limb strategies in response to the trip, older adults had less stable COM movement patterns before perturbation, had longer transient destabilization (>25%) after perturbation, required more gait cycles to recover double-support duration (older, 3.48 ± 0.7 cycles; young, 2.88 ± 0.4 cycles), and had larger phase shifts that persisted after perturbation (older, −83° to −90°; young, −39° to −42°). Older adults also had larger disruptions to interlimb coordination of the arms and legs. The timing of the initial disruption in coordination was correlated with the disturbance in gait stability only in young adults. In older adults, greater initial COM instability was related to greater longer term arm incoordination. These results suggest a relationship between interlimb coordination and gait stability, which may be associated with fall risk in older adults. Reduced coordination and gait stability suggest a need for stability-related functional training even in high-functioning older adults.

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“…Subjects walked on a self-paced treadmill (Stephenson et al 2009) and wore a safety harness attached to the ceiling to prevent falling (Fig. 1A).…”

Section: Methodsmentioning

confidence: 99%

Stability of gait and interlimb coordination in older adults

Krasovsky

Baniña

Hacmon

et al. 2012

Journal of Neurophysiology

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“…Although there was no significant difference between the groups for the measures of coordination patterns, the stroke subjects could walk at a faster speed for the supported arm condition compared with the unsupported condition. Since the study comprised higher functioning stroke, poststroke gait rehabilitation may incorporate the supported arm movement as an intervention method [74]. The lower limb training also influences the upper limb.…”

Section: Locomotionmentioning

confidence: 99%

Interlimb neural coupling: Implications for poststroke hemiparesis

Arya

Pandian

2014

Annals of Physical and Rehabilitation Medicine

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Interlimb coordination is essential to perform goal-directed daily tasks and purposeful locomotion. The coordination occurs due to spatiotemporal coupling of movements, which also comprises interactions in segmental kinematics, joint dynamics, and muscle activity. Neuroanatomical and neurophysiological linkages at the spinal and brain level are responsible for the coordination. The linkage is termed "neural coupling". According to the task demand, the coupling may occur between two upper limbs or two lower limbs or all four limbs. Central pattern generators play a key role in interlimb coordination by regulating the rhythmic upper and lower limb movements. Neuroanatomically, multiple areas of both cerebral hemispheres via the corpus callosum interact and control the bimanual upper limb movements. There is an interhemispheric synchronization and disinhibition to control the coupled bimanual upper and lower limb movements. Movement of the upper limb also enhances neuromuscular recruitment of the lower limb. In stroke, bimanual motor impairments exist in the form of asymmetry and reduced coordination, which may be related to weakness of the ipsilateral body side lesser than the contralateral side. The aim of the present review was to understand the interlimb coordination and neural coupling and its implication in stroke rehabilitation. The review suggests incorporating the movements of bilateral upper and lower limbs either simultaneously or consecutively for hemiparetic subjects. Further, the conventional and contemporary rehabilitation methods need to be reconsidered while utilizing the coupling concept.

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“…The treadmill used was fitted with custom built sliding handles that were mounted with a low-friction bearing system on horizontal bars, allowing arm movements in the sagittal plane [14]. Handles were fitted with a load cell that was sensitive to force in the vertical direction (Omega, Stamford, CT).…”

Section: Equipmentmentioning

confidence: 99%

“…We fitted a treadmill with bilateral handles that could slide in the horizontal direction, allowing arm movements in the sagittal plane while still assisting with balance maintenance. When using the sliding handles, individuals who had sustained a stroke were able to incorporate arm movements into their gait pattern at faster speeds than they were otherwise able to do so [14]. This suggests that these handrails may have potential for use in gait rehabilitation, where speed is important [15], however a thorough understanding of their effect on the gait pattern is necessary before recommendations can be made.…”

Section: Introductionmentioning

confidence: 99%

“…Impairment Inventory [16] score <7/7 for the leg and foot) and sufficient ability to use the handrails (Chedoke-McMaster !3/7 for the arm and hand), and are the same subjects as those previously studied [14]. The project was approved by the institutional ethics committee and subjects provided free and informed consent prior to participation.…”

Section: Introductionmentioning

confidence: 99%

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