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      Postural threat during walking: effects on energy cost and accompanying gait changes

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          Abstract

          Background

          Balance control during walking has been shown to involve a metabolic cost in healthy subjects, but it is unclear how this cost changes as a function of postural threat. The aim of the present study was to determine the influence of postural threat on the energy cost of walking, as well as on concomitant changes in spatiotemporal gait parameters, muscle activity and perturbation responses. In addition, we examined if and how these effects are dependent on walking speed.

          Methods

          Healthy subjects walked on a treadmill under four conditions of varying postural threat. Each condition was performed at 7 walking speeds ranging from 60-140% of preferred speed. Postural threat was induced by applying unexpected sideward pulls to the pelvis and varied experimentally by manipulating the width of the path subjects had to walk on.

          Results

          Results showed that the energy cost of walking increased by 6-13% in the two conditions with the largest postural threat. This increase in metabolic demand was accompanied by adaptations in spatiotemporal gait parameters and increases in muscle activity, which likely served to arm the participants against a potential loss of balance in the face of the postural threat. Perturbation responses exhibited a slower rate of recovery in high threat conditions, probably reflecting a change in strategy to cope with the imposed constraints. The observed changes occurred independent of changes in walking speed, suggesting that walking speed is not a major determinant influencing gait stability in healthy young adults.

          Conclusions

          The current study shows that in healthy adults, increasing postural threat leads to a decrease in gait economy, independent of walking speed. This could be an important factor in the elevated energy costs of pathological gait.

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          Most cited references41

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          The condition for dynamic stability.

          The well-known condition for standing stability in static situations is that the vertical projection of the centre of mass (CoM) should be within the base of support (BoS). On the basis of a simple inverted pendulum model, an extension of this rule is proposed for dynamical situations: the position of (the vertical projection of) the CoM plus its velocity times a factor (square root l/g) should be within the BoS, l being leg length and g the acceleration of gravity. It is proposed to name this vector quantity 'extrapolated centre of mass position' (XcoM). The definition suggests as a measure of stability the 'margin of stability' b, the minimum distance from XcoM to the boundaries of the BoS. An alternative measure is the temporal stability margin tau, the time in which the boundary of the BoS would be reached without intervention. Some experimental data of subjects standing on one or two feet, flatfoot and tiptoe, are presented to give an idea of the usual ranges of these margins of stability. Example data on walking are also presented.
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            Assessing the stability of human locomotion: a review of current measures.

            Falling poses a major threat to the steadily growing population of the elderly in modern-day society. A major challenge in the prevention of falls is the identification of individuals who are at risk of falling owing to an unstable gait. At present, several methods are available for estimating gait stability, each with its own advantages and disadvantages. In this paper, we review the currently available measures: the maximum Lyapunov exponent (λS and λL), the maximum Floquet multiplier, variability measures, long-range correlations, extrapolated centre of mass, stabilizing and destabilizing forces, foot placement estimator, gait sensitivity norm and maximum allowable perturbation. We explain what these measures represent and how they are calculated, and we assess their validity, divided up into construct validity, predictive validity in simple models, convergent validity in experimental studies, and predictive validity in observational studies. We conclude that (i) the validity of variability measures and λS is best supported across all levels, (ii) the maximum Floquet multiplier and λL have good construct validity, but negative predictive validity in models, negative convergent validity and (for λL) negative predictive validity in observational studies, (iii) long-range correlations lack construct validity and predictive validity in models and have negative convergent validity, and (iv) measures derived from perturbation experiments have good construct validity, but data are lacking on convergent validity in experimental studies and predictive validity in observational studies. In closing, directions for future research on dynamic gait stability are discussed.
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              Mechanical and metabolic determinants of the preferred step width in human walking.

              We studied the selection of preferred step width in human walking by measuring mechanical and metabolic costs as a function of experimentally manipulated step width (0.00-0.45L, as a fraction of leg length L). We estimated mechanical costs from individual limb external mechanical work and metabolic costs using open circuit respirometry. The mechanical and metabolic costs both increased substantially (54 and 45%, respectively) for widths greater than the preferred value (0.15-0.45L) and with step width squared (R(2) = 0.91 and 0.83, respectively). As predicted by a three-dimensional model of walking mechanics, the increases in these costs appear to be a result of the mechanical work required for redirecting the centre of mass velocity during the transition between single stance phases (step-to-step transition costs). The metabolic cost for steps narrower than preferred (0.10-0.00L) increased by 8%, which was probably as a result of the added cost of moving the swing leg laterally in order to avoid the stance leg (lateral limb swing cost). Trade-offs between the step-to-step transition and lateral limb swing costs resulted in a minimum metabolic cost at a step width of 0.12L, which is not significantly different from foot width (0.11L) or the preferred step width (0.13L). Humans appear to prefer a step width that minimizes metabolic cost.
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                Author and article information

                Contributors
                Journal
                J Neuroeng Rehabil
                J Neuroeng Rehabil
                Journal of NeuroEngineering and Rehabilitation
                BioMed Central
                1743-0003
                2014
                22 April 2014
                : 11
                : 71
                Affiliations
                [1 ]MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, the Netherlands
                [2 ]Heliomare Research & Development, Relweg 51, 1949 EC Wijk aan Zee, the Netherlands
                [3 ]University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Center for Rehabilitation, Antonius Deusinglaan 1, 9713AV Groningen, the Netherlands
                [4 ]Brunel University, School of Sport and Education, Kingston Lane, Middlesex UB8 3PH, Uxbridge, UK
                Article
                1743-0003-11-71
                10.1186/1743-0003-11-71
                4008479
                24755345
                3b7afe8d-4bf4-45a0-99fa-f7d6e4eb65b4
                Copyright © 2014 IJmker et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Research

                Neurosciences
                Neurosciences

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