Steps to Take to Enhance Gait Stability: The Effect of Stride Frequency, Stride Length, and Walking Speed on Local Dynamic Stability and Margins of Stability

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Abstract

The purpose of the current study was to investigate whether adaptations of stride length, stride frequency, and walking speed, independently influence local dynamic stability and the size of the medio-lateral and backward margins of stability during walking. Nine healthy subjects walked 25 trials on a treadmill at different combinations of stride frequency, stride length, and consequently at different walking speeds. Visual feedback about the required and the actual combination of stride frequency and stride length was given during the trials. Generalized Estimating Equations were used to investigate the independent contribution of stride length, stride frequency, and walking speed on the measures of gait stability. Increasing stride frequency was found to enhance medio-lateral margins of stability. Backward margins of stability became larger as stride length decreased or walking speed increased. For local dynamic stability no significant effects of stride frequency, stride length or walking speed were found. We conclude that adaptations in stride frequency, stride length and/or walking speed can result in an increase of the medio-lateral and backward margins of stability, while these adaptations do not seem to affect local dynamic stability. Gait training focusing on the observed stepping strategies to enhance margins of stability might be a useful contribution to programs aimed at fall prevention.

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The condition for dynamic stability.

A. L. Hof, M Gazendam, W Sinke (2005)

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.

S Bruijn, O G Meijer, P. J. Beek … (2013)

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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Falls in individuals with stroke.

Paul van Helden, Vivian Weerdesteyn, Alexander C. H. Geurts … (2007)

Stroke survivors are at high risk for falls in all poststroke stages. Falls may have severe consequences, both physically and psychosocially. Individuals with stroke have an increased risk for hip fractures, and after such a fracture, they less often regain independent mobility. In addition, fear of falling is a common consequence of falls, which may lead to decreased physical activity, social deprivation and, eventually, loss of independence. Important risk factors for falls are balance and gait deficits. Stroke-related balance deficits comprise reduced postural stability during quiet standing and delayed and less coordinated responses to both self-induced and external balance perturbations. Gait deficits include reduced propulsion at push-off, decreased hip and knee flexion during the swing phase, and reduced stability during the stance phase. Interventions addressing these deficits can be expected to prevent falls more successfully. Preliminary evidence shows that task-specific exercise programs targeting balance and gait deficits can indeed reduce the number of falls in individuals with stroke. Technological advances in assistive devices are another promising area. More research is needed, however, to provide conclusive evidence of the efficacy of these interventions regarding the prevention of falls in individuals with stroke.

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Author and article information

Contributors

Amir A. Zadpoor: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2013

Publication date (Electronic): 13 December 2013

Volume: 8

Issue: 12

Electronic Location Identifier: e82842

Affiliations

[1 ]Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands

[2 ]Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands

Delft University of Technology (TUDelft), The Netherlands

Author notes

* E-mail: j.van.dieen@ 123456vu.nl

Competing Interests: The authors have the follwing interests: The contribution of Laura Hak is partly sponsored by Motek Medical ( www.motekmedical.com). This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Conceived and designed the experiments: LH HH JHD. Performed the experiments: LH. Analyzed the data: LH. Contributed reagents/materials/analysis tools: LH. Wrote the paper: LH HH JHD PJB.

Article

Publisher ID: PONE-D-13-13724

DOI: 10.1371/journal.pone.0082842

PMC ID: 3862734

PubMed ID: 24349379

SO-VID: b00e3062-191e-4acc-bd83-322b0c1db51e

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 4 April 2013

Date accepted : 24 October 2013

Page count

Pages: 8

Funding

The contribution of Laura Hak is partly sponsored by Motek Medical ( www.motekmedical.com). No additional external funding was received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Steps to Take to Enhance Gait Stability: The Effect of Stride Frequency, Stride Length, and Walking Speed on Local Dynamic Stability and Margins of Stability

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Abstract

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Most cited references 35

The condition for dynamic stability.

Assessing the stability of human locomotion: a review of current measures.

Falls in individuals with stroke.

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