Increased use of stepping strategy in response to medio-lateral perturbations in the elderly relates to altered reactive tibialis anterior activity

Publication date: Available online 9 January 2019

Source: Gait & Posture

Author(s): Maarten Afschrift, Robert van Deursen, Friedl De Groote, Ilse Jonkers

Abstract

Background

The influence of aging on reactive control of balance during walking has been mainly investigated in the sagittal plane, whereas balance control in response to frontal plane perturbations is largely unexplored in the elderly. This is remarkable, given that walking mainly requires active control in the frontal plane. An extensive gait perturbation protocol was used to test whether reactive control of walking balance changes with aging and whether these changes are more pronounced in the frontal than in the sagittal plane.

Research question

We hypothesize that alterations in reactive muscle activity cause an age-related shift from lateral ankle to stepping strategy in response to perturbations in the frontal and sagittal plane, and that the alterations in the frontal plane will be larger than the alterations in the sagittal plane.

Method

A treadmill-based perturbation protocol imposed frontal and sagittal plane perturbations of different magnitudes during different phases of the gait cycle. Motion capture and electromyography measured the response to the different perturbations in a group of eighteen young and ten older adults.

Results

Only for a small subset of the perturbations, reactive muscle activity and kinematic strategies differed between young and older subjects. When perturbation magnitude increased, the older adults relied more on a stepping strategy for inward directed frontal plane perturbations and for sagittal plane perturbation just before heelstrike. Tibialis anterior activity increased less in the older compared to the young subjects. Using simulations, we related tibialis anterior activity to backward and outward movement of the center of pressure in the stance foot and confirmed its contribution to the ankle strategy. We concluded that deficient tibialis anterior activity predisposes elderly to use stepping rather than lateral ankle strategies to control balance.

Significance

Rehabilitation targets for fall prevention in elderly need to also focus on ankle muscle reactivity.

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