Abstract
BackgroundStep climbing is a demanding task required for personal autonomy in daily living. Anticipatory Postural Adjustments (APAs) preceding gait initiation have been widely investigated revealing to be hypometric in Parkinson’s disease (PD) with consequences in movement initiation. However, only few studies focused on APAs prior to step climbing. In this work, a novel method based on wearable inertial sensors for the analysis of APAs preceding gait initiation and step climbing was developed to further understand dynamic balance control. Validity and sensitivity of the method have been evaluated.MethodsEleven PD and 20 healthy subjects were asked to perform two transitional tasks from quiet standing to level walking, and to step climbing respectively. All the participants wore two inertial sensors, placed on the trunk (L2-L4) and laterally on the shank. In addition, a validation group composed of healthy subjects and 5 PD patients performed the tasks on two force platforms. Correlation between parameters from wearable sensors and force platforms was evaluated. Temporal parameters and trunk acceleration from PD and healthy subjects were analyzed.ResultsSignificant correlation was found for the validation group between temporal parameters extracted from wearable sensors and force platforms and between medio-lateral component of trunk acceleration and correspondent COP displacement. These results support the validity of the method for evaluating APAs prior to both gait initiation and step climbing. Comparison between PD subjects and a subgroup of healthy controls confirms a reduction in PD of the medio-lateral acceleration of the trunk during the imbalance phase in the gait initiation task and shows similar trends during the imbalance and unloading phase of the step climbing task. Interestingly, PD subjects presented difficulties in adapting the medio-lateral amplitude of the imbalance phase to the specific task needs.ConclusionsValidity of the method was confirmed by the significant correlation between parameters extracted from wearable sensors and force platforms. Sensitivity was proved by the capability to discriminate PD subjects from healthy controls. Our findings support the applicability of the method to subjects of different age. This method could be a possible valid instrument for a better understanding of feed-forward anticipatory strategies.
Highlights
Step climbing is a demanding task required for personal autonomy in daily living
It was demonstrated that subjects affected by Parkinson’s disease (PD) have an increased risk of falling compared to healthy controls [10], and that Fear Of Falling (FOF) in the PD population is strongly dependent on walking difficulties, turning hesitation and limited ability to climb stairs [11]
It is possible to notice that the highest error (6.3%) is associated with the detection of the Anticipatory Postural Adjustments (APAs) onset in the step climbing task: no statistically significant differences in mean absolute errors (MAEs) were noticed between the two tasks (p = 0.79) and between younger adults (60 yo), and PD patients (p = 0.73)
Summary
Anticipatory Postural Adjustments (APAs) preceding gait initiation have been widely investigated revealing to be hypometric in Parkinson’s disease (PD) with consequences in movement initiation. A novel method based on wearable inertial sensors for the analysis of APAs preceding gait initiation and step climbing was developed to further understand dynamic balance control. Stair negotiation (i.e. ascending and descending stairs) is a demanding and hazardous task for frail people, in particular for older adults and subjects affected by neuromotor disorders, such as Parkinson’s disease (PD). Previous studies showed that these functional limitations are highly associated to alterations in dynamic balance control and to poorly coordinated anticipatory postural adjustments (APAs) prior to voluntary limb movements [12]
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