Abstract
Perturbation-based gait assessment has been used to quantify gait stability in older adults. However, knowledge on which perturbation type is most suitable to identify poor gait stability is lacking. We evaluated the effects of ipsi- and contra-lateral sway, belt acceleration and deceleration, and visual and auditory perturbations on medio-lateral (ML) and anterior-posterior (AP) margins of stability (MoS) in young and older adults. We aimed to evaluate (1) which perturbation type disturbed the gait pattern substantially, (2) how participants recovered, and (3) whether recovery responses could discriminate between young and older adults. Nine young (25.1 ± 3.4 years) and nine older (70.1 ± 7.6 years) adults walked on the CAREN Extended (Motek BV, The Netherlands). The perturbation effect was quantified by deviation in MoS over six post-perturbation steps compared to baseline walking. Contra-lateral sway and deceleration perturbations resulted in the largest ML (1.9–4 times larger than other types) and AP (1.6–5.6 times larger than other types) perturbation effects, respectively. After both perturbation types, participants increased MoS by taking wider, shorter, and faster steps. No differences between young and older adults were found. We suggest to evaluate the potential of using contra-lateral sway and deceleration perturbations for fall risk identification by including both healthy and frail older adults.Graphical abstractMargins of stability during steady state (left) and perturbed (right) gait to quantify reactive gait stability in response to various perturbation types in young and older adults.
Highlights
Gait impairments are among the main risk factors for falls in older adults [1]
The gait pattern was differently affected by the different perturbation types, without group or interaction effects (Main effects of perturbation for 6S ML margins of stability (MoS) F = 76.023, p < 0.001, and for 6S AP MoS F = 85.281, p < 0.001)
Post hoc pairwise comparisons revealed that 6S ML MoS in response to the contralateral sway perturbation was significantly larger compared to all other perturbation types meaning that ML MoS deviated most from baseline waking after the contralateral sway perturbation (Fig. 4a)
Summary
Gait impairments are among the main risk factors for falls in older adults [1]. Since walking is one of the most common activities in our everyday life, it is not surprising that most falls occur while walking, due to trips or slips [2, 3]. Medio-lateral (ML) perturbations have been applied by means of sideways platform movement [22,23,24] or waist-pulls [25,26,27,28,29]. Of less focus have been sensory perturbations, such as visual oscillations [30, 31] or low
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