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

Abstract

BackgroundThe 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 questionDo alterations in reactive muscle activity cause an age-related shift in stepping strategy in response to perturbations in the frontal and sagittal planes during walking? MethodA 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. ResultsOnly 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. SignificanceRehabilitation targets for fall prevention in elderly need to also focus on ankle muscle reactivity.