Walking Balance Research Articles

Effect of mediolateral leg perturbations on walking balance in people with chronic stroke: A randomized controlled trial.

Many people with chronic stroke (PwCS) exhibit deficits in step width modulation, an important strategy for walking balance. A single exposure to swing leg perturbations can temporarily strengthen this modulation. The objective of this parallel, double-blinded, randomized controlled trial was to investigate whether repeated perturbations cause sustained increases in step modulation (NCT02964039; funded by the VA). 54 PwCS at the Medical University of South Carolina were randomly assigned to one of three intervention groups: Control (n = 18), with minimal forces; Assistive (n = 18), pushing the swing leg toward a mechanically appropriate location; Perturbing (n = 18), pushing the swing leg away from a mechanically appropriate location. All intervention groups included 24 training sessions over 12-weeks with up to 30-minutes of treadmill walking while interfaced with a novel force-field and a 12-week follow-up period, with five interspersed assessment sessions. Our primary outcome measure was paretic step width modulation, the partial correlation between step width and pelvis displacement (ρSW). Secondarily, we quantified swing and stance leg contributions to step modulation, clinical assessments of walking balance and confidence, and real-world falls. Outcomes were analyzed for participants who completed all assessment sessions (n = 44). Only the Perturbing group exhibited significant increases in paretic ρSW, which were present after 4-weeks of training and sustained through follow-up (t = 2.42-3.17). These changes were due to improved control of paretic swing leg positioning. However, perturbation-induced changes in step modulation were not always significantly greater than those in the Control group, and clinical assessments were similar across intervention groups. Participants in the Perturbing group experienced a lower fall rate than those in the Control group (incidence rate ratio = 0.53), although our small sample size warrants caution. The present results indicate that perturbations can cause sustained modifications of targeted biomechanical characteristics of post-stroke gait, although such changes alone may be insufficient to change more complex clinical assessments.

Vision Is Not Required to Elicit Balance Improvements From Beam Walking Practice.

Beam walking is a highly studied assessment of walking balance. Recent research has demonstrated that brief intermittent visual rotations and occlusions can increase the efficacy of beam walking practice on subsequent beam walking without visual perturbations. We sought to examine the influence of full vision removal during practice walking on a treadmill-mounted balance beam. Although visual disruptions improved performance of this task, we hypothesized that removing visual feedback completely would lead to less balance improvements than with normal vision due to the specificity of practice. Twenty healthy young adults trained to walk at a fixed speed on a treadmill-mounted balance beam for 30min, either with, or without, normal vision. We compared their balance pre-, during, and posttraining by calculating their step-offs per minute and the percentage change in step-offs per minute. Balance improved in both groups after training, with no significant difference in percentage change in step-offs between the normal vision and the no vision participants. On average, the no vision participants had twice as many step-offs per minute as the normal vision group during training. Although previous experiments show that intermittent visual perturbations led to large enhancements of the effectiveness of beam walking training, completely removing visual feedback did not alter training effectiveness compared with normal vision training. It is likely a result of sensory reweighting in the absence of vision, where a greater weight was placed on proprioceptive, cutaneous, and vestibular inputs.

Modelling strategies supplemental to foot placement for frontal-plane stability in walking.

Walking is unstable and requires active control. Foot placement is the primary strategy to maintain frontal-plane balance with contributions from lateral ankle torques, ankle push-off and trunk postural adjustments. Because these strategies interact, their individual contributions are difficult to study. Here, we used computational modelling to understand these individual contributions to frontal-plane walking balance control. A three-dimensional bipedal model was developed based on linear inverted pendulum dynamics. The model included controllers that implement the stabilization strategies seen in human walking. The control parameters were optimized to mimic human gait biomechanics for typical spatio-temporal parameters during steady-state walking and when perturbed by mediolateral ground shifts. Using the optimized model as a starting point, the contributions of each stabilization strategy were explored by progressively removing strategies. The lateral ankle and trunk strategies were more important than ankle push-off, with their removal causing up to 20% worse balance recovery compared with the full model, while removing ankle push-off led to minimal changes. Our results imply a potential benefit of preferentially training these strategies in populations with poor balance. Moreover, the proposed model could be used in future work to investigate how walking stability may be preserved in conditions reflective of injury or disease.

Walking balance control in different settings: Effects of walking speed and biological sex

BackgroundPrevious research has suggested that spatiotemporal step parameters differ between settings; however, it remains unclear how different settings influence walking balance control. Research questionHow do settings and sex influence walking balance control during walking at different speeds for young adults? MethodsForty-two adults (21 male (23 ± 4 years), 21 female (24 ± 5 years)) completed overground walking trials in four settings: laboratory (10 m), hallway, indoor open, and outdoor pathway (all 20 m) at three self-selected speeds (slow, preferred, fast) following verbal instructions. Participants wore 17 inertial sensors (Xsens Awinda, Movella, Henderson, NV) to capture total body kinematics. The number of included strides was matched across all conditions, with six strides included in each condition for all participants. Medial-lateral and anterior-posterior total body angular momentum range over each stride was calculated (HML range and HAP range). Setting × speed × sex mixed factorial analysis of variance with repeated measures on setting and speed were used for statistical analysis (α =.05). ResultsSignificant setting × speed interactions (p <.001) were present for both outcomes. HML range was greater in the laboratory and hallway compared to the indoor open and outdoor pathway settings for slow walking speed only. HAP range was lower in the outdoor pathway compared to all indoor settings at slow and preferred walking speeds. Differences in HAP range between settings was more pronounced at the slow speed condition. Across setting and speed conditions, HML range was greater for males compared to females. SignificanceYoung adults may alter their balance control strategy depending on the setting (laboratory, indoor open and outdoor pathway), particularly at slow speeds. Researchers and clinicians are cautioned not to assume walking in laboratory settings reflects walking in all settings nor that males and females can be examined as a single group.

Amplify Gait to Improve Locomotor Engagement in Spinal Cord Injury (AGILE SCI) trial: study protocol for an assessor blinded randomized controlled trial

BackgroundAmong ambulatory people with incomplete spinal cord injury (iSCI), balance deficits are a primary factor limiting participation in walking activities. There is broad recognition that effective interventions are needed to enhance walking balance following iSCI. Interventions that amplify self-generated movements (e.g., error augmentation) can accelerate motor learning by intensifying sensorimotor feedback and facilitating exploration of motor control strategies. These features may be beneficial for retraining walking balance after iSCI. We have developed a cable-driven robot that creates a movement amplification environment during treadmill walking. The robot applies a continuous, laterally-directed, force to the pelvis that is proportional in magnitude to real-time lateral velocity. Our purpose is to investigate the effects of locomotor training in this movement amplification environment on walking balance. We hypothesize that for ambulatory people with iSCI, locomotor training in a movement amplification environment will be more effective for improving walking balance and participation in walking activities than locomotor training in a natural environment (no applied external forces).MethodsWe are conducting a two-arm parallel-assignment intervention. We will enroll 36 ambulatory participants with chronic iSCI. Participants will be randomized into either a control or experimental group. Each group will receive 20 locomotor training sessions. Training will be performed in either a traditional treadmill environment (control) or in a movement amplification environment (experimental). We will assess changes using measures that span the International Classification of Functioning, Disability and Health (ICF) framework including 1) clinical outcome measures of gait, balance, and quality of life, 2) biomechanical assessments of walking balance, and 3) participation in walking activities quantified by number of steps taken per day.DiscussionTraining walking balance in people with iSCI by amplifying the individual’s own movement during walking is a radical departure from current practice and may result in new strategies for addressing balance impairments. Knowledge gained from this study will expand our understanding of how people with iSCI improve walking balance and how an intervention targeting walking balance affects participation in walking activities. Successful outcomes could motivate development of clinically feasible tools to replicate the movement amplification environment within clinical settings.Trial registrationNCT04340063.

Effectiveness of kneeling training in improving mobility and balance post-stroke

BackgroundFall prevention and balance control constitute critical components of rehabilitation for stroke survivors. Kneeling training, characterized by its low center of gravity focus, has been incorporated into rehabilitation regimens to enhance postural control across various pathological conditions. Despite its widespread use, empirical evidence substantiating the efficacy of kneeling training is limited, particularly in the context of mobility and balance improvement for patients who have had a stroke. This study aims to substantiate the safety and effectiveness of kneeling training in individuals recovering from stroke.MethodsA randomized controlled trial comparing kneeling training and conventional rehabilitation training was conducted, involving sixty-seven participants allocated to the Kneeling Training Group (KNT) and the Conventional Rehabilitation Group (CVR). The KNT group underwent 30-minute sessions of kneeling training, while the CVR group received conventional treadmill walking training, both administered six times per week over four weeks. Evaluation encompassed the Fugl-Meyer Assessment for Lower Extremity (FMA-LE), the Berg Balance Scale (BBS), and gait analysis was conducted at baseline, as well as at the 2 and 4-week intervals.ResultsOur study established the safety of a 4-week kneeling training program. Notably, the KNT group exhibited more pronounced improvements in BBS scores at weeks 2 and 4 compared to the CVR group. However, no significant disparities emerged in FMA-LE and gait analysis between the two groups. Our findings suggest that kneeling training may serve as a viable option for enhancing lower limb balance in survivors who have had a stroke.ConclusionsWe conclude that kneeling training, characterized by its safety, simplicity, and no restrictions on location or equipment, represents a valuable therapeutic approach for enhancing walking balance in individuals recovering from stroke.Trial registrationClinical trials ChiCTR1900028385, December 20, 2019.

PENGGUNAAN ANKLE FOOT ORTHOSIS (AFO) TERHADAP KESEIMBANGAN FUNGSIONAL PADA ANAK PENDERITA CEREBRAL PALSY

Children with cerebral palsy will experience problems with their movements. Cerebral palsy affects muscles and a person's ability to control them. One of the disorders that occur in children with CP is disturbances in walking balance, which ultimately results in disturbances in walking motor skills, so children experience disturbances in daily living (ADL) activities in their daily lives. This research aims to determine the effect of using Anke Foot Orthosis on children's functional balance. Cerebral Palsy. Method: This type of research uses a Quasy Experiment with a pretest-posttest with a control group design. The total sample for this study was 10 respondents. Data collection was carried out using observation sheets. Analysis of this research data using univariate and bivariate analysis with Wilcoxon. Results: The influence of using Anke Foot Orthosis on the functional balance of Cerebral Palsy children, data taken before and after treatment with a value &gt; 0.05. The conclusion is that there is no significant effect between using Anke Foot Orthosis and functional balance in children with cerebral palsy.

Jalan Tendem Menurunkan Resiko Jatuh Lansia

Abstract Background: The aging process causes elderly people to experience functional changes. Some of these changes include neurological, sensory, musculoskeletal and cognitive changes. Some of these problems will have an impact on the elderly's ability to control their balance. One of the most influential factors in reducing the ability to control balance is the musculoskeletal system. Changes in the musculoskeletal system will reduce muscle mass and muscle strength. Decreased muscle mass results in slowness in movement, short footsteps, decreased muscle strength, especially in the lower extremities which experience balance problems and ultimately risk falling. Muscle weakness results in physical decline which is one of the main factors at risk of falls in the elderly. Tandem walking balance training is an exercise in posture or body position, controlling balance, muscle coordination and body movements as well as knowing the risk of falls that elderly people in Tohudan Wetan Village have. Objectives: This study aims to determine the effect of tandem walking balance training on the risk of falls in the elderly in Tohudan Wetan Village, Colomadu, Karanganyar. Methods: The design of this research is quantitative pre-experimental using a one-group pretest-posttest design. Sample selection used purposive sampling technique. Hypothesis testing using Paired Samples T Test. Result: The research results obtained a sig value. 0.000 (p&lt;0.005) means that there is a significant influence on the risk of falls in the elderly before and after being given the tandem walking balance training intervention. Conclusion: This research shows that there is an effect of tandem walking balance training on the risk of falls in the elderly in Tohudan Wetan Village, Colomadu, Karanganyar. Key words: Tandem walking balance training, risk of falls, elderly

Corticomuscular and intermuscular coherence as a function of age and walking balance difficulty

We determined beta-band intermuscular (IMC) and corticomuscular coherence (CMC) as a function of age and walking balance difficulty. Younger (n=14, 23y) and older individuals (n=19, 71y) walked 13 m overground, on a 6-cm-wide ribbon overground, and on a 6-cm-wide (5-cm-high) beam. Walking distance as a proxy for walking balance and speed were computed. CMC was estimated between electroencephalographic signal at Cz electrode and surface electromyographic signals of seven leg muscles, while IMC was calculated in four pairs of leg muscles, during stance and swing gait phases. With increasing difficulty, walking balance decreased in old individuals and speed decreased gradually independent of age. Beam walking increased IMC, while age increased IMC in proximal muscle pairs, and decreased IMC in distal muscle pairs. Age and difficulty increased CMC independent of gait phases. Concluding, CMC and IMC increased with walking balance difficulty and age, except for distal muscle pairs, which had lower IMC with age. These findings suggest an age-related increase in corticospinal involvement in the neural control of walking balance. Data AvailabilityThe datasets used in this study are available from the corresponding author upon reasonable request.

Walking balance in patient with acromegaly

Walking balance in patient with acromegaly

Balance Evaluation Based on Walking Experiments with Exoskeleton Interference.

The impairment of walking balance function seriously affects human health and will lead to a significantly increased risk of falling. It is important to assess and improve the walking balance of humans. However, existing evaluation methods for human walking balance are relatively subjective, and the selected metrics lack effectiveness and comprehensiveness. We present a method to construct a comprehensive evaluation index of human walking balance. We used it to generate personal and general indexes. We first pre-selected some preliminary metrics of walking balance based on theoretical analysis. Seven healthy subjects walked with exoskeleton interference on a treadmill at 1.25 m/s while their ground reaction force information and kinematic data were recorded. One subject with Charcot-Marie-Tooth walked at multiple speeds without the exoskeleton while the same data were collected. Then, we picked a number of effective evaluation metrics based on statistical analysis. We finally constructed the Walking Balance Index (WBI) by combining multiple metrics using principal component analysis. The WBI can distinguish walking balance among different subjects and gait conditions, which verifies the effectiveness of our method in evaluating human walking balance. This method can be used to evaluate and further improve the walking balance of humans in subsequent simulations and experiments.

The effects of plantarflexor weakness and reduced tendon stiffness with aging on gait stability.

Falls among older adults are a costly public health concern. Such falls can be precipitated by balance disturbances, after which a recovery strategy requiring rapid, high force outputs is necessary. Sarcopenia among older adults likely diminishes their ability to produce the forces necessary to arrest gait instability. Age-related changes to tendon stiffness may also delay muscle stretch and afferent feedback and decrease force transmission, worsening fall outcomes. However, the association between muscle strength, tendon stiffness, and gait instability is not well established. Given the ankle's proximity to the onset of many walking balance disturbances, we examined the relation between both plantarflexor strength and Achilles tendon stiffness with walking-related instability during perturbed gait in older and younger adults-the latter quantified herein using margins of stability and whole-body angular momentum including the application of treadmill-induced slip perturbations. Older and younger adults did not differ in plantarflexor strength, but Achilles tendon stiffness was lower in older adults. Among older adults, plantarflexor weakness associated with greater whole-body angular momentum following treadmill-induced slip perturbations. Weaker older adults also appeared to walk and recover from treadmill-induced slip perturbations with more caution. This study highlights the role of plantarflexor strength and Achilles tendon stiffness in regulating lateral gait stability in older adults, which may be targets for training protocols seeking to minimize fall risk and injury severity.

Coordinated energy-efficient walking assistance for paraplegic patients by using the exoskeleton-walker system

Overground walking can be achieved for patients with gait impairments by using the lower limb exoskeleton robots. Since it is a challenge to keep balance for patients with insufficient upper body strength, a robotic walker is necessary to assist with the walking balance. However, since the walking pattern varies over time, controlling the robotic walker to follow the walking of the human-exoskeleton system in coordination is a critical issue. Inappropriate control strategy leads to the unnecessary energy cost of the human-exoskeleton-walker (HEW) system and also results in the bad coordination between the human-exoskeleton system and the robotic walker. In this paper, we proposed a Coordinated Energy-Efficient Control (CEEC) approach for the HEW system, which is based on the extremum seeking control algorithm and the coordinated motion planning strategy. First, the extremum seeking control algorithm is used to find the optimal supporting force of the support joint in real time to maximize the energy efficiency of the human-exoskeleton system. Second, the appropriate reference joint angles for wheels of the robotic walker can be generated by the coordinated motion planning strategy, causing the good coordination between the human-exoskeleton system and the robotic walker. The proposed approach has been tested on the HEW simulation model, and the experimental results indicate that the coordinated energy-efficient walking can be achieved with the proposed approach, which is increased by 60.16% compared to the conventional passive robotic walker.

Compensatory increase in ipsilesional supplementary motor area and premotor connectivity is associated with greater gait impairments: a personalized fMRI analysis in chronic stroke.

Balance and mobility impairments are prevalent post-stroke and a large number of survivors require walking assistance at 6 months post-stroke which diminishes their overall quality of life. Personalized interventions for gait and balance rehabilitation are crucial. Recent evidence indicates that stroke lesions in primary motor pathways, such as corticoreticular pathways (CRP) and corticospinal tract (CST), may lead to reliance on alternate motor pathways as compensation, but the current evidence lacks comprehensive knowledge about the underlying neural mechanisms. In this study, we investigate the functional connectivity (FC) changes within the motor network derived from an individualized cortical parcellation approach in 33 participants with chronic stroke compared to 17 healthy controls. The correlations between altered motor FC and gait deficits (i.e., walking speed and walking balance) were then estimated in the stroke population to understand the compensation mechanism of the motor network in motor function rehabilitation post-stroke. Our results demonstrated significant FC increases between ipsilesional medial supplementary motor area (SMA) and premotor in stroke compared to healthy controls. Furthermore, we also revealed a negative correlation between ipsilesional SMA-premotor FC and self-selected walking speed, as well as the Functional Gait Assessment (FGA) scores. The increased FC between the ipsilesional SMA and premotor regions could be a compensatory mechanism within the motor network following a stroke when the individual can presumably no longer rely on the more precise CST modulation of movements to produce a healthy walking pattern. These findings enhance our understanding of individualized motor network FC changes and their connection to gait and walking balance impairments post-stroke, improving stroke rehabilitation interventions.

Does the effect of walking balance perturbations generalize across contexts?

Balance perturbations are used to study locomotor instability. However, these perturbations are designed to provoke a specific context of instability that may or may not generalize to a broader understanding of falls risk. The purpose of this study was to determine if the effect of balance perturbations on instability generalizes across contexts. 29 younger adults and 28 older adults completed four experimental trials, including unperturbed walking and walking while responding to three perturbation contexts: mediolateral optical flow, treadmill-induced slips, and lateral waist-pulls. We quantified the effect of perturbations as an absolute change in margin of stability from unperturbed walking. We found significant changes in mediolateral and anteroposterior margin of stability for all perturbations compared to unperturbed walking in both cohorts (p-values ≤ 0.042). In older adults, the mediolateral effects of lateral waist-pulls significantly correlated with those of optical flow perturbations and treadmill-induced slips (r ≥ 0.398, p-values ≤ 0.036). In younger adults but not in older adults, we found positive and significant correlations between the anteroposterior effect of waist-pull perturbations and optical flow perturbations, and the anteroposterior and mediolateral effect of treadmill-induced slips (r ≥ 0.428, p-values ≤ 0.021). We found no “goldilocks” perturbation paradigm to endorse that would support universal interpretations about locomotor instability. Building the most accurate patient profiles of instability likely requires a series of perturbation paradigms designed to emulate the variety of environmental contexts in which falls may occur.

Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke

BackgroundMany people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS. Research questionAre biomechanical metrics of mediolateral step modulation related to common clinical balance measures among PwCS? MethodsIn this cross-sectional study, 93 PwCS walked on a treadmill at their self-selected speed for 3-minutes. We quantified mediolateral step modulation for both paretic and non-paretic steps by calculating partial correlations between mediolateral pelvis displacement at the start of each step and step width (ρSW), mediolateral foot placement relative to the pelvis (ρFP), and final mediolateral location of the pelvis (ρPD) at the end of the step. We also assessed several common clinical balance measures (Functional Gait Assessment [FGA], Activities-specific Balance Confidence scale [ABC], self-reported fear of falling and fall history). We performed Spearman correlations to relate each biomechanical metric of step modulation to FGA and ABC scores. We performed Wilcoxon rank sum tests to compare each biomechanical metric between individuals with and without a fear of falling and a history of falls. ResultsOnly ρFP for paretic steps was significantly related to all four clinical balance measures; higher paretic ρFP values tended to be observed in participants with higher FGA scores, with higher ABC scores, without a fear of falling and without a history of falls. However, the strength of each of these relationships was only weak to moderate. SignificanceWhile the present results do not provide insight into causality, they justify future work investigating whether interventions designed to increase ρFP can improve clinical measures of post-stroke balance in parallel.

An IMU-Based Ground Reaction Force Estimation Method and Its Application in Walking Balance Assessment.

Walking is one of the most common daily movements of the human body. Therefore, quantitative evaluation of human walking has been commonly used to assist doctors in grasping the disease degree and rehabilitation process of patients in the clinic. Compared with the kinematic characteristics, the ground reaction force (GRF) during walking can directly reflect the dynamic characteristics of human walking. It can further help doctors understand the degree of muscle recovery and joint coordination of patients. This paper proposes a GRF estimation method based on the elastic elements and Newton-Euler equation hybrid driving GRF estimation method. Compared with the existing research, the innovations are as follows. 1) The hardware system consists of only two inertial measurement units (IMUs) placed on shanks. The acquisition of the overall motion characteristics of human walking is realized through the simplified four-link walking model and the thigh prediction method. 2) The method was validated not only on 10 healthy subjects but also on 11 Parkinson's patients and 10 stroke patients with normalized mean absolute errors (NMAEs) of 5.95%±1.32%, 6.09%±2.00%, 5.87%±1.59%. 3) This paper proposes a dynamic balance assessment method based on the acquired motion data and the estimated GRF. It evaluates the overall balance ability and fall risk at four key time points for all subjects recruited. Because of the low-cost system, ease of use, low motion interference and environmental constraints, and high estimation accuracy, the proposed GRF estimation method and walking balance automatic assessment have broad clinical value.

A Passive Polycentric Mechanism to Improve Active Mediolateral Balance in Prosthetic Walking.

Prosthetic legs are typically passive systems without active ankle control, restricting mediolateral balancing to a hip strategy. Resulting balance control impairments for persons with a lower extremity amputation may be mitigated by increasing hip strategy effectiveness, in which relatively small hip moments of force are adequate for mediolateral balancing. To increase hip strategy effectiveness we have developed a prosthetic leg prototype based on the Peaucellier mechanism, the Sideways Balance Mechanism (SBM). This polycentric mechanism adds a frontal plane degree of freedom, reducing mediolateral body displacements. Adding a passive joint alone introduces instability, in which mediolateral body rotation leads to CoM height loss, ultimately resulting in a fall. The SBM however provides stability typically absent by lengthening under rotation, thereby compensating for CoM height loss. By allowing for both foot rotation (in-/eversion), and increased mediolateral ground reaction force the SBM increases hip strategy effectiveness. We aimed to provide proof of principle that the SBM can improve active mediolateral balance control in prosthetic walking by increasing hip strategy effectiveness compared to a typical set-up. Comparison between a typical set-up and the SBM showed an increased mediolateral ground reaction force at equal hip moments of force for a 2D forwards dynamics computer simulation, and a reduced hip moment of force at equal mediolateral ground reaction force for a case study. Results validate increased hip strategy effectiveness of the SBM compared to a typical set-up, providing proof of principle that adding an SBM to a prosthetic set-up improves mediolateral balance control in prosthetic walking.

Abduction/Adduction Assistance From Powered Hip Exoskeleton Enables Modulation of User Step Width During Walking.

As the first step to show its potential, the objective of this study was to investigate how human's step width reacted to hip exoskeleton's admittance control parameter changes during walking. Ten non-disabled individuals walked on a treadmill at a self-selected speed, while wearing our bilateral robotic hip exoskeleton. We used two equilibrium positions to define the direction of assistance. We studied the influence of multiple stiffness values in the admittance control on the participants' step width, step length, and electromyographic (EMG) activity of the gluteus medius. Step width were significantly modulated by the change of stiffness in exoskeleton control, while step length did not show significant changes. When the stiffness changed from zero to our studied stiffness values, the participants' step width started to modulate immediately. Within 4 consecutive heel strikes right after a stiffness change, the step width showed a significant change. Interestingly, EMG activity of the gluteus medius did not change significantly regardless the applied stiffness and powered direction. Tuning of stiffness in admittance control of a hip exoskeleton, acting in mediolateral direction, can be a viable way for controlling step width in normal walking. Unvaried gluteus medius activity indicates that the increase in step width were mainly caused by the assistive torque applied by the exoskeleton. Our study results pave a new way for future design and control of wearable robotics in enhancing mediolateral walking balance for various rehabilitation applications.

PEMBERDAYAAN LANSIA MELALUI LATIHAN JALAN TENDEM DALAM RANGKA MENGURANGI RESIKO JATUH

Health is a basic and important element. Poor health conditions result in people being unable to regulate their own lifestyle and development in their area. As an emerging physiological syndrome in elderly health, frailty is a predictive factor of negative health outcomes, such as increased risk of death, decreased activities of daily living. This Community Service Activity aims to create a community that has knowledge and abilities, especially the elderly, especially in the health sector. The government's basic concept in developing elderly health program services aims to enable elderly people to live healthy lives by optimizing physical, mental, cognitive and spiritual functions through various promotive, preventive, curative and rehabilitative efforts including elderly empowerment programs in the community (Ministry of Health, 2020). One of the elderly empowerment programs is to reduce the risk of falls through tendem walking exercises. Tendemic walking exercises are exercises, attitudes or body positions to control balance, muscle coordination and body movements in order to reduce the risk of falls which often occur in the elderly. The aim of this community service activity is to empower the elderly by providing walking balance training in order to reduce the risk of falls in Tohudan Wetan Village, Colomadu, Karanganyar, Central Java. The target for counseling is 30 participants. Method. The method used is quantitative descriptive. The instrument used was a material understanding questionnaire containing 12 closed questions. This counseling aims to optimize the understanding of the elderly in order to minimize the risk of falls through walking balance exercises. The evaluation method used is a questionnaire to assess understanding of the pre- and post-activity counseling material. Results. Elderly empowerment activities are carried out through lecture methods, discussions and distribution of material leaflets. Material regarding the understanding and knowledge of elderly people about the risk of falling, risk factors for falling, understanding the tendem walk, implementation of the tendem walk exercise carried out every day in the morning and evening for one week with a duration of 10-15 minutes, the benefits of the tendem walk, evidence base of the tendem walk. The results of discussions carried out with the elderly showed that there was a change in knowledge about the importance of doing balance exercises in the form of tendem walking to reduce the risk of falls which often occur in the elderly. Conclusion. Based on the pretest and posttest results, a value of 0.000 (p&lt;0.005) was obtained, meaning (1) tandem walking exercises provide increased information for the elderly in an effort to prevent the risk of falls (2) tandem walking exercises can improve balance in the elderly, (3) elderly people agree to do the exercises This tendem balance walk is carried out routinely, both individually and in groups, (3) this activity requires follow-up and cooperation between village officials, elderly organization administrators, health cadres and the elderly so that this training program can be continued.