What were you thinking?

We were just talking about cognitive tasking and arm swing, and have talked about cognition altering gait. Here is a another paper on cognition (or inattention in this case) boding not so well

 

ABSTRACT: We examined factors related to conditions of life function and falls, including eye movements and gait variability, in community-dwelling older adults in Japan.

METHODS: Participants were 82 older adults (21 men, 61 women, mean age 76.1 years). We measured eye movements and gait variability during walking, and cognitive, attentional and life function. We compared two groups according to their fall history, and used a multiple logistic regression analysis to determine its relevance.

RESULTS: Fixation time, which was estimated from eye movements during obstacle crossing, and gait variability (vertical) were significantly associated with falls. There was also a significant correlation between fixation time and gait variability during obstacle crossing. In other words, the higher the gait variability in older adults, the higher the risk of falls, which was due to reduced attention estimated from eye movements during obstacle crossing that required obstacle avoidance.

CONCLUSIONS: These results show that poor attention during gait is a critical risk factor for falls in community-dwelling older adults. For fall prevention, it is necessary to promote exercises for attention, and to maintain an older adult-friendly pedestrian environment.

 

 

Inoue T, Kamijo K, Haraguchi K, Suzuki A, Noto M, Yamashita Y, Nakamura T. Risk factors for falls in terms of attention during gait in community-dwelling older adults. Geriatr Gerontol Int. 2018 Jun 27. doi: 10.1111/ggi.13462. [Epub ahead of print]

 

Slow Down already...

"too much tripping, soles worn thin.... too much trippin and my souls worn thin"
Scott Weiland: Stone Temple Pilots

Nothing earth shattering here. Tripping (no, not THAT kind) can be due to many variables including biomechanical as well as alterations in surfaces and/or terrain. For probable proprioceptive reasons and less brain "interpolation", walking slower decreases your trip risk. This study looked at minimal clearance of the great toe (requiring adequate ankle dorsiflexion as well as great toe dorsiflexion). This was classically used to determine trip risk. This new measure called the "trip risk integral" calculates stability throughout the gait cycle rather than just a single point in time.

The results?
 "... slower gait is both an important covariate and potential intervention for trip-related falls."

our conclusion: Look at the WHOLE gait cycle, not just at one point intime...

 

 

Schulz BW A new measure of trip risk integrating minimum foot clearance and dynamic stability across the swing phase of gait. J Biomech. 2017 Apr 11;55:107-112. doi: 10.1016/j.jbiomech.2017.02.024. Epub 2017 Feb 27.

Turning: Connecting the kinetic chain

Look at the photo, which way am I turning my head ? How hard am I turning ? Perhaps I am turning hard through my neck and thoracic spine to look over my shoulder.  The point is, you can see it in my feet and if you know your biomechanics you should easily know which way I am turned.

 It should be simple and clear that I am turning my neck and thoracic spine strongly to the left.  The left rotation has forced me to find stability over the lateral left foot while driving the rotation with the right foot.  Left foot had to supinate, right had to pronate. No rocket science here.
Earlier in the week I posted a brief discussion on the neck and proprioception and the upper and lower limb. I caught some questions on challenging the strength of the neurological linkages to the lower limb, so I promised a simple picture to solidify my point.
Where is what i wrote earlier this week.
"From the study: "Limb proprioception is an awareness by the central nervous system (CNS) of the location of a limb in three-dimensional space and is essential for movement and postural control. The CNS uses the position of the head and neck when interpreting the position of the upper limb, and altered input from neck muscles may affect the sensory inputs to the CNS and consequently may impair the awareness of upper limb joint position."

We say it is not just the upper limb however, the neck and head posture is used in interpreting the position of the lower limb as well. And similarly altered head/neck muscle input can impair awareness of the lower limb posture as well. Think about it, we are trying to stay upright in the gravitational plane while keeping the eyes and vestibular centers on the horizon. Gait is nothing more than a single leg balancing act repeated over and over. Faulty info on where our center of pressure is from a visual or vestibular aspect will alter where we put our foot in space. Just look at how many neurologic diseases end up with a wider based gait, because our proprioceptive centers no longer trust our base of support. It is all connected."

Exp Brain Res. 2015 May;233(5):1663-75. doi: 10.1007/s00221-015-4240-x. Epub 2015 Mar 13.

Neck muscle fatigue alters upper limb proprioception.

Zabihhosseinian M1, Holmes MW, Murphy B.
 

As in this study, and putting it together with my photo and discussion at the start here today, limb proprioception is an awareness by the CNS of the location of the limb and is essential for proper movement and postural control. If I had rotated to the left and had my CNS not known where the foot was in space and in relation to the rest of my body, I may have fallen over to the left. Instead, my CNS sensed the weight shift to the left from the neck and torso rotation, and moved my foot weight bearing into supination (affording a slightly greater lateral weight bearing on the foot) to accommodate the shift in my center of pressure and mass laterally.  So, the CNS used the position of the head and neck, and the weight shift, in interpreting the appropriate positioning of the lower limbs. Sometimes moving the foot into supination to accommodate the lateral load is not enough, and we need to actually step laterally to maintain upright.  Altered input from my neck muscles might affect the sensory inputs to the CNS and consequently may impair the awareness of my limb joint positioning in space. This happens often in vestibular challenged clients and in client of aging decline where the system is losing proprioception. If we do not know where a body part is in space, we don't know how to use it or how to load it (think about chronic ankle sprains).

As i said earlier this week, think about it, we are trying to stay upright in the gravitational plane while keeping the eyes and vestibular centers on the horizon. Gait is nothing more than a single leg balancing act repeated over and over. Faulty info on where our center of pressure is from a visual or vestibular aspect will alter where we put our foot in space. Just look at how many neurologic diseases end up with a wider based gait, because our proprioceptive centers no longer trust our base of support. It is all connected.

Think about how amazing this system is when it works right, we can run on a track leaning into the curve, we can ride a bike and lean into turns, we can run forward and yet turn to look behind us, all without falling over -- thanks to our CNS and joint proprioception.

Dr. Shawn Allen, the other gait guy

Difference between adult and infant gait compensation.

We highly doubt the infants compensated to the point of “recovering symmetrical gait”. It just isn’t possible seeing as there was frank asymmetry in leg length. However, it is quite possible they accomodated quicker with a more reasonable compensation, that MAY have appeared to have less limp. We did not do the study, but over a beer we might guess that the investigators might agree that our verbiage is closer to accurate. None the less, cool stuff to cogitate. We are very appreciative of this study, there is something to take from this study.

“The stability of a system affects how it will handle a perturbation: The system may compensate for the perturbation or not. This study examined how 14-month-old infants-notoriously unstable walkers-and adults cope with a perturbation to walking. We attached a platform to one of participants’ shoes, forcing them to walk with one elongated leg. At first, the platform shoe caused both age groups to slow down and limp, and caused infants to misstep and fall. But after a few trials, infants altered their gait to compensate for the platform shoe whereas adults did not; infants recovered symmetrical gait whereas adults continued to limp. Apparently, adult walking was stable enough to cope with the perturbation, but infants risked falling if they did not compensate. Compensation depends on the interplay of multiple factors: The availability of a compensatory response, the cost of compensation, and the stability of the system being perturbed.”- From the Cole et all study (reference below)

- thoughts by Shawn Allen

references:

Infant Behav Dev. 2014 Aug;37(3):305-14. doi: 10.1016/j.infbeh.2014.04.006. Epub 2014 May 20.Coping with asymmetry: how infants and adults walk with one elongated leg.Cole WG1, Gill SV2, Vereijken B3, Adolph KE4.

http://www.ncbi.nlm.nih.gov/pubmed/24857934