Unexpected walking perturbations: Reliability and validity of a new treadmill protocol to provoke muscular reflex activities at lower extremities and the trunk.

Instrumented treadmills offer the potential to generate standardized walking perturbations, which are particularly rapid and powerful. However, technical requirements to release adequate perturbations regarding timing, duration and amplitude are demanding. This study investigated the test-retest reliability and validity of a new treadmill perturbation protocol releasing rapid and unexpected belt perturbations to provoke muscular reflex responses at lower extremities and the trunk. Fourteen healthy participants underwent two identical treadmill walking protocols, consisting of 10 superimposed one-sided belt perturbations (100ms duration; 2m/s amplitude), triggered by a plantar pressure insole 200ms after heel contact. Delay, duration and amplitude of applied perturbations were recorded by 3D-motion capture. Muscular reflex responses (within 200ms) were measured at lower extremities and the trunk (10-lead EMG). Data was analyzed descriptively (mean±SD). Reliability was analyzed using test-retest variability (TRV%) and limits of agreement (LoA, bias±1.96∗SD). Perturbation delay was 202±14ms, duration was 102±4ms and amplitude was 2.1±0.01m/s. TRV for perturbation delay, duration and amplitude ranged from 5.0% to 5.7%. LoA reached 3±36ms for delay, 2±13ms for duration and 0.0±0.3m/s for amplitude. EMG amplitudes following perturbations ranged between 106±97% and 909±979% of unperturbed gait and EMG latencies between 82±14ms and 106±16ms. Minor differences between preset and observed perturbation characteristics and results of test-retest analysis prove a high validity with excellent reliability of the setup. Therefore, the protocol tested can be recommended to provoke muscular reflex responses at lower extremities and the trunk in perturbed walking.

Stumbling reactions during perturbed walking: Neuromuscular reflex activity and 3-D kinematics of the trunk - A pilot study.

Reflex activity of the lower leg muscles involved when compensating for falls has already been thoroughly investigated. However, the trunk׳s role in this compensation strategy remains unclear. The purpose of this study, therefore, was to analyze the kinematics and muscle activity of the trunk during perturbed walking. Ten subjects (29 ± 3 yr;79 ± 11 cm;74 ± 14 kg) walked (1m/s) on a split-belt treadmill, while 5 randomly timed, right-sided perturbations (treadmill belt deceleration: 40 m/s(2)) were applied. Trunk muscle activity was assessed with a 12-lead-EMG. Trunk kinematics were measured with a 3D-motion analysis system (12 markers framing 3 segments: upper thoracic area (UTA), lower thoracic area (LTA), lumbar area (LA)). The EMG-RMS [%] (0-200 ms after perturbation) was analyzed and then normalized to the RMS of normal walking. The total range of motion (ROM;[°]) for the extension/flexion, lateral flexion and rotation of each segment were calculated. Individual kinematic differences between walking and stumbling [%; ROM] were also computed. Data analysis was conducted descriptively, followed by one- and two-way ANOVAs (α=0.05). Stumbling led to an increase in ROM, compared to unperturbed gait, in all segments and planes. These increases ranged between 107 ± 26% (UTA/rotation) and 262 ± 132% (UTS/lateral flexion), significant only in lateral flexion. EMG activity of the trunk was increased during stumbling (abdominal: 665 ± 283%; back: 501 ± 215%), without significant differences between muscles. Provoked stumbling leads to a measurable effect on the trunk, quantifiable by an increase in ROM and EMG activity, compared to normal walking. Greater abdominal muscle activity and ROM of lateral flexion may indicate a specific compensation pattern occurring during stumbling.

Plantar pressure trigger for reliable nerve stimulus application during dynamic H-reflex measurements.

In dynamic H-reflex measurements, the standardisation of the nerve stimulation to the gait cycle is crucial to avoid misinterpretation due to altered pre-synaptic inhibition. In this pilot study, a plantar pressure sole was used to trigger the stimulation of the tibialis nerve with respect to the gait cycle. Consequently, the intersession reliability of the soleus muscle H-reflex during treadmill walking was investigated. Seven young participants performed walking trials on a treadmill at 5 km/h. The stimulating electrode was placed on the tibial nerve in the popliteal fossa. An EMG was recorded from the soleus muscle. To synchronize the stimulus to the gait cycle, initial heel strike was detected with a plantar pressure sole. Maximum H-reflex amplitude and M-wave amplitude were obtained and the Hmax/Mmax ratio was calculated. Data reveals excellent reliability, ICC=0.89. Test-retest variability was 13.0% (±11.8). The Bland-Altman analysis showed a systematic error of 2.4%. The plantar pressure sole was capable of triggering the stimulation of the tibialis nerve in a reliable way and offers a simple technique for the evaluation of reflex activity during walking.