Mechanically induced stumbling during human treadmill walking.

A new method to study the reactions to unexpected mechanical perturbations during human walking on a treadmill is presented. Perturbations consisted of an obstruction of the forward swinging foot during the early swing phase. These were caused by obstacles which were dropped on the treadmill in front of the subject. The timing of the perturbation was controlled by an electromagnet which released the obstacle at a preprogrammed delay after left or right heel strike. This kind of perturbation evoked stumbling reactions. The electromyographic (EMG) responses during these stumbling reactions had mean latencies of 76 ms in both the ipsilateral biceps femoris and rectus femoris when perturbations were applied in early swing. During the perturbed swing, increased flexion in the knee occurred to lift the foot over the obstacle. Both the EMG and kinesiologic responses were reproducible when perturbations were presented in the same part of the swing phase of different step cycles.

Widespread short-latency stretch reflexes and their modulation during stumbling over obstacles.

The present study investigated whether short-latency stretch reflexes are present during human stumbling reactions. While subjects walked on a treadmill, the forward sway of the foot was unexpectedly obstructed with an obstacle. All subjects showed reflex responses with average latencies of 34-42 ms in both the upper and the lower leg flexors and extensors of the obstructed leg. The amplitudes of these responses depended on the phase in the step cycle and were not strictly related to either the background activity of the corresponding muscles or variations in the perturbation. Hence, mechanisms at a premotoneuronal level might play a role in the active phase-dependent control of these responses. The coactivation of antagonists as well as the lack of obvious kinesiologic consequences following the responses suggest that the short-latency responses may generate joint stiffness. This may be a first line of defense in preparing for the functional reaction, which is generated by longer latency responses, in order to take appropriate action concerning the obstacle.

Distraction affects the performance of obstacle avoidance during walking.

In this study, dual-task interference in obstacle-avoidance tasks during human walking was examined. Ten healthy young adults participated in the experiment. While they were walking on a treadmill, an obstacle suddenly fell on the treadmill in front of their left leg during either midswing, early stance, or late stance of the ipsilateral leg. Participants were instructed to avoid the obstacle, both as a single task and while they were concurrently performing a cognitive secondary task (dual task). Rates of failure, avoidance strategy, and a number of kinematic parameters were studied under both task conditions. When only a short response time was available, rates of failure on the avoidance task were larger during the dual task than during the single task. Smaller crossing swing velocities were found during the dual task as compared with those observed in the single task. The difference in crossing swing velocities was attributable to increased stiffness of the crossing swing limb. The results of the present study indicated that divided attention affects young and healthy individuals' obstacle-avoidance performance during walking.

[Breast biopsy technique]. / Techniques de cytoponction mammaire.

The authors remind the fundamental bases of a successful needle puncture, both for cytological and histological purposes. Their different methods of puncture are described and for each modality, practical advice is aiming at increasing the cellular or tissular component of the samples are given.

Current management of lobular in situ neoplasia.

Although the term of lobular neoplasia was first proposed in 1978 and the term Lobular In situ Neoplasia (LIN) has been incorporated in the current World Health Organisation (WHO) classification to cover both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS), the clinical significance and the natural history of lobular neoplasia is far from being fully understood. Furthermore problems and confusion still remain surrounding (1) the most appropriate terminology and classification for these lesions, (2) the best course of long-term management after diagnosis.This article summarizes the opinions on LCIS management of a group of Belgian experts.

Stumbling over obstacles in older adults compared to young adults.

Falls are a major problem in older adults. Many falls occur because of stumbling. The aim of the present study is to investigate stumbling reactions of older adults and to compare them with young adults. While subjects walked on a treadmill, a rigid obstacle unexpectedly obstructed the forward sway of the foot. In general, older adults used the same movement strategies as young adults ("elevating" and "lowering"). The electromyographic responses were categorized according to latencies: short-latency (about 45 ms, RP1), medium-latency (about 80 ms, RP2), and long-latency responses (about 110 ms, RP3; about 160 ms, RP4). Latencies of RP1 responses increased by about 6 ms and of RP2 by 10-19 ms in older adults compared with the young. Amplitudes of RP1 were similar for both age groups, whereas amplitudes of RP2-RP4 could differ. In the early-swing elevating strategy (perturbed foot directly lifted over the obstacle) older adults showed smaller responses in ipsilateral upper-leg muscles (biceps femoris and rectus femoris). This was related to shorter swing durations, more shortened step distances, and more failures in clearing the obstacle. In parallel, RP4 activity in the contralateral biceps femoris was enhanced, possibly pointing to a higher demand for trunk stabilization. In the late-swing lowering strategy (foot placed on the treadmill before clearing the obstacle) older adults showed lower RP2-RP3 responses in most muscles measured. However, kinematic responses were similar to those of the young. It is concluded that the changes in muscular responses in older adults induce a greater risk of falling after tripping, especially in early swing.

Muscular responses and movement strategies during stumbling over obstacles.

Although many studies have investigated reflexes after stimulation of either cutaneous or proprioceptive afferents, much less is known about responses after more natural perturbations, such as stumbling over an obstacle. In particular, the phase dependency of these responses and their relation to the stumbling behavior has received little attention. Hence response strategies during stumbling reactions after perturbations at different times in the swing phase of gait were studied. While subjects walked on a treadmill, a rigid obstacle unexpectedly obstructed the forward sway of the foot. All subjects showed an "elevating strategy" after early swing perturbations and a "lowering strategy" after late swing perturbations. During the elevating strategy, the foot was directly lifted over the obstacle through extra knee flexion assisted by ipsilateral biceps femoris (iBF) responses and ankle dorsiflexion assisted by tibialis anterior (iTA) responses. Later, large rectus femoris (iRF) activations induced knee extension to place the foot on the treadmill. During the lowering strategy, the foot was quickly placed on the treadmill and was lifted over the obstacle in the subsequent swing. Foot placement was actively controlled by iRF and iBF responses related to knee extension and deceleration of the forward sway. Activations of iTA mostly preceded the main ipsilateral soleus (iSO) responses. For both strategies, four response peaks could be distinguished with latencies of approximately 40 ms (RP1), approximately 75 ms (RP2), approximately 110 ms (RP3), and approximately 160 ms (RP4). The amplitudes of these response peaks depended on the phase in the step cycle. The phase-dependent modulation of the responses could not be accounted for by differences in stimulation or in background activity and therefore is assumed to be premotoneuronal in origin. In mid swing, both the elevating and lowering strategy could occur. For this phase, the responses of the two strategies could be compared in the absence of phase-dependent response modulation. Both strategies had the same initial electromyographic responses till approximately 100 ms (RP1-RP2) after perturbation. The earliest response (RP1) is assumed to be a short-latency stretch reflex evoked by the considerable impact of the collision, whereas the second (RP2) has features reminiscent of cutaneous and proprioceptive responses. Both these responses did not determine the behavioral response strategy. The functionally important response strategies depended on later responses (RP3-RP4). These data suggest that during stumbling reactions, as a first line of defense, the CNS releases a relatively aspecific response, which is followed by an appropriate behavioral response to avoid the obstacle.

Modulation of the startle response during human gait.

While many studies have shown that there is a phase-dependent modulation of proprioceptive and exteroceptive reflexes during gait, little is known about such modulation for auditory reflexes. To examine how startle reactions are incorporated in an ongoing gait pattern, unexpected auditory stimuli were presented to eight healthy subjects in six phases of the step cycle during walking on a treadmill at 4 km/h. For both legs, electromyographic activity (EMG) was recorded in the biceps femoris (BF), the rectus femoris (RF), the tibialis anterior (TA), and the soleus (SO). In addition, stance and swing phases of both legs, along with knee angles of both legs and the left ankle angle, were measured. All subjects showed various response peaks. Responses with latencies of approximately 60 ms (F1), approximately 85 ms (F2), and approximately 145 ms (F3) were found. The amplitude of the reflex responses was dependent on the timing of the startle stimulus in the step cycle. Although the startle response habituated rapidly, the phase-dependent modulation pattern generally remained the same. The phase-dependent amplitude modulations were not strictly correlated with the modulation of the background activity. The TA even showed a transition from facilitatory F2 responses during stance to suppressive responses during midswing. Responses were observed in both flexors and extensors, often in coactivation, especially during stance. Furthermore the gait characteristics showed a shortening of the subsequent step cycle and a small decrease in the range of motion of ankle and knees. These results suggest that the responses are adapted to achieve extra stability dependent on the phase of the step cycle. However, even in the first trials, the changes in kinematics were small allowing a smooth progression of gait.