Influence of aging on the relation between head control and hip joint kinematics during crossover stepping.

Falls in older individuals are a serious health issue in super-aged societies. The stepping reaction is an important postural strategy for preventing falls. This study aimed to reveal the characteristics of lateral stepping in response to mechanical disturbance by means of an analysis of the hip joint kinematics in the stepping leg and head stability during crossover steps. The participants included 11 healthy older and 13 younger individuals. An electromagnet-controlled disturbance-loading device induced crossover steps due to lateral disturbance. Responses were measured using a motion capture system and force plates. The righting reaction of the head was quantified by lateral displacement (sway), neck joint kinematics (angle displacement, angular velocity), and neck joint moment during crossover stepping. Moreover, the relationship between the neck lateral bending moment and angular velocity of hip flexion/adduction of the stepping leg was examined. The lateral head sway was significantly larger in the older participants (1.13±0.7 m/s2) than in the younger individuals (0.54±0.3 m/s2); whereas, the angle displacement (older -14.1±7.1 degree, young -8.3±4.5 degree) and angular velocity (older 9.9±6.6 degree/s, 41.2±27.7 degree/s) of the head were significantly lower in the older than in the younger participants. In both groups, the moment of neck lateral bending exhibited a significant negative correlation with the hip flexion angular velocity of the stepping leg. Correlation analysis also showed a significant negative correlation between the neck lateral bending moment and hip adduction angular velocity only in the older group (r = 0.71, p<0.01). In conclusion, older individuals increased instability in the lateral direction of the head and decreased righting angle displacement and angular velocity of the head during crossover steps. The correlation between neck moment and hip flexion/adduction angular velocity suggested a decrease in step speed due to increased neck muscle tone, which could be influenced by vestibulospinal reflexes.

Age-Related Changes in Inter-Joint Interactions for Global and Local Kinematics While Standing.

Inter-joint interactions are involved in human standing. These interactions work not only for global kinematics that control the center of mass (COM) of the entire body, but also for local kinematics that control joint angular movements. Age-related changes in these interactions are thought to cause unstable standing postures in older people. Interactions of global kinematics are known to be deficient owing to aging. However, it is unclear whether the interaction of local kinematics is affected by aging. We investigated the age-related changes in inter-joint interactions, especially local kinematics, during standing. Differences were investigated in these two inter-joint interactions between older and younger adults in three different postures: normal, eyes-closed, and foam-surface standings. The inter-joint interaction for local kinematics was computed using the induced-acceleration analysis with a double-inverted pendulum model and quantified using an uncontrolled manifold approach. Consistent with previous studies, the inter-joint interaction for COM acceleration (global kinematics) deteriorated in older adults. In contrast, the interactions for angular accelerations in the ankle and hip joints (local kinematics) were slightly better in the older adults. Moreover, the individual components of angular acceleration which were induced by net torques from homonymous and remote joints were significantly increased in older adults. Thus, global and local inter-joint interactions are driven by distinct neural mechanisms and the interaction of local kinematics can compensate for the increment of each component of joint angular acceleration in older adults.

Postoperative Recovery of Gait Function at Early Phase Is Delayed in Patients with Spinal Tumors with Impairment of the Joint Position Sense in the Big Toe: A Retrospective Cohort Study.

Introduction: We investigated the effect of preoperative joint position sense in the big toe on the postoperative recovery of gait function after spinal tumor surgery. Methods: Seventy-three patients with spinal tumors who underwent surgery at our hospital between 2014 and 2019 and could be followed for at least 6 months after surgery were included. The patients were divided into the cervical spinal (41 cases) and thoracic spinal (32 cases) groups according to the localization of the tumor. These groups were further classified into an Impaired group (cervical spinal, 34 cases; thoracic spinal, 19 cases) and an Intact group (cervical spinal, 7 cases; thoracic spinal, 13 cases) according to the presence or absence of preoperative joint position sense in the big toe. The amount of change in ambulatory function from the preoperative period to 3 and 6 months postoperatively was compared between the Impaired and Intact groups within each tumor localization category. Results: Impaired preoperative joint position sense in the big toe in patients undergoing thoracic spinal tumor surgery delayed the recovery of gait function in the early postoperative period. Conclusions: In patients with thoracic spinal tumor surgery, the absence of preoperative joint position sense in the big toe delayed the recovery of postoperative gait function.

Discrimination of standing postures between young and elderly people based on center of pressure.

Posturography is utilized to assess the influence of aging on postural control. Although this measurement is advantageous for finding group-level differences between the young and the elderly, it is unclear whether it has the potential to differentiate elderly individuals who are affected by various impacts of aging. The purpose of this study was to determine the utility of posturography to discriminate elderly individuals from young adults. We investigated the performances of the random forest classifiers constructed from center of pressure (COP) indices for discriminating standing postures between healthy elderly and young people. Postural sways in 19 young and 31 community-dwelling elderly participants were measured using force plates in 4 standing conditions: bipedal standing, standing on a narrow base, standing on foam rubber, and standing with eyes closed. We further verified the informative predictors that contributed to the prediction model. As the results, the classifier based on the COP indices for standing on foam rubber showed the best performance (accuracy: 93.4%, sensitivity: 94.4%, specificity: 93.6%, area under the curve of receiving operator characteristics: 0.95), followed by the classifier for standing with eyes closed. The informative predictors varied depending on the postural conditions. Our findings demonstrated the potential of posturography for identifying elderly postures. The evaluation of sensory re-weighting using the appropriate COP indices would be a useful clinical tool for detecting the progress of aging on postural control.

Age-related changes in standing ability on a foam surface based on the center-of-mass acceleration of each body segment.

[Purpose] The purpose of this study was to elucidate the age-related changes in the stability of the quiet standing posture based on the acceleration of the center of mass of each body segment under deteriorated somatosensory conditions. [Participants and Methods] The participants in this study were 18 healthy elderly persons and 11 healthy young adults. A foam surface was placed on the force plate for load-bearing onto the somatosensory system. The participants maintained a quiet position on the force plate under two conditions: a firm surface and a foam surface. The accelerations of the head, thorax, pelvis, and whole body center of mass when quiet standing in two conditions were measured by a motion capture system. In the statistical analysis, regarding the center of mass of each body segment, the interactions were examined by performing a two-way analysis of variance using age and surface condition as factors. [Results] A two-way analysis of variance detected an interaction between age and surface factors for anteroposterior acceleration at the center of mass of the head. For other body segments, interactions between the two factors were not detected. [Conclusion] The results of anteroposterior acceleration at the center of mass of the head suggest that under conditions of deteriorated somatosensory function in the lower limbs, minute anteroposterior position adjustment of the head is an essential characteristic of the standing posture control mechanism in the elderly.

A successful backward step correlates with hip flexion moment of supporting limb in elderly people.

PURPOSE: The objective of this study was to determine the positional relationship between the center of mass (COM) and the center of pressure (COP) at the time of step landing, and to examine their relationship with the joint moments exerted by the supporting limb, with regard to factors of the successful backward step response. METHODS: The study population comprised 8 community-dwelling elderly people that were observed to take successive multi steps after the landing of a backward stepping. Using a motion capture system and force plate, we measured the COM, COP and COM-COP deviation distance on landing during backward stepping. In addition, we measured the moment of the supporting limb joint during backward stepping. The multi-step data were compared with data from instances when only one step was taken (single-step). Variables that differed significantly between the single- and multi-step data were used as objective variables and the joint moments of the supporting limb were used as explanatory variables in single regression analyses. RESULTS: The COM-COP deviation in the anteroposterior was significantly larger in the single-step. A regression analysis with COM-COP deviation as the objective variable obtained a significant regression equation in the hip flexion moment (R2 = 0.74). CONCLUSIONS: The hip flexion moment of supporting limb was shown to be a significant explanatory variable in both the PS and SS phases for the relationship with COM-COP distance. This study found that to create an appropriate backward step response after an external disturbance (i.e. the ability to stop after 1 step), posterior braking of the COM by a hip flexion moment are important during the single-limbed standing phase.

Sagittal plane spinal mobility is associated with dynamic balance ability of community-dwelling elderly people.

[Purpose] The purpose of this study was to clarify the correlation between the range of spinal mobility on the sagittal plane and the dynamic balance ability of elderly people living in communities. [Subjects and Methods] The persons studied were 31 healthy elderly people living in the community (16 females and 15 males). The range of mobility of the participants' spines in the sagittal plane was measured by using a spinal mouse®. Balance ability was evaluated by using Functional reach (FR), Timed up and go (TUG), and Maximum walking speed (MWS). [Results] A significant positive correlation between the flexion range of the lumbar vertebrae and the FR distance was identified, and a significant negative correlation between the extension range of the thoracic vertebrae and the time required for TUG was also identified. In addition, a significant positive correlation between the extension range of the entire spine and MWS, was identified. [Conclusion] The result of this study have clarified that mobility of the spine in the sagittal plane is associated with dynamic balance ability, which is related to falling.

Relationship between muscular strength and deflection characteristics of the center of foot pressure during landing after crossover stepping in the elderly.

This study aimed to investigate the relationship between the muscular strength of the lower extremity in a load side and the characteristics of center of foot pressure (COP) during landing after crossover stepping in the elderly. The study population comprised 8 elderly subjects (average age, 75.8+/-8.0 years) and 9 young individuals (average age, 21.6+/-2.5 years). Using a separation-type force plate, we measured the deflection characteristics of the COP; these were defined by the root mean square of positional change (COP-RMS) and the deflection velocity of the COP (COP-Vel) during landing after crossover stepping. Furthermore, we measured the muscular strength of the lower extremity by using a hand-held dynamometer. By using multiple regression analysis, we detected the calculated muscular strength as the independent variable of the deflection characteristics of the COP. Compared to the young group the elderly group showed significantly higher anterior-posterior COP-RMS values (p<0.05) and lower lateral COP-Vel values (p<0.001). In the elderly, the muscular strengths of the tibialis anterior and adductor magnus were detected as a significant independent variable of the anterior-posterior COP-RMS (R(2)=0.85, R(2)=0.76, p<0.01) and lateral COP-Vel (R(2)=0.75, R(2)=0.65, p<0.05), respectively. With regard to the COP deflection characteristics during landing after crossover stepping in the elderly, we recognized the diagnostic character of the anterior-posterior COP-RMS and lateral COP-Vel. Furthermore, it was suggested that the muscular strengths of the tibialis anterior and adductor magnus played a role in regulating the COP deflection characteristics.

The effect of aging on the backward stepping reaction as estimated from the velocity of center of foot pressure and muscular strength.

By estimating the deflection velocity from the center of foot pressure (COP), this study aims to prove that the characteristics of the backward stepping reaction in the elderly are related to the strength of the antigravity muscles. The participants in this study were 10 elderly (average age 75.6+/-7.6 years) and 13 young (average age 22.0+/-2.6 years) subjects. Using force plate analysis, we measured the shift in the deflection velocity (V-RMS) and the maximum deflection velocity (V-MAX) from the beginning of the COP movement to the onset of the stepping reaction. Furthermore, we measured the strength of the antigravity muscles using a hand-held dynamometer. We correlated the V-RMS, V-MAX, and the rate of change of the deflection velocity (MAX/RMS) with muscular strength. When compared with the young subjects, the elderly showed significantly lower values of V-RMS (p<0.05) and significantly higher values of MAX/RMS (p<0.01). Furthermore, when compared with the young subjects, the elderly showed significantly lower values of muscular strength for all muscles studied (p<0.001). We established a significant correlation between the V-RMS, MAX/RMS, and muscular strength by carrying out a regression analysis (V-RMS: gluteus maximus (r=0.50, p<0.05) and rectus abdominis (r=0.48, p<0.05); MAX/RMS: adductor magnus (r=-0.66, p<0.001) and flexor digitorum longus (r=-0.62, p<0.01)). Differences were observed in the V-RMS and MAX/RMS during the backward stepping reaction; it was proposed that these differences were related to the age and muscular strength of the subjects. Therefore, further investigations should be undertaken in order to understand the effects of aging on the stepping reaction. In other words, the change-in-support strategy, including the preparatory phase of the stepping reaction, and its relationship with muscular strength should be further investigated.