Use of 'wearables' to assess the up-on-the-toes test.

The mechanical output at the ankle provides key contribution to everyday activities, particularly step/stair ascent and descent. Age-related decline in ankle functioning can lead to an increased risk of falls on steps and stairs. The rising up-on-the-toes (UTT) 30-second test (UTT-30) is used in the clinical assessment of ankle muscle strength/function and endurance; the main outcome being how many repetitive UTT movements are completed. This preliminary study describes how inertial measurement units (IMUs) can be used to assess the UTT-30. Twenty adults (26.2 ± 7.7 years) performed a UTT-30 at a comfortable speed, with IMUs attached to the dorsal aspect of each foot. Use of IMUs' angular velocity signal to detect the peak plantarflexion angular velocity (p-fAngVelpeak) associated with each repeated UTT movement indicated the number of UTT movements attempted by each participant. Any UTT movements that were performed with a p-fAngVelpeak 2SD below the mean were deemed to have not been completed over a sufficiently 'full' range. Findings highlight that use of IMUs can provide valid assessment of the UTT 30-second test. Their use detected the same number of attempted UTT movements as that observed by a researcher (average difference, -0.1 CI, -0.2 - 0.1), and on average 97.6 ± 3.1% of these movements were deemed to have been completed 'fully'. We discuss the limitations of our approach for identifying the movements not completed fully, and how assessing the consistency in the magnitude of the repeated p-fAngVelpeak could be undertaken and what this would indicate about UTT-30 performance.

Using a smartphone on the move: do visual constraints explain why we slow walking speed?

Viewing one's smartphone whilst walking commonly leads to a slowing of walking. Slowing walking speed may occur because of the visual constraints related to reading the hand-held phone whilst in motion. We determine how walking-induced phone motion affects the ability to read on-screen information. Phone-reading performance (PRP) was assessed whilst participants walked on a treadmill at various speeds (Slow, Customary, Fast). The fastest speed was repeated, wearing an elbow brace (Braced) or with the phone mounted stationary (Fixed). An audible cue ('text-alert') indicated participants had 2 s to lift/view the phone and read aloud a series of digits. PRP was the number of digits read correctly. Each condition was repeated 5 times. 3D-motion analyses determined phone motion relative to the head, from which the variability in acceleration in viewing distance, and in the point of gaze in space in the up-down and right-left directions were assessed. A main effect of condition indicated PRP decreased with walking speed; particularly so for the Braced and Fixed conditions (p = 0.022). Walking condition also affected the phone's relative motion (p < 0.001); post-hoc analysis indicated that acceleration variability for the Fast, Fixed and Braced conditions were increased compared to that for Slow and Customary speed walking (p ≤ 0.05). There was an inverse association between phone acceleration variability and PRP (p = 0.02). These findings may explain why walking speed slows when viewing a hand-held phone: at slower speeds, head motion is smoother/more regular, enabling the motion of the phone to be coupled with head motion, thus making fewer demands on the oculomotor system. Good coupling ensures that the retinal image is stable enough to allow legibility of the information presented on the screen.

Stair Gait in Older Adults Worsens With Smaller Step Treads and When Transitioning Between Level and Stair Walking.

Older people have an increased risk of falling during locomotion, with falls on stairs being particularly common and dangerous. Step going (i.e., the horizontal distance between two consecutive step edges) defines the base of support available for foot placement on stairs, as with smaller going, the user's ability to balance on the steps may become problematic. Here we quantified how stair negotiation in older participants changes between four goings (175, 225, 275, and 325 mm) and compared stair negotiation with and without a walking approach. Twenty-one younger (29 ± 6 years) and 20 older (74 ± 4 years) participants negotiated a 7-step experimental stair. Motion capture and step-embedded force platform data were collected. Handrail use was also monitored. From the motion capture data, body velocity, trunk orientation, foot clearance and foot overhang were quantified. For all participants, as stair going decreased, gait velocity (ascent pA = 0.033, descent pD = 0.003) and horizontal step clearance decreased (pA = 0.001), while trunk rotation (pD = 0.002) and foot overhang increased (pA,D < 0.001). Compared to the younger group, older participants used the handrail more, were slower across all conditions (pA < 0.001, pD = 0.001) and their foot clearance tended to be smaller. With a walking approach, the older group (Group x Start interaction) showed a larger trunk rotation (pA = 0.011, pD = 0.015), and smaller lead foot horizontal (pA = 0.046) and vertical clearances (pD = 0.039) compared to the younger group. A regression analysis to determine the predictors of foot clearance and amount of overhang showed that physical activity was a common predictor for both age groups. In addition, for the older group, medications and fear of falling were found to predict stair performance for most goings, while sway during single-legged standing was the most common predictor for the younger group. Older participants adapted to smaller goings by using the handrails and reducing gait velocity. The predictors of performance suggest that motor and fall risk assessment is complex and multifactorial. The results shown here are consistent with the recommendation that larger going and pausing before negotiating stairs may improve stair safety, especially for older users.

Faster visual reaction times in elite athletes are not linked to better gaze stability.

The issue of whether visually-mediated, simple reaction time (VRT) is faster in elite athletes is contentious. Here, we examined if and how VRT is affected by gaze stability in groups of international cricketers (16 females, 28 males), professional rugby-league players (21 males), and non-sporting controls (20 females, 30 males). VRT was recorded via a button-press response to the sudden appearance of a stimulus (circular target-diameter 0.8°), that was presented centrally, or 7.5° to the left or right of fixation. The incidence and timing of saccades and blinks occurring from 450 ms before stimulus onset to 225 ms after onset were measured to quantify gaze stability. Our results show that (1) cricketers have faster VRT than controls; (2) blinks and, in particular, saccades are associated with slower VRT regardless of the level of sporting ability; (3) elite female cricketers had steadier gaze (fewer saccades and blinks) compared to female controls; (4) when we accounted for the presence of blinks and saccades, our group comparisons of VRT were virtually unchanged. The stability of gaze is not a factor that explains the difference between elite and control groups in VRT. Thus we conclude that better gaze stability cannot explain faster VRT in elite sports players.

Centre of mass control is reduced in older people when descending stairs at an increased riser height.

BACKGROUND: Maintaining body centre of mass (CoM) lowering velocity within manageable/safe limits during stair descent can be problematic for older individuals due to reduced ranges of motion at the involved joints (ankle and knee) and a reduced ability to generate adequate joint moments at the extremes in joint ranges of motion. These problems are likely to magnify in circumstances where the distance of lowering increases, or when misjudging the height of lowering. RESEARCH QUESTION: How does a 50% increase in standard stair riser-height affect control of CoM velocity and acceleration of older people during stair descent? METHODS: Fifteen older (75 ±â€¯3 years) and seventeen young (25 ±â€¯4 years) healthy adults descended a 4-step staircase, at two riser-heights: 170 mm, 255 mm. Changes in peak vertical CoM acceleration and velocity, and lower-limb joint kinetics (moments, work) during landing and lowering phases of stair descent were assessed using a mixed-design repeated measures analysis of variance. RESULTS: Peak CoM accelerations and velocities during landing and lowering were lower in older compared to young adults and increased in both groups at 255 mm riser-height. Duration of lowering also increased, particularly for older adults. Peak ankle moments during landing and lowering, which were lower in older compared to young adults, increased when descending from 255 mm riser-height, whilst the peak knee moment reduced. Both groups produced increased landing-limb negative (eccentric) ankle joint work when descending from 255 mm, but increases were greater for older adults (87.8%) compared to young (76.1%). SIGNIFICANCE: Descending stairs became more challenging in both age groups as riser-height increased. Older adults adopted a strategy of reducing CoM velocity to lessen the eccentric landing demands. In both groups, but more so older adults, there was a greater reliance on using leading-limb eccentric plantarflexion at 255 mm riser-height compared to 170 mm, to arrest/control increased downward CoM velocity and acceleration during landing.

Combined Resistance and Stretching Exercise Training Benefits Stair Descent Biomechanics in Older Adults.

INTRODUCTION: Stair descent is a physically demanding activity of daily life and common risk for falls. Age-related deteriorations in ankle joint capacities make stair descent particularly challenging for older adults in built environments, where larger rise steps are encountered. Exercise training may allow older adults to safely cope with the high biomechanical demands of stair descent. However, little is known about the demands of increased rise stairs for older adults, nor the impact of exercise. AIM: We investigated whether the effects of lower-limb resistance training would alter joint kinetics and movement strategies for older adults when descending standard rise, and increased rise stairs. METHODS: Fifteen older adults descended a four-step stair adjusted to standard rise (170 mm), and increased rise (255 mm) on separate visits. Between these two visits, randomly allocated participants underwent 16 weeks of either: resistance exercise training (n = 8) or habitual activity (n = 7). Kinetic data were measured from step-mounted force plates, and kinematic data from motion-capture cameras. Training involved twice-weekly sessions of lower-limb resistance exercises (three sets of ∼8 repetitions at ∼80% three-repetition maximum), and static plantarflexor stretching (three, 45 s holds per leg). RESULTS: Standard stairs - Peak ankle joint moments increased (p < 0.002) and knee joint moments decreased (p < 0.01) during descent after exercise training. Peak centre of pressure-centre of mass (CoP-CoM) separations increased in posterior (p = 0.005) and medio-lateral directions (p = 0.04) after exercise training. Exercise training did not affect CoM descent velocity or acceleration. Increased rise stairs - Required greater ankle, knee, and hip moments (p < 0.001), peak downward CoM velocity and acceleration (p = 0.0001), and anterior-posterior CoP-CoM separation (p = 0.0001), but lower medial-lateral CoP-CoM separation (p < 0.05), when compared to standard stair descent. Exercise training did not affect joint kinetics or movement strategies. DISCUSSION: Exercise training increased the maximum joint ROM, strength and force production of the ankle, and enabled a greater ankle joint moment to be produced in single-leg support (lowering phase) during standard stair descent. Descending increased rise stairs raised the task demand; exercise training could not overcome this. Future research should prioritize the ankle joint in stair descent, particularly targeting plantarflexor torque development across stairs of varying riser heights.

Energy cost of ambulation in trans-tibial amputees using a dynamic-response foot with hydraulic versus rigid 'ankle': insights from body centre of mass dynamics.

BACKGROUND: Previous research has shown that use of a dynamic-response prosthetic foot (DRF) that incorporates a small passive hydraulic ankle device (hyA-F), provides certain biomechanical benefits over using a DRF that has no ankle mechanism (rigA-F). This study investigated whether use of a hyA-F in unilateral trans-tibial amputees (UTA) additionally provides metabolic energy expenditure savings and increases the symmetry in walking kinematics, compared to rigA-F. METHODS: Nine active UTA completed treadmill walking trials at zero gradient (at 0.8, 1.0, 1.2, 1.4, and 1.6 of customary walking speed) and for customary walking speed only, at two angles of decline (5° and 10°). The metabolic cost of locomotion was determined using respirometry. To gain insights into the source of any metabolic savings, 3D motion capture was used to determine segment kinematics, allowing body centre of mass dynamics (BCoM), differences in inter-limb symmetry and potential for energy recovery through pendulum-like motion to be quantified for each foot type. RESULTS: During both level and decline walking, use of a hyA-F compared to rigA-F significantly reduced the total mechanical work and increased the interchange between the mechanical energies of the BCoM (recovery index), leading to a significant reduction in the metabolic energy cost of locomotion, and hence an associated increase in locomotor efficiency (p < 0.001). It also increased inter-limb symmetry (medio-lateral and progression axes, particularly when walking on a 10° decline), highlighting the improvements in gait were related to a lessening of the kinematic compensations evident when using the rigA-F. CONCLUSIONS: Findings suggest that use of a DRF that incorporates a small passive hydraulic ankle device will deliver improvements in metabolic energy expenditure and kinematics and thus should provide clinically meaningful benefits to UTAs' everyday locomotion, particularly for those who are able to walk at a range of speeds and over different terrains.

Gait termination on declined compared to level surface; contribution of terminating and trailing limb work in arresting centre of mass velocity.

To terminate gait, the mechanical work-done by the lower-limbs is likely to be predominantly negative but how such work is produced/completed has not previously been investigated. The aim of this study was to determine the amount of negative mechanical (external) work-done by the lower-limbs, along with the associated joints (muscle) work, to terminate gait and how these work contributions were affected by a change in surface angle. Eight males completed terminations on the level floor and a declined ramp. Negative mechanical limb-work (limbW(-ve)) was computed (each orthogonal direction) as the dot-product of the ground-reaction-force and centre-of-mass (CoM) velocity. Inverse dynamics was used to calculate ankle, knee and hip negative joints (muscle) work (Wj(-ve)). Measures were determined for each limb for the two-locomotor steps of gait termination. The trailing-limb did 67% (-0.386 J/kg) of the overall limbW(-ve) to terminate gait on the level; and this increased to 74% (-0.451 J/kg) for ramp trials. Wj(-ve) was greater for the trailing- (ankle -0.315; knee -0.357; hip -0.054 J/kg) compared to terminating- limb (ankle, -0.063; knee -0.051; hip -0.014 J/kg), with the increases in ankle Wj(-ve) being temporally associated with increases in perpendicular limbW(-ve). Wj(-ve) increased on both limbs for declined compared to level surface, particularly at the knee (declined -0.357, level -0.096 J/kg), with such increases being temporally associated with increases in parallel limbW(-ve). These findings provide new perspectives on how the limbs do work on the CoM to terminate gait, and may be helpful in designing prosthetic limbs to facilitate walking on ramps.

Gait termination on a declined surface in trans-femoral amputees: Impact of using microprocessor-controlled limb system.

BACKGROUND: Walking down ramps is a demanding task for transfemoral-amputees and terminating gait on ramps is even more challenging because of the requirement to maintain a stable limb so that it can do the necessary negative mechanical work on the centre-of-mass in order to arrest (dissipate) forward/downward velocity. We determined how the use of a microprocessor-controlled limb system (simultaneous control over hydraulic resistances at ankle and knee) affected the negative mechanical work done by each limb when transfemoral-amputees terminated gait during ramp descent. METHODS: Eight transfemoral-amputees completed planned gait terminations (stopping on prosthesis) on a 5-degree ramp from slow and customary walking speeds, with the limb's microprocessor active or inactive. When active the limb operated in its 'ramp-descent' mode and when inactive the knee and ankle devices functioned at constant default levels. Negative limb work, determined as the integral of the negative mechanical (external) limb power during the braking phase, was compared across speeds and microprocessor conditions. FINDINGS: Negative work done by each limb increased with speed (p < 0.001), and on the prosthetic limb it was greater when the microprocessor was active compared to inactive (p = 0.004). There was no change in work done across microprocessor conditions on the intact limb (p = 0.35). INTERPRETATION: Greater involvement of the prosthetic limb when the limb system was active indicates its ramp-descent mode effectively altered the hydraulic resistances at the ankle and knee. Findings highlight participants became more assured using their prosthetic limb to arrest centre-of-mass velocity.

Temporal estimation in prediction motion tasks is biased by a moving destination.

An ability to predict the time-to-contact (TTC) of moving objects that become momentarily hidden is advantageous in everyday life and could be particularly so in fast-ball sports. Prediction motion (PM) experiments have sought to test this ability using tasks where a disappearing target moves toward a stationary destination. Here, we developed two novel versions of the PM task in which the destination either moved away from (Chase) or toward (Attract) the moving target. The target and destination moved with different speeds such that collision occurred 750, 1,000 or 1,250 ms after target occlusion. To determine if domain-specific experience conveys an advantage in PM tasks, we compared the performance of different sporting groups ranging from internationally competing athletes to non-sporting controls. There was no difference in performance between sporting groups and non-sporting controls but there were significant and independent effects on response error by target speed, destination speed, and occlusion period. We simulated these findings using a revised version of the linear TTC model of response timing for PM tasks (Yakimoff, Bocheva, & Mitrania, 1987; Yakimoff, Mateeff, Ehrenstein, & Hohnsbein, 1993) in which retinal input from the moving destination biases the internal representation of the occluded target. This revision closely reproduced the observed patterns of response error and thus describes a means by which the brain might estimate TTC when the target and destination are in motion.

Vision and Visual History in Elite/Near-Elite-Level Cricketers and Rugby-League Players.

BACKGROUND: The importance of optimal and/or superior vision for participation in high-level sports remains the subject of considerable clinical research interest. Here, we examine the vision and visual history of elite/near-elite cricketers and rugby-league players. METHODS: Stereoacuity (TNO), colour vision, and distance (with/without pinhole) and near visual acuity (VA) were measured in two cricket squads (elite/international-level, female, n = 16; near-elite, male, n = 23) and one professional rugby-league squad (male, n = 20). Refractive error was determined, and details of any correction worn and visual history were recorded. RESULTS: Overall, 63% had their last eye examination within 2 years. However, some had not had an eye examination for 5 years or had never had one (near-elite cricketers 30%; rugby-league players 15%; elite cricketers 6%). Comparing our results for all participants to published data for young, optimally corrected, non-sporting adults, distance VA was ~ 1 line of letters worse than expected. Adopting α = 0.01, the deficit in distance VA was significant, but only for elite cricketers (p < 0.001) (near-elite cricketers, p = 0.02; rugby-league players, p = 0.03). Near VA did not differ between subgroups or relative to published norms for young adults (p > 0.02 for all comparisons). On average, near stereoacuity was better than in young adults, but only in elite cricketers (p < 0.001; p = 0.03, near-elite cricketers; p = 0.47, rugby-league players). On-field visual issues were present in 27% of participants and mostly (in 75% of cases) comprised uncorrected ametropia. Some cricketers (near-elite 17.4%; elite 38%) wore refractive correction during play, but no rugby-league player did. Some individuals with prescribed correction choose not to wear it when playing. CONCLUSIONS: Aside from near stereoacuity in elite cricketers, the basic visual abilities we measured were not better than equivalent, published data for optimally corrected adults; 20-25% exhibited sub-optimal vision, suggesting that the clearest possible vision might not be critical for participation at the highest levels in the sports of cricket or rugby league. Although vision could be improved in a sizeable proportion of our sample, the impact of correcting these, mostly subtle, refractive anomalies on playing performance is unknown.

The addition of stripes (a version of the 'horizontal-vertical illusion') increases foot clearance when crossing low-height obstacles.

Trips over obstacles are one of the main causes of falling in older adults, with vision playing an important role in successful obstacle negotiation. We determined whether a horizontal-vertical illusion, superimposed onto low-height obstacles to create a perceived increase in obstacle height, increased foot clearances during obstacle negotiation thus reducing the likelihood of tripping. Eleven adults (mean ± 1 SD: age 27.3 ± 5.1 years) negotiated obstacles of varying heights (3, 5, 7 cm) with four different appearance conditions; two were obstacles with a horizontal-vertical illusion (vertical stripes of different thickness) superimposed on the front, one was a plain obstacle and the fourth a plain obstacle with a horizontal black line painted on the top edge. Foot clearance parameters were compared across conditions. Both illusions led to a significant increase in foot clearance when crossing the obstacle, compared to the plain condition, irrespective of obstacle height. Superimposing a horizontal-vertical illusion onto low-height obstacles can increase foot clearance, and its use on the floor section of a double-glazing door frame for example may reduce the incidence of tripping in the home. Practitioner Summary: Low-height obstacles such as the floor section of a double-glazing door frame are potential tripping hazards. In a gait lab-based study we found that a horizontal-vertical illusion superimposed onto low-height obstacles led to significantly higher foot clearances; indicating their potential as a useful safety measure.

Intermediate addition multifocals provide safe stair ambulation with adequate 'short-term' reading.

PURPOSE: A recent randomised controlled trial indicated that providing long-term multifocal wearers with a pair of distance single-vision spectacles for use outside the home reduced falls risk in active older people. However, it also found that participants disliked continually switching between using two pairs of glasses and adherence to the intervention was poor. In this study we determined whether intermediate addition multifocals (which could be worn most of the time inside and outside the home and thus avoid continual switching) could provide similar gait safety on stairs to distance single vision spectacles whilst also providing adequate 'short-term' reading and near vision. METHODS: Fourteen healthy long-term multifocal wearers completed stair ascent and descent trials over a 3-step staircase wearing intermediate and full addition bifocals and progression-addition lenses (PALs) and single-vision distance spectacles. Gait safety/caution was assessed using foot clearance measurements (toe on ascent, heel on descent) over the step edges and ascent and descent duration. Binocular near visual acuity, critical print size and reading speed were measured using Bailey-Lovie near charts and MNRead charts at 40 cm. RESULTS: Gait safety/caution measures were worse with full addition bifocals and PALs compared to intermediate bifocals and PALs. The intermediate PALs provided similar gait ascent/descent measures to those with distance single-vision spectacles. The intermediate addition PALs also provided good reading ability: Near word acuity and MNRead critical print size were better with the intermediate addition PALs than with the single-vision lenses (p < 0.0001), with a mean near visual acuity of 0.24 ± 0.13 logMAR (~N5.5) which is satisfactory for most near vision tasks when performed for a short period of time. CONCLUSIONS: The better ability to 'spot read' with the intermediate addition PALs compared to single-vision spectacles suggests that elderly individuals might better comply with the use of intermediate addition PALs outside the home. A lack of difference in gait parameters for the intermediate addition PALs compared to distance single-vision spectacles suggests they could be usefully used to help prevent falls in older well-adapted full addition PAL wearers. A randomised controlled trial to investigate the usefulness of intermediate multifocals in preventing falls seems warranted.

Restricting ankle motion via orthotic bracing reduces toe clearance when walking over obstacles.

BACKGROUND: When trans-tibial amputees cross obstacles leading with their prosthesis, foot clearance is achieved using compensatory swing-phase kinematics. Such compensation would suggest able-bodied individuals normally use swing-phase ankle dorsiflexion to attain adequate obstacle clearance; however, direct evidence of such contribution is equivocal. This study determined the contribution of sagittal plane ankle motion in achieving lead-limb clearance during obstacle negotiation. METHODS: Twelve male able-bodied individuals (ages 18-30) completed obstacle crossing trials while walking on a flat surface. Lead-limb (right) ankle motion was manipulated using a knee-ankle-foot orthosis. Trials were completed with the ankle restricted at a neutral angle or unrestricted (allowing ∼±15° plantar/dorsiflexion). FINDINGS: Restricted ankle motion caused significant increase in trail-limb foot placement distance before the obstacle (p=0.005); significant decrease in vertical toe clearance (p<0.003), vertical heel clearance (p=0.045), and lead-limb foot placement distance after the obstacle (p=0.045); but no significant changes in knee angle at instant of crossing or in average walking speed. INTERPRETATION: The shifts in foot placements altered the part of swing that the lead-limb was in when the foot crossed the obstacle, which led to a decrease in clearance. These adaptations may have been due to being unable to dorsiflex the ankle to 'lift' the toes in mid-swing or to plantarflex the ankle during initial contact following crossing, which changed how the lead-limb was to be loaded. These findings suggest individuals using ankle bracing or those with ankle arthrodesis, will have reduced gait safety when negotiating obstacles.

Biomechanics of ramp descent in unilateral trans-tibial amputees: Comparison of a microprocessor controlled foot with conventional ankle-foot mechanisms.

BACKGROUND: Walking down slopes and/or over uneven terrain is problematic for unilateral trans-tibial amputees. Accordingly, 'ankle' devices have been added to some dynamic-response feet. This study determined whether use of a microprocessor controlled passive-articulating hydraulic ankle-foot device improved the gait biomechanics of ramp descent in comparison to conventional ankle-foot mechanisms. METHODS: Nine active unilateral trans-tibial amputees repeatedly walked down a 5° ramp, using a hydraulic ankle-foot with microprocessor active or inactive or using a comparable foot with rubber ball-joint (elastic) 'ankle' device. When inactive the hydraulic unit's resistances were those deemed to be optimum for level-ground walking, and when active, the plantar- and dorsi-flexion resistances switched to a ramp-descent mode. Residual limb kinematics, joints moments/powers and prosthetic foot power absorption/return were compared across ankle types using ANOVA. FINDINGS: Foot-flat was attained fastest with the elastic foot and second fastest with the active hydraulic foot (P<0.001). Prosthetic shank single-support mean rotation velocity (p =0.006), and the flexion (P<0.001) and negative work done at the residual knee (P=0.08) were reduced, and negative work done by the ankle-foot increased (P<0.001) when using the active hydraulic compared to the other two ankle types. INTERPRETATION: The greater negative 'ankle' work done when using the active hydraulic compared to other two ankle types, explains why there was a corresponding reduction in flexion and negative work at the residual knee. These findings suggest that use of a microprocessor controlled hydraulic foot will reduce the biomechanical compensations used to walk down slopes.

Prehension of a Flanked Target in Individuals With Amblyopia.

PURPOSE: Reduced binocularity is a prominent feature of amblyopia and binocular cues are thought to be important for prehension. We examine prehension in individuals with amblyopia when the target-object was flanked, thus mimicking everyday prehension. METHODS: Amblyopes (n = 20, 36.4 ± 11.7 years; 6 anisometropic, 3 strabismic, 11 mixed) and visually-healthy controls (n = 20, 27.5 ± 6.3 years) reached forward, grasped, and lifted a cylindrical target-object that was flanked with objects either (lateral) side of the target, or in front and behind it in depth. Only six amblyopes (30%) had measurable stereoacuity. Trials were completed in binocular and monocular viewing, using the better eye in amblyopic participants. RESULTS: Compared with visual normals, amblyopes displayed a longer overall movement time (P = 0.031), lower average reach velocity (P = 0.021), smaller maximum aperture (P = 0.007), and a longer duration between object contact and lift (P = 0.003). Differences between groups were more apparent when the flankers were in front and behind, compared with either side, as evidenced by significant group-by-flanker configuration interactions for reach duration (P < 0.001), size and timing of maximum aperture (P ≤ 0.009), end-of-reach to object-contact (P < 0.001), and object-contact to lift (P = 0.044), suggesting that amblyopic deficits are greatest when binocular cues are richest. Both groups demonstrated a significant binocular advantage, in that in both groups performance was worse for monocular compared with binocular viewing, but interestingly, amblyopic deficits in binocular viewing largely persisted during monocular viewing with the better eye. CONCLUSIONS: These results suggest that amblyopes either display considerable residual binocularity or that they have adapted to make good use of their abnormal binocularity.

What you see is what you step: the horizontal-vertical illusion increases toe clearance in older adults during stair ascent.

PURPOSE: Falls on stairs are a significant cause of morbidity and mortality in elderly people. A simple safety strategy to avoid tripping on stairs is increasing foot clearance. We determined whether a horizontal-vertical illusion superimposed onto stairs to create an illusory perceived increase in stair-riser height would increase stair ascent foot clearance in older participants. METHODS: Preliminary experiments determined the optimum parameters for the horizontal-vertical illusion. Fourteen older adults (mean age ± 1 SD, 68.5 ± 7.4 years) ascended a three-step staircase with the optimized version of the horizontal-vertical illusion (spatial frequency: 12 cycles per stair riser) positioned either on the bottom or top stair only, or on the bottom and top stair simultaneously. These were compared to a control condition, which had a plain stair riser with edge highlighters positioned flush with each stair-tread edge. Foot clearance and measures of postural stability were compared across conditions. RESULTS: The optimized illusion on the bottom and top stair led to a significant increase in foot clearance over the respective stair edge, compared to the control condition. There were no significant decreases in postural stability. CONCLUSIONS: An optimized horizontal-vertical visual illusion led to significant increases in foot clearance in older adults when ascending a staircase, but the effects did not destabilize their postural stability. Inclusion of the horizontal-vertical illusion on raised surfaces (e.g., curbs) or the bottom and top stairs of staircases could improve stair ascent safety in older adults.

The effects of laterality on obstacle crossing performance in unilateral trans-tibial amputees.

BACKGROUND: Unilateral trans-tibial amputees have bilaterally reduced toe clearance, and an increased risk of foot contact, while crossing obstacles compared to the able-bodied. While the able-bodied tend to lead with a 'preferred' limb it is equivocal whether amputees prefer to lead with the intact or prosthetic limb. This study determined the effects of laterality, compared to side of amputation, on amputees' obstacle crossing performance. To help understand why laterality could affect performance we also assessed knee proprioception for both limbs. METHODS: Foot placement and toe clearance parameters were recorded while nine amputees crossed obstacles of varying heights leading with both their intact and prosthetic limbs. Joint-position sense was also assessed. Participants self-reported which limb was their preferred (dominant) limb. FINDINGS: There were no significant differences in foot placements or toe clearance variability across lead-limb conditions. There were no significant differences in toe clearance between intact and prosthetic lead-limbs (p=0.28) but toe clearance was significantly higher when amputees led with their preferred compared to non-preferred limb (p=0.025). There was no difference in joint-position sense between the intact and residual knees (p=0.34) but joint-position sense tended to be more accurate for the preferred, compared to non-preferred limb (p=0.08). INTERPRETATION: Findings suggest that, despite the mechanical constraints imposed by use of a prosthesis, laterality may be as important in lower-limb amputees as it is in the able bodied. This suggests that amputees should be encouraged to cross obstacles leading with their preferred limb.

The effects of walking speed on minimum toe clearance and on the temporal relationship between minimum clearance and peak swing-foot velocity in unilateral trans-tibial amputees.

BACKGROUND: Minimum toe clearance is a critical gait event because it coincides with peak forward velocity of the swing foot, and thus, there is an increased risk of tripping and falling. Trans-tibial amputees have increased risk of tripping compared to able-bodied individuals. Assessment of toe clearance during gait is thus clinically relevant. In able-bodied gait, minimum toe clearance increases with faster walking speeds, and it is widely reported that there is synchronicity between when peak swing-foot velocity and minimum toe clearance occur. There are no such studies involving lower-limb amputees. OBJECTIVES: To determine the effects of walking speed on minimum toe clearance and on the temporal relationship between clearance and peak swing-foot velocity in unilateral trans-tibial amputees. STUDY DESIGN: Cross-sectional. METHODS: A total of 10 trans-tibial participants walked at slow, customary and fast speeds. Minimum toe clearance and the timings of minimum toe clearance and peak swing-foot velocity were determined and compared between intact and prosthetic sides. RESULTS: Minimum toe clearance was reduced on the prosthetic side and, unlike on the intact side, did not increase with walking speed increase. Peak swing-foot velocity consistently occurred (~0.014 s) after point of minimum toe clearance on both limbs across all walking speeds, but there was no significant difference in the toe-ground clearance between the two events. CONCLUSION: The absence of speed related increases in minimum toe clearance on the prosthetic side suggests that speed related modulation of toe clearance for an intact limb typically occurs at the swing-limb ankle. The temporal consistency between peak foot velocity and minimum toe clearance on each limb suggests that swing-phase inter-segmental coordination is unaffected by trans-tibial amputation. CLINICAL RELEVANCE: The lack of increase in minimum toe clearance on the prosthetic side at higher walking speeds may potentially increase risk of tripping. Findings indicate that determining the instant of peak swing-foot velocity will also consistently identify when/where minimum toe clearance occurs.

Impact on the biomechanics of overground gait of using an 'Echelon' hydraulic ankle-foot device in unilateral trans-tibial and trans-femoral amputees.

BACKGROUND: If a prosthetic foot creates resistance to forwards shank rotation as it deforms during loading, it will exert a braking effect on centre of mass progression. The present study determines whether the centre of mass braking effect exerted by an amputee's habitual rigid 'ankle' foot was reduced when they switched to using an 'Echelon' hydraulic ankle-foot device. METHODS: Nineteen lower limb amputees (eight trans-femoral, eleven trans-tibial) walked overground using their habitual dynamic-response foot with rigid 'ankle' or 'Echelon' hydraulic ankle-foot device. Analysis determined changes in how the centre of mass was transferred onto and above the prosthetic-foot, freely chosen walking speed, and spatio-temporal parameters of gait. FINDINGS: When using the hydraulic device both groups had a smoother/more rapid progression of the centre of pressure beneath the prosthetic hindfoot (p≤0.001), and a smaller reduction in centre of mass velocity during prosthetic-stance (p<0.001). As a result freely chosen walking speed was higher in both groups when using the device (p≤0.005). In both groups stance and swing times and cadence were unaffected by foot condition whereas step length tended (p<0.07) to increase bilaterally when using the hydraulic device. Effect size differences between foot types were comparable across groups. INTERPRETATION: Use of a hydraulic ankle-foot device reduced the foot's braking effect for both amputee groups. Findings suggest that attenuation of the braking effect from the foot in early stance may be more important to prosthetic-foot function than its ability to return energy in late stance.