Environmental risk assessment of selected pharmaceuticals in hospital wastewater in nothern Vietnam.

Pharmaceuticals are progressively employed in both human and veterinary medicine and increasingly recognized as environmental contaminants. This study investigated the occurrence of selected pharmaceuticals in influent and effluent of wastewater treatment plants of 12 hospitals in Hanoi and 3 northern cities of Vietnam during dry and rainy seasons. In addition, environmental risk of pharmaceuticals in both hospital influents and effluents were evaluated based on risk quotients (RQs). Nine selected pharmaceutical compounds including sulfamethoxazole (SMX), naproxen (NPX), diclofenac (DCF), ibuprofen (IBU), acetaminophen (ACT), carbamazepine (CBM), iopromide (IOP), atenolol (ATN), and caffeine (CAF) were frequently detected in most influent and effluent wastewaters of 12 investigated hospitals. Detected compound levels exhibited a wide range, from as low as 1 ng/L for DCF to as high as 61,772 ng/L for ACT. Among these compounds, ACT, CAF, SMX, and IOP were consistently detected at substantial concentrations in both influents and effluents. This investigation also highlighted potential risks posed by SMX, ACT, and CAF residues present in influents and effluents of hospital wastewater treatment plants (WWTPs) to aquatic ecosystem. These finding are expected to provide scientific-based evidence for the development of hospital waste management and environmental management programs in Vietnam.

Climate change and human health in Vietnam: a systematic review and additional analyses on current impacts, future risk, and adaptation.

This study aims to investigate climate change's impact on health and adaptation in Vietnam through a systematic review and additional analyses of heat exposure, heat vulnerability, awareness and engagement, and projected health costs. Out of 127 reviewed studies, findings indicated the wider spread of infectious diseases, and increased mortality and hospitalisation risks associated with extreme heat, droughts, and floods. However, there are few studies addressing health cost, awareness, engagement, adaptation, and policy. Additional analyses showed rising heatwave exposure across Vietnam and global above-average vulnerability to heat. By 2050, climate change is projected to cost up to USD1-3B in healthcare costs, USD3-20B in premature deaths, and USD6-23B in work loss. Despite increased media focus on climate and health, a gap between public and government publications highlighted the need for more governmental engagement. Vietnam's climate policies have faced implementation challenges, including top-down approaches, lack of cooperation, low adaptive capacity, and limited resources.

Generating variability from motor primitives during infant locomotor development.

Motor variability is a fundamental feature of developing systems allowing motor exploration and learning. In human infants, leg movements involve a small number of basic coordination patterns called locomotor primitives, but whether and when motor variability could emerge from these primitives remains unknown. Here we longitudinally followed 18 infants on 2-3 time points between birth (~4 days old) and walking onset (~14 months old) and recorded the activity of their leg muscles during locomotor or rhythmic movements. Using unsupervised machine learning, we show that the structure of trial-to-trial variability changes during early development. In the neonatal period, infants own a minimal number of motor primitives but generate a maximal motor variability across trials thanks to variable activations of these primitives. A few months later, toddlers generate significantly less variability despite the existence of more primitives due to more regularity within their activation. These results suggest that human neonates initiate motor exploration as soon as birth by variably activating a few basic locomotor primitives that later fraction and become more consistently activated by the motor system.

Human babies start to walk on their own when they are about one year old, but before that, they can move their legs to produce movements called 'stepping', where they take steps when held over a surface; and kicking, where they kick in the air when lying on their backs. These two behaviors are known as 'locomotor precursors' and can be observed from birth. Previous studies suggest that infants produce these movements by activating a small number of motor primitives, different modules in the nervous system ­ each activating a combination of muscles to produce a movement. However, babies and toddlers exhibit a lot of variability when they move, which is a hallmark of typical development that furthers exploring and learning. So far, it has been unclear whether such differences arise as soon as babies are born and if so, how a small number of motor primitives could result in this variability. Hinnekens et al. hypothesized that the great variety of movements in infants can be generated from a small set of motor primitives, when several cycles of flexing and extending the legs are considered. To test their hypothesis, the researchers first needed to establish how and when infants generate this variability of movement. To do so, they used electromyography to record the leg muscle activity of 18 babies during either movement resulting in a body displacement (locomotor movement) or rhythmic movement. These measurements were taken at either two or three timepoints between birth and the onset of walking. Next, the scientists used a state-of-the-art machine learning approach to model the neural basis underlying these recordings, which showed that newborns generate a lot of movement variability, but they do so by activating a small number of motor primitives, which they can combine in different ways. Hinnekens et al. also show that as babies get older, the number of motor primitives increases while the variety of movements decreases due to a more steady activation of each motor primitive. Cerebral plasticity is maximal during the first year of life, and infants can regularly learn new motor skills, each leading to the ability to perform more movements. Motor variability is believed to play an important role in this learning process and is known to be decreased in atypical development. As such, examining motor variability may be a promising tool to identify neurodevelopmental delays at younger ages.

Optimization of modularity during development to simplify walking control across multiple steps.

Introduction: Walking in adults relies on a small number of modules, reducing the number of degrees of freedom that needs to be regulated by the central nervous system (CNS). While walking in toddlers seems to also involve a small number of modules when considering averaged or single-step data, toddlers produce a high amount of variability across strides, and the extent to which this variability interacts with modularity remains unclear. Methods: Electromyographic activity from 10 bilateral lower limb muscles was recorded in both adults (n = 12) and toddlers (n = 12) over 8 gait cycles. Toddlers were recorded while walking independently and while being supported by an adult. This condition was implemented to assess if motor variability persisted with reduced balance constraints, suggesting a potential central origin rather than reliance on peripheral regulations. We used non-negative matrix factorization to model the underlying modular command with the Space-by-Time Decomposition method, with or without averaging data, and compared the modular organization of toddlers and adults during multiple walking strides. Results: Toddlers were more variable in both conditions (i.e. independent walking and supported by an adult) and required significantly more modules to account for their greater stride-by-stride variability. Activations of these modules varied more across strides and were less parsimonious compared to adults, even with diminished balance constraints. Discussion: The findings suggest that modular control of locomotion evolves between toddlerhood and adulthood as the organism develops and practices. Adults seem to be able to generate several strides of walking with less modules than toddlers. The persistence of variability in toddlers when balance constraints were lowered suggests a link with the ability to explore rather than with corrective mechanisms. In conclusion, the capacity of new walkers to flexibly activate their motor command suggests a broader range of possible actions, though distinguishing between modular and non-modular inputs remains challenging.

Vertical ground reaction force oscillation during standing on hard and compliant surfaces: The "postural rhythm".

When a person stands upright quietly, the position of the Centre of Mass (CoM), the vertical force acting on the ground and the geometrical configuration of body segments is accurately controlled around to the direction of gravity by multiple feedback mechanisms and by integrative brain centres that coordinate multi-joint movements. This is not always easy and the postural muscles continuously produce appropriate torques, recorded as ground reaction force by a force platform. We studied 23 young adults during a 90 s period, standing at ease on a hard (Solid) and on a compliant support (Foam) with eyes open (EO) and with eyes closed (EC), focusing on the vertical component of the ground reaction force (VGRF). Analysis of VGRF time series gave the amplitude of their rhythmic oscillations (the root mean square, RMS) and of their frequency spectrum. Sway Area and Path Length of the Centre of Pressure (CoP) were also calculated. VGRF RMS (as well as CoP sway measures) increased in the order EO Solid ≈ EC Solid < EO Foam < EC Foam. The VGRF frequency spectra featured prevailing frequencies around 4-5 Hz under all tested conditions, slightly higher on Solid than Foam support. Around that value, the VGRF frequencies varied in a larger range on hard than on compliant support. Sway Area and Path Length were inversely related to the prevailing VGRF frequency. Vision compared to no-vision decreased Sway Area and Path Length and VGRF RMS on Foam support. However, no significant effect of vision was found on VGRF mean frequency for either base of support condition. A description of the VGRF, at the interface between balance control mechanisms and sway of the CoP, can contribute information on how upright balance is maintained. Analysis of the frequency pattern of VGRF oscillations and its role in the maintenance of upright stance should complement the traditional measures of CoP excursions in the horizontal plane.

Cutaneous and muscular afferents from the foot and sensory fusion processing: Physiology and pathology in neuropathies.

The foot-sole cutaneous receptors (section 2), their function in stance control (sway minimisation, exploratory role) (2.1), and the modulation of their effects by gait pattern and intended behaviour (2.2) are reviewed. Experimental manipulations (anaesthesia, temperature) (2.3 and 2.4) have shown that information from foot sole has widespread influence on balance. Foot-sole stimulation (2.5) appears to be a promising approach for rehabilitation. Proprioceptive information (3) has a pre-eminent role in balance and gait. Reflex responses to balance perturbations are produced by both leg and foot muscle stretch (3.1) and show complex interactions with skin input at both spinal and supra-spinal levels (3.2), where sensory feedback is modulated by posture, locomotion and vision. Other muscles, notably of neck and trunk, contribute to kinaesthesia and sense of orientation in space (3.3). The effects of age-related decline of afferent input are variable under different foot-contact and visual conditions (3.4). Muscle force diminishes with age and sarcopenia, affecting intrinsic foot muscles relaying relevant feedback (3.5). In neuropathy (4), reduction in cutaneous sensation accompanies the diminished density of viable receptors (4.1). Loss of foot-sole input goes along with large-fibre dysfunction in intrinsic foot muscles. Diabetic patients have an elevated risk of falling, and vision and vestibular compensation strategies may be inadequate (4.2). From Charcot-Marie-Tooth 1A disease (4.3) we have become aware of the role of spindle group II fibres and of the anatomical feet conditions in balance control. Lastly (5) we touch on the effects of nerve stimulation onto cortical and spinal excitability, which may participate in plasticity processes, and on exercise interventions to reduce the impact of neuropathy.

Modularity underlying the performance of unusual locomotor tasks inspired by developmental milestones.

Motor behaviors are often hypothesized to be set up from the combination of a small number of modules encoded in the central nervous system. These modules are thought to combine such that a variety of motor tasks can be realized, from reproducible tasks such as walking to more unusual locomotor tasks that typically exhibit more step-by-step variability. We investigated the impact of step-by-step variability on the modular architecture of unusual tasks compared with walking. To this aim, 20 adults had to perform walking and two unusual modes of locomotion inspired by developmental milestones (cruising and crawling). Sixteen surface electromyography (EMG) signals were recorded to extract both spatial and temporal modules. Modules were extracted from both averaged and nonaveraged (i.e., single step) EMG signals to assess the significance of step-to-step variability when participants practiced such unusual locomotor tasks. The number of modules extracted from averaged data was similar across tasks, but a higher number of modules was required to reconstruct nonaveraged EMG data of the unusual tasks. Although certain walking modules were shared with cruising and crawling, task-specific modules were necessary to account for the muscle patterns underlying these unusual locomotion modes. These results highlight a more complex modularity (e.g., more modules) for cruising and crawling compared with walking, which was only apparent when the step-to-step variability of EMG patterns was considered. This suggests that considering nonaveraged data is relevant when muscle modularity is studied, especially in motor tasks with high variability as in motor development.NEW & NOTEWORTHY This study addresses the general question of modularity in locomotor control. We demonstrate for the first time the importance of intraindividual variability in the muscle modularity of unusual locomotor behaviors that exhibit greater step-by-step variability than standard walking. Crawling and cruising, the unusual locomotor modes considered, are based on a more complex modular organization than walking. More spatial and temporal modules, task specific or shared with walking modules, are needed to reconstruct muscle patterns.

Short-term DHEA administration in recreational athletes: impact on food intake, segmental body composition and adipokines.

BACKGROUND: Dehydroepiandrosterone (DHEA) administration is potentially therapeutic because it has been shown to decrease fat mass and adipokines and improve eating and mood disturbances. However, its impact on these parameters has never been investigated in a young healthy population. This study therefore sought to determine whether short-term DHEA administration would alter food intake, segmental body composition, adipokine secretion and mood in young healthy male and female volunteers with regular sport practice. METHODS: Following a double-blind and randomized protocol, 20 young healthy recreational athletes (10 men and 10 women) received treatment with either oral placebo or DHEA (100 mg/day for 4 weeks). Body weight, segmental body composition and adipokines (i.e., leptin, adiponectin and resistin) were determined before and at the end of each treatment. In parallel, spontaneous food intake was assessed at the end of each treatment, and mood was assessed before and at the end of treatment with the positive and negative affect schedule (PANAS). RESULTS: Body weight and segmental body composition showed no significant change in the men or women. Similarly, no change in adipokine secretion was found after DHEA administration. Total food intake was not affected by DHEA in any subject, despite an increase in fat intake by male subjects under DHEA (P<0.05). Positive and negative affect were not altered. CONCLUSIONS: In conclusion, in contrast to pathological populations, a young healthy population of men and women was not significantly affected by short-term DHEA administration with regard to total food intake, segmental body composition, adipokines or mood.

Short-term Dehydroepiandrosterone Intake and Supramaximal Exercise in Young Recreationally-trained Women.

WADA has banned dehydroepiandrosterone (DHEA) but its ergogenic effect in female athletes has never been investigated. The aim of this study was to determine whether short-term DHEA intake would improve performance during a supramaximal field exercise in healthy young recreationally trained women. Its impact on body composition, metabolic responses was also measured. Eleven young female volunteers completed four running-based anaerobic sprint tests: just before and after treatment with either oral placebo or DHEA (100 mg/day/28days), following a double-blind and randomized protocol. Bioelectrical impedance assessed body composition. At rest and after passive recovery, blood samples were collected for lactate measurement and saliva samples for DHEA, testosterone and cortisol analysis. There was no significant difference in body composition or performance parameters after DHEA administration, despite a tendency toward increased peak power and decreased fat mass. However, DHEA treatment induced a very marked increase in saliva DHEA and testosterone concentrations (p<0.001), with no change in cortisol or lactate levels. In conclusion, short-term DHEA administration did not improve performance or have an anabolic effect in young female recreationally trained athletes, despite the increase in androgenic hormones. Further studies are needed to determine whether a higher daily dose would generate an ergogenic effect during anaerobic exercise.

Effects of short-term DHEA intake on hormonal responses in young recreationally trained athletes: modulation by gender.

BACKGROUND: Dehydroepiandrosterone (DHEA) figures on the World Anti-Doping Agency list of prohibited substances in sport because it is assumed that athletes expect a significant increase in testosterone through DHEA administration. The literature on the hormonal effects of DHEA intake nevertheless appears to be very scant in healthy young subjects, especially women. PURPOSE: We examined the effects of DHEA on adrenal and gonadal hormones, IGF1 and free T3 in healthy young male and female recreationally trained volunteers. METHODS: The study followed a double-blind, randomized-order crossover design. Lean healthy young men (n = 10) and women (n = 11), with all women using oral contraceptives, were treated daily with 100 mg of DHEA and placebo for 4 weeks. DHEA, DHEA-sulfate (DHEA-S), androstenedione, total testosterone (Tes), dihydrotestosterone (DHT), SHBG, estrone, cortisol, IGF1, and free T3 were measured before, in the middle and at the end of each treatment, as were blood glucose, liver transaminases and lipid status. RESULTS: We observed a significant increase in DHEA, DHEA-S, androstenedione, Tes, DHT, and estrone in both men and women in the middle and at the end of DHEA treatment, but the increase in Tes was more marked in women (p < 0.001) than men (p < 0.05). No changes were found in the other parameters, irrespective of gender. CONCLUSION: In young athletes, DHEA administration induces significant blood hormonal changes, some modulated by gender, which can be used as biomarkers of doping.

Rigid Ankle Foot Orthosis Deteriorates Mediolateral Balance Control and Vertical Braking during Gait Initiation.

Rigid ankle-foot orthoses (AFO) are commonly used for impeding foot drop during the swing phase of gait. They also reduce pain and improve gait kinematics in patients with weakness or loss of integrity of ankle-foot complex structures due to various pathological conditions. However, this comes at the price of constraining ankle joint mobility, which might affect propulsive force generation and balance control. The present study examined the effects of wearing an AFO on biomechanical variables and electromyographic activity of tibialis anterior (TA) and soleus muscles during gait initiation (GI). Nineteen healthy adults participated in the study. They initiated gait at a self-paced speed with no ankle constraint as well as wearing an AFO on the stance leg, or bilaterally. Constraining the stance leg ankle decreased TA activity ipsilaterally during the anticipatory postural adjustment (APA) of GI, and ipsilateral soleus activity during step execution. In the sagittal plane, the decrease in the stance leg TA activity reduced the backward displacement of the center of pressure (CoP) resulting in a reduction of the forward velocity of the center of mass (CoM) measured at foot contact (FC). In the frontal plane, wearing the AFO reduced the displacement of the CoP in the direction of the swing leg during the APA phase. The mediolateral velocity of the CoM increased during single-stance prompting a larger step width to recover balance. During step execution, the CoM vertical downward velocity is normally reduced in order to lessen the impact of the swing leg with the floor and facilitates the rise of the CoM that occurs during the subsequent double-support phase. The reduction in stance leg soleus activity caused by constraining the ankle weakened the vertical braking of the CoM during step execution. This caused the absolute instantaneous vertical velocity of the CoM at FC to be greater in the constrained conditions with respect to the control condition. From a rehabilitation perspective, passively- or actively-powered assistive AFOs could correct for the reduction in muscle activity and enhance balance control during GI of patients.

Postural Preparation to Stepping: Coupled Center of Pressure Shifts in the Anterior-Posterior and Medio-Lateral Directions.

We explored changes in the postural preparation to stepping introduced by modifications of the initial coordinates of the center of pressure (COP). We hypothesized that the postural adjustments in the anterior-posterior direction would persist across all initial COP manipulations while the adjustments in the medio-lateral direction would be highly sensitive to the initial COP coordinate. Healthy subjects stood on a force plate, shifted the body weight to one of the initial conditions that spanned the range of COP coordinates in both directions, and initiated a single step or started to walk. No major changes were observed between the stepping and walking conditions. Changes in the initial COP coordinate in the medio-lateral direction led to scaling of the magnitude of the COP shift in that direction prior to stepping accompanied by a nearly proportional change in the COP shift in the anterior-posterior direction. Changes in the initial COP coordinate in the anterior-posterior direction led to scaling of the magnitude of the COP shift in that direction prior to stepping without consistent changes in the COP shift in the medio-lateral direction. We interpret the results as reflecting a neural organization using a small set of referent body configurations for the postural adjustments.

The Neuro-Mechanical Processes That Underlie Goal-Directed Medio-Lateral APA during Gait Initiation.

Gait initiation (GI) involves passing from bipedal to unipedal stance. It requires a rapid movement of the center of foot pressure (CoP) towards the future swing foot and of the center of mass (CoM) in the direction of the stance foot prior to the incoming step. This anticipatory postural adjustment (APA) allows disengaging the swing leg from the ground and establishing favorable conditions for stepping. This study aimed to describe the neuro-mechanical process that underlies the goal-directed medio-lateral (ML) APA. We hypothesized that controlled knee flexion of the stance leg contributes to the initial ML displacement of the CoP and to the calibration of the first step. Fourteen subjects initiated gait starting from three different initial stance widths of 15 cm (Small), 30 cm (Medium), and 45 cm (Large). Optoelectronic, force platform and electromyogram (EMG) measurements were performed. During APA, soleus activity diminished bilaterally, while tibialis anterior (TA) activity increased, more so in the stance leg than in the swing leg, and to a larger extent with increasing initial stance width. Knee flexion of the stance leg was observed during APA and correlated with the ML CoP displacement towards the swing leg. ML CoP and CoM displacements during APA increased with increasing stance width. The activity of stance-leg TA was correlated with the degree of knee flexion. Swing-leg tensor fasciae latae (TFL) was also active during APA. Across subjects, when stance-leg tibialis activity was low, TFL activity was large and vice versa. The modulation of the ML CoP position during APA allowed the gravity-driven torque to place the CoM just lateral to the stance foot during step execution. Accordingly, the gravity-driven torque, the ML CoM velocity during step execution, and the step width at foot contact (FC) were lower in the Small and greater in the Large condition. Consequently, the position of the stepping foot at FC remained close to the sagittal plane in all three conditions. Conclusively, coordinated activation of hip abductors and ankle dorsiflexors during APA displaces the CoP towards the swing leg, and sets the contact position for the swing foot.

Towards an explanation of age-related difficulties in crossing a two-way street.

Crossing a two-way street is a complex task that involves visual, cognitive and motor abilities, all of which are known to decline with ageing. In particular, older pedestrians may experience difficulties when crossing two-way streets because of incorrect gap acceptance choices and impossible or unperceived evasive actions. To understand the overrepresentation of older pedestrians in crash statistics, several experimental studies have sought to identify traffic-related factors as well as those related to the abilities of the individuals themselves. However, none of these studies has required participants to actually walk across an experimental two-way street with curbs, which is a particularly challenging situation for older pedestrians. To fill this research gap, a quasi-experiment was conducted in a simulator including a total of 58 healthy aged participants (25 younger-old [age 60-72] and 33 older-old [age 72-92]) and 25 young adults (aged 18-25 years). Participants carried out a street-crossing task in a simulated two-way traffic environment; curbs were present on both sides of the experimental street. Participants also undertook a battery of tests to assess their visual and cognitive abilities. In addition, during the experiment, the participants' gait parameters were recorded. In line with earlier findings, the older-old group of participants made a higher number of decisions that led to collisions with approaching cars compared with the other groups. The two groups of older participants experienced specific difficulties when vehicles were in the far lane or when they approached rapidly. A regression analysis identified visual acuity, speed of processing (assessed using the UFOV(®) test), and step length as significant predictors of collisions. Our results have implications for understanding the difficulties experienced by older pedestrians and allow to draw up several recommendations for improving their safety.

Postural disturbances resulting from unilateral and bilateral diaphragm contractions: a phrenic nerve stimulation study.

Thoracoabdominal breathing movements are a complex source of postural disturbance, but there are contradictory reports in the literature with inspiration described as having either a backward or a forward disturbing effect. To elucidate the mechanisms underlying this phenomenon, the present study studied the postural disturbance caused by isolated contractions of the diaphragm. Eight male and four female healthy subjects followed an original paradigm of phrenic nerve stimulation (bilateral and unilateral) and "diaphragmatic" voluntary sniff maneuvers in the seated and standing postures. Center of gravity (CG) acceleration was calculated from force plate recordings, and respiratory kinematics were assessed with thoracic and abdominal sensor belts. CG and respiratory signals revealed that, while seated, bilateral phrenic stimulation and sniff maneuvers consistently produced expansion of the abdomen associated with a forward peak of CG acceleration. In the standing posture, the direction of the CG peak was reversed and always directed backward. Unilateral phrenic stimulation induced an additional medial-lateral acceleration of the CG, directed toward the nonactive side while seated, but in the opposite direction while standing. These results suggest that isolated diaphragmatic contractions produce a constant disturbing pattern for a given posture, but with opposite effects between standing and seated postures. This could be related to the different biomechanical configuration of the body in each posture, corresponding to distinct kinematic patterns of the osteoarticular chain. In addition, the lateral component of the CG acceleration induced by unilateral diaphragm contractions could be clinically relevant in patients with hemidiaphragm paralysis.

Ergogenic and metabolic effects of oral glucocorticoid intake during repeated bouts of high-intensity exercise.

All systemically administered glucocorticoids (GC) are prohibited in-competition, because of the potential ergogenic effects. Although short-term GC intake has been shown to improve performance during submaximal exercise, literature on its impact during brief intense exercise appears to be very scant. The purpose of this study was to examine the ergogenic and metabolic effects of prednisone during repeated bouts of high-intensity exercise. In a double-blind randomized protocol, ten recreational male athletes followed two 1-week treatments (Cor: prednisone, 60mg/day or Pla: placebo). At the end of each treatment, they hopped on their dominant leg for 30s three times consecutively and then hopped until exhaustion, with intervals of 5min of passive recovery. Blood and saliva samples were collected at rest and 3min after each exercise bout to determine the lactate, interleukin-6, interleukin-10, TNF-alpha, DHEA and testosterone values. The absolute peak force of the dominant leg was significantly increased by Cor but only during the first 30-s hopping bout (p<0.05), whereas time to exhaustion was not significantly changed after Cor treatment vs Pla (Pla: 119.9±24.7; Cor: 123.1±29.5s). Cor intake lowered basal and end-exercise plasma interleukin-6 and saliva DHEA (p<0.01) and increased interleukin-10 (p<0.01), whereas no significant change was found in blood lactate and TNF-alpha or saliva testosterone between Pla and Cor. According to these data, short-term glucocorticoid intake did not improve endurance performance during repeated bouts of high-intensity exercise, despite the significant initial increase in absolute peak force and anti-inflammatory effect.

By counteracting gravity, triceps surae sets both kinematics and kinetics of gait.

In the single-stance phase of gait, gravity acting on the center of mass (CoM) causes a disequilibrium torque, which generates propulsive force. Triceps surae activity resists gravity by restraining forward tibial rotation thereby tuning CoM momentum. We hypothesized that time and amplitude modulation of triceps surae activity determines the kinematics (step length and cadence) and kinetics of gait. Nineteen young subjects participated in two experiments. In the gait initiation (GI) protocol, subjects deliberately initiated walking at different velocities for the same step length. In the balance-recovery (BR) protocol, subjects executed steps of different length after being unexpectedly released from an inclined posture. Ground reaction force was recorded by a large force platform and electromyography of soleus, gastrocnemius medialis and lateralis, and tibialis anterior muscles was collected by wireless surface electrodes. In both protocols, the duration of triceps activity was highly correlated with single-stance duration (GI, R (2) = 0.68; BR, R (2) = 0.91). In turn, step length was highly correlated with single-stance duration (BR, R (2) = 0.70). Control of CoM momentum was obtained by decelerating the CoM fall via modulation of amplitude of triceps activity. By modulation of triceps activity, the central nervous system (CNS) varied the position of CoM with respect to the center of pressure (CoP). The CoM-CoP gap in the sagittal plane was determinant for setting the disequilibrium torque and thus walking velocity. Thus, by controlling the gap, CNS-modified walking velocity (GI, R (2) = 0.86; BR, R (2) = 0.92). This study is the first to highlight that by merely counteracting gravity, triceps activity sets the kinematics and kinetics of gait. It also provides evidence that the surge in triceps activity during fast walking is due to the increased requirement of braking the fall of CoM in late stance in order to perform a smoother step-to-step transition.

Methodological requirement to analyze biomechanical postural control mechanisms with two platforms.

In 1996, Winter and colleagues proposed the existence of two postural control mechanisms in both the anteroposterior and mediolateral axes: a bodyweight (loading/unloading) distribution mechanism and a complementary center of pressure location mechanism. To measure the loading/unloading forces under each foot, the feet had to be placed side by side in the mediolateral axis and one foot ahead of the other in the anteroposterior axis. Our first objective was to reexamine the validity of anteroposterior data published with the feet side by side. In that foot condition, we expected no change in the anteroposterior loading/unloading forces (regardless of the task performed), and consequently no change in the complementary mechanism. Our second objective was to confirm our hypotheses with experimental data. Twelve healthy, young adults performed three types of body oscillation in the anteroposterior axis (at the hips, at the ankles and alternately at the ankles and hips) and a quiet stance condition with the feet side by side. As expected, the bodyweight mechanism did not vary significantly. Although the complementary mechanism was significantly higher in the ankle and alternating conditions, the change was very tiny (<0.3%). Thus, we propose methodological requirements to analyze both mechanisms.

High-level gait and balance disorders in the elderly: a midbrain disease?

The pathophysiology of gait and balance disorders in elderly people with 'higher level gait disorders' (HLGD) is poorly understood. In this study, we aimed to identify the brain networks involved in this disorder. Standardised clinical scores, biomechanical parameters of gait initiation and brain imaging data, including deep white matter lesions (DWML) and brain voxel-based morphometry analyses, were assessed in 20 HLGD patients in comparison to 20 age-matched controls. In comparison to controls, HLGD patients presented a near-normal preparatory phase of gait initiation, but a severe alteration of both locomotor and postural parameters of first-step execution, which was related to 'axial' hypokinetic-rigid signs. HLGD patients showed a significant grey matter reduction in the mesencephalic locomotor region (MLR) and the left primary motor cortex. This midbrain atrophy was related to the severity of clinical and neurophysiologically determined balance deficits. HLGD patients also showed a reduction in speed of gait, related to 'appendicular' hypokinetic-rigid signs and frontal-lobe-like cognitive deficits. These last two symptoms were correlated with the severity of DWML, found in 12/20 HLGD patients. In conclusion, these data suggest that the gait and balance deficits in HLGD mainly result from the lesion or dysfunction of the network linking the primary motor cortex and the MLR, brain regions known to be involved in the control of gait and balance, whereas cognitive and 'appendicular' hypokinetic-rigid signs mainly result from DWML that could be responsible for a dysfunction of the frontal cortico-basal ganglia loops.

The braking force in walking: age-related differences and improvement in older adults with exergame training.

The purposes of this present research were, in the first study, to determine whether age impacts a measure of postural control (the braking force in walking) and, in a second study, to determine whether exergame training in physically-simulated sport activity would show transfer, increasing the braking force in walking and also improving balance assessed by clinical measures, functional fitness, and health-related quality of life in older adults. For the second study, the authors developed an active video game training program (using the Wii system) with a pretest-training-posttest design comparing an experimental group (24 1-hr sessions of training) with a control group. Participants completed a battery comprising balance (braking force in short and normal step conditions), functional fitness (Senior Fitness Test), and health-related quality of life (SF-36). Results show that 12 weeks of video game-based exercise program training improved the braking force in the normal step condition, along with the functional fitness of lower limb strength, cardiovascular endurance, and motor agility, as measured by the Senior Fitness Test. Only the global mental dimension of the SF-36 was sensitive to exergame practice. Exergames appear to be an effective way to train postural control in older adults. Because of the multimodal nature of the activity, exergames provide an effective tool for remediation of age-related problems.