Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks.

The objective of this systematic review is to identify motion analysis parameters measured during challenging walking tasks which can predict fall risk in the older population. Numerous studies have attempted to predict fall risk from the motion analysis of standing balance or steady walking. However, most falls do not occur during steady gait but occur due to challenging centre of mass displacements or environmental hazards resulting in slipping, tripping or falls on stairs. We conducted a systematic review of motion analysis parameters during stair climbing, perturbed walking and obstacle crossing, predictive of fall risk in healthy older adults. We searched the databases of Pubmed, Scopus and IEEEexplore.A total of 78 articles were included, of which 62 simply compared a group of younger to a group of older adults. Importantly, the differences found between younger and older adults did not match those found between older adults at higher and lower risk of falls. Two prospective and six retrospective fall history studies were included. The other eight studies compared two groups of older adults with higher or lower risk based on mental or physical performance, functional decline, unsteadiness complaints or task performance. A wide range of parameters were reported, including outcomes related to success, timing, foot and step, centre of mass, force plates, dynamic stability, joints and segments. Due to the large variety in parameter assessment methods, a meta-analysis was not possible. Despite the range of parameters assessed, only a few candidate prognostic factors could be identified: older adults with a retrospective fall history demonstrated a significant larger step length variability, larger step time variability, and prolonged anticipatory postural adjustments in obstacle crossing compared to older adults without a fall history. Older adults who fell during a tripping perturbation had a larger angular momentum than those who did not fall. Lastly, in an obstacle course, reduced gait flexibility (i.e., change in stepping pattern relative to unobstructed walking) was a prognostic factor for falling in daily life. We provided recommendations for future fall risk assessment in terms of study design.In conclusion, studies comparing older to younger adults cannot be used to explore relationships between fall risk and motion analysis parameters. Even when comparing two older adult populations, it is necessary to measure fall history to identify fall risk prognostic factors.

A little damping goes a long way: a simulation study of how damping influences task-level stability in running.

It is currently unclear if damping plays a functional role in legged locomotion, and simple models often do not include damping terms. We present a new model with a damping term that is isolated from other parameters: that is, the damping term can be adjusted without retuning other model parameters for nominal motion. We systematically compare how increased damping affects stability in the face of unexpected ground-height perturbations. Unlike most studies, we focus on task-level stability: instead of observing whether trajectories converge towards a nominal limit-cycle, we quantify the ability to avoid falls using a recently developed mathematical measure. This measure allows trajectories to be compared quantitatively instead of only being separated into a binary classification of 'stable' or 'unstable'. Our simulation study shows that increased damping contributes significantly to task-level stability; however, this benefit quickly plateaus after only a small amount of damping. These results suggest that the low intrinsic damping values observed experimentally may have stability benefits and are not simply minimized for energetic reasons. All Python code and data needed to generate our results are available open source.

Anticipatory coadaptation of ankle stiffness and sensorimotor gain for standing balance.

External perturbation forces may compromise standing balance. The nervous system can intervene only after a delay greater than 100 ms, during which the body falls freely. With ageing, sensorimotor delays are prolonged, posing a critical threat to balance. We study a generic model of stabilisation with neural delays to understand how the organism should adapt to challenging balance conditions. The model suggests that ankle stiffness should be increased in anticipation of perturbations, for example by muscle co-contraction, so as to slow down body fall during the neural response delay. Increased ankle muscle co-contraction is indeed observed in young adults when standing in challenging balance conditions, and in older relative to young adults during normal stance. In parallel, the analysis of the model shows that increases in either stiffness or neural delay must be coordinated with decreases in spinal sensorimotor gains, otherwise the feedback itself becomes destabilizing. Accordingly, a decrease in spinal feedback is observed in challenging conditions, and with age-related increases in neural delay. These observations have been previously interpreted as indicating an increased reliance on cortical rather than spinal control of balance, despite the fact that cortical responses have a longer latency. Our analysis challenges this interpretation by showing that these observations are consistent with a functional coadaptation of spinal feedback gains to functional changes in stiffness and neural delay.

Postural adjustments in anticipation of predictable perturbations allow elderly fallers to achieve a balance recovery performance equivalent to elderly non-fallers.

BACKGROUND: In numerous laboratory-based perturbation experiments, differences in the balance recovery performance of elderly fallers and non-fallers are moderate or absent. This performance may be affected by the subjects adjusting their initial posture in anticipation of the perturbation. RESEARCH QUESTIONS: Do elderly fallers and non-fallers adjust their posture in anticipation of externally-imposed perturbations in a laboratory setting? How does this impact their balance recovery performance? METHODS: 21 elderly non-fallers, 18 age-matched elderly fallers and 11 young adults performed both a forward waist-pull perturbation task and a Choice Stepping Reaction Time (CSRT) task. Whole-body kinematics and ground reaction forces were recorded. For each group, we evaluated the balance recovery performance in the perturbation task, change in initial center of mass (CoM) position between the CSRT and the perturbation task, and the influence of initial CoM position on task performance. RESULTS: The balance recovery performance of elderly fallers was equivalent to elderly non-fallers (p > 0.5 Kolmogorov-Smirnov test). All subject groups anticipated forward perturbations by shifting their CoM backward compared to the CSRT task (young: 2.1% of lower limb length, elderly non-fallers: 2.7%, elderly fallers: 2.2%, Hodges-Lehmann estimator, p < 0.001 Mann-Whitney U). This backward shift increases the probability of resisting the traction without taking a step. SIGNIFICANCE: The ability to anticipate perturbations is preserved in elderly fallers and may explain their preserved balance recovery performance in laboratory-based perturbation tasks. Therefore, future fall risk prediction studies should carefully control for this postural strategy, by interleaving perturbations of different directions for example.

Mobility as the Purpose of Postural Control.

Counteracting the destabilizing force of gravity is usually considered to be the main purpose of postural control. However, from the consideration of the mechanical requirements for movement, we argue that posture is adjusted in view of providing impetus for movement. Thus, we show that the posture that is usually adopted in quiet standing in fact allows torque for potential movement. Moreover, when performing a movement-either voluntarily or in response to an external perturbation-we show that the postural adjustments are organized both spatially and temporally so as to provide the required torque for the movement. Thus, when movement is performed skillfully, the force of gravity is not counteracted but actually used to provide impetus to movement. This ability to move one's weight so as to exploit the torque of gravity seems to be dependent on development and skill learning, and is impaired in aging.

Supervised learning with decision margins in pools of spiking neurons.

Learning to categorise sensory inputs by generalising from a few examples whose category is precisely known is a crucial step for the brain to produce appropriate behavioural responses. At the neuronal level, this may be performed by adaptation of synaptic weights under the influence of a training signal, in order to group spiking patterns impinging on the neuron. Here we describe a framework that allows spiking neurons to perform such "supervised learning", using principles similar to the Support Vector Machine, a well-established and robust classifier. Using a hinge-loss error function, we show that requesting a margin similar to that of the SVM improves performance on linearly non-separable problems. Moreover, we show that using pools of neurons to discriminate categories can also increase the performance by sharing the load among neurons.