Electrical Brain Activity during Human Walking with Parametric Variations in Terrain Unevenness and Walking Speed.

Mobile brain imaging with high-density electroencephalography (EEG) can provide insight into the cortical processes involved in complex human walking tasks. While uneven terrain is common in the natural environment and poses challenges to human balance control, there is limited understanding of the supraspinal processes involved with traversing uneven terrain. The primary objective of this study was to quantify electrocortical activity related to parametric variations in terrain unevenness for neurotypical young adults. We used high-density EEG to measure brain activity when thirty-two young adults walked on a novel custom-made uneven terrain treadmill surface with four levels of difficulty at a walking speed tailored to each participant. We identified multiple brain regions associated with uneven terrain walking. Alpha (8 - 13 Hz) and beta (13 - 30 Hz) spectral power decreased in the sensorimotor and posterior parietal areas with increasing terrain unevenness while theta (4 - 8 Hz) power increased in the mid/posterior cingulate area with terrain unevenness. We also found that within stride spectral power fluctuations increased with terrain unevenness. Our secondary goal was to investigate the effect of parametric changes in walking speed (0.25 m/s, 0.5m/s, 0.75 m/s, 1.0 m/s) to differentiate the effects of walking speed from uneven terrain. Our results revealed that electrocortical activities only changed substantially with speed within the sensorimotor area but not in other brain areas. Together, these results indicate there are distinct cortical processes contributing to the control of walking over uneven terrain versus modulation of walking speed on smooth, flat terrain. Our findings increase our understanding of cortical involvement in an ecologically valid walking task and could serve as a benchmark for identifying deficits in cortical dynamics that occur in people with mobility deficits.

Correlations between reach, lean and ladder tipping risk.

Overreaching is a common cause of ladder falls, which occur frequently among older adults in the domestic setting. Reaching and body leaning during ladder use likely influence the climber-ladder combined center of mass and subsequently center of pressure (COP) position (location of the resultant force acting at the base of the ladder). The relationship between these variables has not been quantified, but is warranted to assess ladder tipping risk due to overreaching (i.e. COP traveling outside the ladder's base of support). This study investigated the relationships between participant maximum reach (hand position), trunk lean, and COP during ladder use to improve assessment of ladder tipping risk. Older adults (n = 104) were asked to perform a simulated roof gutter clearing task while standing on a straight ladder. Each participant reached laterally to clear tennis balls from a gutter. Maximum reach, trunk lean, and COP were captured during the clearing attempt. COPwas positively correlated withmaximum reach(p < 0.001; r = 0.74) and trunk lean (p < 0.001; r = 0.85). Maximum reach was positively correlated with trunk lean (p < 0.001; r = 0.89). The relationship between trunk lean and COP was stronger than that between maximum reach and COP, denoting the importance of body positioning on ladder tipping risk. For this experimental setup, regression estimates indicate reaching and lean distance of 113 cm and 29 cm from the ladder midline, respectively, would lead to ladder tipping on average. These findings assist with developing thresholds of unsafe reaching and leaning on a ladder, which can aid in reducing ladder falls.

Uneven terrain treadmill walking in younger and older adults.

We developed a method for altering terrain unevenness on a treadmill to study gait kinematics. Terrain consisted of rigid polyurethane disks (12.7 cm diameter, 1.3-3.8 cm tall) which attached to the treadmill belt using hook-and-loop fasteners. Here, we tested four terrain unevenness conditions: Flat, Low, Medium, and High. The main objective was to test the hypothesis that increasing the unevenness of the terrain would result in greater gait kinematic variability. Seventeen younger adults (age 20-40 years), 25 higher-functioning older adults (age 65+ years), and 29 lower-functioning older adults (age 65+ years, Short Physical Performance Battery score < 10) participated. We customized the treadmill speed to each participant's walking ability, keeping the speed constant across all four terrain conditions. Participants completed two 3-minute walking trials per condition. Using an inertial measurement unit placed over the sacrum and pressure sensors in the shoes, we calculated the stride-to-stride variability in step duration and sacral excursion (coefficient of variation; standard deviation expressed as percentage of the mean). Participants also self-reported their perceived stability for each condition. Terrain was a significant predictor of step duration variability, which roughly doubled from Flat to High terrain for all participant groups: younger adults (Flat 4.0%, High 8.2%), higher-functioning older adults (Flat 5.0%, High 8.9%), lower-functioning older adults (Flat 7.0%, High 14.1%). Similarly, all groups exhibited significant increases in sacral excursion variability for the Medium and High uneven terrain conditions, compared to Flat. Participants were also significantly more likely to report feeling less stable walking over all three uneven terrain conditions compared to Flat. These findings support the hypothesis that altering terrain unevenness on a treadmill will increase gait kinematic variability and reduce perceived stability in younger and older adults.

Situational factors that influence overreaching on a ladder during a gutter clearing task among older adults.

Ladder falls from overreaching are a problem in older adults. Evidence suggests ladder use behavior to be dependent on interfacing user and environmental circumstances (i.e. situational factors). This study investigates the effects of situational factors (remaining debris, ladder position, time into task, hand dominant reach, reaching disposition) on reaching during a gutter clearing task on a ladder in 104 older adults. Reaching was quantified as the maximum lateral center of pressure (COP) displacement from the ladder's center. A reach was classified as an overreach when the COP displaced outside the ladder width, indicative of a ladder tip. Reaching disposition, remaining debris, ladder position, and the interaction of reaching disposition and remaining debris predicted 20% of the reaching variability during the ladder task. Overreaching was observed in 40% of participants accounting for 13% of all extended reaches (beyond ladder). This work can guide interventions on mitigating overreaching and improving ladder safety.

Ladder Use in Older People: Type, Frequency, Tasks and Predictors of Risk Behaviours.

Ladder fall and injury risk increases with age. People who present to a hospital after an injurious ladder fall have been surveyed, but little is known about ladder use in the community. The purpose of this study was to: (1) document salient factors related to ladder safety, and (2) determine physical, executive function, psychological and frequency-of-use factors associated with unsafe ladder use in older people. One hundred and two older people (aged 65+ years) were recruited. Participants completed questionnaires on demographics, health, and ladder use (type, frequency, task, behaviours) and underwent assessments of physical and executive function ability. Results showed both older men and women commonly use step ladders (61% monthly, 96% yearly), mostly inside the home for tasks such as changing a lightbulb (70%) and decorating (43%). Older men also commonly use straight ladders (27% monthly, 75% yearly), mostly outside the home for tasks such as clearing gutters (74%) and pruning trees (40%). Unsafe ladder use was more common in males and individuals with greater ladder use frequency, greater quadriceps strength, better upper limb dexterity, better balance, better stepping ability, greater self-reported everyday risk-taking, a lower fear of falling, and fewer health problems compared to their counterparts (all p < 0.05). These findings document ladder use by older people and provide insight into unsafe ladder behaviours that may be amenable to interventions to reduce ladder falls and associated injuries.

Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests.

OBJECTIVE: To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers. DATA SOURCE: PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles. STUDY SELECTION: Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65). RESULTS: A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers. CONCLUSIONS: This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.

Individual factors that influence task performance on a straight ladder in older people.

Older adults have the highest incidence of domestic ladder falls, but little investigation has been given to this important injury issue. There is therefore a need to understand the influence of individual factors like physical and cognitive ability and psychological status on safe and effective ladder use in this population. This study investigated associations between vision, lower and upper limb sensation, upper limb control, strength, balance, cognitive function and psychological status with task completion time and number of ladder moves taken in a simulated roof gutter clearing task on a straight ladder in 97 older adults. Several measures from upper limb control, strength, balance, processing speed, executive function and psychological domains were significantly associated with the two ladder task performance measures. Upper limb bimanual coordination, knee extension strength, coordinated leaning balance, and self-reported risk-taking were identified as independent and significant predictors of task completion time in a multiple regression model, predicting 56% of the variability in ladder task completion time. Upper limb bimanual coordination and proprioception, simple reaction time and coordinated leaning balance were independent and significant predictors of the number of ladder moves in a separate multiple regression model, predicting 38% of the variability in ladder moves taken. These findings help identify individuals at greater ladder fall risk and can guide ladder fall interventions, such as strength and balance training, ladder design and targeted safety instructions.

Effects of Student Interests on Engagement and Performance in Biomechanics.

There is a need for pedagogical techniques that increase student engagement among underrepresented groups in engineering. Relating engineering content to student interests, particularly through biomechanics applications, shows promise toward engaging a diverse group of students. This study investigates the effects of student interests on engagement and performance in 10th grade students enrolled in a summer program for students underrepresented in the science, technology, engineering, and mathematics fields. The authors assessed the effects of interest-tailored lectures on student engagement and performance in a 5-week program with bioengineering workshops, focusing on the delivery of biomechanics content. A total of 31 students received interest-tailored lectures (intervention) and 23 students received only generic lectures (control) in biomechanics. In addition, the authors assessed the effects of teaching method (lecture, classroom activities, and laboratory tours) on student engagement. The authors found interest-tailored lectures to significantly increase student engagement in lecture compared with generic lectures. Students that received interest-tailored lectures had an insignificant, but meaningful 5% increase in student performance. Students rated laboratory tours higher in engagement than other teaching methods. This study provides detailed examples that can directly assist student teaching and outreach in biomechanics. Furthermore, the pedagogical techniques in this study can be used to increase engagement of underrepresented students in engineering.

Traction performance across the life of slip-resistant footwear: Preliminary results from a longitudinal study.

INTRODUCTION: Slips, trips, and falls are a major cause of injury in the workplace. Footwear is an important factor in preventing slips. Furthermore, traction performance (friction and under-shoe fluid drainage) are believed to change throughout the life of footwear. However, a paucity of data is available for how traction performance changes for naturally worn, slip-resistant footwear. METHOD: The presented research is a preliminary analysis from an ongoing, larger study. Participants wore slip-resistant footwear while their distance walked was monitored. Friction and under-shoe fluid pressures were measured using a robotic slip tester under a diluted glycerol contaminant condition after each month of wear for the left and right shoes. The size of the worn region was also measured. RESULTS: Friction initially increased and then steadily decreased as the distance walked and the size of the worn region increased. Fluid pressures increased as the shoes were worn and were associated with increased walking distance and size of the worn region. DISCUSSION: Consistent with previous research, increases in the size of the worn region are associated with increased under-shoe fluid pressures and decreased traction. These trends are presumably due to reduced fluid drainage between the shoe-floor interface when the shoe becomes worn. CONCLUSIONS: Traction performance changes with natural wear. The distance walked in the shoe and the size of the worn region may be valuable indicators for assessing loss of traction performance. Practical Applications: Current shoe replacement recommendations for slip-resistant shoes are based upon age and tread depth. This study suggests that tools measuring the size of the worn region and/or distance traveled in the shoes are appropriate alternatives for tracking traction performance loss due to shoe wear.

Hand-rung forces after a ladder climbing perturbation.

The hands are believed to be important for arresting falls from ladders. Yet, there is a paucity of kinetic data for the hand-handhold interface during recovery from a ladder climbing perturbation. This study quantified the hand-rung forces utilized after ladder climbing perturbations and the factors (upper body strength, fall severity, reestablished foot placement) contributing to hand-rung force. A ladder rung was released under the foot of the participants to simulate a climbing misstep perturbation. Hand-rung forces after the perturbation were quantified from load cells connected to two ladder rungs. Mean peak hand-rung force magnitudes were found to range between 46% and 84% of the climber's body weight. These magnitudes approached and, in some cases, exceeded individuals' grasping capacity. Individual upper body strength was not found to consistently contribute to hand-rung force, but increased hand-rung force was clearly linked with greater fall severity after an ascending perturbation. Individuals that reestablished foot placement after an ascending perturbation utilized lower hand-rung forces. Therefore, this study suggests hand-rung force to be dependent on circumstances of the falling event (fall severity, reestablished foot placement) as opposed to the climber's capability of producing upper body force. This knowledge highlights the importance of handhold and ladder designs for arresting a falling event, and is critical to inform ladder fall interventions such as designing handholds that resist high forces and permitting steps that enable reestablished foot placement.

Characterizing the shoe-rung friction requirements during ladder climbing.

Ladder slip and falls cause negative financial and health impacts due to their severity and frequency. However, frictional requirements of climbing, which presumably influence slip risk, are unknown. The purpose of this study was to quantify frictional requirements during climbing at different ladder angles. The required coefficient of friction (RCOF) was calculated during ladder climbing and assessed for three ladder angles (75.5°, 82.8°, and 90°). Data was collected from 10 participants at each angle. Kinetic data and kinematic data of the climber's shoe was collected and used to map friction and normal forces to the shoe. These forces were then used to calculate the RCOF. The RCOF and friction force at 90° was higher than at lower angles (75.5° and 82.8°). RCOF was correlated with shoe angle and body angle supporting both the relevance of shoe orientation and body position to slip risk. This study suggests that frictional requirements of ladder climbing are dependent on ladder angle, shoe orientation, and body angle.

Effects of upper body strength, hand placement and foot placement on ladder fall severity.

BACKGROUND: A plurality of fatal falls to lower levels involve ladders. After a slip/misstep on a ladder, climbers use their upper and lower limbs to reestablish contact with the ladder. RESEARCH QUESTION: This study investigates the impact of upper body strength, hand placement and foot placement on fall severity after a ladder climbing perturbation. METHODS: Participants performed upper body strength tests (breakaway and grip strength) and climbed a vertical, fixed ladder while a misstep perturbation was applied under the foot. After the perturbation, three hand placement and two foot placement responses were generally observed. Common hand placement responses included the hand moving two rungs, one rung, or did not move to a different rung. Foot placement responses included at least one foot or no feet reestablished contact with the ladder rung(s). Fall severity was quantified by the peak harness force observed after the perturbation. RESULTS: Increased strength, reestablishing at least one foot on the ladder, and ascending (compared with descending) the ladder was associated with a reduction in fall severity. An interaction effect indicated that the impact of hand placement was altered by climbing direction. Moving the hand one rung during ascent and moving the hand two rungs during descent was associated with an increased fall severity. Cases where the hand decoupled from the ladder was associated with higher fall severity. Upper body strength assessed using a portable grip dynamometer was sufficient to predict fall severity. DISCUSSION: This study confirms the multifactor role of upper body strength, hand placement and foot placement in preventing falls from ladders. Furthermore, a portable dynamometer shows potential to screen for high-risk individuals. Results of this investigation may guide targeted interventions to prevent falls from ladders.

Effects of Gloves and Pulling Task on Achievable Downward Pull Forces on a Rung.

Objective We examined the impacts of pulling task (breakaway and pull-down tasks at different postures), glove use, and their interaction on achievable downward pull forces from a ladder rung. Background Posture, glove use, and the type of pulling task are known to affect the achievable forces. However, a gap in the literature exists regarding how these factors affect achievable downward pulling forces, which are relevant to recovery from a perturbation during ladder climbing. Methods Forty subjects completed four downward pulling tasks (breakaway force; pull force at maximum height, shoulder height, and a middle height), using three glove conditions with varying coefficient of friction (COF) levels (cotton glove, low COF; bare hand, moderate COF; and latex-coated glove, high COF) with their dominant and nondominant hand. The outcome variable was the maximum force normalized to body weight. Results The highest forces were observed for the highest hand postures (breakaway and maximum height). Increased COF led to higher forces and had a larger effect on breakaway force than the other tasks. The dominant hand was associated with higher forces than the nondominant hand. Male subjects generated greater forces than female subjects, particularly for higher hand positions. Conclusion This study suggests that a higher hand position on the ladder, while avoiding low-friction gloves, may be effective for improving recovery from ladder perturbations. Application This study may guide preferred climbing strategies (particularly those that lead to a higher hand position) for improving recovery from a perturbation during ladder climbing.

Factors affecting fall severity from a ladder: Impact of climbing direction, gloves, gender and adaptation.

Ladder falls cause many fatal injuries. The factors that affect whether a ladder perturbation leads to a fall are not well understood. This study quantified the effects of several factors on a person's ability to recover from a ladder perturbation. Thirty-five participants each experienced six unexpected ladder missteps, for three glove conditions (bare hands, high friction, low friction) and two climbing directions (ascent, descent). Fall severity was increased during ladder descent (p < 0.001). Gloves did not affect fall severity. Females compared to males had greater fall severity during ascent (p < 0.001) and descent (p = 0.018). During ascent, females had greater fall severity during the second perturbation but similar fall severity to males during the other perturbations. Additional protection may be needed when descending a ladder. Also, females may benefit from targeted interventions like training. This study does not suggest that gloves are effective for preventing ladder falls.

Effects of foot placement, hand positioning, age and climbing biodynamics on ladder slip outcomes.

Ladder falls frequently cause severe injuries; yet the factors that influence ladder slips/falls are not well understood. This study aimed to quantify (1) the effects of restricted foot placement, hand positioning, climbing direction and age on slip outcomes, and (2) differences in climbing styles leading to slips versus styles leading to non-slips. Thirty-two occupational ladder users from three age groups (18-24, 25-44 and 45-64 years) were unexpectedly slipped climbing a vertical ladder, while being assigned to different foot placement conditions (unrestricted vs. restricted toe clearance) and different hand positions (rails vs. rungs). Constraining foot placement increased the climber's likelihood of slipping (p < 0.01), while younger and older participants slipped more than the middle-aged group (p < 0.01). Longer double stance time, dissimilar and more variable foot and body positioning were found in styles leading to a slip. Maintaining sufficient toe clearance and targeting ladder safety training to younger and older workers may reduce ladder falls. Practitioner Summary: Ladder falls frequently cause severe occupational fall injuries. This study aims to identify safer ladder climbing techniques and individuals at risk of falling. The results suggest that ladders with unrestricted toe clearance and ladder climbing training programmes, particularly for younger and older workers, may reduce ladder slipping risk.