Falls are a leading cause of injury among older adults and most often occur during walking. While strength and balance training moderately improve falls risk, training reactive recovery responses following sudden perturbations during walking may be more task-specific for falls prevention. The aim of this review was to determine the variety, characteristics and effectiveness of gait perturbation paradigms that have been used for improving reactive recovery responses during walking and reducing falls among healthy older adults. A systematic search was conducted in PubMed, Web of Science, MEDLINE and CINAHL databases in December 2015, repeated in May 2016, using sets of terms relating to gait, perturbations, adaptation and training, and ageing. Inclusion criteria: studies were conducted with healthy participants of 60 years or older; repeated, unpredictable, mechanical perturbations were applied during walking; and reactive recovery responses to gait perturbations or the incidence of laboratory or daily life falls were recorded. Results were narratively synthesised. The risk of bias for each study (PEDro Scale) and the levels of evidence for each perturbation type were determined. In the nine studies that met the inclusion criteria, moveable floor platforms, ground surface compliance changes, or treadmill belt accelerations or decelerations were used to perturb the gait of older adults. Eight studies used a single session of perturbations, with two studies using multiple sessions. Eight of the studies reported improvement in the reactive recovery response to the perturbations. Four studies reported a reduction in the percentage of laboratory falls from the pre- to post-perturbation experience measurement and two studies reported a reduction in daily life falls. As well as the range of perturbation types, the magnitude and frequency of the perturbations varied between the studies. To date, a range of perturbation paradigms have been used successfully to perturb older adults’ gait and stimulate reactive response adaptations. Variation also exists in the number and magnitudes of applied perturbations. Future research should examine the effects of perturbation type, magnitude and number on the extent and retention of the reactive recovery response adaptations, as well as on falls, over longer time periods among older adults.

/pdf/a-systematic-review-of-gait-perturbation-paradigms-for-2s99p3v3lg.pdf

A systematic review of gait perturbation paradigms for improving reactive stepping responses and falls risk among healthy older adults

Objective:In this review, we detail the impact of environmental stress on cognitive and military task performance and highlight any individual characteristics or interventions which may mitigate an...

The Impact of Environmental Stress on Cognitive Performance: A Systematic Review:

Perturbation-based gait assessment has been used to quantify gait stability in older adults. However, knowledge on which perturbation type is most suitable to identify poor gait stability is lacking. We evaluated the effects of ipsi- and contra-lateral sway, belt acceleration and deceleration, and visual and auditory perturbations on medio-lateral (ML) and anterior-posterior (AP) margins of stability (MoS) in young and older adults. We aimed to evaluate (1) which perturbation type disturbed the gait pattern substantially, (2) how participants recovered, and (3) whether recovery responses could discriminate between young and older adults. Nine young (25.1 ± 3.4 years) and nine older (70.1 ± 7.6 years) adults walked on the CAREN Extended (Motek BV, The Netherlands). The perturbation effect was quantified by deviation in MoS over six post-perturbation steps compared to baseline walking. Contra-lateral sway and deceleration perturbations resulted in the largest ML (1.9-4 times larger than other types) and AP (1.6-5.6 times larger than other types) perturbation effects, respectively. After both perturbation types, participants increased MoS by taking wider, shorter, and faster steps. No differences between young and older adults were found. We suggest to evaluate the potential of using contra-lateral sway and deceleration perturbations for fall risk identification by including both healthy and frail older adults. Graphical abstract Margins of stability during steady state (left) and perturbed (right) gait to quantify reactive gait stability in response to various perturbation types in young and older adults.

/pdf/gait-stability-in-response-to-platform-belt-and-sensory-1b6mhtc49u.pdf

Gait stability in response to platform, belt, and sensory perturbations in young and older adults.

Reduced lower extremity range of motion (ROM) and muscle strength are related to functional disability in older adults who cannot perform one or more activities of daily living (ADL) independently. The purpose of this study was to determine which factors of seven lower extremity ROMs and two muscle strengths play dominant roles in the physical performance of community-dwelling older women. Ninety-five community-dwelling older women (mean age ± SD, 70.7 ± 4.7 years; age range, 65–83 years) were enrolled in this study. Seven lower extremity ROMs (hip flexion, hip extension, knee flexion, internal and external hip rotation, ankle dorsiflexion, and ankle plantar flexion) and two muscle strengths (knee extension and flexion) were measured. Physical performance tests, including functional reach test (FRT), 5 m gait test, four square step test (FSST), timed up and go test (TUGT), and five times sit-to-stand test (FTSST) were performed. Stepwise regression models for each of the physical performance tests revealed that hip extension ROM and knee flexion strength were important explanatory variables for FRT, FSST, and FTSST. Furthermore, ankle plantar flexion ROM and knee extension strength were significant explanatory variables for the 5 m gait test and TUGT. However, ankle dorsiflexion ROM was a significant explanatory variable for FRT alone. The amount of variance on stepwise multiple regression for the five physical performance tests ranged from 25 (FSST) to 47% (TUGT). Hip extension, ankle dorsiflexion, and ankle plantar flexion ROMs, as well as knee extension and flexion strengths may play primary roles in the physical performance of community-dwelling older women. Further studies should assess whether specific intervention programs targeting older women may achieve improvements in lower extremity ROM and muscle strength, and thereby play an important role in the prevention of dependence on daily activities and loss of physical function, particularly focusing on hip extension, ankle dorsiflexion, and ankle plantar flexion ROMs as well as knee extension and flexion strength.

https://link.springer.com/content/pdf/10.1186%2Fs40101-016-0120-8.pdf

Association of lower extremity range of motion and muscle strength with physical performance of community-dwelling older women.

A central question relevant to the prevention of falls is: How does the robust control of walking and balance break down during a fall? Previous work has focused on muscle coordination during succe...

/pdf/neuromuscular-responses-differ-between-slip-induced-falls-y6rmw923dw.pdf

Neuromuscular responses differ between slip-induced falls and recoveries in older adults.

Muscle weakness is related to slip-initiated falls among community-dwelling older adults.

An algorithm for simulating human arm movement considering the comfort level

BACKGROUND High-temperatures in the cockpit environment can adversely influence pilot behavior and performance. OBJECTIVE To investigate the impact of high thermal environments on Chinese pilot performance in a simulated cockpit environment. METHODS Ten subjects volunteered to participate in the tests under 40°C and 45°C high-temperature simulations in an environmentally controlled chamber. Measures such as grip strength, perception, dexterity, somatic sense reaction, and analytical reasoning were taken. The results were compared to the Combined Index of Heat Stress (CIHS). RESULTS CIHS exceeded the heat stress safety limit after 45 min under 40°C, grip strength decreased by 12% and somatic perception became 2.89 times larger than the initial value. In the case of 45°C, CIHS exceeded the safety limit after only 20 min, while the grip strength decreased just by 3.2% and somatic perception increased to 4.36 times larger than the initial value. Reaction and finger dexterity were not statistically different from baseline measurements, but the error rate of analytical reasoning test rose remarkably. CONCLUSION Somatic perception was the most sensitive index to high-temperature, followed by grip strength. Results of this paper may help to improve environmental control design of new fighter cockpit and for pilot physiology and cockpit environment ergonomics research for Chinese pilots.

Simulating extreme environments: Ergonomic evaluation of Chinese pilot performance and heat stress tolerance.

Effects of EVA gloves on grip strength and fatigue under low temperature and low pressure.

The objective of this investigation is to measure and document any significant difference in motion performance between the partial pressure suit (PPS) and the common clothing (CC), and therefore to explore the ergonomics evaluation indexes and appraisal methods of protective clothing (PC). This paper presents the results of three human mechanics tests and two operational performance tests conducted on nine male subjects which made possible the comparative evaluation under these two different situations. The human mechanics tests included a range of motion (ROM) test, a grip strength test, and a torque test while the operational performance tests included a target-aiming test and a screwing nuts test. Significant difference was found between the two suits in the ROM test, the grip strength test as well as the target-aiming test. This study demonstrates that motion performances vary significantly between the two suits and ROM together with grip strength can serve as ergonomics evaluation indexes of PC.

/pdf/investigation-on-ergonomics-characteristics-of-protective-4tlkih90s8.pdf

Investigation on ergonomics characteristics of protective clothing based on capture of three-dimensional body movements

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