Variability and Specificity in Reactive Stabilization Movements to Diverse Slip Perturbations

Study Overview
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Brief Summary
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Recent research on slips has shown that use of perturbation training to improve specific motor skills to resist slips can vastly reduce falls. However, these interventions have only addressed slips occurring at heel-strike, and not the diverse range of slipping disturbances presented by a complex environment. This project will focus on slips that occur across the gait cycle, and the reactive stabilization movements that follow. Slips at different phases of the gait cycle have unique biomechanical contexts, and successful reactive stabilization movements are likely to be highly specific to that context. Yet nothing is known about the specificity of the repertoire of reactive stabilization movements to resist different slip conditions. Furthermore, variability in the repertoire of reactive stabilization movements is likely to affect the success/failure rate of resisting these disturbances. Thus, the objective of the proposed project is to determine the roles of variability and specificity in reactive stabilization movements to resist falling in diverse slipping conditions. A novel wearable apparatus for slip perturbations will deliver lifelike, unexpected slips in early, middle and late stance in younger and older adults. Biomechanical analysis based on three-dimensional motion capture data of the reactive stabilization movements will generate novel results on the specificity and variability of protective stepping and arm swinging responses. The central hypothesis is that increases in specificity and decreases in variability of reactive stabilization movements will reduce fall rates. The long-term objective of this research is to support future studies into the repertoire of reactive stabilization movements across the full range of disturbances faced in navigating the environment.

Detailed Description
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Subjects will be recruited through fliers from local exercise and community centers, independent senior living centers, and on the campus of the University of Nebraska at Omaha. Younger subjects age 19-35 years will be recruited. Older adults age 65-79 years will be recruited. At entry in the study, all subjects must self-report to be free from the following: history of 1 or more falls in the previous year, ear infections, vertigo, Meniere's disease, chronic dizziness. Subjects will not be excluded, but information will be collected on the following factors: hip/knee replacements, pain in the body, body-mass index, daily physical activity measures. A written informed consent approved by the Institutional Review Board of the University of Nebraska Medical Center (the IRB of record) will be obtained prior to the screening process. Study Procedures Overview: Analysis of responses and falls from diverse slip perturbations will take place in the main Motion Analysis Laboratory of the Biomechanics Research Building at the University of Nebraska at Omaha. Each subject will participate in 3 visits within the span of 1 week. On the initial visit, subjects will perform informed consent, then be asked to provide demographic information (age, gender, height, body mass), a medical questionnaire to assess exclusion criteria, and a physical activity questionnaire. Upper and lower body strength will be measured using a hand-held dynamometer during the first and last visits. On each of the three visits, subjects will perform a gait variability assessment followed by a diverse slip perturbation assessment. Gait variability assessment procedures: Before recording data, retroreflective markers will be placed on specific anatomical locations. These locations are defined to create a full-body dynamics model. Following familiarization, subjects will walk on a treadmill for 5 minutes at a prescribed pace of 1.3 meters per second while whole body kinematics are collected. Both linear and nonlinear measures of gait variability will be calculated (Table 1) to determine possible relationships between these measures and other outcome variables such as learning rate for reactive movements, and fall rate. Diverse slip perturbation assessment procedures: subjects will walk overground back and forth across a large motion capture area. Previous studies show that walking speed is highly correlated with some outcome measures, specifically variations in whole body angular momentum, gait variability measures, and loss of balance following a slip. Therefore, we will control gait speed across all subjects to 1.3 ± 0.2 m/s, a typically comfortable speed for both younger and older adults. Participants will be informed that a slip may occur, and that if slipped, they should attempt to maintain balance and continue walking. Subjects will then be slipped without warning at a randomly chosen time after 1 to 3 minutes of walking. Slips will be administered to both feet simultaneously during early, middle or late stance in a randomized order. After each slip, subjects will rest seated for 5 minutes. During this rest period, motion capture data and force data from the harness will be recorded, and the WASP will be reset for the next trial. Subjects will complete four slips in each of early, middle, and late stance on each visit. Measures of falls, slip severity, and reactive stabilization movements will be calculated.

Official Title
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Variability and Specificity in Reactive Stabilization Movements to Diverse Slip Perturbations

Conditions
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Slip Perturbations

Intervention / Treatment
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* Other: Administered Slip Perturbations


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 19-35 years for younger adults group, or age 65-79 for older adults group. Exclusion Criteria: Uncontrolled hypertension Peripheral arterial disease Vertigo Meniere's disease Chronic dizziness History of back or lower extremity injury Surgery that affects the subject's mobility Any neurological disease or impairment that affects limits the ability to walk, e.g. Stroke, Parkinson's disease, Multiple sclerosis

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 79 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Slipping Perturbations<br>The intervention involves exposing participants to a series of 12 unannounced slip perturbations while walking overground. These perturbations will be delivered at 3 different times within the gait cycle - early phase, middle phase, and late phase. | Other: Administered Slip Perturbations<br>* Slips will be administered in early, middle or late phases of stance during overground walking.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fall Percentage | Percentage of slip perturbations that result in a fall are assessed. Trials are classified as falls if the maximum force on the load cell in the harness system exceeds 30% body weight. | Up to 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Heel Displacement of the Slipping Foot Following Slip Perturbation | The total displacement of the slipping foot from the point of administered slip perturbation, until the foot stops sliding is assessed. | Up to 7 days | 
| Trunk Angular Momentum Following Slip Perturbation | Angular momentum of the trunk is assessed during the period of time from the onset of slip perturbation until the subject recovers or falls. | Up to 7 days | 
| Position of the Recovery Step Following Slip Perturbation | Position of the placement of the swing foot relative to the center of mass in the transverse plane following slip perturbation will be assessed. | Up to 7 days | 
| Coefficient of Variation of Stride Time Time Series | The coefficient of variation of the time series of stride times during treadmill walking is assessed. | Up to 7 days | 
| Maximum Heel Sliding Velocity of the Slipping Foot Following Slip Perturbation | The maximum velocity of the slipping foot will be assessed within the period from the administered slip perturbation, until the foot stops sliding. | Up to 7 days | 
| Time of the Recovery Step Following Slip Perturbation | Time of the placement of the swing foot relative to the onset of the administered slip perturbation is assessed | Up to 7 days | 
| Sample Entropy of Stride Time Time Series | The sample entropy of the time series of stride times during treadmill walking is assessed. | Up to 7 days |