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Query: UMLS:C0241981 (loss of balance)
 452 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Stepping reactions are often triggered rapidly in response to loss of balance. It has been unclear whether spatial step parameters are defined at time of step-initiation or whether they can be modulated online, during step execution, in response to sensory feedback about the evolving state of instability. This study explored the capacity to actively alter step direction subsequent to step initiation in six healthy young-adult subjects. To elicit forward-step reactions, subjects were released suddenly from a tethered forward lean. A second perturbation (medio-lateral support-surface translation) was applied at lags of 0-200 ms. Active reaction to the second perturbation was determined primarily through analysis of swing-leg hip-abductor activation. In addition, to gauge the biomechanical consequence of the changes in muscle activation, we compared the measured medio-lateral swing-foot displacement to that predicted by a simple passive mechanical model. Perturbations at 0-100 ms lag evoked active medio-lateral swing-foot deviation, allowing balance to be recovered with a single step. However, when the second perturbation occurred near foot-off (200-ms lag), there was no evidence of active alteration of step direction and subjects typically required additional steps to recover balance. The results suggest that step direction can be reparameterized during early stages of stepping reactions, but that step direction was not actively modulated in response to perturbation arising near start of swing phase.
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PMID:Online mutability of step direction during rapid stepping reactions evoked by postural perturbation. 1506 97

The reasons for higher fall risk of people with osteoarthritis (OA) compared to people without OA are not known. It is possible that following a loss of balance OA may negatively affect the recovery stepping response. Stepping responses have not been reported for people with knee OA. Here, we compared recovery step kinematics following laboratory-induced trip and following a large treadmill-delivered perturbation simulating a trip between a group of women with and without self-reported knee OA. We hypothesized that knee OA would significantly impair recovery step kinematics compared to those of a control group. Following the laboratory-induced trip, step length and trunk flexion velocity at recovery step completion of women with OA were significantly impaired and more so for the women who fell. Following the treadmill-delivered perturbation, the recovery step kinematics of women with OA were not significantly impaired. For both perturbations, the women who fell had significantly impaired recovery step kinematics compared to those who did not fall, regardless of OA. The results are consistent with previous work on healthy middle aged and older women and suggest that the same biomechanical risk factors for trip-related falls are shared by middle age and older women regardless of the presence of knee OA. The results support the need to determine whether training protocols which have been shown to improve recovery step kinematics and reduce prospective falls by healthy older women can have similar outcomes for people with knee OA.
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PMID:Knee osteoarthritis negatively affects the recovery step following large forward-directed postural perturbations. 2694 35