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Age-related changes in mediolateral dynamic stability control during volitional stepping

Jonathan C Singer, Stephen D Prentice, William E McIlroy
Gait & Posture 2013, 38 (4): 679-83
23523282
The control of mediolateral dynamic stability during stepping can be particularly challenging for older adults and appears to be related to falls and hip fracture. The specific mechanisms or control challenges that lead to mediolateral instability, however, are not fully understood. This work focussed on the restabilisation phase of volitional forward stepping, subsequent to foot contact, which we believe to be a principal determinant of mediolateral dynamic stability. Twenty younger (age 24±5 years; 50% women) and 20 older participants (age 71±5 years; 50% women) performed three different single-step tasks of various speed and step placement, which varied the challenge to dynamic stability. The trajectory of the total body centre of mass (COM) was quantified. Mediolateral COM incongruity, defined as the difference between the peak lateral and final COM position, and trial-to-trial variability of incongruity were calculated as indicators of dynamic stability. Older adults exhibited increased instability compared to young adults, as reflected by larger COM incongruity and trial-to-trial variability. Such increases among older adults occurred despite alterations in COM kinematics during the step initiation and swing phases, which should have led to increased stability. Task related increases in instability were observed as increased incongruity magnitude and trial-to-trial variability during the two rapid stepping conditions, relative to preferred speed stepping. Our findings suggest that increased COM incongruity and trial-to-trial variability among older adults signify a reduction in dynamic stability, which may arise from difficulty in reactive control during the restabilisation phase.

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