Falls associated with tripping over an obstacle can be devastating to elderly individuals, yet little is known about the strategies used for stepping over obstacles by either old or young adults. The gait of gender-matched groups of 24 young and 24 old healthy adults (mean ages 22 and 71 years) was studied during a 4 m approach to and while stepping over obstacles of 0, 25, 51, or 152 mm height and in level obstacle-free walking. Optoelectronic cameras and recorders were used to record approach and obstacle crossing speeds as well as bilateral lower extremity kinematic parameters that described foot placement and movement trajectories relative to the obstacle. The results showed that age had no effect on minimum swing foot clearance (FC) over an obstacle. For the 25 mm obstacle, mean FC was 64 mm, or approximately three times that used in level gait; FC increased nonlinearly with obstacle height for all subjects. Although no age differences were found in obstacle-free gait, old adults exhibited a significantly more conservative strategy when crossing obstacles, with slower crossing speed, shorter step length, and shorter obstacle-heel strike distance. In addition, the old adults crossed the obstacle so that it was 10% further forward in their obstacle-crossing step. Although all subjects successfully avoided the riskiest form of obstacle contact, tripping, 4/24 healthy old adults stepped on an obstacle, demonstrating an increased risk for obstacle contact with age.
BAT and dCIT exhibited similar beneficial effects on movement smoothness but differential effects on force at movement initiation and functional performance. Therefore, BAT is a better option if improvement of force generation is the treatment goal, and dCIT is more appropriate for improving functional ability and use of the affected arm in daily life. These findings may assist in the planning of individually tailored rehabilitation therapies.
Selective control of the proximal lower limb may be the main determinant of walking velocity. The compensatory adaptations were similar, except for pelvic motion, in stroke patients with different levels of motor recovery, whereas the poor group walked with synergistic mass patterns and reduced stability.
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