Advanced age brings a greater reliance on visual feedback to maintain balance during walking

Franz, Jason R.; Francis, Carrie A.; Allen, Matthew S.; O’Connor, Shawn M.; Thelen, Darryl G.

doi:10.1016/j.humov.2015.01.012

Cited by 96 publications

(111 citation statements)

References 36 publications

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“…Incorrect step placement can then further compromise mediolateral balance, requiring subsequent recovery steps to restore balance, thereby contributing to the increase in step width variability observed here. Interestingly, we previously found that the visual perturbation frequencies permeate old adult's center of mass motion [28]. That old adults' gait patterns entrain to one or both of the frequencies used in the perturbed visual flow further supports the idea that they were relying upon the aberrant visual feedback in their sensorimotor control of walking.…”

Section: Discussionmentioning

confidence: 75%

Gait variability in healthy old adults is more affected by a visual perturbation than by a cognitive or narrow step placement demand

et al. 2015

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Gait variability measures have been linked to fall risk in older adults. However, challenging walking tasks may be required to elucidate increases in variability that arise from subtle age-related changes in cognitive processing and sensorimotor function. Hence, the study objective was to investigate the effects of visual perturbations, increased cognitive load, and narrowed step width on gait variability in healthy old and young adults. Eleven old (OA, 71.2 ± 4.2 years) and twelve young (YA, 23.6 ± 3.9 years) adults walked on a treadmill while watching a speed-matched virtual hallway. Subjects walked: 1) normally, 2) with mediolateral visual perturbations, 3) while performing a cognitive task (serial seven subtractions), and 4) with narrowed step width. We computed the mean and variability of step width (SW and SWV, respectively) and length (SL, SLV) over one three minute trial per condition. Walking normally, old and young adults exhibited similar SWV and SLV. Visual perturbations significantly increased gait variability in old adults (by more than 100% in both SWV and SLV), but not young adults. The cognitive task and walking with narrowed step width did not show any effect on SWV or SLV in either group. The dramatic increase in step width variability when old adults were subjected to mediolateral visual perturbations was likely due to increased reliance on visual feedback for assessing whole body position. Further work is needed to ascertain whether these findings may reflect sub-clinical balance deficits that could contribute to the increased fall risk seen with advancing age.

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Section: Discussionmentioning

confidence: 75%

Gait variability in healthy old adults is more affected by a visual perturbation than by a cognitive or narrow step placement demand

et al. 2015

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“…2 Sensory reweighting provides a compensatory mechanism for altered afferent input arising from musculoskeletal injuries and aging. [3][4][5][6] Specifically, a recent meta-analysis 3 found that patients with chronic ankle instability re-weight to visual feedback to maintain single-limb balance, as a compensatory mechanism for reduced fidelity of somatosensory input from the injured ankle joint.…”

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confidence: 99%

“…5,6 This visual reliance may enable patients with somatosensory deficits to maintain standing balance, but it can be dangerous during activities of daily living or/and sports. These activities often involve multiple tasks; thus, patients' visual attention may be largely diverted from balance control, revealing the deficiencies in the compensatory mechanism and possibly resulting in falls and/or injury.…”

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confidence: 99%

Stroboscopic Vision to Induce Sensory Reweighting During Postural Control

Kim¹,

Kim²,

Grooms³

2017

Journal of Sport Rehabilitation

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Context: Patients with somatosensory deficits have been found to rely more on visual feedback for postural control. However, current balance tests may be limited in identifying increased visual dependence (sensory reweighting to the visual system), as options are typically limited to eyes open or closed conditions with no progressions between. Objective: To assess the capability of stroboscopic glasses to induce sensory reweighting of visual input during single-leg balance. Design:Descriptive Setting: Laboratory Participants: 18 healthy subjects without vision or balance disorders or lower extremity injury history (9 females; age = 22.1 ± 2.1 y; height = 169.8 ± 8.5 cm; mass = 66.5 ± 10.6 kg) participated. Interventions: Subjects performed 3 trials of unipedal stance for 10 s with eyes open (EO) and closed (EC), and with stroboscopic vision (SV) that was completed with specialized eyewear that intermittently cycled between opaque and transparent for 100 ms at a time. Balance tasks were performed on firm and foam surfaces, with the order randomized. Main Outcome Measures: Ten center-of-pressure parameters were computed. Results: Separate ANOVAs with repeated measures found significant differences between the 3 visual conditions on both firm (P-values =< .001) and foam (P-values =< .001 to .005) surfaces for all measures. For trials on firm surface, almost all measures showed that balance with SV was significantly impaired relative to EO, but less impaired than EC. On the foam surface, almost all postural stability measures demonstrated significant impairments with SV compared with EO, but the impairment with SV was similar to EC. Conclusions:SV impairment of single-leg balance was large on the firm surface, but not to the same degree as EC. However, the foam surface disruption to somatosensory processing and sensory reweighting to vision lead to greater disruptive effects of SV to the same level as EC. This indicates that when the somatosensory system is perturbed even a moderate decrease in visual feedback (SV) may induce an EC level impairment to postural control during single-leg stance.

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“…Prior studies have shown that older adults rely more on visual feedback to maintain balance during walking than younger adults, and those with significant visual impairment have slower walking speeds compared to age-matched controls. 20–21 Moreover, one study found that proprioceptive feedback exercises improved walking speed in individuals with Parkinson’s disease, suggesting the importance of proprioceptive inputs to gait function. 22 We adjusted for both visual acuity and monofilament testing in our regression models and did not observe that these factors explained the association between static balance and walking speed.…”

Section: Discussionmentioning

confidence: 99%

Age-Related Imbalance Is Associated With Slower Walking Speed: An Analysis From the National Health and Nutrition Examination Survey

Xie

Liu

Anson

et al. 2017

Journal of Geriatric Physical Therapy

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Background and purpose Walking speed is an important dimension of gait function and is known to decline with age. Gait function is a process of dynamic balance and motor control that relies on multiple sensory inputs (e.g. visual, proprioceptive and vestibular) and motor outputs. These sensory and motor physiologic systems also play a role in static postural control, which has been shown to decline with age. In this study, we evaluated whether imbalance that occurs as part of healthy aging is associated with slower walking speed in a nationally-representative sample of older adults. Methods We performed a cross-sectional analysis of the previously collected1999–2002 National Health and Nutrition Examination Survey (NHANES) data to evaluate whether age-related imbalance is associated with slower walking speed in older adults aged 50 to 85 (n=2,116). Balance was assessed on a pass/fail basis during a challenging postural task—Condition 4 of the modified Romberg test, and walking speed was determined using a 20-feet (6.10 m) timed walk. Multivariable linear regression was used to evaluate the association between imbalance and walking speed, adjusting for demographic and health-related covariates. A structural equation model was developed to estimate the extent to which imbalance mediates the association between age and slower walking speed. Results In the unadjusted regression model, inability to perform the NHANES balance task was significantly associated with 0.10 m/s slower walking speed (95% confidence interval [CI]: −0.13, −0.07; p<0.01). In the multivariable regression analysis, inability to perform the balance task was significantly associated with 0.06 m/s slower walking speed (95% CI: −0.09, −0.03; p<0.01), an effect size equivalent to 12 years of age. The structural equation model estimated that age-related imbalance mediates 12.2% of the association between age and slower walking speed in older adults. Conclusion In a nationally-representative sample, age-related balance limitation was associated with slower walking speed. Balance impairment may lead to walking speed declines. Additionally, reduced static postural control and dynamic walking speed that occur with aging may share common etiologic origins, including the decline in visual, proprioceptive, and vestibular sensory and motor functions.

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Advanced age brings a greater reliance on visual feedback to maintain balance during walking

Cited by 96 publications

References 36 publications

Gait variability in healthy old adults is more affected by a visual perturbation than by a cognitive or narrow step placement demand

Gait variability in healthy old adults is more affected by a visual perturbation than by a cognitive or narrow step placement demand

Stroboscopic Vision to Induce Sensory Reweighting During Postural Control

Age-Related Imbalance Is Associated With Slower Walking Speed: An Analysis From the National Health and Nutrition Examination Survey

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