Search

Purpose. Tendons behave viscoelastically and exhibit adaptive responses to conditions of increased loading and disuse. Strain patterns in tendons may not be uniform, as tendons show stress-shielded areas and areas subjected to compressive loading at the enthesis. These areas correspond to the sites where tendinopathic characteristics are typically seen. Method. We review the biomechanic literature on Achilles tendon, trying to interpret it on the basis that classic inflammatory changes are not frequently seen in chronic athletic tendon conditions. Results. Biomechanical studies show that the strains within the tendons near their insertion site are not uniform. If the material properties are similar throughout the tendon, forces transferred through the insertion site preferentially load the side of the tendon that is usually not affected initially in tendinopathy. In that case, the side affected by tendinopathy is generally 'stress shielded'. Conclusion. The presence of differential strains opens the possibility of alternative biomechanical explanations for the pathology found in these regions of the tendon. The traditional concept of tensile failure may not be the essential feature of the pathomechanics of insertional tendinopathy. Additional work is needed ascertain whether such principles should be incorporated in current rehabilitation. [ABSTRACT FROM AUTHOR]

At whole muscle level, the reduction in intrinsic force observed with ageing is probably the result of the combined effect of changes in: (i) muscle architecture, (ii) tendon mechanical properties, (iii) neural drive (reduced agonist and increased antagonist muscles' activity), and (iv) single fibre specific tension. Only recently have alterations in muscle architecture and in tendon mechanical properties been shown to contribute to the reduction in intrinsic muscle force, and tendon stiffness changes play an important role. Of note is the fact that most of these changes may be reversed by 14 weeks of resistive training, for both fibre fascicle length and tendon stiffness were found to be increased by 10% and 64%, respectively. Surprisingly, however, training had no effect on the estimated relative length-tension properties of the muscle, indicating that the effects of increased tendon stiffness and increased fascicle length cancelled out each other. It seems that natural strategies may be in place to ensure that the relative operating range of muscle remains unaltered by changes in physical activity, and perhaps age. [ABSTRACT FROM AUTHOR]

Background: Falling on stairs is a major health hazard for older people. Risk factors for stair falls have been identified, but these are mostly examined in controlled biomechanics/gait laboratory environments, on experimental stairs with a given set of step dimensions. It remains unknown whether the conclusions drawn from these controlled environments would apply to the negotiation of other domestic staircases with different dimensions in real houses where people live., Objectives: The aim of this paper is to investigate whether selected biomechanical stepping behavior determined through stair gait parameters such as foot clearance, foot contact length and cadence are maintained when the staircase dimensions are different in real houses., Methods: Twenty-five older adults (>65 years) walked on a custom-made seven-step laboratory staircase. Older adults were classified into two groups (fallers and non-fallers) based on recent fall history. Among the 25 participants, 13 people had at least one fall, trip, or slip in the last six months and they were assigned to the fallers group; 12 people did not experience any fall in the last six months, so they were assigned to the non-fallers group. In addition, these participants walked on the stairs in three different real exemplar houses wearing a novel instrumented shoe sensor system that could measure the above stair gait parameters. MATLAB was used to extract fall risk parameters from the collected data. One-way ANOVA was used to compare fall risk parameters on the different staircases. In addition, the laboratory-based fall risk parameters were compared to those derived from the real house stairs., Results: There was a significant difference in selected stair-fall biomechanical risk factors among the house and laboratory staircases. The fall risk group comparisons suggest that high-risk fallers implemented a biomechanically riskier strategy that could increase overall falling risk., Conclusions: The significant differences due to the main effects of the fallers and non-fallers groups were obtained. For example, when ascending, the fallers group had less foot clearance on the entry ( p = 0.016) and middle steps ( p = 0.003); in addition, they had more foot clearance variability on the entry steps ( p = 0.003). This suggests that the fallers group in this present study did not adopt more conservative stepping strategies during stair ascent compared to low-risk older adults. By showing less foot clearance and more variability in foot clearance, the risk for a trip would be increased.

Background: The patellofemoral joint is an important source of pain in knee osteoarthritis. Most biomechanical research in knee osteoarthritis has focused on the tibiofemoral joint during level walking. It is unknown what happens during stair negotiation in patients with patellofemoral joint osteoarthritis, a task commonly increasing pain. Conservative therapy for patellofemoral joint osteoarthritis includes the use of a sleeve knee brace. We aimed to examine the effect of a sleeve knee brace on knee biomechanics during stair negotiation in patellofemoral joint osteoarthritis patients., Methods: 30 patellofemoral joint osteoarthritis patients (40-70 years) ascended and descended an instrumented staircase with force plates under two conditions - wearing a Lycra flexible knee support (Bioskin Patellar Tracking Q Brace) and no brace (control condition). Knee joint kinematics (VICON) and kinetics were recorded., Findings: During stair ascent, at the knee, the brace significantly reduced the maximal flexion angle (2.7 0 , P = 0.002), maximal adduction angle (2.0 0 , P = 0.044), total sagittal range of motion (2.0 0 , P = 0.008), total frontal range of motion (1.7 0 , P = 0.023) and sagittal peak extension moment (0.05 Nm/kg, P = 0.043) compared to control. During stair descent, at the knee, the brace significantly reduced the maximal flexion angle (1.8 0 , P = 0.039) and total sagittal range of motion (1.5 0 , P = 0.045) compared to control., Interpretation: The small changes in knee joint biomechanics during stair negotiation observed in our study need to be investigated further to help explain mechanisms behind the potential benefits of a sleeve knee brace for painful patellofemoral joint osteoarthritis., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Trips and slips are significant causal perturbations leading to falls on stairs, especially in older people. The risk of a trip caused by a toe or heel catch on the step edge increases when clearance is small and variable between steps. The risk of a slip increases if the proportion of the foot area in contact with the step is reduced and variable between steps. To assess fall risk, these measurements are typically taken in a gait lab using motion-capture optoelectronic systems. The aim of this work was to develop a novel smart shoe equipped with sensors to measure foot placement and foot clearance on stairs in real homes. To validate the smart shoe as a tool for estimating stair fall risk, twenty-five older adults' sensor-based measurements were compared against foot placement and clearance measurements taken in an experimental staircase in the lab using correlations and Bland-Altman agreement techniques. The results showed that there was a good agreement and a strong positive linear correlation for foot placement (r = 0.878, p < 0.000) and foot clearance (r = 0.967, p < 0.000) between sensor and motion analysis, offering promise for advancing the current prototype into a measurement tool for fall risk in real-life staircases.

Background: Toe clearance on stairs is typically measured using optoelectronic systems, though these are often constrained to the laboratory, due to their complex setups. Here we measured stair toe clearance through a novel prototype photogate setup and compared this to optoelectronic measurements. Methods: Twelve participants (age 22 ± 3 years) completed 25 stair ascent trials, each on a seven-step staircase. Toe clearance over the fifth step edge was measured using Vicon and the photogates. Twenty-two photogates were created in rows through laser diodes and phototransistors. The height of the lowest photogate broken at step-edge crossing was used to determine photogate toe clearance. A limits of agreement analysis and Pearson's correlation coefficient compared the accuracy, precision and relationship between systems. Results: We found a mean difference of -1.5 mm (accuracy) between the two measurement systems, with upper and lower limits (precision) of 10.7 mm and -13.8 mm, respectively. A strong positive correlation was also found ( r = 70, n = 12, p = 0.009) between the systems. Discussion: The results suggest that photogates could be an option for measuring real-world stair toe clearances, where optoelectronic systems are not routinely used. Improvements to the design and measurement factors may help to improve the precision of the photogates.

Exercise training can induce adaptive changes to tendon tissue both structurally and mechanically; however, the underlying compositional changes that contribute to these alterations remain uncertain in humans, particularly in the context of the ageing tendon. The aims of the present study were to determine the molecular changes with ageing in patellar tendons in humans, as well as the responses to exercise and exercise type (eccentric (ECC) and concentric (CON)) in young and old patellar tendon. Healthy younger males (age 23.5 ± 6.1 years; n = 27) and older males (age 68.5 ± 1.9 years; n = 27) undertook 8 weeks of CON or ECC training (3 times per week; at 60% of 1 repetition maximum (1RM)) or no training. Subjects consumed D 2 O throughout the protocol and tendon biopsies were collected after 4 and 8 weeks for measurement of fractional synthetic rates (FSR) of tendon protein synthesis and gene expression. There were increases in tendon protein synthesis following 4 weeks of CON and ECC training (P < 0.01; main effect by ANOVA), with no differences observed between young and old males, or training type. At the transcriptional level however, ECC in young adults generally induced greater responses of collagen and extracellular matrix-related genes than CON, while older individuals had reduced gene expression responses to training. Different training types did not appear to induce differential tendon responses in terms of protein synthesis, and while tendons from older adults exhibited different transcriptional responses to younger individuals, protein turnover changes with training were similar for both age groups., (© 2022. The Author(s).)

Participants exposed to a simulated slip with forward loss of balance (FLB) develop large lower limb joint moments which may be a limiting factor for those whose muscle-tendon units’ (MTUs) properties are deteriorated. Whether the age-related decline in these properties limits participants’ capacity to recover their balance following a slip with FLB remains unclear. We combined isokinetic dynamometry, ultrasound and EMG to understand how knee extensor and ankle plantarflexor muscle strength and power, rate of moment development, electromechanical delay, and tendon stiffness affected the balance of young (25.3 ± 3.9 years) and older adults (62.8 ± 7.1 years) when recovering from a single slip with FLB triggered whilst walking on a split-belt instrumented treadmill. Except for the patellar tendon’s stiffness, knee extensor and ankle plantarflexor electromechanical delays, older adults’ MTUs properties were deteriorated compared to those of young participants (p < 0.05). We found no significant relationship between age or the MTUs properties of participants and balance recovery. These findings provide additional support that neither maximal nor explosive strength training are likely to be successful in preventing a fall for healthy older adults, and that other type of interventions, such as task-specific training that has already proved efficacious in reducing the risk of falling, should be developed.

Aim: Exposure to repeated gait perturbations improves the balance of older adults (OAs) and decreases their risks of falling, but little is known about the underpinning mechanical adjustments. We aimed to quantify the changing temporo-spatial and kinetic characteristics of balance recovery following repeated backward slips to better understand the mechanical adjustments responsible for improved balance. Methods: We exposed 17 young adults (YAs) (25.2 ± 3.7 years) and 17 OAs (62.4 ± 6.6 years) to 10 backward slips simulated on an instrumented treadmill by unilateral backward belt accelerations. We measured the balance of the participants (margin of stability: MoS), balance recovery (n steps : number of steps necessary to return to a steady gait for at least three consecutive steps), temporo-spatial (step length), and kinetics [ground reaction force (GRF) angle, lower limb joint moments] for 15 steps following each slip. The results were compared with baseline. Results: Participants in both groups improved their MoS and n steps with repeated exposure to the slips, but no significant effect of age was detected. During the perturbed step, the GRF vector was directed more posteriorly during mid-stance and more anteriorly during push-off than baseline, which resulted in a longer step. These adjustments were maintained from the first (Slip01) to the last (Slip10) slip, and by Slip10 were correlated with better balance (MoS) on the second recovery step. During the first recovery step following Slip01, participants developed lower plantarflexor and larger knee extensor moments whilst taking a shorter step, these adjustments were correlated with poorer balance and were not maintained with repeated slips. Joint moments and step length of the first recovery step returned to normal levels by Slip10. Conclusion: Young adults and OAs improved their balance with repeated slips. The adjustments that were positively correlated with balance (changes in step length, GRF angle) were maintained whilst those that were not (changes in joint moments) were discarded. All the responses observed in Slip10 were observed in Slip01. The observed balance improvements were achieved by refining the initial strategy rather than by developing a new one. The underlying mechanics were correlated with step length of the first recovery steps, which was associated with balance and should be monitored in fall prevention interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Debelle, Maganaris and O'Brien.)

Introduction: Stair falls can be caused by inconsistent stair dimensions. During ascent, inconsistently taller stair risers lead to reduced foot clearances as the inconsistency goes unnoticed. A stair horizontal-vertical illusion increases perceived riser heights and foot clearance and could offset reduced foot clearances over inconsistently taller risers, though this might impact other stair safety measures., Method: Twelve participants (age: 22 (3) years) ascended a seven-step staircase under three conditions: i) all steps consistent in riser height (consistent), ii) a 1cm increase in step 5 riser height (inconsistent) and iii) a 1cm increase in step 5 riser height, superimposed with a stair horizontal-vertical illusion (illusion). Vertical foot clearance, foot overhang, and margins of stability were assessed over step 4, 5 and 6. Perceived riser height due to the illusion was determined through a computer perception test. A One-Way Repeated Measures ANOVA compared biomechanical variables between conditions. A One Sample t test compared perceived riser height to the true height., Results: Over the inconsistent step 5, foot clearance reduced by 0.8cm compared to consistent. Illusion increased foot clearance by 1.1cm and decreased foot overhang by 4% compared to inconsistent. On step 4 the illusion led to more anterior instability compared to inconsistent. Illusion and inconsistent led to more mediolateral stability compared to consistent. The illusion increased perceived riser height by 12%., Discussion: Foot clearance reductions over inconsistently taller risers can be offset by a stair horizontal-vertical illusion. Additional benefits included a safer foot overhang and unaffected stability over the inconsistent riser. Changes to step 4 stability might have resulted from leaning forward to look at the step 5 illusion. The stair horizontal-vertical illusion could be a practical solution for inconsistently taller stair risers, where a rebuild is usually the only solution., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Tripping on stairs results from insufficient foot to step edge clearance and can often lead to a fall in older adults. A stair horizontal-vertical illusion is suggested to increase the perceived riser height of a step and increase foot clearance when stepping up. However, this perception-action link has not been empirically determined in older adults. Previous findings suggesting a perception-action effect have also been limited to a single step or a three-step staircase. On larger staircases, somatosensory learning of step heights may be greater which could override the illusory effect on the top step. Furthermore, the striped nature of the existing stair horizontal-vertical illusion is associated with visual stress and may not be aesthetically suitable for use on public stairs. These issues need resolving before potential future implementation on public stairs., Methods: Experiment 1. A series of four computer-based perception tests were conducted in older (N = 14: 70 ± 6 years) and young adults (N = 42: 24 ± 3 years) to test the influence of different illusion designs on stair riser height estimation. Participants compared images of stairs, with horizontal-vertical illusions or arbitrary designs on the bottom step, to a plain stair with different bottom step riser heights and selected the stair they perceived to have the tallest bottom riser. Horizontal-vertical illusions included a previously developed design and versions with modified spatial frequencies and mark space ratios. Perceived riser height differences were assessed between designs and between age groups. Experiment 2. To assess the perception-action link, sixteen older (70 ± 7 years) and fifteen young (24 ± 3 years) adults ascended a seven-step staircase with and without horizontal-vertical illusions tested in experiment 1 placed onto steps one and seven. Foot clearances were measured over each step. To determine whether changes in perception were linked to changes in foot clearance, perceived riser heights for each horizontal-vertical illusion were assessed using the perception test from experiment 1 before and after stair ascent. Additional measures to characterise stair safety included vertical foot clearance, margins of stability, foot overhang, stair speed, and gaze duration, which were assessed over all seven steps., Results: Experiment 1. All horizontal-vertical illusion designs led to significant increases in the perceived riser height in both young and older adults (12-19% increase) with no differences between age groups. Experiment 2. On step 7, each horizontal-vertical illusion led to an increase in vertical foot clearance for young (up to 0.8 cm) and older adults (up to 2.1 cm). On step 1 significant increases in vertical foot clearance were found for a single horizontal-vertical illusion when compared to plain (1.19 cm increase). The horizontal-vertical illusions caused significant increases in the perceived riser height (young; 13% increase, older; 11% increase) with no differences between illusion design, group or before and after stair ascent. No further differences were found for the remaining variables and steps., Conclusion: Results indicate a perception-action link between perceived riser height and vertical foot clearance in response to modified versions of the horizontal-vertical illusion in both young and older adults. This was shown with no detriment to additional stair safety measures. Further evaluating these illusions on private/public stairs, especially those with inconsistently taller steps, may be beneficial to help improve stair safety for older adults., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Step-surface visual properties are often associated with stair falls. However, evidence for decorating stairs typically concerns the application of step-edge highlighters rather than the entire step-surface. Here we examine the influence of step-surface visual properties on stair descent safety, with a view to generating preliminary evidence for safe stair décor., Methods: Fourteen young (YA: 23.1 ± 3.7 years), 13 higher (HAOA: 67 ± 3.5) and 14 lower (LAOA: 73.4 ± 5.7) ability older adults descended a seven-step staircase. Older adults were stratified based on physiological/cognitive function. Step-surface décor patterns assessed were: Black and white (Busy); fine grey (Plain); and striped multicolour (Striped); each implemented with/without black edge-highlighters (5.5 cm width) totalling six conditions. Participants descended three times per condition. Confidence was assessed prior to, and anxiety following, the first descent in each condition. 3D kinematics (Vicon) quantified descent speed, margin of stability, and foot clearances with respect to step-edges. Eye tracking (Pupil-labs) recorded gaze. Data from three phases of descent (entry, middle, exit) were analysed. Linear mixed-effects models assessed within-subject effects of décor (×3) and edge highlighters (×2), between-subject effects of age (×3), and interactions between terms (α = p < .05)., Results: Décor: Plain décor reduced anxiety in all ages and abilities (p = .032, effect size: g av  = 0.3), and increased foot clearances in YA and HAOA in the middle phase (p < .001, g av  = 0.53), thus improving safety. In contrast, LAOA exhibited no change in foot clearance with Plain décor. Patterned décor slowed descent (Busy: p < .001, g av  = 0.2), increased margins of stability (Busy: p < .001, g av  = 0.41; Striped: p < .001, gav = 0.25) and reduced steps looked ahead (Busy: p = .053, gav = 0.25; Striped: p = .039, gav = 0.28) in all ages and abilities. This reflects cautious descent, likely due to more challenging conditions for visually extracting information about the spatial characteristics of the steps useful to guide descent. Edge highlighters: Step-edge highlighters increased confidence (p < .001, g av  = 0.53) and reduced anxiety (p < .001, g av  = 0.45) in all ages and abilities and for all décor, whilst removing them slowed descent in HAOA (p = .01, g av  = 0.26) and LAOA (p = .003, g av  = 0.25). Step-edge highlighters also increased foot clearance in YA and HAOA (p = .003, g av  = 0.14), whilst LAOA older adults showed no adaptation. No change in foot clearances with décor or step-edge highlighters in LAOA suggests an inability to adapt to step-surface visual properties., Conclusion: Patterned step surfaces can lead to more cautious and demanding stair negotiation from the perspective of visually extracting spatial information about the steps. In contrast, plain décor with step edge highlighters improves safety. We therefore suggest plain décor with edge highlighters is preferable for use on stairs., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Stairs are associated with falls, especially when step dimensions are inconsistent. However, the mechanisms by which inconsistencies cause this higher risk are mostly theoretical. In this experimental study we quantified the effect of inconsistent rise heights on biomechanical measurements of stepping safety from younger (n = 26) and older adults (n = 33). In ascent, both groups decreased foot clearance (~9 mm) over the inconsistently higher step (F(1,56) = 48.4, p < 0.001). In descent, they reduced foot contact length on the higher step by 3% (F(1,56) = 9.1, p < 0.01). Reduced clearance may result in a toe-catch potentially leading to a trip, while reduced foot contact lengths increase the risk of overstepping which may also lead to a fall. These effects occurred because participants did not alter their foot trajectories, indicating they either did not detect or were not able to adjust to the inconsistent rise, increasing the likelihood of a fall. Consistent stair construction is vital, and existing inconsistencies should be identified and safety interventions developed., Competing Interests: Declaration of competing interest Mike Roys is an independent consultant working as a sole trader under the name of Rise and Going Consultancy. There is no conflict of interest with how this study was run nor the outcome measures reported. No other competing interests exist., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aim: Falls commonly occur from trips and slips while walking. Recovery strategies from trips and backward falling slips have been extensively studied. However, until recently, forward falling slips (FFSs) have been considered less dangerous and have been understudied. This study aimed first to create an application to realistically simulate FFSs using a split-belt instrumented treadmill and then to understand the biomechanical requirements for young adults to recover from an FFS. Methods: We developed a semi-automatic custom-made application on D-Flow that triggered FFSs by briefly and unexpectedly increasing the speed ( a = 5 m·s -2 ) of the right belt during stance. To validate the protocol, we tested against criteria defined for an ecologically and experimentally valid FFS: unexpected occurrence of the slip, increased foot velocity, forward loss of balance during the slip and consistent perturbation timing. We evaluated the recovery strategies of 17 young adults by measuring dynamic stability, joint moments and ground reaction force (GRF) vector angles before, during and on 15 steps following the FFS. Results: The application successfully triggered FFSs, according to the criteria we defined. Participants' balance returned to normal for a minimum of three consecutive steps in 10.9 (7.0) steps. Recovery from the FFSs was characterised by larger hip flexor and knee extensor moments to support the centre of mass during the slip, and a longer first recovery step with large hip extensor moments to arrest the fall followed by large knee extensor moments to raise and advance the centre of mass into the next step ( p < 0.001 compared with normal gait). Subsequent steps progressively returned to normal. Conclusion: This is the first study to experimentally simulate FFSs meeting the aforementioned criteria, and to measure their effects on the dynamic balance and kinetic parameters. The split-belt instrumented treadmill proved a promising tool to better study the mechanisms of falls and recovery. The required large hip and knee joint moments generally agree with findings on trips and backward falling slips and provide an indication of the functional capacities that should be targeted in fall-prevention interventions. These findings should be used to better understand and target the mechanisms of balance loss and falls in older adults following FFSs., (Copyright © 2020 Debelle, Harkness-Armstrong, Hadwin, Maganaris and O'Brien.)

This study combines in vivo ultrasound measurements of the Vastus Lateralis (VL) and Gastrocnemius Medialis (GM) muscles with electromyographic, kinematic, and kinetic measurements during treadmill running at different speeds (10, 13, and 16 km/h) to better understand the role of muscle and tendon behavior in two functionally different muscle-tendon units. In addition, the force-length and force-velocity relationships of VL and GM were experimentally assessed by combining dynamometry and EMG data with ultrasound measurements. With increasing running speed, the operating length of the fascicles in the stance phase shifted toward smaller lengths in the GM (P < .05; moving down the ascending limb of the F-L relationship) and longer lengths in the VL (P < .05; moving down the descending limb) at all speeds; however, both muscles contracted close to their optimal length L 0 , where isometric force is maximal. Whereas the length of VL SEE did not change as a function of speed, GM SEE lengthened and shortened more at higher speeds. With increasing running speed, the contribution of elastic strain energy to the positive power generated by the MTU increased more for GM (from 0.75 to 1.56 W/kg) than for VL (from 0.62 to 1.02 W/kg). Notwithstanding these differences, these results indicate that, at increasing running speeds, both the VL and GM muscles produce high forces at low contraction velocities, and that the primary function of both muscle-tendon units is to enhance the storage and recovery of elastic strain energy., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Older people have an increased risk of falling during locomotion, with falls on stairs being particularly common and dangerous. Step going (i.e., the horizontal distance between two consecutive step edges) defines the base of support available for foot placement on stairs, as with smaller going, the user's ability to balance on the steps may become problematic. Here we quantified how stair negotiation in older participants changes between four goings (175, 225, 275, and 325 mm) and compared stair negotiation with and without a walking approach. Twenty-one younger (29 ± 6 years) and 20 older (74 ± 4 years) participants negotiated a 7-step experimental stair. Motion capture and step-embedded force platform data were collected. Handrail use was also monitored. From the motion capture data, body velocity, trunk orientation, foot clearance and foot overhang were quantified. For all participants, as stair going decreased, gait velocity (ascent p A = 0.033, descent p D = 0.003) and horizontal step clearance decreased (p A = 0.001), while trunk rotation (p D = 0.002) and foot overhang increased (p A,D < 0.001). Compared to the younger group, older participants used the handrail more, were slower across all conditions (p A < 0.001, p D = 0.001) and their foot clearance tended to be smaller. With a walking approach, the older group ( Group x Start interaction) showed a larger trunk rotation (p A = 0.011, p D = 0.015), and smaller lead foot horizontal (p A = 0.046) and vertical clearances (p D = 0.039) compared to the younger group. A regression analysis to determine the predictors of foot clearance and amount of overhang showed that physical activity was a common predictor for both age groups. In addition, for the older group, medications and fear of falling were found to predict stair performance for most goings, while sway during single-legged standing was the most common predictor for the younger group. Older participants adapted to smaller goings by using the handrails and reducing gait velocity. The predictors of performance suggest that motor and fall risk assessment is complex and multifactorial. The results shown here are consistent with the recommendation that larger going and pausing before negotiating stairs may improve stair safety, especially for older users., (Copyright © 2020 Di Giulio, Reeves, Roys, Buckley, Jones, Gavin, Baltzopoulos and Maganaris.)

Aim: To study the causes of locomotor dysfunction, estimate muscle forces, or understand the influence of altered sarcomere and muscle properties and behaviours on whole body function, it is necessary to examine the leverage with which contractile forces operate. At the ankle joint, current methods to quantify this leverage for the plantarflexors do not account for curvature of the Achilles tendon, and so may not be appropriate when studying equinus gait. Thus, novel methodologies need to be developed and implemented to quantify the Achilles tendon moment arm length during locomotion. Methods: Plantarflexor internal moment arm length and effective mechanical advantage of 11 typically developed young adults were calculated throughout stance, while heel-toe walking and voluntarily toe-walking on an instrumented treadmill. Achilles tendon moment arm was defined in two-ways: (1) assuming a straight tendon, defined between the gastrocnemius medialis myotendinous junction and Achilles tendon insertion point, and (2) accounting for tendon curvature, by tracking the initial path of the Achilles tendon from the calcaneal insertion. Results: When accounting for tendon curvature, Achilles tendon moment arm length and plantarflexor effective mechanical advantage did not differ between walking conditions ( p > 0.05). In contrast, when assuming a straight tendon, Achilles tendon moment arm length ( p = 0.043) and plantarflexor effective mechanical advantage ( p = 0.007) were significantly greater when voluntary toe-walking than heel-toe walking in late stance. Discussion: Assuming a straight Achilles tendon led to a greater Achilles tendon moment arm length and plantarflexor effective mechanical advantage during late stance, compared to accounting for tendon curvature. Consequently, plantarflexor muscle force would appear smaller when assuming a straight tendon. This could lead to erroneous interpretations of muscular function and fascicle force-length-velocity behaviour in vivo , and potentially inappropriate and ineffective clinical interventions for equinus gait., (Copyright © 2020 Harkness-Armstrong, Debelle, Maganaris, Walton, Wright, Bass, Baltzopoulos and O’Brien.)

Introduction: Poor lighting has been associated with stair falls in young and older adults. However, current guidelines for illuminating stairs seem arbitrary, differ widely between sources, and are often difficult to interpret., Aims: Here we examined the influence of real-world bulb illumination properties on stair descent safety in young and older adults, with a view to generating preliminary evidence for appropriate lightbulb use/stair illumination., Methods: Stair tread illumination (lx) was measured in a standard UK home (2.23 m ceiling) from a low (50 W; 630 lm) and a high (103 W, 1450 lm) power compact fluorescent lamp (CFL) bulb from the time they were turned on until they reached full brightness. This enabled modelling of their illumination characteristics during warm up. Illumination was also measured from a low (40 W, 470 lm) and a high (100 W, 1521 lm) power LED bulb at first turn-on. Computer-controlled custom lighting then replicated these profiles, in addition to a Bright control (350 lx), on an instrumented staircase descended (3 × trials per light condition) by 12 young (25.3 ± 4.4 years; 5 males), 12 higher ability older (HAOA: 69.6 ± 4.7 years; 5 males) and 13 lower ability older (LAOA: 72.4 ± 4.2; 3 males) healthy adults. Older adults were allocated to ability groups based on physiological and cognitive function. Stair-specific confidence was assessed prior to the first descent in each new lighting condition, and whole-body 3D kinematics (Vicon) quantified margins of stability and foot clearances with respect to the step edges. Mixed ANOVAs examined these measures for within-subject effects of lighting (×5), between-subject effects of age (×3) and interactions between lighting and age., Results: Use of CFL bulbs led to lower self-reported confidence in older adults (20.37%, p = .01), and increased margins of stability (12.47%, p = .015) and foot clearances with respect to the step edges (10.36%, p = .003). Importantly, using CFL bulbs increased foot clearance variability with respect to the bottom step (32.74%, p = .046), which is where a high proportion of falls occur., Conclusion: Stair-tread illumination from CFL bulbs at first turn on leads to less safe stair negotiation. We suggest high powered LED bulbs may offer a safer alternative., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Human movement control requires attention to accurately tune motor commands in response to environmental changes. Dual task paradigms are used to test the role of attention on motor performance. Usually the tasks used have little resemblance with every day experience. Here we ask: Does a common cognitive task, such as a mobile phone conversation, compromise motor performance on stairs? Eight young participants negotiated an instrumented seven-step staircase. Stair negotiation while talking on a mobile phone was compared to normal stair negotiation. Stepping parameters, jerk cost (measure of smoothness of locomotion) and step clearance were measured. When talking on a mobile phone, participants' overall body velocity (mean(sd): Ascent 0.534(0.026) vs 0.511(0.024) m/s, Descent 0.642(0.026) vs 0.511(0.024) m/s, No phone/Phone respectively) and cadence decreased significantly (Ascent 75.8(5.8) vs 65.6(4.4) steps/min, Descent 117.4(4.2) vs 108.6(6.0) steps/min, No Phone/Phone respectively). Pelvis and feet jerk cost also changed significantly, mostly decreasing with phone use. Foot clearance did not show significant changes between No Phone and Phone conditions. These pilot results show that, even for young, healthy and cognitively intact individuals, talking on a mobile phone whilst negotiating a staircase induces measurable changes in motor performance. Participants moved slowly but more smoothly, reducing the motor control cost, possibly at the expense of movement accuracy. The reduction in motor performance is likely to be due to the difficulty in integrating the two sub-tasks. These results suggest that even young, healthy individuals show stair gait impairment when simultaneously negotiating stairs and performing another cognitive task, such as talking on the phone., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Stair falls are a major health problem for older people. Most studies on identification of stair fall risk factors are limited to staircases set in given step dimensions. However, it remains unknown whether the conclusions drawn would still apply if the dimensions had been changed to represent more challenging or easier step dimensions encountered in domestic and public buildings. The purpose was to investigate whether the self-selected biomechanical stepping behaviours are maintained when the dimensions of a staircase are altered. Sixty-eight older adults (>65 years) negotiated a seven-step staircase set in two step dimensions (shallow staircase: rise 15 cm, going 28 cm; steep staircase: rise 20 cm, going 25 cm). Six biomechanical outcome measures indicative of stair fall risk were measured. K-means clustering profiled the overall stair-negotiating behaviour and cluster profiles were calculated. A Cramer's V measured the degree of association in membership between clusters. The cluster profiles revealed that the biomechanically risky and conservative factors that characterized the overall behaviour in the clusters did not differ for the majority of older adults between staircases for ascent and descent. A strong association of membership between the clusters on the shallow staircase and the steep staircase was found for stair ascent (Cramer's V: 0.412, p < 0.001) and descent (Cramer's V: 0.380, p = 0.003). The findings indicate that manipulating the demand of the task would not affect the underpinning mechanism of a potential stair fall. Therefore, for most individuals, detection of stair fall risk might not require testing using a staircase with challenging step dimensions., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interests to declare., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Hyper-resistance at the joint is one of the most common symptoms in children with cerebral palsy (CP). Alterations to the structure and mechanical properties of the musculoskeletal system, such as a decreased muscle length and an increased joint stiffness are typically managed conservatively, by means of physiotherapy involving stretching exercises. However, the effectiveness of stretching-based interventions for improving function is poor. This may be due to the behavior of a spastic muscle during stretch, which is poorly understood. The main aim of this paper is to provide a mechanistic explanation as to why the effectiveness of stretching is limited in children with CP and consider clinically relevant means by which this shortcoming can be tackled. To do this, we review the current literature regarding muscle and tendon plasticity in response to stretching in children with CP. First, we discuss how muscle and tendon interact based on their morphology and mechanical properties to provide a certain range of motion at the joint. We then consider the effect of traditional stretching exercises on these muscle and tendon properties. Finally, we examine possible strategies to increase the effectiveness of stretching therapies and we highlight areas of further research that have the potential to improve the outcome of non-invasive interventions in children with cerebral palsy., (Copyright © 2020 Kalkman, Bar-On, O’Brien and Maganaris.)

Background: Older adults are at greater risk of falls while descending stairs. Cognitive deficits can further influence one's ability and mild cognitive impairments (MCI) specifically affect visual attention and dual tasking behavior. The present study aimed at comparing the attentional costs at different points during the approach to and descent of a staircase between older adults with and without MCI., Methods: Eleven older adults with MCI and twenty-three healthy older individuals without cognitive impairments were recruited. Neuropsychological tests were carried out. In addition, participants approached and descended a 5-step staircase while a simultaneous visual Stroop dual-task was randomly introduced during the approach, transition or steady state descent phases across trials. Three-dimensional kinematics and accuracy on the Stroop task were analyzed and dual task costs were calculated., Results: The MCI group showed deficits for visuo-spatial attention, memory and multi-tasking abilities, as well as balance and decreased confidence for falls efficacy, but not for daily activity scores. Despite such changes, this group of community-dwelling individuals with MCI presented a functional capacity to descend stairs even during divided visual attention. However, there were subtle, but significant, group differences for movement fluidity and performance on the simultaneous cognitive task, particularly during the approach and transition to descent phases. The MCI group also tended to descend slower while using the handrails more than healthy older adults., Conclusion: The present cohort of community-dwelling older adults with MCI were functional, but appeared to prioritize locomotor demands over the simultaneous cognitive task in a possible "posture first" strategy to descend stairs. The present findings should be considered for developing more ecologically based clinical assessments of mobility deficits following cognitive impairments, with the approach and transition phases during stair descent as key points of focus., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier B.V. All rights reserved.)