Lida Mademli

Deficits in the way to achieve balance related to mechanisms of dynamic stability control in the elderly

The purpose of this study was to examine the postural corrections related to components of dynamic stability aimed to increase our understanding of successful postural control among the elderly population. This was done by comparing balance behaviour of older adults who were able to recover stability (stable) and others who failed to regain stability (unstable) with a single step after a forward fall. Thirty-eight old male adults (64+/-3yr, 176+/-6cm, 78.5+/-7.8kg) had to recover balance after a sudden induced forward fall. All participants performed maximal isometric ankle plantarflexion and knee extension contractions on a dynamometer. The elongation of the gastrocnemius medialis and the vastus lateralis tendon and aponeuroses during isometric contraction was examined by ultrasonography. There were no differences in leg-extensor muscle strength or tendon stiffness between the two groups showing that the muscle tendon capacities may not be the reason for the observed differences in dynamic stability control. The unstable participants created a higher horizontal ground reaction push-off force of the support limb in the second part ( approximately 260ms after release) of the phase until touchdown leading to an unstable body position at touchdown. The results indicate deficits in the way to achieve balance related to mechanisms responsible for dynamic stability control within the elderly population.

Dynamic stability control in forward falls: postural corrections after muscle fatigue in young and older adults

Many studies report that muscle strength loss may alter the human system’s capacity to generate rapid force for balance corrections after perturbations, leading to deficient recovery behaviours. Yet little is known regarding the effect of modifications in the neuromuscular system induced by fatigue on dynamic stability control during postural perturbations. This study investigates the effect of muscle strength decline induced by fatiguing contractions on the dynamic stability control of young and older adults during forward falls. Eleven young and eleven older male adults had to regain balance after sudden falls before and after submaximal fatiguing knee extension–flexion contractions. Young subjects had a higher margin of stability than older ones before and after the fatiguing task. This reflects their enhanced ability in using mechanisms for maintaining dynamic stability (i.e. a greater base of support). The margin of stability, the boundary of the base of support and the position of the extrapolated centre of mass, remained unaffected by the reduction in muscle strength induced by the fatiguing contractions, indicating an appropriate adjustment of the motor commands to compensate the deficit in muscle strength. Both young and older adults were able to counteract the decreased horizontal ground reaction forces after the fatiguing task by flexing their knee to a greater extent, leading to similar decreases in the horizontal velocity of centre of mass as in the pre fatigue condition. The results demonstrate the ability of the central nervous system to rapidly modify the execution of postural corrections including mechanisms for maintaining dynamic stability.

Effect of voluntary activation on age-related muscle fatigue resistance.

Ageing is associated with a higher fatigue resistance during submaximal or maximal fatiguing contractions. The present study aimed to investigate the contribution of the central and peripheral fatigue to the age-related differences in fatigue development of the plantar flexor muscles. Therefore, the voluntary activation, rest twitch moment and voluntary plantar flexor moment were examined before during as well as 2, 5 and 10min after a fatiguing task. This consisted of intermittent isometric submaximal plantar flexor contractions at equal intensity for both young and old adults (considering the age-related differences in muscle inhibition). Consequently, possible differences between young and old adults in voluntary activation during the maximal contraction utilised for determining the intensity of the fatiguing task, which can influence fatigue development, have been taken into account. The plantar flexors moment was calculated using inverse dynamics and the voluntary activation was measured using the twitch interpolation technique. Changes in voluntary activation and rest twitch moment during the fatiguing task were used to assess central and peripheral fatigue, respectively. In both young and old adults, peripheral ( approximately 20%) as well as central fatigue ( approximately 9%) contributed to the time to task failure. Old adults demonstrated greater time to task failure than young ones, but similar voluntary activation behaviour during the fatiguing task. We concluded that, the age-related enhancement in fatigue resistance is not attributable to voluntary activation but is linked to mechanisms located within the working muscle.

Age-Related Effect of Static and Cyclic Loadings on the Strain-Force Curve of the Vastus Lateralis Tendon and Aponeurosis

The objective of the present study was to investigate the age-related effects of submaximal static and cyclic loading on the mechanical properties of the vastus lateralis (VL) tendon and aponeurosis in vivo. Fourteen old and 12 young male subjects performed maximal voluntary isometric knee extensions (MVC) on a dynamometer before and after (a) a sustained isometric contraction at 25% MVC and (b) isokinetic contractions at 50% isokinetic MVC, both until task failure. The elongation of the VL tendon and aponeurosis was examined using ultrasonography. To calculate the resultant knee joint moment, the kinematics of the leg were recorded with eight cameras (120 Hz). The old adults displayed significantly lower maximal moments but higher strain values at any given tendon force from 400 N and up in all tested conditions. Neither of the loading protocols influenced the strain-force relationship of the VL tendon and aponeurosis in either the old or young adults. Consequently, the capacity of the tendon and aponeurosis to resist force remained unaffected in both groups. It can be concluded that in vivo tendons are capable of resisting long-lasting static (~4.6 min) or cyclic (~18.5 min) mechanical loading at the attained strain levels (4-5%) without significantly altering their mechanical properties regardless of age. This implies that as the muscle becomes unable to generate the required force due to fatigue, the loading of the tendon is terminated prior to provoking any significant changes in tendon mechanical properties.

Plasticity of the human tendon to short- and long-term mechanical loading.

This review examines the effects of short- and long-term static and cyclic mechanical loading on the mechanical properties of tendons. Tendons do not alter their mechanical properties after static and cycling loading that occurs during fatiguing contractions. Adaptations can occur after the application of long-term loading, but the strain magnitude must exceed a given threshold.

Neuromuscular interactions around the knee in children, adults and elderly

Although injury and neuromuscular activation patterns may be common for all individuals, there are certain factors which differentiate neuromuscular activity responses between children, adults and elderly. The purpose of this study is to review recent evidence on age differences in neural activation and muscle balances around the knee when performing single joint movements. Particularly, current evidence indicates that there are some interesting similarities in the neuromuscular mechanisms by which children or the elderly differ compared with adults. Both children and elderly display a lower absolute muscle strength capacity than adults which cannot fully be explained by differences in muscle mass. Quadriceps activation failure is a common symptom of all knee injuries, irrespective of age but it is likely that its effect is more evident in children or adults. While one might expect that antagonist co-activation would differ between age categories, it appears that this is not the case. Although hamstring: quadriceps ratio levels are altered after knee injury, it is not clear whether this is an age specific response. Finally, evidence suggests that both children and the elderly display less stiffness of the quadriceps muscle-tendon unit than adults which affects their knee joint function.

Commentaries on viewpoint: On the hysteresis in the human Achilles tendon.

114:518-520, 2013. ; J Appl Physiol Karamanidis and Sudarshan R. Nelatury Alexandre Foure, Christophe Cornu, Gaspar Morey-Klapsing, Lida Mademli, Kiros Maganaris, Rene B. Svensson, Christian Coupe, Andreas Hershenhan, Pernilla Eliasson, Adamantios Arampatzis, Mary C. Vagula, Andrew G. Cresswell, Constantinos N. Glen A. Lichtwark, Robert F. Ker, Neil D. Reeves, S. Peter Magnusson, Antoine Nordez, human Achilles tendon Commentaries on Viewpoint: On the hysteresis in the

Lower safety factor for old adults during walking at preferred velocity

Older adults are more prone to falls during walking than young adults, although they walk more slowly and demonstrate higher stability state. This paradox of higher stability state but less safe locomotion let us hypothesize that older people may move closer to their dynamic stability limits. In order to investigate this hypothesis, the present study examined the safety factor of dynamic stability in old and young individuals when walking at their preferred velocity. Twelve older and 12 young male participants walked at their (a) walk-to-run transition velocity (WRV, i.e., maximum capacity) and (b) preferred walking velocity (PWV, i.e., actual applied load). Whole body kinematic data and ground reaction forces were captured. Dynamic stability was assessed using the “margin of stability (MoS)” as a criterion for the stability state of the body (extrapolated center of mass concept). The safety factor was calculated as the ratio between MoS at WRV and MoS at PWV. We found that, although older participants walked slower and provided a higher stability state compared to young ones, they showed a significantly reduced safety factor during preferred walking. This confirmed our hypothesis. Old adults do not walk slowly enough in relation to their maximum walking velocity, resulting to a lower safety factor during normal locomotion. Apparently, the age-related muscle degeneration affects WRV more than PWV. The resulting lower safety factor for the older participants may partly explain the increased risk of falls in their daily life, in spite of slower locomotion.

Commentaries on Viewpoint: On the hysteresis in the human Achilles tendonINFERRING TENDON MECHANICAL PROPERTIES USING ULTRASOUND IMAGINGTHE HYSTERESIS OF TENDON, IN VITRO AND IN VIVOCOMMON PROBLEMS IN THE MEASUREMENT OF HUMAN TENDON HYSTERESIS IN VIVOVIEWPOINT: ON THE HYSTERESIS IN THE HUMAN ACHILLES TENDONON THE HYSTERESIS IN THE HUMAN ACHILLES TENDON: INFLUENCE OF THE LOADING RATE AND MUSCLE COORDINATIONCOMMENTARY ON VIEWPOINTSTIFFNESS AND HYSTERESIS OF HUMAN TENDONS

114:518-520, 2013. ; J Appl Physiol Karamanidis and Sudarshan R. Nelatury Alexandre Foure, Christophe Cornu, Gaspar Morey-Klapsing, Lida Mademli, Kiros Maganaris, Rene B. Svensson, Christian Coupe, Andreas Hershenhan, Pernilla Eliasson, Adamantios Arampatzis, Mary C. Vagula, Andrew G. Cresswell, Constantinos N. Glen A. Lichtwark, Robert F. Ker, Neil D. Reeves, S. Peter Magnusson, Antoine Nordez, human Achilles tendon Commentaries on Viewpoint: On the hysteresis in the