Seton Hall University eRepository @ Seton Hall Seton Hall University Dissertations and Theses Seton Hall University Dissertations and Theses (ETDs) Fall 12-2017 Effects of Direction Time Constraints and Walking Speed on Turn Strategies and Gait Adaptations in Healthy Older and Young Adults Dennis Torre [email protected] Follow this and additional works at: https://scholarship.shu.edu/dissertations Part of the Biomechanics Commons, Motor Control Commons, Other Kinesiology Commons, Physical Therapy Commons, Physiotherapy Commons, and the Psychology of Movement Commons Recommended Citation Torre, Dennis, "Effects of Direction Time Constraints and Walking Speed on Turn Strategies and Gait Adaptations in Healthy Older and Young Adults" (2017). Seton Hall University Dissertations and Theses (ETDs). 2445. https://scholarship.shu.edu/dissertations/2445 Effects of Direction Time Constraints and Walking Speed on Turn Strategies and Gait Adaptations in Healthy Older and Young Adults By Dennis Torre Dissertation Committee: G. Pinto Zipp PT, EdD, (Chair) P. Nair PT, PhD R. K. Parasher PT, EdD Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Health Sciences Seton Hall University Fall 2017 2 Copyright © Dennis Torre 2017 All rights reserved 3 4 ACKNOWLEDGEMENTS There are so many individuals both on a personal & professional level who have contributed in various ways to the emergence of this document, and for upon whom I ask Almighty God’s blessings: my beloved-departed Mom & Dad, Jennie & Anthony Torre, for their countless sacrifices which can never be repaid; Dr Genevieve Zipp, committee chairperson, for her inspiring mentorship, steadfast-of-purpose to keep me focused & great gift of wisdom; Dr Raju Parasher who conceived the study’s original theme & Dr Preeti Nair, both committee members, for their depth of knowledge, sound critical scholarship, & collaboration despite different time-zones; Dr Wendiann Sethi for her invaluable statistical counsel; my brother Charles Torre, PE for engineering & building the “PhD Box” to control switch-mats & signal-lights; Dr Terrence Cahill, Dr Lee Cabell, Dr Deborah DeLuca & Ms Joanne DeBerto for partaking & aiding in my scholarly formation; my research assistants Mr Kweku Agyeman, Dr Gerard Fiordalisi, & Mr Anthony Porcelli for their logistical & essential support; my dear girlfriend Sonia Rivera, sisters Mary Jane Catalanotti & Fran Torone, & late brothers Anthony & Frank Torre for their love, comfort & prayers; all the dedicated Sisters, Priests, & Brothers who instilled in me a passion for learning & faith at an early-age; and all the considerate study participants who gave of their valuable time & effort. 5 DEDICATION All to the Glory of God the Father, God the Son, and God the Holy Spirit Amen. 6 TABLE OF CONTENTS ACKNOWLEDGEMENTS ..................................................................................... 4 DEDICATION ........................................................................................................ 5 LIST OF TABLES ............................................................................................... 15 LIST OF FIGURES ............................................................................................. 18 ABSTRACT ........................................................................................................ 21 I. INTRODUCTION Relationship between Elderly Falls, Hurrying, Turns and Hip Fracture ....... 23 Age-Related Differences in Turning & Related Behaviors: What is Known? .............................................................................................................. 27 Elderly use of partial pivots & extra step mixed-turns during the TUGS .................................................................................................................. 27 Elderly preference to step-wide when circumventing .............................. 28 Elderly more proactive adjusting speed, step-length but similar step- width change when response time to turn is not constrained ...................... 29 Elderly difficulty with deceleration when response time to turn is constrained ........................................................................................................ 31 Elderly avoidance of limb cross-over when response time to lane shift is constrained ........................................................................................... 34 Elderly less proactive adjusting step-width when response time to circumvent is constrained ................................................................................ 35 A gap in the literature: need to compare turn strategies & gait changes in both age-groups under the same conditions of one study when time is constrained ................................................................................. 36 7 Purpose of the Study and Rational .................................................................. 38 Research Questions ......................................................................................... 39 Research Hypotheses ....................................................................................... 39 Theoretical Framework(s) ................................................................................. 40 Motor program theory: central pattern generators (CPGs) ...................... 40 Dynamic systems theory ............................................................................. 43 Attention limitation theories ....................................................................... 46 Ecological visual perception theory........................................................... 51 II. REVIEW OF LITERATURE Turn Behavior during a Typical Day ................................................................ 53 Prevalence of turn steps, and influence of the environment and task .... 53 Average angle of a typical turn ................................................................... 54 Turn strategies used by young adults and preferences when response time is constrained ........................................................................... 56 Bias to turn in direction opposite the stability limb equates with a step-turn preference and its modulation across speeds and conditions .... 60 Biomechanical Principles of Turning while Walking ..................................... 67 Closer examination of step-turns and spin-turns ..................................... 67 Medial/lateral COM acceleration and balance control strategies during relaxed standing & straight gait ........................................................... 72 Turn approach control mechanisms .......................................................... 79 Linear deceleration of forward momentum ............................................... 79 Top-down axial segment reorientation ...................................................... 81 8 Two strategies to accelerate the COM in the frontal plane: hip/trunk roll strategy and ML foot placement ................................................................ 85 Changes in ground reaction forces.......................................................... 109 Turn Behavior with Aging ............................................................................... 118 Elderly turn strategy preferences across speeds and turn angles when direction is known in advance ............................................................. 118 Elderly/middle-aged turn strategy preferences when response time is constrained as gleaned from control group performance in patient- based studies .................................................................................................. 123 III. METHODS Design .............................................................................................................. 132 Operant Definitions ......................................................................................... 133 Turn strategy operant definitions ............................................................. 133 Standardized operant definitions are lacking ......................................... 133 Framework & approach used for turn strategy assessment .................. 136 Kinovea software ....................................................................................... 137 Operant definitions used for step-turn and spin-turn ............................. 139 Operant definitions used for mixed-turns ............................................... 141 Small amplitude mixed-step-turn & mixed-spin-turn .................................... 141 Extra footfall mixed-step-turn & mixed-spin-turn .......................................... 145 Spatial-temporal operant definitions ........................................................ 151 The Gaitrite ................................................................................................. 151 Limited to final four recorded footfalls absent the pivot ........................ 152 9 Operant definitions of Gaitrite variables of interest: speed, stride- length, heel-to-heel base-of-support ............................................................. 154 Inclusion of partial penultimate & antepenultimate Gaitrite footfalls .... 157 Subjects ........................................................................................................... 158 Standardized Tools, other Instrumentation and Lab Set-Up ....................... 159 Procedures ...................................................................................................