Vestibulopathy and the age effects on protective stepping during unperturbed standing

This study examined the prevalence of protective stepping and accompanying preparatory postural responses associated with lateral weight transfer (WT) while subjects attempted to sustain stationary standing. The subjects were 92 healthy young and older adults and persons with vestibular hypofunction. Force platform and whole-body-motion recordings were used to evaluate the prevalence of stepping and WT responses during stationary standing (eyes open or closed) using a semi-tandem foot position. WT components were also evaluated for volitionally requested step initiation, and as a function of support base configuration and direction of stepping among younger subjects. Only 10% of trials by subjects with bilateral vestibular hypofunction (BVH) during semi-tandem standing with eyes closed were completed without a step, while 31% of subjects with UVH, 69% of healthy elders, and all young healthy subjects were able to stand for the entire 7-sec trials. WT responses always preceded volitional steps from a standard feet-parallel orientation but occurred in only 13% of the spontaneous steps. The prevalence of WT was influenced by the direction of volitional stepping from semi-tandem standing, but not by the initial standing width. Spontaneous stepping to maintain standing balance is a naturally occurring and prevalent behavior among older adults and persons with vestibular hypofunction during tests of quasi-static standing. Differences between volitional and spontaneous step initiation involving the prevalence of preparatory lateral WT are a complex function of motor planning, mechanical constraints, and functional context.