Age-related alterations in reactive stepping following unexpected mediolateral perturbations during gait initiation

A common technique to regain stability following an unexpected perturbation is reactive stepping, aimed to control the accelerated center of mass (COM). Many older adults (OA) struggle to execute the fast, coordinated stepping strategy required to arrest COM movement within the base of support (BOS) during these unexpected events, likely due to age-related physiological declines. Recent ecological data also suggests that many falls in OA occur due to errors in transferring or shifting body weight during activities of daily living. The present study utilized gait initiation, which requires a coordinated transition from quiet stance to dynamic gait, as an example of one of these difficult transitional movements.

Our goal was to combine this inherently unstable task, gait initiation, with an unexpected mediolateral (ML) perturbation of the support surface to examine age-related changes in reactive stepping patterns during a novel transitional gait task.

A total of 18 young adults (YA) and 16 OA (>65 years) performed 35 trials containing 10 unexpected ML perturbations of the support surface. To quantify age-related differences, we calculated step width, length, time and COM velocity in the first two steps following the perturbation.

We observed that, in general, OA walked slower and took shorter, faster steps (reducing time in single support) compared to YA. Following the perturbation, OA altered their stepping patterns by reducing their BOS (more narrow step width compared to YA), and required more than the two steps used by YA to complete the goal-directed task.

These age-related changes are concerning as a multi-step recovery strategy has been previously associated with an elevated risk of falls in OA.