Balance strategies for recovery from perturbed overground walking

Bipedal locomotion is naturally unstable and requires active control. Walking is believed to be primarily stabilized through the selection of foot placements; however, other strategies are available, including regulation of ankle inversion/eversion, ankle push-off, and angular momentum through trunk postural adjustments. The roles of these strategies in maintaining overall stability are often masked by the dominant foot placement strategy. The objectives of this study were to describe how the four strategies are used to respond to medial or lateral ground perturbations during overground walking in healthy individuals and determine reliance on each strategy. Fifteen healthy adults walked with and without perturbations applied to the right foot at heel strike while body kinematics and surface electromyographic activity were measured. Medial perturbations resulted in decreased step width on the first step after the perturbation, increased ankle inversion, increased ankle push-off, and rightward trunk sway. Lateral perturbations resulted in increased step width, decreased ankle inversion, no change in ankle push-off, and leftward trunk sway. EMG activity was consistent with the observed strategies (e.g. increased peroneus longus EMG activity during ankle eversion) with the exception of increased bilateral erector spinae activity for all perturbations. Foot placement was the dominant strategy in response to perturbations, with other strategies showing reduced, yet significant, roles. This work demonstrates that multiple strategies are recruited to improve the balance response in addition to foot placement alone. These results can serve as a reference for future studies of populations with impaired balance to identify potential deficits in strategy selection.