for the initial swing phase of gait and pelvic stability, so an atrophied psoas muscle will affect stride length and pelvic stability. Because of the instabil-ity in the spine and pelvic areas, these persons use these areas less (19), com-pensating more in the lower limb structures, so walking speed and stride length are decreased, causing a more cautious gait.(20) Because the spine and pelvis are not swaying in a rhyth-mic pattern with walking, step width increases to improve balance.(21,22). With all these adaptations occurring in the spine, pelvic and lower limb, some studies are showing there may be a link to the increased energy demands and slowing gait pattern in the aging per-son.(23,24) Some studies are showing there may be a link to the increased energy demands and slowing gait pattern in the aging person. symptoms of increased step width, re-duced ankle joint range of motion and increased co-activation of the antago-nist muscles. These changes cause a chaotic coordinative behavior between trunk and hip that affect gait perfor-mance and stability transforming the upper body into a generator of pertur-bations.(33) The corticospinal system is also affected (34), more so in chal-lenging walking conditions (35), as are the frontal cortex and basal ganglia regions.(36) The entire nervous system is involved in gait, so we should all walk regularly for our physical and cognitive health. Posture. 2019 May; 70: 156-161. 16. Dewolf A, et al. Differential Activation of Lumbar and Sacral Motor Pools During Walking at Different Speeds and Slopes. J Neurophysiol . 2019 Aug 1; 122(2): 872-887. 17. Lawrence M, et al. Effects of Tibiofibular and Ankle Joint Manipulation on Hip Strength and Muscle Activation. J Manipulative Physiol Ther. 2020 Jun;43(5):406-417. 18. Masaki M, et al. Association of Sagittal Spinal Alignment With Thickness and Echo Intensity of Lumbar Back Muscles in Middle-Aged and Elderly Women. Arch Gerontol Geriatr. Sep-Oct 2015; 61(2): 197-201. 19. Crawford R, et al. Age-related Changes in Trunk Muscle Activity and Spinal and Lower Limb Kinematics During Gait. PLoS One. 2018 Nov 8; 13(11): e0206514. 20. Herssens N, et al. Do Spatiotemporal Parameters and Gait Variability Differ Across the Lifespan of Healthy Adults? A Systematic Review. Gait Posture. 2018 Jul; 64: 181-190. 21. Skiadopoulos A, et al. Step Width Variability as a Discriminator of Age-Related Gait Changes. J Neuroeng Rehabil. 2020 Mar 5 ;17(1): 41. 22. Kasović , et al. Domain-Specific and Total Sedentary Behavior Associated With Gait Velocity in Older Adults: The Mediating Role of Physical Fitness. Int J Environ Res Public Health. 2020 Jan 16; 17(2): 593. 23. Schrack J, et al. Rising Energetic Cost of Walking Predicts Gait Speed Decline With Aging. J Gerontol A Biol Sci Med Sci. 2016 Jul; 71(7): 947-53. 24. Chen H, et al. Aging Effects on the Mechanical Energy Transfer Through the Lower Extremity Joints During the Swing Phase of Level Walking. Sci Rep. 2019 Jul 2; 9(1): 9555. 25. Takakusaki K. Neurophysiology of Gait: From the Spinal Cord to the Frontal Lobe. Mov Disord. 2013 Sep 15; 28(11): 1483-91. 26. Takakusaki K. Functional Neuroanatomy for Posture and Gait Control. J Mov Disord. 2017 Jan; 10(1): 1-17. 27. Lee J, et al. Neuroanatomy, Extrapyramidal System. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan 23. 28. Delval A, et al. Cortical Oscillations During Gait: Wouldn’t Walking Be So Automatic? Brain Sci. 2020 Feb 9; 10(2): 90. 29. MacKinnon C. Sensorimotor Anatomy of Gait, Balance, and Falls. Handb Clin Neurol. 2018; 159: 3-26. 30. Spedden M, et al. Corticospinal Control of Normal and Visually Guided Gait in Healthy Older and Younger Adults. Neurobiol Aging. 2019 Jun; 78: 29-41. 31. McCrum C, et al. The Walking Speed-Dependency of Gait Variability in Bilateral Vestibulopathy and Its Association With Clinical Tests of Vestibular Function. Sci Rep. 2019 Dec 5; 9(1): 18392. 32. Rao A, et al. Ataxic Gait in Essential Tremor: A Disease-Associated Feature? Tremor Other Hyperkinet Mov (N Y). 2019 Jun 19; 9. 33. Serrao M, et al. Neurophysiology of Gait. Handb Clin Neurol. 2018; 154: 299-303. 34. Gennaro F, et al. Corticospinal Control of Human Locomotion as a New Determinant of Age-Related Sarcopenia: An Exploratory Study. J Clin Med. 2020 Mar 6; 9(3): 720. 35. Allali G, et al. Brain Structure Covariance Associated With Gait Control in Aging. J Gerontol A Biol Sci Med Sci. 2019 Apr 23; 74(5): 705-713. 36. Wilson J, et al. The Neural Correlates of Discrete Gait Characteristics in Ageing: A Structured Review. Neurosci Biobehav Rev. 2019 May; 100: 344-369. NERVOUS SYSTEM Are there brain areas that have an effect on the gait cycle? There is a basic loco-motor program which controls adjust-ments of posture, muscle tone and rhythmic limb movements. It consists of proprioceptive signals coming in from the feet, entering the spinal cord, projecting to the cerebellum and all the receiving areas. Information goes out from the cerebral cortex, basal ganglia and brain stem to the descending cor-ticospinal tracts for muscle tone of posture and rhythmic limb movements. (25) If we were capable of consciously controlling these activities, it would consume our entire day and all our energy. Proprioceptive, visual and ves-tibular sensations, act on certain parts of the brain for posture-gait control and descending tracts control balance and precise stepping.(26,27) Think of taking a step. It is a complex activity involving cognitive and cortical(mo-tor), ie. sensorimotor control. If you add more demanding tasks such as changing speeds or dual tasks, other cortical areas must be involved(28,29), and aging affects corticospinal control and precise stepping mechanics.(30) Are there specific brain areas that contribute to changes in the gait cycle and pattern? Persons with vestibulop-athy causes changes in slowing of gait and step width variability, especially at increasing speeds (31), and may result in difficulty performing functional tasks and increase falls risk.(32) Recent studies of the gait pattern of cerebellar patients highlights a few key REFERENCES 1. 2. Laribi M, et al. Human lower limb operation tracking via motion capture systems. in Design and Operation of Human Locomotion Systems, 2020 Pages 83-107. Cruz-Jimenez M. Normal Changes in Gait and Mobility Problems in the Elderly. Phys Med Rehabil Clin N Am. 2017 Nov; 28(4): 713-725. Sobiech M, et al. Postural disorders in the elderly in static assessment. Wiad Lek. 2019; 72(9 cz 1): 1703-1707. Kirkwood R, et al, The Slowing Down Phenomenon: What Is the Age of Major Gait Velocity Decline? Maturitas. 2018 Sep; 115: 31-36. Menz H. Biomechanics of the Ageing Foot and Ankle: A Mini-Review. Gerontology . 2015; 61(4): 381-8. Rodríguez-Sanz D, et al. Foot Disorders in the Elderly: A Mini-Review. Dis Mon. 2018 Mar; 64(3): 64-91. Hortobágyi T, et al. Age and Muscle Strength Mediate the Age-Related Biomechanical Plasticity of Gait. Eur J Appl Physiol. 2016 Apr; 116(4): 805-14. Schmitz A, et al. Differences in Lower-Extremity Muscular Activation During Walking Between Healthy Older and Young Adults. J Electromyogr Kinesiol. 2009 Dec; 19(6): 1085-91. Kara M, et al. A “Neuromuscular Look” to Sarcopenia: Is It a Movement Disorder? J Rehabil Med. 2020 Apr 14; 52(4): jrm00042. 3. 4. 5. 6. 7. 8. 9. 10. Soendenbroe C, et al. Molecular indicators of denervation in aging human skeletal muscle. Muscle & Nerve. 2019 Oct. 60(4): 453–463. 11. Kirk E, et al. Neuromuscular Changes of the Aged Human Hamstrings. J Neurophysiol . 2018 Aug 1; 120(2): 480-488. 12. Chandran V, et al. Knee Muscle Co-Contractions Are Greater in Old Compared to Young Adults During Walking and Stair Use. Gait Posture. 2019 Sep; 73: 315-322. 13. Henry M, et al. Age-related Changes in Leg Proprioception: Implications for Postural Control. J Neurophysiol . 2019 Aug 1; 122(2): 525-538. 14. Gueugnon M, et al. Age-Related Adaptations of Lower Limb Intersegmental Coordination During Walking. Front Bioeng Biotechnol. 2019 Jul 17; 7: 173. 15. Dewolf A, et al. Effect of Walking Speed on the Intersegmental Coordination of Lower-Limb Segments in Elderly Adults. Gait 22 Chiropractic and Naturopathic Doctor July/August 2021 www.Cndoctor.ca
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