ORIGINAL PAPER
An analysis of lateral stepping using proactive and reactive assessment methods in young adults
1
Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (deemed to be university), Chennai, India
These authors had equal contribution to this work
Submission date: 2023-09-27
Acceptance date: 2024-02-02
Publication date: 2025-06-18
Corresponding author
Sivakumar Ramachandran
Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (deemed to be university), No 1, Sri Ramachandra Nagar, Porur, Chennai 600116, India
Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research (deemed to be university), No 1, Sri Ramachandra Nagar, Porur, Chennai 600116, India
Physiother Quart. 2025;33(2):1-5
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Stepping is a common reactive postural control strategy. Lateral stepping is a more challenging movement and has unique biomechanical characteristics. Stepping is commonly assessed using the Balance Evaluation System Test (BESTest), waist pulls and surface translation. The speed and characteristics of stepping are critical to prevent a fall. It is important to consider the influence of the test construct on stepping behaviour. The aim of this study is to identify differences in stepping characteristics between two selected methods and determine which method elicits the most optimal stepping response as indicated by smaller spatio-temporal characteristics.
Methods:
Sixty healthy young adults aged between 18 and 26 years were tested for lateral stepping using the BESTest and moving platform perturbations. Video recordings of the test procedures were analysed using “TRACKER” software to measure various spatio-temporal parameters of the lateral stepping reactions, such as first step time, balance recovery length, balance recovery time and number of steps. The Mann–Whitney U test was used to assess differences between the parameters from both methods of assessment.
Results:
The mean values of spatio-temporal parameters of stepping triggered by the moving platform were smaller compared to the BESTest. Furthermore, the stepping characteristics differed between the two assessment methods.
Conclusions:
The perturbations induced by the moving platform elicited stepping responses of shorter duration and shorter distances, indicating the participants’ best stepping behaviour. The method of assessment significantly influenced the stepping behaviour, highlighting the importance of carefully selecting an appropriate assessment for postural control testing.
Stepping is a common reactive postural control strategy. Lateral stepping is a more challenging movement and has unique biomechanical characteristics. Stepping is commonly assessed using the Balance Evaluation System Test (BESTest), waist pulls and surface translation. The speed and characteristics of stepping are critical to prevent a fall. It is important to consider the influence of the test construct on stepping behaviour. The aim of this study is to identify differences in stepping characteristics between two selected methods and determine which method elicits the most optimal stepping response as indicated by smaller spatio-temporal characteristics.
Methods:
Sixty healthy young adults aged between 18 and 26 years were tested for lateral stepping using the BESTest and moving platform perturbations. Video recordings of the test procedures were analysed using “TRACKER” software to measure various spatio-temporal parameters of the lateral stepping reactions, such as first step time, balance recovery length, balance recovery time and number of steps. The Mann–Whitney U test was used to assess differences between the parameters from both methods of assessment.
Results:
The mean values of spatio-temporal parameters of stepping triggered by the moving platform were smaller compared to the BESTest. Furthermore, the stepping characteristics differed between the two assessment methods.
Conclusions:
The perturbations induced by the moving platform elicited stepping responses of shorter duration and shorter distances, indicating the participants’ best stepping behaviour. The method of assessment significantly influenced the stepping behaviour, highlighting the importance of carefully selecting an appropriate assessment for postural control testing.
REFERENCES (16)
1.
Pai YC, Maki BE, Iqbal K, McIlroy WE, Perry SD. Thresholds for step initiation induced by support-surface translation: a dynamic center-of-mass model provides much better prediction than a static model. J Biomech. 2000;33(3):387–92; doi: 10.1016/s0021-9290(99)00199-2.
2.
Brough LG, Klute GK, Neptune RR. Biomechanical response to mediolateral foot-placement perturbations during walking. J Biomech. 2021;116:110213; doi: 10.1016/j.jbiomech.2020.110213.
3.
Sibley KM, Inness EL, Straus SE, Salbach NM, Jaglal SB. Clinical assessment of reactive postural control among physiotherapists in Ontario, Canada. Gait Posture. 2013;38(4):1026–31; doi: 10.1016/j.gaitpost.2013.05.016.
4.
McIlroy WE, Maki BE. Task constraints on foot movement and the incidence of compensatory stepping following perturbation of upright stance. Brain Res. 1993;616(1–2):30–8; doi: 10.1016/0006-8993(93)90188-s.
5.
Adams M, Brüll L, Lohkamp M, Schwenk M. The stepping threshold test for reactive balance: validation of two observer-based evaluation strategies to assess stepping behavior in fall-prone older adults. Front Sports Act Living. 2021;3:715392; doi: 10.3389/fspor.2021.715392.
6.
Maki BE, Edmondstone MA, McIlroy WE. Age-related differences in laterally directed compensatory stepping behavior. J Gerontol A Biol Sci Med Sci. 2000;55(5):270–7; doi: 10.1093/gerona/55.5.m270.
7.
Bair WN, Prettyman MG, Beamer BA, Rogers MW. Kinematic and behavioral analyses of protective stepping strategies and risk for falls among community living older adults. Clin Biomech. 2016;36:74–82; doi: 10.1016/j.clinbiomech.2016.04.015.
8.
Borrelli J, Creath R, Pizac D, Hsiao H, Sanders O, Rogers MW. Perturbation-evoked lateral steps in older adults: why take two steps when one will do?. Clin Biomech. 2019;63:41–7; doi: 10.1016/j.clinbiomech.2019.02.014.
9.
Gray V-L, Yang CL, Fujimoto M, McCombe Waller S, Rogers MW. Stepping characteristics during externally induced lateral reactive and voluntary steps in chronic stroke. Gait Posture. 2019;71:198–204; doi: 10.1016/j.gaitpost.2019.05.001.
10.
Tashiro H, Sato Y, Fukumoto K, Toki M, Kozuka N. Spatiotemporal characteristics of lateral reactive stepping in individuals with chronic stroke. J Mot Behav. 2022;54(6):744–54; doi: 10.1080/00222895.2022.2080172.
11.
Hilliard MJ, Martinez KM, Janssen I, Edwards B, Mille M-L, Zhang Y, Rogers MW. Lateral balance factors predict future falls in community-living older adults. Arch Phys Med Rehabil. 2008;89(9):1708–13; doi: 10.1016/j.apmr.2008.01.023.
12.
Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Phys Ther. 2009;89(5):484–98; doi: 10.2522/ptj.20080071.
13.
Hsiao-Wecksler ET, Robinovitch SN. The effect of step length on young and elderly women’s ability to recover balance. Clin Biomech Bristol Avon. 2007;22(5):574–80; doi: 10.1016/j.clinbiomech.2007.01.013.
14.
Verniba D, Gage W. A comparison of balance-correcting responses induced with platform-translation and shoulder-pull perturbation methods. J Biomech. 2020;112:11001; doi: 10.1016/j.jbiomech.2020.110017 7.
15.
Afschrift M, van Deursen R, De Groote F, Jonkers I. Increased use of stepping strategy in response to medio-lateral perturbations in the elderly relates to altered reactive tibialis anterior activity. Gait Posture. 2019;68:575–82; doi: 10.1016/j.gaitpost.2019.01.010.
16.
Depasquale L, Toscano L. The Spring Scale Test: a reliable and valid tool for explaining fall history. J Geriatr Phys Ther. 2009;32(4):159–67.
| eISSN: | 2544-4395 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
