ISPGR World Congress Program

On-site COVID-19 Guidelines

Although not currently mandatory, ISPGR strongly encourages attendees to wear a face mask in the Congress meeting rooms and other public spaces. Please remember to bring a supply of masks with you on your trip. Masks will also be available at the registration desk. ISPGR will adhere to the COVID-19 health requirements in place in Montreal and the Province of Quebec at the time of the conference.

Exceptions from mask wearing will be made for all oral presenters, along with all attendees during breaks and social events with catering. Therefore, it is advised that ISPGR attendees consider their comfort levels when attending social events, given that large groups will be congregating without face coverings.

We ask that you are mindful of social distancing throughout the conference, and respect other people’s COVID-19 concerns.

PROGRAM AT-A-GLANCE

ABSTRACT PROCEEDINGS

SYMPOSIUM SESSIONS

KEYNOTE SPEAKERS

Congress Program:

ISPGR 2022 will be a hybrid congress, providing both an in-person event for attendees in Montreal, as well as a virtual option for our attendees participating internationally from anywhere in the world.

The virtual elements include the live streaming of all plenary content, plus the live streaming of 1x breakout per session bloc. For a full list of what’s included for virtual and on-site attendees, please visit the registration page.

If you are a presenter at ISPGR 2022, please make sure to review the presenter guidelines.

Schedule

Pre-Congress Workshops

The pre-Congress workshops will take place on July 3rd at the Hotel Bonaventure, and will be available to all on-site attendees in Montreal. Attendees can register for these sessions during Congress registration.

8:30AM - 11:30AM: WS.1 - Univariate and bivariate fractal methods for movement science

Organiser: Aaron Likens, University of Nebraska at Omaha, USA

In movement science, time series data are often noisy. For example, spatiotemporal parameters measured while walking or maintaining upright posture often vary considerably over several minutes of observation. Traditional linear statistics such as the mean and standard deviation often fail to capture these time varying properties. A key feature of biological signals such as heart rate, neural activity, and human walking is that they entail coordination across many timescales. These scales range from milliseconds (I.e., Neurons) to the multiple minutes that make up bouts of walking. Thus, analytical methods capable of addressing the multiscale nature of human movement and physiological data are needed. One class of methods, collectively known as multifractal analysis, is naturally suited to complete this task. This workshop will introduce fractal theory and their relevance to human locomotion and posture research. In addition, workshop attendees will be provided with hands-on instruction to apply the best practices of multifractal and nonlinear methods using MATLAB. Upon workshop completion, participants will acquire (1) a deeper understanding of the underlying mathematics and theory on multifractals in movement science, (2) software for performing analyses on their own data, and (3) knowledge of best practices for multifractal analysis in research. Workshop attendees are strongly encouraged to bring their own data to maximize learning during the workshop; however, example datasets will also be provided. The only prerequisites are college level algebra and a basic proficiency with MATLAB. Participants of all backgrounds including researchers, clinicians, and students of all levels are encouraged to attend.

8:30AM - 11:30AM: WS.2 - A primer on low-cost, customisable technology and software for posture and gait research: From measuring forces and balance with bathroom scales and the Wii to muscle excitation with EMG (VIRTUAL)

Organiser: Ross Clark, University of the Sunshine Coast, AUS

This workshop will provide hand-on experience with some of the simple to make, low-cost yet valid and scientifically robust sensor systems that are now available. This workshop is designed for everyone from novice users to experienced technicians. We will provide working examples for participants to trial, and access to the open-source code to tweak settings and explore how the systems work. We will go over how to create, customise and use: Bathroom scales as force platforms with simple rewiring and addition of an Arduino microcontroller with only a few lines of code. This opens the door for home-based systems such as weightbearing asymmetry measurement devices to be created for very low cost. Low-cost electromyography (EMG) systems such as the Myoware with Arduino-based microcontrollers to build systems for collecting data and performing assistive technology functions such as simulating mouse button clicks. Load cell systems for measuring strength, with examples using button load cells and 3D printing for finger strength and handheld dynamometry. LIDAR and time of flight sensors with microcontrollers to measure gait speed with 10+ times less error than stopwatches. Video game controllers such as the Wii Balance Board to measure physical function. All software and designs will be made freely available to the workshop attendees.

 Please note: An access link will be provided ahead of time to all attendees who sign up for this workshop.

8:30AM - 11:30AM: WS.3 - Real-world monitoring of gait: easier said than done

Organiser: Claudia Mazzà, University of Sheffield, GBR

Real- world monitoring of gait is enabled by wearable devices including inertial measurement units (IMUs) that allow to quantify digital mobility outcomes (DMOs). While these devices and the associated DMOs are adopted more and more frequently, there is still limited awareness of how complex it is to ensure their validity and what could hinder comparability of data obtained during such assessments. In this workshop we will aim at raising this awareness by sharing the experience we gained as part of Mobilise-D, a project funded by the European Union (EU) as part of the Innovative Medicine Initiative, aiming at fostering regulatory approval and clinical adoption of DMOs. To reach our aim we will share the complementary and multi-disciplinary experiences from the researchers involved in the project to discuss the various challenges that they encountered in association to the following activities: a) Conceptual definitions of DMOs and their operational implementation (including data standardisation); b) Algorithm requirements and implementation; c) Devices characterisation and spot-checks d) Experimental protocols for the validation of the DMOs e) Statistical analysis and visualisation tools.

12:30PM - 3:30PM: WS.4 - The job seeker's toolkit: what you need to effectively manage your career search both in and outside of academia

Organiser: Alexander Stamenkovic, Virginia Commonwealth University, USA

The learning and tools provided in this workshop will appeal to many that are job seeking both inside and outside of academia. Of the nearly 400 student members, the majority of those are PhD candidates — eligible for internships or interviewing for post graduate paths. The presenters are representative of the broad research areas that ISPGR student members associate with — aging, balance control, and emerging tech. While the presenters are all currently employed in the US, many are from elsewhere or left the US along their academic journeys; we hope that these diverse backgrounds and experiences resonate with many and encourages workshop attendance. During this workshop you will learn to: Identify which of your skills are valuable in and out of the lab Summarize your personal achievements clearly and effectively in multiple modalities Apply the STAR model to answer interview questions succinctly and successfully Create an inviting and professional media presence Evaluate your current personal branding strategy.

12:30PM - 3:30PM: WS.5 - Perturbations-based fall-risk assessment and training

Organiser: Eric Jenkins, DIH Technology, Inc., USA

While ambulating during daily activities, obstacles are often encountered which need to be avoided while maintaining balance and prevent falls. These obstacles range from stepping up to a curb, avoiding pedestrians, or avoiding puddles among many others. While these might be a non-issue to a healthy individual, to an elderly person, or someone with a disability, these challenges can be difficult to overcome, which increases the risk of falling and the fear of falling. Consequently, understanding adaptive behavior to deal with these challenging conditions can provide insight to make ambulation safer. Assessing compensatory responses to avoid these obstacles in a controlled laboratory setting can be accomplished through immersive virtual reality and dynamic platform control. Therefore, this workshop aims to discuss the themes of development, implementation, and application of perturbations while walking in an immersive virtual reality environment.

In this workshop, we will discuss current and relevant literature utilizing various perturbations across participant populations, including best practices for perturbation implementation. Attendees will take away an understanding of how perturbations applied dynamically in a virtual reality environment can uncover gait deficiencies, and how to train towards improvement relevant to various participant populations with a focus on both static balance and gait.

14:00PM - 3:30PM: ISEK-ISPGR Joint Symposium - Neural control of trunk muscles in healthy and clinical conditions

Organisers & Presenters:

Hugo Massé-Alarie, Cirris, Université Laval, CAN

Shin-Yi Chiou, School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, GBR

Edit Elgueta Cancino, School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, GBR

Martin Simoneau, Cirris, Université Laval, CAN

Jean-Sébastien Blouin, School of Kinesiology, The University of British Columbia, CAN

 

Background: Trunk muscles are critical to perform daily activities involving volitional movements, maintaining static postures or regulating the control of balance. Most human movements combine postural, balance and volitional elements of trunk control that complexifies their research in humans. It is often assumed that brainstem networks are mainly involved in automatic control (e.g. posture and balance) whereas cortical networks are mainly involved in volitional control of trunk muscles. However, neural networks involved trunk control are spread across the central nervous system and may be involved in both automatic and volitional movement. The neural control of trunk muscles can be tested using neurophysiological approaches including electrical vestibular stimulation (EVS) and transcranial magnetic stimulation (TMS). EVS activates primary vestibular afferents and can be used to reveal the task- (balance-movement transitions) and muscle-dependent (trunk vs. appendicular muscles) control of balance. TMS provides important insights into the cortical control of trunk muscles that is essentially different from limb muscles. It may also be used to understand neural interactions between trunk and limb muscles, for example, during limb movements triggering anticipatory postural adjustment of the trunk. Specificities in trunk control support the importance to test directly these networks in humans. Considering the essential role of trunk muscles in human movement and how many clinical conditions may impact on their control, understanding the neural control of trunk muscles may help treatment and management of clinical conditions. Aims: This symposium is divided in two main aims subdivided in specific aims: 1- To discuss the neural control of trunk muscles in humans a. To discuss the corticomotor control of trunk muscles during static trunk- and dynamic limb-movement (Elgueta Cancino, Chiou, Massé-Alarie). b. Present the physiological mechanisms underlying electrical vestibular stimulation and their consequences in understanding the vestibular control of balance (Blouin, Simoneau) 2- To discuss potential adaptations in neural control of trunk muscles in different health population a. To discuss the impact of neck (Elgueta Cancino) and low back (Massé-Alarie) pain on cortical control of trunk muscles. b. To discuss the impact of spinal cord injury on neural interactions between the upper limbs and the trunk (Chiou) c. To discuss the impact of scoliosis on the neural control of trunk muscles (Simoneau) Relevance: The aims of the symposium are twofold: (i) to review the latest knowledge in the neural control of trunk muscles, and (ii) to determine the influence of various clinical conditions on the neural control of the trunk muscles. Thus, the symposium will be of broad interest since it has the potential to attract attendees interested in research on sensorimotor control as much as clinicians working with clinical populations.

Symposium Sessions

The Congress includes a series of break out symposium sessions as part of the Congress program. Please click on each of the blue + below to read more details on each symposium. Attendees will be asked to select the symposium they are most likely to attend at the Congress during the registration process.

Monday 4th July

14:00 – 15:30

S.1: Understanding heterogeneity in PD for personalized rehabilitation of gait & balance

Chair & Moderator: Alice Nieuwboer, KU LEUVEN, BEL

Presenters:

Caroline Paquette¹, Franziska Albrecht², Moran Gilat³

¹McGill University, ²Karolinska Institutet, ³KU Leuven

Gait disorders and postural instability are the leading causes of falls and disability in Parkinson’s disease (PD). PD is a heterogeneous disorder, characterized by different clinical phenotypes. Clinical, genetic, neuroimaging, and pathological data support the idea that PD should rather be considered as a syndrome, divided into disease subtypes. This subtyping approach extends beyond the concept of clinical phenotyping as it is based on multimodal data emerging from clinical, motor, cognitive, and neuroimaging variables that may potentially better describe specific PD syndrome-groups. Specific symptoms that affect mobility, such as freezing of gait and impaired cognitive function, play an important role in the wide variation in posture and gait performance. Although this heterogeneity across individuals with PD is well known, no consensus on a subtype classification, or guidelines, currently exist which are helpful for the field of exercise and rehabilitation.What is more, it is unknown how to plan rehabilitation adequately from the prodromal to the late disease stages. Defining data-driven PD subtypes based on a combination of clinical phenotypes and neuroimaging profiles would contribute to a better understanding of disease progression and lead to a more personalized approach in the treatment of mobility problems in people with PD. PD-subtype-informed exercise interventions and rehabilitation strategies targeting gait and posture impairments could potentially lead to more effective interventions giving new hope to patients for a life with improved health and independence. The approach of grouping PD and treating it as a syndrome can yield great potential but it needs to be discussed how to include the interindividual variability in people with PD. This interactive symposium will inform the audience of a wealth of approaches that investigate and compare clinically and data-driven informed PD subtypes. The speakers will summarize data-driven PD subtype identification and analyses of phenotypes in relation to gait and balance and exercise response. The freezing-of-gait symptom will be used as an example of specific clinical phenotype. Its distinct neural control of gait signature will be presented. The audience will gain knowledge in what is needed for personalized rehabilitation for gait and balance impairments in PD. We will engage the audience interactively in various thought-provoking activities to explore the potential of how knowledge of the heterogeneity in people with PD could inform treatment strategies and/or exercise interventions in future research and in clinical settings. With this symposium, we will shed light on the broad heterogeneity observed within PD and develop novel ideas and approaches with potential to inform clinical treatment and decision-making. By advancing our understanding and knowledge of PD heterogeneity described in subtypes, this symposium will pave the way to personalized medicine and rehabilitation for everyone.

 

 

S.2: Investigating the role of multisensory brain processes when walking in a virtual reality: How do we differ from virtual zombies in the Walking Dead?

Chair: W. Geoffrey Wright, Temple University, USA

Moderators: W. Geoffrey Wright, Temple University, USA & Meir Plotnik, Sheba Medical Center, ISR

Presenters:

W. Geoffrey Wright¹, Daniel Jacobs¹, Meir Plotnik², Meytal Wilf², Chanel LaJacono³, Chris Rhea⁴

¹Temple University, ²Sheba Medical Center , ³Missouri Southern State University, ⁴UNC-Grensboro

Over the last decade, virtual reality (VR) technology has gone through an explosion of growth due to the gaming industry, which has driven down cost making it nearly universally affordable and accessible. Advancements in the technology have increased portability, ease-of-use, and levels of immersion and reality with expanded tracking systems and the addition of multiple users within the same environment. This has resulted in its application in many areas outside of gaming, including in basic science research and in clinical applications. However, in these latter instances, the importance of rigorous scientific research is still critically important especially, if it involves advancing fundamental knowledge about the human biological system or ensuring clinical efficacy and safety. Moreover, when using this technology in research there are unknowns in the human-machine interaction that remain underexplored because the market drive to sell the product far exceeds the resources and expertise available, as well as the time needed to gain this knowledge. Because this technology is designed to stimulate the visual system (and visual-vestibular processes), create the illusion of motion, alter one’s sense of presence/immersion in the environment, and affect one’s attentional processes, these all pose inherent risks to walking and balance. The research that will be presented and discussed in this symposium will cover an exciting range of topics from basic to applied research, clinical to psychophysical issues, and current to future technology. We will bring together six experts, who have extensive experience with VR, gait, and human-machine collaboration, who will present novel research and bring unique perspectives to this exponentially evolving field. Dr. Jacobs will present new research on how to calibrate our visuomotor system to virtual walking using a self-paced treadmill. Specifically, what somatic and environmental perceptual factors influence the gait and balance variables and how labile are these perceptual mappings. Dr. Plotnik will describe novel findings on gait-vision-autonomic nervous system relations during exposure to virtual and real surface inclinations. Dr. Wilf will present the impact of dual-tasking on walking in a virtual environment in both healthy and aging populations. Dr. LoJacono will present research that investigates how training dynamic gait in a VR obstacle course translates to real-world obstacle avoidance, then determining if such training is influenced by age. Finally, in a panel session with our VR and gait experts, we will debate a number of issues that researchers and clinicians still face as they attempt to understand what’s really important when navigating a virtual environment and whether all technological advances are worth the risk.

S.3: Is increasing muscle co-activation beneficial to balance control?

Chair: Giovanni Martin, Emory Universit, USA

Moderator: Lena H Ting – WH Coulter Department of Biomedical Engineering at Emory University and Georgia Institute of Technology, USA

Presenters:

Giovanni Martino¹, Friedl De Groote², Charlotte Le Mouel³, Dorothy Barthélemy⁴

¹Emory University, ²KU Leuven, ³University of Münster, ⁴Université de Montréal

MOTIVATION. Agonist-antagonist co-activation is considered a strategy to improve balance by increasing joint stiffness. Increased co-activation during standing has been observed during challenging or threatening conditions, and during postural perturbations feedforward and feedback adjustments can show co-activation patterns, contributing to the idea that the mechanical stiffening is beneficial for stability. Increased co-activation is often associated with individuals with impaired balance, like with aging or in movement disorders such as patients with spasticity or parkinsonian rigidity. However, co-activation can also be detrimental for the musculoskeletal system and increase effort and fatigue, as well as limit the use of different balance strategies and reduce robustness to perturbations. Co-activation is reduced with training, and persons who practice martial arts and relax their muscles show better postural stability. These considerations raise the questions when muscle co-activation is a beneficial strategy and when it impairs balance control. However, new approaches are needed to investigate and understand the role of muscle coactivation in balance control. AIMS. Here we will discuss novel experimental and computational approaches to study the role of coactivation in balance. Martino will show how a tendon tensiometer can be used to quantify increased muscle forces during co-activation during reactive balance control in response to support surface perturbation. De Groote will show computer simulations predicting how co-contraction might be a minimal effort strategy in the presence of sensory noise. Le Mouel will demonstrate how co-contraction might improve balance control in the presence of sensorimotor delays, and will show experimental data of wrist muscle co-activation in gymnasts performing a handstand. Finally, Barthélemy will present experimental data showing co-activation strategies in challenging conditions and how delayed coactivation coupling may contribute to balance impairments in people with incomplete spinal cord injury. The novel experimental approaches and careful manipulation of co-contraction in healthy subjects presented here are essential to validate simulation outcome, and to begin to understand the origins of increased co-contraction in pathologies. RELEVANCE. Understanding muscle co-contraction is important in both gait and posture. Standing balance control provides a tractable and functionally relevant paradigm for testing whether and when muscle co-activation is beneficial or detrimental to movement. The novel techniques and principles elucidated will be generally applicable to gait, other movements, as well as to the understanding of a posture and gait from highly skilled individuals to a wide variety of motor impaired populations.

 

Tuesday 5th July

08:30 – 10:00

S.4: Clinical feasibility of reactive balance training: from the lab to community

Chair & Moderator: Professor Stephen Lord, Neuroscience Research Australia, AUS

Presenters:

Avril Mansfield², Jon Lurie³, Marissa Gerards⁴, Yoshiro Okubo¹

¹Neuroscience Research Australia, ²University Health Network / University of Toronto, ³The Dartmouth Institute, ⁴Maastricht University

A key feature of reactive balance training (RBT) is to intentionally expose participants with repeated mechanical perturbations to improve reactive balance. The effectiveness of RBT in reducing falls has been demonstrated in growing evidence. While RBT has the potential to transform clinical practice in fall prevention, it is yet to be translated into practice due to issues such as accessibility to equipment and safety concerns. This symposium will discuss how research can address these issues for successful integration of RBT into clinical practice. It involves four speakers with unique perspectives and experiences with RBT. A/Prof Mansfield will present her survey findings of healthcare professionals that found the need for specialized or custom perturbation equipment is a barrier to implementing RBT in practice. She focuses on ‘manual perturbations’ (e.g., a push or pull by the therapist) and ‘internal perturbations’ that clinicians can easily implement for RBT. She has found that this type of RBT can improve reactive balance control and prevent falls among people with stroke. She will also discuss her ongoing work aimed to determine the optimal dose of RBT for people soon after stroke. Prof Jon Lurie will present his findings of his multi-center, randomized controlled trial (RCT) that examined the effect of adding a component of RBT using a commercially available perturbation treadmill. He will discuss his highly-pragmatic trial that involved high-risk older adults referred to 8 outpatient physical therapy clinics that found RBT significantly reduced the rate of fall-related injuries compared to usual treatment. Ms Gerard will present her findings on RBT in older adults, and its clinical applicability. She has developed a RBT protocol using an instrumented treadmill based on literature review on clinically feasibility. The training is standardized where necessary, and personalized where possible. Her most recent work comprised a mixed-methods RCT focusing on the acceptability and effects of RBT on balance, falls-efficacy, and daily-life falls in older adults. Dr Okubo will present his research directed towards developing clinically feasible RBT methods. His novel RBT program uses manual tether-release perturbations and readily available equipment to train responses to trips and slips. This is based on three RCTs of RBT using a boobytrap slip and trip walkway in older adults, people with multiple sclerosis and Parkinson’s disease. His recent work examines the perceived feasibility of the RBT program by clinicians. Prof Lord will moderate a semi-structured discussion that will discuss how researchers can address practical issues for successful integration of RBT. He will pose key questions to presenters that focus on practical evidence clinicians will need for them to implement in their practice. He will also take comments from the audience and use an electronic poll to collect audience votes.

 

S.5: The future is already here - using dynamic neuroimaging methods to identify biomarkers for disease detection, disease progression and effectiveness of treatments

Chair: Inbal Maidan, Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, ISR

Moderator: Prof. Anat Mirelman, Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, ISR

Presenters:

Inbal Maidan¹, Martina Mancini², Jasmine Menant³, Sam Stuart⁴

¹Tel-Aviv Sourasky Medical Center, ²OHSU, ³UNSW, ⁴Northumbria University

Gait is a complex function regulated and controlled by multiple brain networks. Yet, till recently, gait was only assessed through performance-based measures using wearable devices and accelerometers. In recent years, advancements in technology introduced new neuroscientific methods that allow to explore brain function while it is actually computing and executing gait, thereby enabling the assessment of brain activation patterns on multiple layers. Such technologies include Electroencephalogram (EEG) which evaluates aspects of electrical brain activity at a high temporal resolution on the order of miliseconds and functional near infrared spectroscopy (fNIRS) that detects hemodynamic changes in the cortex, especially in prefrontal cortex. Assuming that changes in brain activity precede gait impairments, the ability to quantify brain alterations with EEG and fNIRS during walking sets the stage to the development of new markers of disease, disease progression and response to intervention. Prof. Martina Mancini will discuss how to use fNIRS measures as biomarkers to differentiate between neurological symptoms and neurological diseases while Dr. Inbal Maidan will present how EEG methods can be used as biomarkers in different neurological diseases. Dr. Jasmine Menant will discuss different applications of fNIRS methods to assess various aspects of disease progression and Dr. Sam Stuart will present how EEG and fNIRS methods can be used to examine the effectiveness of treatments and interventions. Novel mobile brain and body imaging methods will be presented and innovative approach that involves the quantification of brain variability measures will be discussed as potential markers. The aim of this symposium is to discuss whether the assessment of brain function using dynamic neuroimaging methods may be a more sensitive measure than functional gait performance outcomes to assess (1) specific markers of disease, (2) disease trajectories and progression, and (3) the effectiveness of treatments and interventions. The accumulating evidence in the recent years shows that dynamic neuroimaging reveal alterations in large-scale neural networks that reflect the utilization of compensatory mechanisms required maintaining normal walking in various neurological diseases. Therefore, future studies should combine the assessment of posture and gait with real time evaluation of brain activation patterns. We believe that future clinical trials will involve evaluation of both behavior measurements and neural activation to better understand the pathophysiological changes associated with neurological diseases.

S.6: Maintaining Energy: A Potential Transformative Power to Promote Mobility in Aging

Chairs & Moderators: Professor Teresa Liu-Ambrose, University of British Columbia, CAD; Professor Caterina Rosano, University of Pittsburgh, USA

Presenters:

Teresa Liu-Ambrose¹, Jennifer Davis², Ryan Dougherty³, Rebecca Enrenkranz⁴, Caterina Rosano⁴

¹University of British Columbia, ²University of British Columbia – Okanagan, ³John Hopkins, ⁴University of Pittsburgh

Background and Relevance: Reduced energy is a hallmark feature of aging. Maintaining higher energy late in life may be critical in mitigating the challenges of aging and in promoting resilience. The lack of energy and presence of fatigue are often viewed as the same construct, and energy and fatigue are frequently considered opposite sides of the same domain. However, recent evidence suggests energy and fatigue have distinct underlying neurobiology. A better understanding of the energy/fatigue dichotomy is needed to promote healthy and functional aging. This symposium will provide compelling and novel epidemiological, neuroimaging, and clinical experimental evidence that energy is a related but distinct construct from tiredness, can be modified, and critical to healthy mobility in aging. Aims: 1) Explore similarities and differences between energy and fatigue, including clinical and neurobiological phenotypes; 2) Understand whether self-reported and objective metrics of energy reflect mobility resilience in aging; and 3) Whether energy can be modified or improved in older adults. We will first a) present epidemiological and neurobiological justifications for operationalizing energy as a separate construct from fatigue in older age (Rosano, Ehrenkranz, Dougherty). We will then provide preliminary evidence that feelings of energy or fatigue can be modified by lifestyle interventions (Davis). Taken together, our results suggest self-reported or objectively measured energy: a)may reflect a distinct neural signature (Rosano); b) may signal resilience against falls (Davis), as well as age-related declining mobility despite self-reported tiredness (Ehrenkranz); c) appear negatively influenced by Alzheimer’s neuropathology (Dougherty); and d) may be modifiable with exercise and may, in part, explain how exercise reduces the incidence of falls (Davis).

Wednesday 6th July

10:30 – 12:00

S.7: Perception and self- evaluation of gait and balance performance

Chair: Kara Patterson, University of Toront, CAD

Moderator: Sjoerd Bruijn, VU Amsterdam, NLD

Presenters:

Kara Patterson¹, Mirjam Pijnappels², Elmar Kal³

¹University of Toronto, ²VU Amsterdam, ³Brunel University London

Improving walking and balance ability is paramount to independence and quality of life, both for healthy adults who engage in fall prevention exercise programmes as well as for people undergoing rehabilitation after a neurological injury. Motor (re)learning underlies the rehabilitation process as patients practice motor tasks repeatedly with the goal of improving performance and retaining those gains long term. Asking an individual to subjectively evaluate their own movement performance throughout practice or training, can improve their motor performance on a follow-up retention test, compared to those who are not instructed to subjectively evaluate their movements. Physical, cognitive, and psychological changes that occur with ageing or after neurological injury may alter the extent to which a person engages in self-monitoring and evaluation, the accuracy of such judgements, and their ability to use these judgements to adjust motor performance. Further, some individuals may engage in excessive, anxious self-monitoring which could lead to inaccurate perception, inefficient motor control and subsequently to falls. This symposium will present 1) a summary of previous work that investigated self-evaluation of motor performance; 2) recent work that investigated how well younger and older judged their stepping ability; 3) recent work that investigated evaluation of temporal gait asymmetry in people with stroke and healthy adults walking with an induced asymmetry and 4) recent studies that show how psychological influences could shape self-monitoring and evaluation, and thereby impact on balance or falls. The audience will have the opportunity to perform a motor ability judgement task designed to foster reflection. The audience will also have a chance to engage in a moderator-led discussion about methodological considerations and clinical applications of self-evaluation and monitoring of motor performance.

S.8: Multisensory contributions to mobility in older adults

Chairs: Bettina Wollesen, University of Hamburg, DEU

Moderator: Kim Delbaere, Neuroscience Research Australia, AUS

Presenters:

Bettina Wollesen¹, Ralf Krampe², Berkley Petersen³, Claudia Voelcker-Rehage

¹University of Hamburg, ²LU Leuven, ³Concordia University, ⁴University of Munester

Multisensory contributions to mobility The detection of mechanisms of cognitive-motor interference while walking performance and daily life mobility is an emerging area of research. Multitasking is an integral part of our daily life. Driving a car while using a mobile phone, and strolling on the sidewalk while watching shop windows, are often-cited examples of everyday behavior in which we execute multiple actions concurrently. It is well established that multitasking skills deteriorate in older age. This deterioration has been attributed to an interrelated decay of perceptual, sensorimotor, and cognitive functions. Dual-task (DT) and multitask situations themselves are often associated with decrements in walking performance such as increased sway velocity, decrements in gait quality like reduced step length and velocity, with indications that older adults with different physical or cognitive abilities (eg., hearing impairments, decrements in cognitive abilities, affecting spatial orientation, concerns of falling) suffer even more decrements under these conditions. Evidence suggests, increased cognitive load, sensory loss and cognitive impairments alone reduce postural control while standing or walking, but rarely are these factors considered in conjunction. Since older adults often exhibit hearing impairments that severely affect their lives, investigating the interaction between age-related hearing impairment and decline in other domains (e.g., vision, cognition, and mobility) at the behavioral and neurophysiological levels could elucidate the underlying mechanisms. Next to the approaches that examine cognitive-motor interactions with behavioral approaches, the Mobile brain/body imaging (MoBI) combines mobile brain imaging (in most cases Electroencephalography; EEG or fNIRS) of freely moving participants with synchronized recordings of task performance and body movements. Integrating the MoBI apporach could lead to therapeutically promising insights by providing a better understanding of the mechanisms for mobility, risk of falls leading towards improved fall prevention or targeted training programs for older adults and hearing-impaired persons. Within this symposium different aspects of multisensory modulation especially hearing and visual information processing and their contribution to mobility (standing and walking abilities) of older adults will be presented.

S.9: Emerging Interventions for Rehabilitation of Mild Neurocognitive Disorders: Evidence from Neuromodulatory and Cognitive-Motor Training Approaches

Chair: Joyce Fung, PT, PhD, Associate Professor, School of Occupational and Physical Therapy, McGill University, CAD

Moderator: Eric Anson, PT, PhD, Assistant Professor, Department of Otolaryngology, University of Rochester Medical Center, USA

Presenters:

Tanvi Bhatt¹, Joe Varghese², Brooke Klatt³, Brad Manor⁴

¹University of Illinois at Chicago, ²Albert Einstein College of Medicine, ³University of Pittsburgh,, ⁴Harvard Medical School, Beth Israel Deaconess Medical Center

The incidence of mild neurocognitive disorders (NCD) is a term used by the American Psychiatric Association to include acquired mild cognitive impairment (MCI) disorders of all age groups diagnosed by using several cognitive criteria versus a single one. Typically, adults with NCD exhibit subjective memory decline and subtle balance and gait deficits resulting in a two-fold increase in fall risk compared to healthy counterparts. Studies have postulated that balance centers in the central nervous system (CNS) share resources with areas of cognitive processing. But in a diseased state, such as NCD the CNS draws on more attentional resources to maintain mobility and stability resulting in cognitive-motor interference when dual-tasking. Rehabilitation of people with NCD to maintain functional independence has gained significant interest in the past decade. This symposium will cover the following: 1) Etiology, classification, and pathophysiology of NCD; 2) Determine the different types of cognitive-motor interference patterns and possible neural correlates associated with NCD; 3) Identify clinical and instrumented tests for evaluating cognitive-motor interference during gait and balance tasks; 4) Describe the results of current outcomes of research incorporating cognitive-motor dual-task training in people with NCD; and 5) Describe use of neuromodulatory approaches such as transcranial direct stimulation as a therapeutic adjunct to for balance rehabilitation in people with NCD. Participants will engage in an interactive scientific exchange to understand it there is enough current evidence for clinicians to use assessment tools and interventions for balance and gait rehabilitation for people with NCD and to understand if it is feasible and within the scope of practice for rehabilitation clinicians to implement neurocognitive assessment and training into their practice. There will also be a discussion on future directions for both laboratory-based and clinical research.

 

Thursday 7th July

16:00 – 17:30

S.10: Quantitative snobs no more! Integrating qualitative approaches into posture and gait research

Chair: Andrew Sawers, University of Illinois at Chicago, USA

Moderators: All presenters

Presenters:

Andrew Sawers¹, Kristin Musselman², Kathryn Sibley³

¹The University of Illinois at Chicago, ²University of Toronto, ³University of Manitoba

Posture and gait research has long been dominated by quantitative methods. Here we suggest that largely ignored qualitative methods can enrich traditional lines of quantitative inquiry. Partnerships and engagement with key stakeholders including patients, their families, and care-givers to explore fall-related experiences can yield unique insights into factors that contribute to falls, as well as the assessment and treatment of balance deficits. Despite the opportunities presented by qualitative methods in posture and gait research, they have received limited attention, highlighting the historical focus on, and bias towards quantitative methodologies. The objective of this symposium is to demonstrate how qualitative methods can provide novel insights into the assessment, treatment, and mechanisms of balance and falls. This symposium will begin with a brief “Qualitative 101” to familiarize attendees with key concepts of qualitative research. In each talk that follows, speakers will address three guiding questions : i) what scientific or clinical gap motivated you to begin using qualitative methods? ii) how have qualitative methods advanced your posture and gait research, and iii) what new research directions emerged from your qualitative research that might have otherwise been overlooked? Andrew Sawers will begin by describing how focus groups and cognitive interviews were used to develop the first structured lower limb prosthesis user-specific fall survey. He will then highlight how the ensuing administration of the fall survey to 235 lower limb prosthesis users revealed previously undocumented balance recovery strategies favored by lower limb prosthesis users. Next, Kristin Musselman will demonstrate how the qualitative methods of photovoice and participatory co-design were used to understand the complexity of falls after spinal cord injury and develop balance training interventions and technologies. Finally, highlighting the complexities of balance assessments in clinical settings, Kathryn Sibley will demonstrate how semi-structured interviews and focus groups were used to identify factors that influence physiotherapists’ perceptions of measuring reactive balance, and exercise professionals’ perspectives on integrating technology into balance assessments of older adults. This diverse collection of talks will address different topics in posture and gait research, using a variety of qualitative methods, applied to an array of clinical populations, to arrive at specific solutions. Attendees will leave the session understanding how this unique branch of research can be used to advance our knowledge of key posture and gait phenomena. Preliminary steps required to begin using qualitative methods will also be discussed in an interactive exchange.

S.11: Gait speed and balance control

Chair & Moderator: Hendrik Reimann, University of Delaware, USA

Presenters:
Amy Wu¹, Hendrik Reimann², Jesse Dean³, Sjoerd Bruijn⁴
¹Queens University, ²University of Delaware, ³Medical University of South Carolina, ⁴Vrije Universiteit Amsterdam

Walking with a stable gait is a complex task. The difficulty can be appreciated by looking at both ends of the age spectrum: toddlers fall regularly and get back up while gradually learning to walk. As people get older, they fall more frequently again, and these falls often lead to injuries. While balance control is a largely automatic and sub-conscious neural process, its failure can have dramatic consequences. Walking speed has long been known to be a reliable indicator of general health, or even a “sixth vital sign”. Although preferred walking speed is a good predictor of fall risk in older adults, it is not well understood how walking speed affects upright stability. People with increased risk of falling often tend to walk more slowly, but the causal relationship between these phenomena is unclear. Such a slower gait has been suggested to be a conservative strategy, allowing more time to react to changes in the environment, and limiting the consequences of an impact when failing to avoid a collision or fall. However, it has also been suggested that slow walking in and of itself is actually less stable. Theoretical models imply that faster walking is more stable, because as cadence increases, the central nervous system has more opportunities to make discrete control actions through foot placement modulation. This would imply that by choosing to walk more slowly, older adults and populations with neuromotor impairments, e.g. stroke survivors and people with Parkinson’s Disease or Cerebral Palsy, inadvertently decrease the stability of their gait pattern.

The goal of this symposium is to discuss interactions between gait speed and balance control. In the first part of the symposium, we will present balance as a sensorimotor feedback process and discuss how the biomechanics and neuromuscular control aspects of this control problem change with walking speed. In the second part of the symposium, we will discuss slow walking in populations with neuromotor impairments. Although people with neuromotor impairments often walk substantially slower than neurotypical controls, the reasons why they do so are not necessarily related to balance. Moreover, it is unclear if, or to what extend, slow walking in healthy subjects can be compared to slow walking in populations with locomotor pathologies, and if, and to what extend, we can even make comparisons between pathological and healthy populations.

In order to provoke more lively engagement, We will discuss these two topics in a non- standard format, with multiple short talks on each subject by all presenters, and ample room for discussion between the panel and the audience after the prepared presentations.

 

S.12: Watch your step! - Fundamentals and clinical applications of walking adaptability

Chair: Vivian Weerdesteyn, Radboud University Medical Center, Nijmegen & Melvyn Roerdink, Vrije Universiteit, Amsterdam, NLD

Moderator: Kristen Hollands, University of Salford, GBR

Presenters:

Vivian Weerdesteyn¹, Melvyn Roerdink², Daniel Marigold³, Will Young⁴

¹Donders Institute, Radboud University Medical Center, ²Vrije Universiteit, ³Simon Fraser University, ⁴University of Exeter

Poor balance and gait are the number 1 modifiable risk factors for accidental falls and constitute a key target of fall-risk screening and intervention strategies. Traditional strategies typically include exercises that are performed under well-controlled and unperturbed conditions, yet it is increasingly recognized that these types of exercises do not adequately represent daily-life fall scenarios. In recent years, a paradigm shift towards perturbation-based training programs with the aim to improve recovery responses to unexpected losses-of-balance (e.g. trips or slips) has emerged. Notwithstanding the benefits of practicing recovery responses, we argue that it is equally important to prevent such perturbations from happening in the first place. Walking is inherently dynamic and complex, and the environment often presents the precipitating factor for an accidental fall. Hence, walking adaptability is key for safe community ambulation, but it is an underdeveloped concept for our understanding of walking ability and related assessment and training. To address this missed opportunity for reducing fall risk, we aim to: 1) Build a conceptual framework of walking adaptability that encompasses the interactions between visual sampling, postural demands, stepping movements, task prioritization, and psychological factors 2) Provide directions on improving walking adaptability testing and training This multidisciplinary symposium will cover the state-of-the-art on walking adaptability, with each speaker presenting from a different background. Importantly, each speaker’s work is highly translational, such that their contributions will not only provide novel insights into how we adapt our walking pattern to the environment but will also outline concrete diagnostic and therapeutic applications that follow from their work.