ISPGR World Congress Program

Sunday 30th June, 2019: Day 1

Pre-congress workshops

The pre-congress workshops outlined below are priced at $45USD per workshop, and registrations can be purchased when registering for the ISPGR World Congress.

Please click on each of the blue + below to read more details on each workshop

8:30AM - 11:30AM: WS.1 - Mixed reality for posture and gait research: principles and applications

Organiser: Melvyn Roerdink, Vrije Universiteit Amsterdam, NLD

Mixed reality, the integration of real and digital worlds, is the rising star in the virtuality continuum. A promising advance in that regard are untethered and transparent headsets equipped with a holographic display unit, through which 3D holograms are not only overlaid but anchored to and interacting with the wearer’s environment. This merging of real and digital worlds affords a realistic interaction with digital content during free movements in open environments. The main goal of this mixed-reality workshop is to get attendees familiar with the basic principles of mixed reality and its potential for posture and gait research through lecture-like plenary presentations intermingled with demos. What is mixed reality? How does it relate to virtual reality and augmented reality? How does it merge holographic content with the real world? What can I do with mixed reality? A second goal is to offer attendees hands-on experience with mixed reality in a research context through four different interactive demos: 1) the eyes, the ears and the brains of mixed reality, 2) Holobstacle, a mixed-reality application for studying holographic obstacle avoidance in the lab, 3) MR-Automated Mobility Assessment, a mixed-reality application to guide the wearer to self-initiate and complete clinical mobility assessments and 4) Holocue, a mixed-reality application for on-demand cue activation to reduce freezing of gait in Parkinson’s disease patients.

8:30AM - 11:30AM: WS.2 - Pursuing an industry position after graduate school

Organiser: Adam Goodworth, University of Hartford, USA

Free to trainees/graduate students and post docs.

Graduates with advanced degrees in human movement disciplines are often interested in non-academic career pathways. However, graduates are typically provided with very little perspective or direction in how to consider a non-academic career. As it turns out, there are a wide variety of non-academic pathways. These include start up companies, clinical facilities, product development, forensic sciences, private research centers, and more. Our workshop will provide 1) an overview of the common non-academic career pathways, 2) presentations from ISPGR members with significant non-academic employment, 3) a question and answer session with the speakers and a panel of approximately five ISPGR industry sponsors, and 4) an open time for relationship building. To focus on a pragmatic goal, presenters and panel members will address three guiding questions – 1) How is/was research conducted and applied in your non-academic setting, 2) What skills do potential employees need to be successful in your setting, 3) What are practical steps interested researchers and graduate students could take to move toward a career in your setting? The presentation is geared toward graduate students and academic faculty interested in a non-academic careers. However, established academic researchers may also find the workshop interesting to help in their mentoring of graduate students in career directions, and to gain knowledge about how research is translated and used in non-academic settings.

Speakers Include:

Lewis Nashner – Experience leading clinical rehab engineering companies
James Borrelli – Experience in forensic engineering
Tyler Cuddeford – Experience in Nike Sport Research Lab
Rebecca Robins – Data science management at DataCamp

12:30PM - 3:30PM: WS.3 - Assessing real world mobility: are we ready for the digital revolution?

Organiser: Lynn Rochester, Newcastle University, GBR

The goal of the workshop is to provide the audience with a comprehensive overview of the challenges and opportunities of digital technology to assess real world mobility outcomes. Given the ageing population and concomitant increasing chronic burden, we need low-cost, widely-accessible tools to measure, monitor, and predict mobility problems. Mobility assessment in the real world forms the ideal place and digital technology the ideal partner. But are we ready for this? What are the significant challenges associated with this endeavour? This pre-conference workshop will review the state of the art of current mobility assessment tools across a range of different and relevant disease populations to set the scene for where we are now. We will then explore the challenges and opportunities of digital technology to enhance the current status from a range of different perspectives: the technical challenges for accurate measurement; clinical validation; the big-data challenge; the end user of technology; and implementation in practice.

12:30PM - 3:30PM: WS.4 - Advanced rehabilitation technology to boost your research!

Organiser: Frans Steenbrink, Motek Medical

In this workshop we will outline the state-of-the-art of currently available rehabilitation technology for gait and balance research. More specifically, we will focus on real-time visual feedback, gait adaptability, and gait perturbations using an instrumented dual-belt treadmill, motion capturing and other technology in combination with an application development framework to create custom research applications. Compared to most other (over-ground) motion labs, the treadmill set-up allows for more functional gait tasks to be evaluate in scientific protocols. Also controlled manipulations, such as slit-belt walking with deviating speeds for each belt, can be used to study motor-control in both healthy individuals and patient. Cognitive, visual and mechanical perturbations using the walking surface of the treadmill can be used to study pathology-specific responses. By controlling input settings for the perturbations and collecting parameters related to balance and locomotion, input-output responses can be evaluated to better understand the human system. In this workshop we will introduce the different concepts related to advance human movement research. Together, we will think of examples of how new research concepts can be integrated in laboratory setting using different types of technology. Also, we will interactively show and adjust several research applications using motion capture and virtual reality technologies, and invite you to engage in our discussion on how we can use technology better understand the health and pathological human balance-and locomotion system.

The below journal related workshops are free to attend, but pre-registration is required. You can confirm your attendance when you register for the World Congress.

Please click on each of the blue + below to read more details on each workshop

8:30AM - 10:00AM: Authors’ Workshop - Authors’ rights and responsibilities

This workshop will cover ethical issues including plagiarism, and will be presented by the Editors and Publisher of Gait and Posture.

 

10:15AM - 11:45AM: Reviewers’ Workshop - Identifying limitations in scientific articles

Presented by the Editors and Publisher of Gait and Posture.

Sunday 30th June, 2019: Day 1

All conference sessions take place at the Edinburgh International Conference Centre (EICC)

4:30PM – 5:00PM: Opening ceremony

5:00PM – 6:00PM: Keynote lecture 1
Janice Eng, University of British Columbia, CAN

Chairs:
Kristen Hollands, University of Salford, GBR
Michael Cinelli, Wilfrid Laurier University, CAN

Interventions to improve mobility after stroke: A journey from mechanisms and clinical trials to implementation science

Stroke is a common condition with 1 in 5 persons having a stroke after age 55.  Furthermore, there is an increasing stroke occurrence in younger adults due to the epidemic of obesity and diabetes.  While stroke affects multiple domains of function, regaining and improving walking is high on the priority of stroke survivors.  This presentation will first describe mechanistic research aimed at understanding how muscle function, balance and walking are altered by stroke.  In addition, data quantifying the intensity of inpatient rehabilitation and physical activity in the community of individuals after stroke will be presented.  The development and efficacy of interventions to improve postural reflexes, balance, mobility and reduce falls after stroke will then be discussed, including novel interventions utilizing wearable sensors, as well as robotic exoskeletons.  In particular, the concept of repetitions and neuroplasticity, in addition to the importance of the time window of neurological recovery after stroke will be examined.  Lastly, methods and theories to facilitate the implementation of complex stroke rehabilitation and exercise programs will illustrate translation of knowledge to real-world practice.

6:00PM – 7:30PM: Opening reception

Monday 1st July, 2019: Day 2

8:30AM – 9:30AM: Keynote lecture 2
Herman van der Kooij, University of Twente, NLD

Chair:
Vivian Weerdesteyn, Radboud University Medical Center, NLD

Studying human balance control by perturbations and computational models: insights and applications for wearable robotics

We study human balance control during standing and walking by analysing the responses evoked by mechanical perturbations. We developed simple template models and more realistic neuro-mechanical models to interpreted and predict how humans respond to various mechanical perturbations and how they maintain balance. We translate these predictive models into human inspired controllers of wearable robots. We demonstrated that with this translational approach we can enhance standing balance and the walking speed of subjects with an incomplete spinal cord injury wearing an exoskeleton.

9:30AM – 10:00AM: Honourary member presentation

10:00AM – 12:30PM: Posters session 1 and exhibitors (for full list of posters, click here)
(Refreshments provided 10:00AM – 10:30AM)

12:30PM – 1:30PM: Lunch and exhibits

1:30PM – 3:15PM: Symposium Sessions 1 – 3

Please click on each of the blue + below to read more details on each symposium

S.1: Virtual reality in motion: moving posture and gait research forward with do-it-yourself vs turnkey systems

Chair: Anouk Lamontagne, McGill University, CAN

Desiderio Cano Porras¹, Marco Buhler², Nicoleta Bugnariu³, Anouk Lamontagne², Joyce Fung²

¹Tel Aviv University and Center of Advanced Technologies in Rehabilitation, Sheba Medical Center at T, ²McGill University, ³University of North Texas Health Science Center at Forth Worth

Virtual reality (VR) is a powerful tool for the investigation of posture and gait control mechanisms and for clinical applications. It allows generating the experimentally controlled conditions essential for scientific inquiries, while making it possible to understand movement and behavior within complex ecological environments. Thus, VR technology is increasingly used to probe perceptual (e.g. visual, auditory, haptic) and cognitive factors (e.g. executive function) involved in posture and gait control. In recent years, VR has undergone an exponential growth that has not only opened new possibilities but also brought up new challenges. This growth has led to the development and commercialization of low-cost, open-source VR technologies and games engines that are in constant evolution and require intensive programming (do-it-yourself or DIY). This type of technology contrasts with the high-end, turnkey systems conventionally used for posture and gait research. The purpose of this symposium is two-fold: (1) to present original research on the role of perceptual and cognitive factors involved in the control of complex yet ecological postural and locomotor tasks and; (2) to share, discuss and debate on the advantages and challenges of DIY vs. sophisticated turnkey systems in the context of fundamental and applied research. Researchers and graduate trainees with a wealth of experience and diverse perspectives on the use of VR for clinical and fundamental applications in gait and posture will share their research findings and tribulations with the audience. Nicoleta Bugnariu will speak from the perspective of high-end immersive VR environments with integrated motion capture, eye tracking and surround sound, as a tool to investigate multisensory integration and postural control in older adults. Desiderio Cano Porras will present VR paradigms involving incongruent visual input while walking, which reveal underlying mechanisms of multisensory and motor integration pertaining to locomotion. Marco Buhler will present on the validation of low-cost DIY VR systems for the investigation of complex locomotor tasks such as the circumvention of pedestrians. He will further discuss the impact of the type of VR systems on locomotor outcomes. Anouk Lamontagne will present on the development and testing of low-cost VR-based toolkits for assessment and intervention related to complex walking tasks and visual-perceptual disorders in neurological populations. Joyce Fung will moderate the discussion on the pros and cons of both DIY and turnkey systems as well as the utility and exportability of these systems to other platforms. At a time when the investigation of postural and gait control goes well beyond sensorimotor aspects, VR has become a powerful tool to elucidate the contribution of other factors such as perception and cognition. This symposium will explore cutting edge research on such factors while providing a forum to discuss and debate on ideal VR solutions for fundamental and applied research.

 

S.2: fNIRS data to understand cortical mechanisms underpinning exercise interventions

Chair: Jasmine Menant, NeuRA, AUS

Paulo Pelicioni¹, Eling de Bruin², Rodrigo Vitorio³, Anat Mirelman⁴

¹Neuroscience Research Australia, ²ETH Zurich, ³Instituto de Biociências, UNESP – Universidade Estadual Paulista campus Rio Claro, ⁴Tel-Aviv Sourasky Medical Centre

Background: Functional near-infrared spectroscopy (fNIRS) is an optical neuroimaging technique for investigating cortical brain area activation while participants can move freely. This technique is particularly useful for monitoring haemodynamic responses to brain activation in cortical regions before and after stimulation (i.e. resting followed by simple walking or simple walking followed by dual-task walking). Studies using fNIRS technology to examine the neural signature of balance and gait tasks have been increasingly published in the past decade. There is now a considerable amount of literature on prefrontal cortex contribution to the execution of dual-tasks involving balance and / or gait in ageing, and more and more in clinical groups. However, only a few investigations to date have examined the effects of balance and/ or gait training involving or not a cognitive component (e.g. dual-task gait training) on activation of motor and cognitive cortical areas during balance / gait tasks recorded with fNIRS. Aims: The aims of this symposium are to present novel findings on cognitive and motor cortical activation using fNIRS in ageing and Parkinson’s disease in response to: (i) cognitive-motor interventions using various training (stepping mat, treadmill) and testing modalities (stepping, dual-task gait, gait adaptability); (ii) novel findings of acute interventions (acute aerobic exercise); Additional aims of this symposium are to present and discuss capabilities and limits of using fNIRS technology to record cortical activation non-invasively during locomotion and the future of this methodology. Relevance: The debate around the use of fNIRS technology to understand neuroplasticity in response to cognitive and/or motor exercise-based interventions is highly relevant to researchers in gait and posture research. An in-depth understanding of the capabilities and limits of the use of fNIRS will help gait and posture researchers determine whether this technology might be adequate to uncover the neural mechanisms underpinning the effectiveness of therapeutic interventions involving cognitive and/or motor training.

 

S.3: Balance, gait and falls post stroke: steps towards a better future

Chairs:
Vivian Weerdesteyn, Radboud University Medical Center, NLD
Itshak Melzer, Ben-Gurion University of the Negev, ISR

Shirley Handelzalts¹, Tanvi Bhatt², Gelsy Torres-Oviedo³, Jolanda Roelofs⁴, Itshak Melzer¹, Vivian Weerdesteyn⁴

¹Ben-Gurion University of the Negev, ²University of Illinois, ³University of Pittsburgh, Swanson School of Engineering, ⁴Radboud University Medical Center

Balance and gait impairments are highly prevalent post stroke and have a profound impact on a person’s safety and independence in daily life. For instance, persons with stroke (PwS) have a 3-10 times higher risk of falling than their healthy peers (Weerdesteyn et al., 2008). Balance and gait impairments also result in mobility restriction and inactivity, which in turn leads to further deconditioning. Yet, despite the rapidly growing body of literature on interventions aiming at improvements in balance and gait and at preventing falls in PwS, there have not been any recent breakthroughs in this field. In fact, the results from large clinical trials conducted in the past ten years have been disappointing. The LEAPS trial, for instance, failed to demonstrate a surplus value of body-weight supported treadmill training compared to home-based exercise (Duncan et al., 2011). Furthermore, two well-conducted falls prevention RCTs failed to demonstrate a significant reduction in fall rates in PwS (Batchelor et al., 2012; Dean et al., 2102). These latter results are particularly thought provoking, as the experimental interventions were adjusted versions of programs that had previously been found efficacious in the general older population. To address this conundrum the presenters will provide complementary perspective on voids and opportunities in the field of balance and gait rehabilitation post-stroke. Specifically, they will 1) provide new insight into the mechanistic underpinnings of post-stroke balance and gait impairments, 2) present the feasibility and effectiveness of perturbation training, and discuss impairment and intensity considerations for acquiring and retaining training-induced motor learning, 3) discuss factors that determine the effectiveness of split-belt walking (legs moving at different speeds) as an approach to correct gait asymmetry in stroke survivors, and 4) provide recent evidence that people after TIA or minor stroke may also be in need of balance and gait rehabilitation. The symposium will conclude with a general discussion on how to more effectively cross the bridge between basic science studies, like the ones presented in this symposium, and clinical (trials and) practice.

 

3:15PM – 3:45PM: Refreshment break

3:45PM – 5:30PM: Symposium Sessions 4-6

Please click on each of the blue + below to read more details on each symposium

S.4: Going from here to there and beyond: Fundamental theories and applications from what we have learned about human navigation of cluttered environments

Chair: Anouk Lamontagne, McGill University, CAN

Bradford McFadyen¹, Michael Cinelli², Anne-Hélène Olivier³, Julien Pettré³

¹Université Laval; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CI, ²Wilfrid Laurier University, ³Université de Rennes, Inria

Interactions between individuals and their environment represent the basic synergies of our daily life. For example, when walking in the street, we take in information about our surroundings in order to avoid collisions, intercept, meet, or escape other people. In this context, the proposed symposium focuses on how evidence about human navigation behavior in cluttered environments has evolved during the last 30 years. Specifically, research protocols have evolved from simple to more real world paradigms, moving from interactions with static obstacles to person-person interactions. Using various experimental paradigms, which benefit from the advancement of technology, researchers focused on the control laws that govern people’s actions when interacting with other people and other objects in different environments. In such a context, they analyzed both the locomotor adaptations performed by walkers and the visual information (cues) people gather from the elements of the environment that provides information about their future paths. These control laws can then be used to design numerical modeling and simulations of local interactions between pedestrians. In addition to fundamental knowledge about visuo-motor coordination involved while walking, understanding and modelling how walkers interact with their environment, especially with other people, have a wide range of applications. In the field of Health, it can allow one to evaluate the functional capability of specific populations and identify perceptual or motor deficits, related to aging, injury or handicap and develop new assessment and training programs for rehabilitation. Involving virtual humans or robots with more realistic navigation capabilities, will also allow more natural interactions with users, for assessment, training, entertainment or social-robot navigation purposes. While person-person interaction paradigms are highly relevant and natural to study, there are only a very few full members within the ISPGR working on such a paradigm, mainly because until recently, it has been difficult to set up and analyze such interactions. This symposium aims at generating fruitful discussions about research dedicated to the understanding of human navigation behaviors with other humans in perspective of a long history of experiments, the current state of the art protocols and modelling, the applications, and the future directions and challenges related to this topic for both fundamental and applied research.

S.5: Falls prevention should start in middle age - Lessons on prevention from cardiology may advance fall prevention in old age

Chair: Stephen Lord, Neuroscience Research Australia, AUS

James Richardson¹, Michele Callisaya², Mirjam Pijnappels³, Stephen Lord⁴

¹University of Michigan, ²University of Tasmania, ³VU Amsterdam, ⁴University of New South Wales

Background: Three decades of research has allowed the identification of a range of effective interventions to prevent falls in older people. However, despite robust evidence to support these interventions, recent work indicates that insufficient progress has been made in reducing falls in older people at the public health level. This is likely related to the increased average adult lifespan resulting in an ageing population whose health is threatened by increasing burden of falls and mobility-related disability, but it may also be related to our current fall prevention strategy. When attempting to prevent sporadic events such as falls, researchers and clinicians commonly strive to identify specific risk factors that predict which patients are most likely to be affected. In this context, “prior fall” and “poor balance” are consistently defined as the most potent items of any fall risk screening tool. However, these ‘risk factors’ have limited preventative utility because they provide little insight into the mechanisms of an individual’s heightened fall risk and are inherently ‘after the fact’ and contrast sharply with other medical research fields. One such apparent example is the field of cardiology, where the use of physiological and predictive measures applied early in life are used in the prediction (and ultimately prevention) of myocardial infarction. A similar strategy should be perfectly feasible in the prediction and prevention of falls and should be considered key to advancing the field. Aims: To provide evidence that balance problems and fall risk already start at middle age. To discuss how we might work towards the development of longer-term fall risk models (as opposed to the current 1-year models) and what this means for fall prevention. Relevance: Both myocardial infarction and falls are age-related, life-changing, potentially fatal events. Both are the result of a lifetime of sub-optimal age-related changes in specific physiologic risk factors. Focusing on “poor balance” and “prior falls” as the dominant fall risk factors prevents clinicians from detecting sub-optimal age-related changes that start before a fall occurs. Proximal weakness, reduction in peripheral neuromuscular function, changes in short latency neurocognitive functions and psychological alterations all likely begin decades before a fall occurs, and progressively lead to diminished ability to respond successfully to a perturbation in later years. Clinicians dealing with middle-age and old-age patients should assess these predictive fall risk factors at regular intervals as the patient ages. A fall “stress test”, analogous to cardiac stress evaluations, could evaluate physiological reserve. Researchers need to accurately identify these critical attributes and make them routinely available to the health care practitioner in the clinic, and of concern to the patient who can then work in middle age to take responsibility for their own mobility and fall risk in later life.

S.6: Turning as measure of functional mobility: when biomechanics, neural control, and technology come together

Chairs:
Martina Mancini, Oregon Health & Science University, Portland OR, USA
Fay Horak, Oregon Health & Science University, Portland OR, USA

Marco Schieppati¹, Lorenzo Chiari², Inbal Maidan³, Martina Mancini⁴

¹International University of Health, Exercise and Sports,, ²University of Bologna, ³Tel Aviv Sourasky Medical Center, ⁴Oregon Health & Science University

Compared to straight ahead gait, turning requires more neural resources to properly plan and execute the movement. This symposium will focus on understanding the significance and challenge of controlling turning, or locomotion on a curved trajectory in healthy and neurological population to guide potential rehabilitation strategies. We will discuss the physiology and biomechanics of turning and what goes wrong with turning ability in the elderly and patients with Parkinson’s disease. We will show how measurement of turning with body-worn sensors has provided insight into the frequency and quality of turning in everyday life and how it relates to fall risk. In addition, we will discuss the cortical correlates of turning compared to straight ahead gait in neurological populations. A better understanding of turning as a complex motor skill will help therapists develop more effective, innovative approaches to rehabilitation of mobility and reduce risk of falls.

 

Tuesday 2nd July, 2019: Day 3

8:30AM – 9:30AM: Keynote lecture 3
Lynn Rochester, University of Newcastle, UK

Chair:
Sue Lord, Auckland University of Technology, NZL

Gait - a step in the right direction?

How do we keep people with neurodegenerative disease mobile and safe?  This was the question we started with many years ago.  It is a fundamental aim and the raison d’etre for myself and my research group as we directed a concerted, collaborative effort over the subsequent decade. Why is this important?  People who develop age related neurodegenerative conditions such as Parkinson’s have to cope with significant mobility problems. Walking (or gait) features at the top of their list of concerns. This is understandable as it reduces independence and leads to an increased risk of falls.  As if this is not enough, becoming less active adds to the overall burden of disease. To date managing gait problems remains a significant challenge – not helped by the fact that an understanding of the causes is still evolving.  Efforts to mitigate mobility loss by targeting gait impairments are therefore key and we need to start as early as possible.

Gait is complex and complex problems require complex solutions!  Adopting a 360 degree perspective provides a platform to approach this, incorporating a multi-domain approach to include multiple contributing systems (including cognition and vision) and key pathological, neural and genetic substrates.  We had two key objectives: to describe gait impairments from prodromal to late disease in PD; and to determine what drives them. Leveraging large and longitudinal datasets in well described patient cohorts was fundamental in combination with strategic collaboration and multidisciplinary input to help probe these objectives. We aimed to link our findings to novel measurement tools using wearable technology, and intervention development and this was coupled with a focus on our the needs of our key stakeholders.

Key insights demonstrated that gait impairments appear early even in the prodromal stages and drive early falls risk. They evolve selectively underpinned by multiple substrates enhancing our understanding of the mechanisms of gait impairment. Our findings promote an earlier, more preventative approach than previously recognised. Cognitive function, particularly attention, plays a significant early role and impacts on the visual control of gait. We showed this is driven by shared pathological substrates such as cholinergic disturbance and abnormal proteinopathy. These findings have informed therapeutic approaches utilising attention as a substrate to improve movement amongst others.  Conversely, gait impairments also provide insights into cognitive function, demonstrating their symbiotic relationship. This has delivered other benefits such as tools to predict declining cognitive function along with insights for therapeutic development.  Extending the remit of measurement we showed that different features of gait appear sensitive to different dementia subtypes. Together our work suggests that discrete patterns or signatures of impairment may support enhanced diagnosis even in early/prodromal detection and a window of opportunity for neuroprotective therapy.

Collectively our work has contributed to the role of gait as a clinical biomarker for enhanced diagnosis, disease monitoring and risk prediction and provided the basis for therapeutic development. We have linked our findings to develop the tools to translate our work to the real-world using low cost wearable technology. Importantly this has addressed an unmet need for industry, clinicians and patients – the key stakeholders of our work. We set out with an ambitious aim. We have learnt a lot along the way, most important of all being that none of this is feasible without the collaborators and team to deliver it!

9:30AM – 10:00AM: Promising Scientist Award Talk
Jenna Yentes, University of Nebraska at Omaha, USA

Chairs:
Anouk Lamontagne, McGill University, CAN
Mirjam Pijnappels, MOVE Research Institute, NLD

10:00AM – 12:30PM: Posters session 2 and exhibitors (for full list of posters, click here)
(Refreshments provided 10:00AM – 10:30AM)

12:30PM – 1:30PM: Lunch and exhibits

1:30PM – 3:15PM: Symposium Sessions 7 – 9

Please click on each of the blue + below to read more details on each symposium

S.7: From basic science to clinical practice: Anxiety, attentional focus and the control of posture and gait

Chair: William Young, Brunel University London, GBR

Toby Ellmers¹, Elmar Kal², Martin Zaback³, Liis Uiga⁴

¹Brunel University, ²VU University, ³University of British Columbia, ⁴University of Waikato

While the control of posture and gait requires some level of cognitive input, certain experiences (e.g., previous fall) and health conditions (e.g., stroke, Parkinson’s) can increase the degree to which an individual will consciously control their movements during balance tasks. Ironically, conscious, “internal” focus strategies may compromise balance performance by interfering with the subconscious, lower-level processes through which posture and locomotion are primarily regulated. Here we describe the disruptive effects of conscious movement control on balance and locomotion and discuss the complexities of translating these findings to clinical settings. The degree of conscious control may be determined by individual personality differences. As such, it has been shown that older adults with a high inclination to consciously control movements are more aware of their limb movements and less aware of the external environment during walking [Uiga et al., 2015]. High inclination for movement control has further been related to less accurate stepping, despite increased preparation and planning times [Uiga et al., 2018]. Attention to movement can also be caused by different contingencies, with the most obvious one being psychological pressure or anxiety. During balance tasks, this anxiety will likely manifest as fear of falling (FOF). Studies that have induced FOF using postural threat manipulations have consistently shown that young adults, when fearful, adopt an internal focus of attention, with these changes in attention associated with alterations in standing balance [Zaback et al., 2016]. This may be particularly consequential during more dynamic tasks such as walking, as conscious strategies can impair individuals’ ability to allocate attention towards relevant features of the environment, impact the efficiency of attentional processing, and potentially disrupt the capacity for switching attention between tasks [Ellmers & Young, 2018]. Despite the strong evidence against adopting internal focus strategies, research in clinical populations is inconclusive as to the efficacy of interventions aimed at reducing the degree to which patients adopt an internal focus. For example, research in stroke patients suggests that an internal focus only disrupts balance when patients have relatively intact proprioceptive and motor control, and might actually be beneficial in individuals with impairments in these areas [Kal et al., 2018]. As such, anxiety-induced changes in attentional control may sometimes be adaptive in people with movement difficulties. This symposium seeks to provide a multidisciplinary understanding of the specific circumstances which can induce an internal focus of attention, as well as (potentially disruptive) behaviors associated with this attentional strategy. Finally, recommendations will be presented on how to most effectively translate these findings to clinical settings.

S.8: Data analytics in the wild: Translating emerging wearable inertial and camera methods to fall prevention intervention strategies

Chairs:
James Tung, University of Waterloo, CAN
lan Godfrey, Northumbria University, GBR

Alan Godfrey¹, Silvia Del Din², Mina Nouredanesh³, Stephen Robinovitch³, Kim van Schooten⁴

¹Northumbria University, ²Newcastle University, ³University of Waterloo, ⁴Neuroscience Research Australia (NeuRA)

Gait assessment with wearable technologies is emerging as a viable and useful method to track disease onset and progression in those with neurological disorders. Moreover, definitions of gait have shown promising utility to determine fall risk assessment. Inertial sensor-based wearables (i.e., IMUs) have been extensively used to quantify gait and fall risk due to their discrete recording capabilities for use in controlled (laboratory/clinical) environments, providing valid and reliable spatio-temporal outcomes/endpoints. Yet, trends in research are moving beyond the laboratory to more real world (free-living) environments where habitual activities may represent complementary gait and balance performance. However, inertial wearables are being deployed within free-living settings where little or no information about environmental conditions are being used to inform gait analysis. This leads to general assumptions about gait performance (and fall risk assessment) in the wild. The purpose of this symposium is to examine the current state of the art in free-living gait assessment with inertial-based wearables by first highlighting pragmatic challenges and ongoing limitations. The symposium will then shift discussions towards the use of camera-based methods during free-living conditions to inform inertial wearable outcomes, and proposing novel models of harmonised terminologies to streamline and consolidate this field of research. Current and future approaches to wearable camera analytics will be introduced before concluding with lessons from recent projects and recommendations for adoption of wearable technologies to inform future intervention strategies to promote safe and effective gait.

 

S.9: Spinal cord stimulation for gait dysfunction and postural instability in Parkinson's disease

Chair: Mandar Jog, Western University, CAN

Olivia Samotus¹, Romulo Fuentes², Helen Bronte-Stewart³

¹London Health Sciences Centre, ²Universidad de Chile, ³Stanford University

Parkinson’s disease (PD) is one of the most common neurodegenerative disorders. Gait and postural impairments are devastating for patients living with PD as these symptoms increase mortality risk, and greatly affects their quality of life and independence. Parkinsonian gait is narrow based with short stride lengths and freezing of gait (FOG) during gait initiation and walking through narrow walkways are prominent. Current available treatments, which include dopaminergic medication and deep brain stimulation (DBS), exhibit reduced effectiveness and are associated with complications such as motor fluctuations and dyskinesias. Therefore, a new therapeutic option for these refractory symptoms is a critical unmet need. Epidural spinal cord stimulation (SCS) is a novel neuromodulation treatment that has been suggested as a potential method to improve postural and gait symptoms in patients with PD. SCS is less invasive than DBS, easily programmable and implantable. Animal model and preliminary clinical studies have shown a drastic improvement in PD motor symptomologies and motor performance, specifically in gait and posture impairments. However, optimal SCS parameters of stimulation (frequency, pulse width and intensity) have not been studied extensively and are still controversial. There are two clinical studies that demonstrated similar spatiotemporal gait improvements and decreased FOG frequency but used opposite SCS parameters (high versus low frequencies). Additionally, the underlying mechanisms of SCS are not completely elucidated. SCS may activate neuronal mechanisms of spinal afferents and supraspinal circuitry to promote locomotive ability and reduce FOG episodes. Suppression of electrophysiological hallmarks associated with gait disorders, especially the prolonged movement band beta burst durations observed in freezers, have been associated to SCS mechanistic action but may not be the likely cause of locomotive functionality. This symposium will have the presence of remarkable speakers, who will discuss the most important evidence and future challenges of this new treatment for gait and postural dysfunction in PD. The speakers will present the current advancements in the use of spinal cord stimulation to provide efficacious improvements in gait and postural symptoms observed in PD. Furthermore, the speakers will analyze the neural features and brain circuits that are involved in volitional gait and gait impairment seen in gait-dominant movement disorders, which are likely to be modulated for SCS.

 

3:15PM – 3:45PM: Refreshment break

3:45PM – 5:45PM: Oral sessions 1 – 3

Please click on each of the blue + below to read more details on each oral session.

O.1. Parkinson's disease

Co-Chairs:

Martijn Muller, University of Michigan, USA
Brook Galna, University of Newcastle, GBR

O.1.i      Episodic motor impairments of falls and freezing of gait differ in regional cerebral central cholinergic system changes in Parkinson’s disease

Presenter: Nicolaas Bohnen

Nicolaas Bohnen¹, Prabesh Kanel², Zhi Zhou², William Dauer², Roger Albin¹, Martijn Muller²

¹University of Michigan & VAMC, ²University of Michigan

 

O.1.ii     Immediate and long term effects of intensive multimodal balance and gait training on gait and gait variability in Parkinson’s disease

Presenter: Linda Rennie

Linda Rennie¹, Niklas Löfgren², Erika Franzén²

¹Sunnaas Rehabilitation Hospital, ²Karolinska Institutet

 

O.1.iii    Comprehensive measures of balance and gait in GBA mutation carriers and non-carriers in Parkinson’s disease

Presenter: Rosie Morris

Rosie Morris¹, Douglas Martini¹, Katrijn Smulders², Valerie Kelly³, Amie Hiller¹, Kathy Chung¹, Shu-Ching Hu³, Cyrus Zabetian³, Kathleen Poston⁴, Ignacio Mata³, Karen Edwards⁵, Thomas Montine⁶, Joseph Quinn¹, Fay Horak¹

¹Oregon Health & Science University, ²Sint Maartenskliniek, ³University of Washington, ⁴Stanford School of Medicine, ⁵University of California, ⁶Stanford University School of Medicine

 

 

O.1.iv    Effects of a 6-week cognitively challenging agility exercise program in people with Parkinson’s disease

Presenter: Fay Horak

Martina Mancini¹, Fay Horak¹, Naoya Hasegawa¹, Se Hee Jung¹, Vrutangkumar Shah¹, Anjanibhargavi Ragothaman¹, Daniel Peterson², Katrijn Smulders³, Patricia Carlson-Kuhta¹, John Nutt¹, Laurie King¹, Jodi Lapidus¹, Martina Mancini¹

¹Oregon Health & Science University, ²Arizona State University, ³Sint Maartenskliniek

 

O.1.v     Textured insoles improve gait in people with Parkinsons disease who have impaired peripheral sensation

Presenter: Graham Kerr

Graham Kerr¹, Feng Qiu¹, Keith Davids², Ewld Hennig¹, Michael Cole³, Sandy Brauer⁴, Anna Hatton⁴

¹Queensland University of Technology, ²Sheffield Hallam University, ³Australian Catholic University, ⁴University of Queensland

 

O.1.vi    Test-retest reliability and minimal detectable change of the new freezing of gait questionnaire

Presenter: Pieter Ginis

Pieter Ginis¹, Carolien Strouwen², Bauke Dijkstra¹, Bastiaan Bloem³, Alice Nieuwboer¹

¹KU Leuven, ²Hasselt University, ³Radboud University Medical Center

 

O.1.vii   Gait deficits in early stage Parkinson’s disease are related to the expression of REM sleep without atonia

Presenter: Colum MacKinnon

Sommer Amundsen Huffmaster¹, Matthew Petrucci¹, Devin O’Connell¹, Maria Linn-Evans¹, Jae Woo Chung¹, Paul Tuite¹, Colum MacKinnon¹

¹University of Minnesota

 

O.1.viii  Inter-individual balance adaptations in response to perturbation treadmill training in Parkinson’s disease

Presenter: Sarah Klamroth

Sarah Klamroth¹, Heiko Gassner¹, Jürgen Winkler¹, Björn Eskofier¹, Jochen Klucken¹, Klaus Pfeifer¹, Simon Steib¹

¹Friedrich-Alexander-University Erlangen-Nürnberg

O.2 Aging and Falls

Co-chairs:
Kathryn Sibley, University of Manitoba, CAN
Fabio Barbieri, São Paulo State University, BRA

O.2.i      Prevention of cautious strategy in obstacle-avoidance situations in older adults: The effect of spatial constraints on collision-avoidance behavior

Presenter: Takahiro Higuchi

Takahiro Higuchi¹, Risa Okada¹, Ryo Watanabe¹, Takuya Goto¹, Tomoki Hakamata¹, Ryota Hiyoshi¹, Ryuma Yonemoto¹, Akiko Imura¹

¹Tokyo Metropolitan University

O.2.ii     The association of clinic-based mobility tasks and measures of community performance and risk

Presenter: Michele Callisaya

Michele Callisaya¹, Joe Verghese²

¹University of Tasmania, ²Albert Einstein College of Medicine

O.2.iii    The inter-relationships between glycemic markers and gait patterns across age groups

Presenter: Maayan Agmon

Maayan Agmon¹, Ram Weiss², Hagit Hochner², Iaroslav Youssim², Yechiel Friedlander², Tamar Shochat¹, Rachel Kizony¹

¹University of Haifa, ²Hebrew University

O.2.iv    Motoric cognitive risk syndrome and risk for falls, their recurrence and post-fall fractures: Results from a prospective observational population-based cohort study

Presenter: Harmehr Sekhon

Harmehr K Sekhon, Gilles Allali, Olivier Beauchet

Geriatric Medicine, Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University

O.2.v     Obstacle-induced trip perturbation training: Proactive and reactive adaptation to reduce falls in community-dwelling older adults

Presenter: Yiru Wang

Yiru Wang¹, Shuaijie Wang¹, Tanjeev Kaur¹, Tanvi Bhatt¹

¹University of Illinois at Chicago

O.2.vi    Standing steadiness and variability of older adults on a step ladder

Presenter: Erika Pliner

Erika Pliner¹, Daina Sturnieks², Kurt Beschorner¹, Mark Redfern¹, Stephen Lord²

¹University of Pittsburgh, ²Neuroscience Research Australia

O.2.vii   The effectiveness of the StandingTall home-based, unsupervised balance exercise program in preventing falls in community-dwelling older people

Presenter: Kim Delbaere

Kim Delbaere¹, Kim van Schooten¹, Stephen Lord¹, Lindy Clemson², GA Rixt Zijlstra³, Jacqueline Close⁴

¹University of New South Wales, ²University of Sydney, ³University of Maastricht, ⁴Prince of Wales Hospital

O.2.viii  Walking adaptability for targeted fall-risk assessments

Presenter: Daphne Geerse

Daphne Geerse¹, Melvyn Roerdink¹, Johan Marinus², Jacobus van Hilten²

¹Vrije Universiteit Amsterdam, ²Leiden University Medical Center

O.3 Somatosensory & vestibular function

Co-chairs:
Patrick Sparto, University of Pittsburgh, USA
Mark Carpenter, University of British Columbia, CAN

O.3.i      Noisy galvanic stimulation and vestibular perception: Otolith versus semicircular canal mediated mechanisms

Presenter: Klaus Jahn

Klaus Jahn¹, Aram Keywan², Max Wuehr²

¹Schoen Klinik Bad Aibling and University of Munich, ²University of Munich

O.3.ii     Postural regulation strategies in Ehlers-Danlos Syndrome Hypermobility type

Presenter: Emma Gabrielle Dupuy

Emma Dupuy¹, Leslie Decker¹

¹UMR-S 1075 COMETE UNICAEN/INSERM

O.3.iii    Haptic touch feedback that is sway-referenced and graded can improve center of mass stability in post-concussion syndrome.

Presenter: Tyler Cuddeford

Andrew Meszaros¹, Alyssa Carey¹, Tyler Cuddeford¹

¹George Fox University

O.3.iv    Perception of gait movements using gait-like vibrations in individuals with and without sensorimotor deficits

Presenter: Tapin Alexandre

Tapin Alexandre¹

¹Université de Montréal

O.3.v     Signal from noise: Stochastic somatosensory stimulation for probing human motor control

Presenter: Ryan Peters

Ryan Peters¹

¹University of Calgary

O.3.vi    Interaction between lower limb cutaneous and muscle afferent pathways during standing

Presenter: Robyn Mildren

Robyn Mildren¹, Gregg Eschelmuller¹, Ryan Peters², Jean-Sebastien Blouin¹, Mark Carpenter¹, J. Timothy Inglis¹

¹University of British Columbia, ²University of Calgary

O.3.vii   Subthreshold electrical noise enhances mechanically-evoked cutaneous reflexes

Presenter: Tushar Sharma

Tushar Sharma¹, Ryan Peters², Leah Bent¹

¹University of Guelph, ²University of Calgary

O.3.viii  The plantar surface of the foot: the bigger picture

Presenter: Leah Bent

Leah Bent¹, Erika Howe¹, Simone Smith¹, Nicholas Strzalkowski², Ryan Peters³, Timothy Inglis⁴

¹University of Guelph, ²Mount Royal University, ³University of Calgary, ⁴University of British Columbia

Wednesday 3rd July, 2019: Day 4

8:30AM – 9:30AM: Keynote lecture 4
Adolfo Bronstein, Imperial College London, GBR

Chair:
Mark Hollands, John Moores University, GBR

Visual control of posture

In order to isolate the visual contribution to the control of postural balance, experiments in which subjects are exposed to large-field visual motion (optokinetic) stimuli are reviewed.  In these situations, at motion onset, the visual stimulus signals subject self-motion but inertial, vestibulo-proprioceptive cues do not.  Visually evoked postural responses (VEPR) thus induced can be quickly suppressed by cognitive status or simple repetition of the stimulus, if the inertial self-motion cues available to the subject are reliable.  In a conceptual model to be presented, the process of assessing the reliability, and degree of matching, of visual and inertial signals is carried out by a General comparator; in turn able to access the Gain control mechanism of the visuo-postural system.  Complexity and congruency in the visual stimulus itself are assessed by a Visual comparator, e.g. the presence of motion parallax in the visual stimulus can reverse the sway response direction.  VEPR can also be re-oriented according to the position of the eyes in the head and the head on the trunk.  This indicates that ocular and cervical proprioceptors must also access the Gain control mechanism so that visual stimuli can recruit and silence different postural muscles appropriately.  The overall gain of the visuo-postural system is also influenced by less easily defined idiosyncratic factors, such as visual dependence and psychological traits; interestingly both these factors have been found to be associated with poor long term outcome in vestibular disorders.  The experimental results and model presented illustrate that the visuo-postural system is a wonderful example of interaction between physics (e.g. stimuli geometry, body dynamics), neuroscience and the border zone between neurology and psycho-somatic medicine.

References:

Visual control of balance in cerebellar and parkinsonian syndromes. Bronstein AM, Hood JD, Gresty MA, Panagi C. Brain. 1990 Jun;113 ( Pt 3):767-79.

Automatic control of postural sway by visual motion parallax. Bronstein AM, Buckwell D.Exp Brain Res. 1997 Feb;113(2):243-8

Reorientation of a visually evoked postural response during passive whole body rotation. Thurrell A, Bertholon P, Bronstein AM. Exp Brain Res. 2000 Jul;133(2):229-32.

Visual vertigo: symptom assessment, spatial orientation and postural control. Guerraz M, Yardley L, Bertholon P, Pollak L, Rudge P, Gresty MA, Bronstein AM. Brain. 2001 Aug;124(Pt 8):1646-56

Mechanisms underlying visually induced body sway. Guerraz M, Bronstein AM. Neurosci Lett. 2008 Sep 26;443(1):12-6. doi: 0.1016/j.neulet.2008.07.053. Epub 2008 Jul 24. Erratum in: Neurosci Lett. 2008 Nov 14;445(2):193.

Predictors of clinical recovery from vestibular neuritis: a prospective study. Cousins S, Kaski D, Cutfield N, Arshad Q, Ahmad H, Gresty MA, Seemungal BM, Golding J, Bronstein AM. Ann Clin Transl Neurol. 2017 Mar 22;4(5):340-346.

9:30AM – 9:50AM: Emerging Scientist Award Talk
Deborah Jehu, University of British Columbia, CAN

Chairs:
Anouk Lamontagne, McGill University, CAN
Mirjam Pijnappels, MOVE Research Institute, NLD

 

9:50AM – 10:30PM: Yes / No debate

10:30AM – 11:00AM: Refreshment break

11:00AM – 1:00PM: Oral sessions 4 – 6

Please click on each of the blue + below to read more details on each oral session.

O.4 Balance control

Co-chairs:
Vivian Weerdesteyn, Radboud University, NLD
Daniel Peterson, Arizona State University, USA

O.4.i      Effect of external base-of-support perturbation parameters on measures of forward reactive stepping

Presenter: Taylor Winberg

Taylor Winberg¹, Andrew Laing¹

¹University of Waterloo

O.4.ii     Upward perturbation – novel methodology to study stumbling during walking

Presenter: Desiderio/Meir Cano Porras/Plotnik

Desiderio Cano Porras¹, Jesse Jacobs², Rivka Inzelberg³, Gabriel Zeilig¹, Meir Plotnik¹

¹Sheba Medical Center, ²University of Vermont, ³Tel Aviv University

O.4.iii    A startle response is not evoked during falls following large postural perturbations in young adults

Presenter: Andrew Sawers

Andrew Sawers¹, Stephen Robinovitch¹, Vivian Weerdesteyn²

¹University of Illinois at Chicago, ²Radboud University Medical Center

O.4.iv    Cortical midfrontal theta activity scales with acceleration of whole-body mechanical perturbations and reactive stepping behavior

Presenter: Teodoro Solis-Escalante

Teodoro Solis-Escalante¹, Mitchel Stokkermans², Michael Cohen², Vivian Weerdesteyn¹

¹Radboud University Medical Center, ²Donders Institute for Brain, Cognition, and Behavior

O.4.v     Balance perturbation training for rehabilitation of dynamic balance in acquired brain injury victims: an exploratory interventional prospective trial and a neuroimaging investigation

Presenter: Katherin Joubran

Katherin Joubran¹, Lior Shmuelof¹, Simona Bar Haim¹

¹Ben-Gurion University of the Negev

O.4.vi    Impaired sensorimotor transformations for balance in Parkinson disease are associated with future falls

Presenter: J Lucas McKay

Lucas McKay¹, Kimberly Lang², Sistania Bong¹, Madeleine Hackney², Stewart Factor², Lena Ting¹

¹Emory University and Georgia Tech, ²Emory University

O.4.vii   Effects of a single bout of cardiovascular exercise on balance learning: a comparison of different exercise intensities

Presenter: Philipp Wanner

Philipp Wanner¹, Theresa Müller¹, Klaus Pfeifer¹, Simon Steib¹

¹Friedrich-Alexander University Erlangen-Nürnberg

O.4.viii  Neuromodulation of lumbosacral spinal networks enables independent standing after complete paraplegia

Presenter: Dimitry Sayenko

Dimitry Sayenko¹, V. Reggie Edgerton², Yury Gerasimenko²

¹Houston Methodist Research Institute, ²University of California, Los Angeles

O.5 Coordination of gait

Co-chairs:
Nicoleta Bugnariu, University of North Texas Health Science Center, USA
Claudine Lamoth University of Groningen, NLD

O.5.i      Muscle synergy complexity in children with cerebral palsy during the development of walking

Presenter: Annike Bekius

Annike Bekius¹, Coen Zandvoort¹, Jennifer Kerkman¹, Andreas Daffertshofer¹, Annemieke Buizer¹, Jaap Harlaar², Nadia Dominici¹

¹Vrije Universiteit Amsterdam ²Delft University of Technology

O.5.ii     Humans use multi-objective control to regulate lateral foot placement when walking

Presenter: Jonathan Dingwell

Jonathan Dingwell¹, Joseph Cusumano¹

¹Pennsylvania State University

O.5.iii    Walking with narrow steps: are we more stable through increased sensory contributions? A galvanic vestibular stimulation study.

Presenter: Sjoerd Bruijn

Sjoerd Bruijn¹, Jaap Van Dieën¹, Rina Magnani², Patrick Forbes³

¹VU Amsterdam, ²Goiás State University, ³Erasmus MC

O.5.iv    The spine in gait – a differentiated analysis of spinal rotary motion

Presenter: Ulrich Betz

Ulrich Betz¹, Janine Huthwelker¹, Jürgen Konradi¹, Claudia Wolf¹, Ruben Westphal¹, Kjell Heitmann², Helmut Diers¹, Philipp Drees¹

¹University Medical Center of the Johannes Gutenberg University Mainz, ²DIERS International GmbH

O.5.v     Spatial updating of remembered goal position during barrier avoidance

Presenter: Brittany Baxter

Brittany Baxter¹, William Warren¹

¹Brown University

O.5.vi    Type of prosthesis influences functional performance and quality of life in patients with transtibial amputations

Presenter: Ophélie Puissegur

Ophelie Puissegur¹, Gordon Stevens², Elizabeth Ginzel², Rita Patterson¹, Nicoleta Bugnariu¹

¹University of North Texas Health Science Center, ²Baker O&P

O.5.vii   Deficient tibialis anterior activity following inward perturbation during walking predisposes elderly to use stepping rather than ankle strategies to control balance

Presenter: Maarten Afschrift

Maarten Afschrift¹, Friedl De Groote¹, Ilse Jonkers¹

¹KU Leuven

O.5.viii  Influence of required coefficient of friction on rate of shoe wear

Presenter: Sarah Hemler

Sarah Hemler¹, Jessica Sider¹, Kurt Beschorner¹

¹University of Pittsburgh

O.6 Cognitive, attentional and emotional influences

Co-chairs:
Anat Mirelman, Tel Aviv Sourasky Medical Center, ISR
John Stins, VU, Amsterdam, NLD

O.6.i      The effects of dual tasking and aging on event related potential (ERP) components of gait cycle

Presenter: Inbal Maidan

Inbal Maidan¹, Shiran Shustak¹, Dmitry Patashov², Eran Gazit¹, Boris Shapiro², Aviran Levy², Nir Giladi¹, Jeffrey Hausdorff¹, Anat Mirelman¹

¹Tel aviv medical center, ²Holon Institute of technology

O.6.ii     The neural signature of impaired dual tasking in Idiopathic REM sleep behavior disorder patients: An fMRI study

Presenter: Kaylena Ehgoetz Martens

Kaylena Ehgoetz Martens¹, Elie Matar², James Shine¹, Joseph Phillips³, Matthew Georgiades¹, Ronald Grunstein⁴, Glenda Halliday¹, Simon Lewis¹

¹University of Sydney, ²Brain and Mind Centre, ³University of Western Sydney, ⁴Woolcock Medical Institute

O.6.iii    An invisible hand: Automatic preparation for arresting a fall when viewing a handrail

Presenter: David Cole

David Cole¹, Butler Blake¹, Mahmoud Mansour¹, Sarah Schwartz¹, David Bolton¹

¹Utah State University

O.6.iv    Embodiment of painful situations and its postural correlates

Presenter: Thierry Lelard

Thierry Lelard¹, Olivier Godefroy¹, Said Ahmaidi¹, Pierre Krystkowiak¹, Harold Mouras¹

¹Université de Picardie

O.6.v     Shift in attentional allocation during cognitive-motor dual-tasking following cognitive or physical training in healthy older adults

Presenter: Rachel Downey

Karen Li¹, Rachel Downey¹, Louis Bherer², Thien Tuong Minh Vu³, Kristell Pothier⁴, Brittany Intzandt¹, Tudor Vrinceanu², Thomas Vincent⁵, Anil Nigam⁵, Antony Karelis⁶, Laurent Bosquet⁷, Nicolas Berryman⁸

¹Concordia University, ²Université de Montréal, ³Centre hospitalier Université de Montréal, ⁴University of Tours, ⁵Centre de recherche de l’Institut de cardiologie de Montréal, ⁶Université du Québec à Montréal, ⁷Université de Poitiers, ⁸Bishop’s University

O.6.vi    Postural threat effects on perceptions of lower leg somatosensory stimuli during standing

Presenter: Taylor Cleworth

Taylor Cleworth¹, Ryan Peters², Romeo Chua³, J. Timothy Inglis³, Mark Carpenter³

¹University of Waterloo, ²University of Calgary, ³University of British Columbia

O.6.vii   Can split-belt treadmill training improve dual-task turning performance in patients with Parkinson’s disease with Freezing of gait

Presenter: Nicholas D’Cruz

Nicholas D’Cruz¹, Pieter Ginis¹, Jana Seuthe², Christian Schlenstedt², Alice Nieuwboer¹

¹KU Leuven, ²Christian-Albrechts-University (CAU) of Kiel

O.6.viii  Look where you are thinking

Presenter: Yogev Koren

Yogev Koren¹, Yisrael Parmet¹, Ilay Sofer¹, Simona Bar-Haim¹

¹Ben-Gurion University

1:00PM on-wards: Free time and half day excursions

Thursday 4th July, 2019: Day 5

8:30AM – 9:30AM: Keynote lecture 5
Trevor Drew, University of Montreal, CAN

Chair:
Yury Ivanenko, IRCCS Fondazione Santa Lucia, ITA

A Cortical Network for the planning and execution of visually-guided gait modifications

Even in the most mundane of situations, we continually modify our gait to manoeuvre around natural and man-made obstacles, such as the curbs on each side of a street. In more exacting circumstances, for example, walking in the mountains or playing sports, such modifications of gait become more critical and more complex. Common to all such gait modifications in healthy subjects is the use of vision to evaluate the terrain and to anticipate changes to the normal gait pattern.

Such anticipatory gait modifications are produced by a rich network of cortical and subcortical structures. In my presentation, I will discuss the cortical contribution to such visually-guided gait modifications with a particular emphasis on the planning processes that are required to successfully negotiate a moving obstacle. These planning processes begin with the identification of the presence and the dimensions of an obstacle, together with the location of that obstacle with respect to the body. Subsequently, one must select the limb that will be the first to step over that obstacle and assure that the supporting (plant) limb is appropriately positioned in front of the obstacle.

Studies in cats, from multiple laboratories, have shown the importance of the motor cortex for the production of the pattern of muscle activity in the limb as it steps over an obstacle. However, the available evidence suggests that the motor cortex does not participate in the planning of that step. Instead, our studies point to the posterior parietal and premotor cortices (PPC and PMC) as being involved in the planning. Results from lesion and single unit recording studies in cat suggest that the PPC is important in estimating the relative location of an obstacle with respect to the body. However, there is little evidence that the PPC is directly involved in specifying the changes in muscle activity in a given limb during the approach to the obstacle. Instead our recent studies suggest that heterogeneous populations of cells in the PMC contribute to this transformation of a global signal into one that specifies the precise spatiotemporal pattern of muscle activity required to step over a moving obstacle.

In sum, the available evidence suggests a cortical network for the planning and execution of gait modifications that resembles that described in detail for the control of reaching in non-human primates. However, while reaching studies are generally made from a static position, the planning of gait modifications requires dynamic processes that must integrate and account for the movement of both the subject, and if necessary, objects in the environment. The studies summarized here, provide a starting point for understanding this complex behaviour. (Supported by the CIHR).

9:30AM – 10:00AM: Annual General Meeting

10:00AM – 12:30PM: Poster session 3 and exhibits (for full list of posters, click here)
(Refreshment break from 10:00AM – 10:30AM)

12:30PM – 1:30PM: Lunch and exhibits

1:30PM – 3:15PM: Symposium sessions 10 – 12

Please click on each of the blue + below to read more details on each symposium

S.10: Virtual reality as a tool to alter multisensory perception and human motor learning

Chair: Daniel Ferris, University of Florida, USA

Daniel Ferris¹, Jennifer Campos², James Finley³, Karen Li⁴

¹University of Florida, ²Toronto Rehabilitation Institute, ³University of Southern California, ⁴Concordia University

Background: Recent advances in virtual reality technology have increased interest in using virtual reality for entertainment and motor training, both in health and disability. There are now low-cost, fully-immersive systems that can provide interactive virtual environments and specialized training during human movement. However, using the systems to create effective training paradigms requires an understanding of how virtual reality affects multisensory feedback and cognitive activity in humans. Aims: The aims of the symposium are to highlight the negative and positive aspects of using virtual reality for human motor training, and discuss novel ways to leverage the unique characteristics of virtual reality to boost motor learning. The speakers will describe novel experiments using immersive virtual reality to demonstrate how it can alter sensory perceptions, electrocortical brain activity, cognitive loading, and motor learning in humans performing motor tasks. Relevance: With increased interest in using virtual reality for posture and gait rehabilitation, it is imperative that clinicians and researchers fully appreciate the limitations and opportunities that are presented with virtual reality. Under many circumstances, discrepancies between vestibular and visual feedback can increase cognitive loading and slow down motor learning. Alternatively, it might be possible to leverage virtual reality technology to provide artificial tweaks to sensory feedback and enhance motor learning in some instances. The context of the training and virtual reality interaction can determine if the experience is helpful or harmful to motor performance and learning. This symposium will present the current scientific evidence for virtual reality effects on motor performance and motor learning, and discuss the future research that is needed to optimize virtual reality as a training tool.

S.11: Balance training using perturbations to prevent falls: Is it feasible and effective?

Chair: Stephen Lord, Neuroscience Research Australia, AUS

Tanvi Bhatt¹, Kiros Karamanidis², Avril Mansfield³, Yoshiro Okubo⁴

¹College of Applied Health Sciences, ²London South Bank University, ³Toronto Rehabilitation Institute, ⁴Neuroscience Research Australia

Recent systematic reviews and meta-analyses have shown balance training using perturbations has promising efficacy for preventing falls in older people and people with Parkinson’s disease (Mansfield et al., 2015: Okubo et al., 2017). This paradigm utilizes the capacity of the human central nervous system to predictively and reactively adapt balance control to counter given perturbations (Pai and Bhatt, 2007). Perturbation training, therefore, may be a highly effective way to prevent falls because of its high task-specificity. However, there are many important research questions yet to be answered. There has been considerable heterogeneity in perturbation types used to date, e.g. treadmill translations, ankle/waist-cable-pulls, tether-releases, manual pushes, movable plates and hidden obstacles that simulate trips, slips or lateral staggering during gait and stance or sit-to-stand transfers. It is likely efficacy and feasibility of balance training using perturbations depends on the type of perturbation, but studies contrasting perturbation types have yet to be undertaken. There has also been some debate as to the dose (training sessions) required for efficacy and long-term retention for translation to daily life fall prevention. Finally, there is a growing demand from clinicians to utilize perturbation training in their practice, but appropriate efficacy evaluation of techniques (including commercially available perturbation treadmills) is required. This symposium aims to present the latest evidence regarding the feasibility and efficacy of balance training using perturbations and provide an opportunity for an interactive discussion on this cutting-edge paradigm. The first speaker, A/Prof Tanvi Bhatt, will discuss generalization of training across limbs, functional tasks, training devices, opposing types of perturbations and real-life contexts from laboratory-based clinical trials in healthy, aged and neurological populations. The second speaker, Prof Kiros Karamanidis, will discuss long-term retention, generalization across different functional tasks and addition of muscle strengthening to trip perturbation training administered by ankle cable pulls on a treadmill. The third speaker, Dr Yoshiro Okubo, will describe the ecological value of a perturbation walkway that induces unpredictable trips and slips while walking and present findings of a recent randomised controlled trial in older adults. The final speaker, A/Prof Avril Mansfield, will discuss the feasible approaches (i.e. using low-tech methods) to incorporate perturbation training into clinical practice. The discussion will be moderated by Prof Stephen Lord who will pose key questions to facilitate an interactive scientific exchange between the speakers and the audience. The discussion will address issues relating to efficacy and feasibility, perturbation types, long-term retention, optimal training dose and available resources for balance training using perturbations in different populations.

 

S.12: The challenge of preventing stair falls: Understanding the individual contributions of, and interplay between, environmental and intrinsic factors

Chair: Bradford J. McFadyen, Université Laval, CAN

Richard Foster¹, Alison Novak², Neil Reeves³, Mark Hollands¹, Bradford McFadyen⁴

¹Liverpool John Moores University, ²Toronto Rehabilitation Institute-UHN, ³Manchester Metropolitan University, ⁴Université Laval

Over half a million people die globally each year as a result of falling, with the highest proportion of fatal falls occurring on stairs in adults over the age of 60 (Startzell, 2000; Soriano et al., 2007). Older adults are also more susceptible to serious non-fatal injuries, such as broken limbs and head injuries, from stair falls, and thus are more likely to be admitted to hospital or long-stay institutions. Hospitalisation has a profound effect on the independence and quality of life of older adults, representing a severe societal issue which is compounded by burgeoning economic healthcare costs associated with falls. Despite the severity, there is a relatively small body of literature that deals with identifying risk of stair falls and understanding the mechanisms underlying stair falls. Manipulating environmental factors in the research lab to replicate hazardous stair features such as inconsistencies in riser height and tread depth can help to explain the underlying biomechanical factors associated with dynamic balance control on stairs, including changes to the orientation of the upper body or actively increasing the margins of stability (Novak et al., 2016). Handrail design and location may also play a significant role in an individual’s ability to recover from a loss of balance on stairs, with higher handrails reported to provide better stability over lower positioned handrails (Komisar et al., 2018). But what about people with intrinsic limitations hindering their ability to negotiate stairs, such as physical or affective factors? For older adults with sarcopenia or diabetic peripheral neuropathy, a reduction in muscle strength means they work close to their maximum strength capacity at the ankle and knee joint during stair negotiation compared to adults without (Reeves et al., 2008; Brown et al., 2016), and may adopt alternative strategies such as side-stepping to distribute the physical demands of the task between limbs (King et al., 2018) when faced with a challenging built environment. For older adults with anxiety or a fear of falling, ambiguous visual properties related to surface patterning and markings or poor lighting within the stair environment can lead to risky behaviours. For those not hindered by affective factors, patterned surfaces may improve rather than distort visual perception, with recent evidence suggesting the presence of a striped illusion on stair risers lowers the risk of a stair fall without detrimental effects on postural stability (Foster et al., 2015). In summary, a more systemic approach to advancing stair fall prevention research, where the interplay between environmental and intrinsic factors are considered, may improve our ability to identify risk of stair falls and understand the mechanisms underlying stair falls, which could in turn improve translation of research findings to stakeholders (e.g. users, therapists, architects, city planners).

3:15PM – 3:45PM: Refreshment break

3:45PM – 5:30PM: Symposia sessions 13 – 15

Please click on each of the blue + below to read more details on each symposium

S.13: Early development of human locomotion and its functional consequences

Chair: Yury Ivanenko, Fondazione Santa Lucia, ITA

Marianne Barbu-Roth¹, Yury Ivanenko², David Anderson³, Christine Assaiante⁴

¹Paris Descartes University, ²Fondazione Santa Lucia, ³Marian Wright Edelman Institute, San Francisco State University, ⁴Aix Marseille University

The first years of life represent an extremely important phase of maturation and learning and the acquisition of bipedal locomotion is a celebrated milestone in infant development. Central pattern generators are known to provide a basic rhythmic activity, however it is not fully understood how locomotor patterns develop and adapt to continuous changes in the morphology and acquisition of motor skills. We will discuss how infant stepping resembles some features of locomotion observed in other mammals, how locomotor adaptability changes in childhood, to what extent the human bipedal walking pattern and its development are unique, and how the acquisition of locomotion stimulates changes in other domains. Using an assessment of spinal neuromotor networks at birth, a neurosensory approach, brain imaging, as well as methods from behavioural science, we will present data that reveal novel physiological phenomena and motivate new questions about the ontogeny of human locomotion and the sequelae of changes in other domains of functioning that follow the acquisition of specific locomotor skills. Locomotion is an astoundingly complex motor behavior, yet it can be controlled in an automatic but flexible manner, providing an ideal means for exploring the world and stimulating psychological development. We will illustrate and address different aspects of early locomotor development and its functional consequences, including neonatal stepping, maturation of pattern generation circuitry, forms of crawling behavior, the critical role of balance demands, visual proprioception, spatial cognition, and the concept of body schema in a developing brain. Understanding mechanisms of early development and learning within the context of both locomotor and cognitive function are also the basis for designing rehabilitation strategies and interventions for infants at risk for locomotor delays.

S.14: Maximising interdisciplinary methods to assess falls risk in clinical groups

Chair: Chesney Craig, Manchester Metropolitan University, GBR

Chesney Craig¹, Kim van Schooten², Will Young³, Claudine Lamoth⁴, Clemens Becker⁵ Yuhan Zhou⁴

¹Manchester Metropolitan University, ²Neuroscience Research Australia, ³Brunel University London, ⁴University of Groningen, ⁵Robert Bosch Hospital

The high incidence of falls in the healthy older population, and in those with neurodegenerative diseases, is a global public health concern. Falls are a leading cause of accidental injury and mortality worldwide. For example, fall-related injuries are the most common cause of mortality in the 75 age group in the UK. With increasing life expectancy, the number of adults at risk of injurious falls also increases. Early fall-prevention interventions have been shown to be efficacious in reducing fall prevalence. Consequently, an imperative goal within the falls research community is to promote early identification of those at higher falls risk. It is widely accepted that falls are multifarious in nature and in order to assess falls risk, we should employ a multifactorial approach. However, due to the breadth of the falls risk literature, there is often little consensus on what techniques a multifactorial approach might encompass. For example, while clinical falls screening typically focuses on questionnaires and functional tests, basic science suggests a broad range of theoretical distinctions and related potential outcome measures that might offer greater discriminative accuracy in determining falls risk. Several techniques have been suggested in this regard, including gait analysis, posturography, muscle strength assessment, electromyography, sensory function tests, cognitive assessment, eye tracking and neuroimaging. Whilst most literature advocates for the use of multidisciplinary techniques, the numerous techniques available and the plethora of outcome measures for each, can create dissonance between fields, be it physiology, psychology, biomechanics or any number of applied clinical contexts. This may be further exacerbated by different theoretical approaches that lead to interpretational biases in results. Consequently, the key goal of the current symposium is to assemble researchers from different disciplines to discuss how to promote impactful interdisciplinary research in the field of falls risk detection. A panel of speakers who utilise different experimental techniques to assess falls risk will discuss how they implement interdisciplinary methods in their work, including strengths/weaknesses of different techniques and difficulties faced when conducting interdisciplinary research. Following this a moderated open floor discussion will stimulate debate on how to overcome barriers in interdisciplinary research, how to progress the field of falls risk detection, and how to successfully translate scientific findings into clinical outcomes.

 

S.15: STOP! Age-related changes in sensorimotor inhibition and the associated implications for impaired gait and balance control

Chair: Brett Fling, Colorado State University, USA

Brett Fling¹, Rachael Seidler², Tibor Hortobagyi³, Anita Christie⁴

¹Colorado State University, ²University of Florida, ³University of Groningen Medical Center, ⁴University of Western Ontario

Healthy aging is associated with structural and functional alterations in the brain and declines in multiple facets of motor performance including gait, balance, fine motor skills and motor coordination. Inhibitory processes are essential for optimal brain function and undergo age-related alterations that may account for these behavioral deficits. In this regard, a key role is played by gamma-aminobutyric acid (GABA), the principal inhibitory neurotransmitter within the nervous system. Recent studies demonstrate that efficient motor inhibition is related to GABAergic function. Due to the reported age-related alterations in the GABA system, motor inhibition impairments might be linked to GABAergic alterations in the cortico-cortical and cortico-subcortical networks that mediate motor inhibition. Emerging evidence suggests that the GABA system is altered in healthy aging. To study the integrity of the GABAergic neurotransmission system in healthy aging and unravel age-related alterations in inhibitory function, researchers can take advantage of non-invasive brain stimulation techniques like transcranial magnetic stimulation (TMS) as well as neuroimaging techniques such as magnetic resonance spectroscopy (MRS). TMS offers a non-invasive method of studying the biochemical properties of the motor cortex believed to reflect both excitation via glutamatergic activity and inhibition via GABA or GABAergic cortical circuits. While a vast body of literature exists demonstrating the associations between motor cortex inhibition, upper extremity control, and the effects of healthy aging, there remains a substantial lack of knowledge regarding how cortical inhibition is associated with lower extremity control during gait and balance. This symposium will shed light on exciting recent work investigating this question from a multi-modal neuroimaging and behavioral standpoint. Speakers will present their recent age-related work demonstrating 1) reduced tactile surround inhibition and interhemispheric inhibition in older adults, 2) increased excitability of the GABAergic inhibitory circuits of the primary motor cortex in the control of standing balance with increasing task difficulty, and 3) associations between reduced gait coordination and intracortical and interhemispheric inhibition within the leg regions of the primary motor cortices. In addition, work from clinical populations including Parkinson’s disease, multiple sclerosis and traumatic brain injury will provide insight into how age, injury, and disease affect sensorimotor inhibition and result in impaired mobility. Collectively, these novel findings point towards a substantial role of cortical inhibitory control and, by extension, the GABAergic system, in the control of gait and balance. Further, these results emphasize impaired motor cortex inhibition that accompany both healthy aging and specific clinical populations, contributing to mobility impairments.

5:30PM – 6:00PM: Awards presentation ceremony

2019 ISPGR World Congress ends

7:00PM – 12:00AM: Gala dinner