Humans are one of the unique species that utilize bipedal gait to ambulate in our environment. Despite this fact, coordination of the arms with the legs and the rest of body is essential for many daily activities. As such, whole-body responses have emerged as the preferred strategy following perturbations to balance during both standing and walking. Complex neural circuitry may allow for this coordination through the use of propriospinal pathways linking lumbar and cervical pattern generators in the spinal cord, with supraspinal centers altering this control depending on the context of the situation. Based on these findings, we argue that whole-body reactions may be exploited for rehabilitation purposes. Preliminary results have indicated training programs designed to elicit whole-body responses are effective in reducing falls and improving functional mobility in older adults with and without neurological impairment.
Barnett A., Smith B., Lord SR, Williams M., Baumand A.2003. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age Ageing32:407-14.
2.
Bateni H., Heung E., Zettel J., McIlroy WE, Maki BE2004. Can use of walkers or canes impede lateral compensatory stepping movements? Gait Posture20:74-83.
3.
Bateni H., Maki BE2005. Assistive devices for balance and mobility: benefits, demands, and adverse consequences. Arch Phys Med Rehabil86:134-45.
4.
Bateni H., Zecevic A., McIlroy WE, Maki BE2004. Resolving conflicts in task demands during balance recovery: does holding an object inhibit compensatory grasping? Exp Brain Res157:49-58.
5.
Beekhuizen KS, Field-Fote EC2008. Sensory stimulation augments the effects of massed practice training in persons with tetraplegia. Arch Phys Med Rehabil89:602-8.
6.
Berger W., Dietz V., Quintern J.1984. Corrective reactions to stumbling in man: neuronal co-ordination of bilateral leg muscle activity during gait. J Physiol357:109-25.
7.
Bhatt T., Pai YC2008. Can observational training substitute motor training in preventing backward balance loss following an unexpected slip during walking ? J Neurophysiol99:843-52.
8.
Bhatt T., Wening JD, Pai YC2006. Adaptive control of gait stability in reducing slip-related backward loss of balance. Exp Brain Res170:61-73.
9.
Campbell AJ, Borrie MJ, Spears GF1989. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol44:M112-7.
10.
Campbell AJ, Reinken J., Allan BC, Martinez GS1981. Falls in old age: a study of frequency and related clinical factors. Age Ageing10:264-70.
11.
Charron PM, Kirby RL, MacLeod DA1995. Epidemiology of walker-related injuries and deaths in the United States. Am J Phys Med Rehabil74:237-9.
12.
Christensen LOD, Andersen JB, Sinkjaer T., Nielsen JB2001. Transcranial magnetic stimulation and stretch reflexes in the tibialis anterior muscle during human walking. J Physiol531:545-57.
13.
Davis JC, Donaldson MG, Ashe MC, Khan KM2004. The role of balance and agility training in fall reduction . Eur Med Phys40:211-21.
14.
Dietz V.2002. Do human bipeds use quadrupedal coordination? Trends Neurosci25:462-7.
15.
Dietz V., Fouad K., Bastiaanse CM2001. Neuronal coordination of arm and leg movements during human locomotion. Eur J Neurosci14:1906-14.
16.
Eng JJ, Winter DA, Patla AE1994. Strategies for recovery from a trip in early and late swing during human walking. Exp Brain Res102:339-49.
17.
Feldman F., Robinovitch SN2007. Reducing hip fracture risk during sideways falls: evidence in young adults of the protective effects of impact to the hands and stepping . J Biomech40:2612-8.
18.
Ferris DP, Huang HJ, Kao PC2006. Moving the arms to activate the legs. Exerc Sport Sci Rev34:113-20.
19.
Fong S.-M., Ng GY2006. The effects of sensorimotor performance and balance with Tai Chi training. Arch Phys Med Rehabil87:82-7.
20.
Gatts SK, Woollacott MH2006. Neural mechanisms underlying balance improvement with short term Tai Chi Training. Aging Clin Exp Res18:7-19.
21.
Gatts SK, Woollacott MH2007. How Tai Chi improves balance: biomechanics of recovery to a walking slip in impaired seniors. Gait Posture25:205-14.
22.
Georgopoulos AP, Grillner S.1989. Visuomotor coordination in reaching and locomotion . Science245:1209-10.
23.
Gernandt BE, Megirian D.1961. Ascending propriospinal mechanisms. J Neurophysiol24:364-76.
24.
Haridas C., Zehr EP2003. Coordinated interlimb compensatory responses to electrical stimulation of cutaneous nerves in the hand and foot during walking. J Neurophysiol90:2850-61.
25.
Haridas C., Zehr EP, Misiaszek JE2006. Context-dependent modulation of interlimb cutaneous reflexes in arm muscles as a function of stability threat during walking. J Neurophysiol96:3096-103.
26.
Harkema SJ2008. Plasticity of interneuronal networks of the functionally isolated human spinal cord. Brain Res Rev57:255-64.
27.
Harris JE, Eng JJ, Marigold DS, Tokuno CD, Louis CL2005. Relationship of balance and mobility to fall incidence in people with chronic stroke. Phys Ther85:150-8.
28.
Heiden TL, Sanderson DJ, Inglis JT, Siegmund GP2006. Adaptations to normal human gait on potentially slippery surfaces: the effects of awareness and prior slip experience. Gait Posture24: 237-46.
29.
Hocherman S., Dickstein R., Pillar T.1984. Platform training and postural stability in hemiplegia . Arch Phys Med Rehabil65:588-92.
30.
Hummel F., Celnik P., Giraux P., Floel A., Wu W-H., Gerloff C., Cohen LG2005. Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke. Brain128:490-9.
31.
Jeffery DT, Norton JA, Roy FD, Gorassini M.2007. Effects of transcranial direct current stimulation on the excitability of the leg motor cortex. Exp Brain Res182:281-7.
Kearney RE, Chan CW1979. Reflex response of human arm muscles to cutaneous stimulation of the foot. Brain Res170:214-7.
34.
Kearney RE, Chan CW1981. Interlimb reflexes evoked in human arm muscles by ankle displacement. Electroencephalogr Clin Neurophysiol52:65-71.
35.
Liepert J., Bauder H., Wolfgang HR, Miltner WH, Taub E., Weiller C.2000. Treatment-induced cortical reorganization after stroke in humans. Stroke31:1210-6.
36.
Liu-Ambrose T., Khan KM, Eng JJ, Gillies GL, Lord SR, McKay HA2005. The beneficial effects of group-based exercises on fall risk profile and physical activity persist 1 year postintervention in older women with low bone mass: follow-up after withdrawal of exercise . J Am Geriatr Soc53:1767-73.
37.
Liu-Ambrose T., Khan KM, Eng JJ, Janssen PA, Lord SR, McKay HA2004. Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. J Am Geriatr Soc52:657-65.
38.
MacLellan MJ, Patla AE2006. Adaptations of walking pattern on a compliant surface to regulate dynamic stability. Exp Brain Res173:521-30.
39.
Maki BE, Holliday PJ, Topper AK1994. A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol A Biol Sci Med Sci49: M72-84.
40.
Maki BE, McIlroy WE1997. The role of limb movements in maintaining upright stance: the "change-in-support" strategy. Phys Ther77:488-507.
41.
Maki BE, McIlroy WE2006. Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention. Age Ageing35:ii12-8.
42.
Marigold DS, Bethune AJ, Patla AE2003. Role of the unperturbed limb and arms in the reactive recovery response to an unexpected slip during locomotion. J Neurophysiol89:1727-37.
43.
Marigold DS, Eng JJ2006. Altered timing of postural reflexes contributes to falling in persons with chronic stroke. Exp Brain Res171:459-68.
44.
Marigold DS, Eng JJ, Dawson AS, Inglis JT, Harris JE, Gylfadóttir S.2005. Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke . J Am Geriatr Soc53:416-23.
45.
Marigold DS, Patla AE2002. Strategies for dynamic stability during locomotion on a slippery surface: effects of prior experience and knowledge. J Neurophysiol88:339-53.
46.
Marigold DS, Patla AE2005. Adapting locomotion to different surface compliances: neuromuscular responses and changes in movement dynamics. J Neurophysiol94:1733-50.
47.
Marigold DS, Patla AE2008. Age-related changes in gait for multi-surface terrain . Gait Posture27:689-96.
48.
McIlroy WE, Maki BE1995. Early activation of arm muscles follows external perturbation of upright stance. Neurosci Lett184: 177-80.
49.
Menz HB, Lord SR, Fitzpatrick RC2003. Acceleration patterns of the head and pelvis when walking on level and irregular surfaces. Gait Posture18:35-46.
50.
Michel J., van Hedel HJA, Dietz V.2008. Obstacle stepping involves spinal anticipatory activity associated with quadrupedal limb coordination. Eur J Neurosci27:1867-75.
51.
Miller S., Reitsma DJ, van der Meché FGA.1973. Functional organization of long ascending propriospinal pathways linking lumbrosacral and cervical segments in the cat. Brain Res62:169-88.
52.
Miller S., van der BURG, van der Meché FGA.1975. Coordination of movements of the hindlimbs and forelimbs in different forms of locomotion in normal and decerebrate cats . Brain Res91: 217-37.
53.
Misiaszek JE2003. Early activation of arm and leg muscles following pulls to the waist during walking. Exp Brain Res151:318-29.
54.
Misiaszek JE2006. Neural control of walking balance: IF falling THEN react ELSE continue. Exerc Sport Sci Rev34:128-34.
55.
Misiaszek JE, Krauss EM2004. Compensatory arm reactions when holding a stable support during walking. Soc Neurosci Abstr180.4.
56.
Misiaszek JE, Krauss EM2005. Restricting arm use enhances compensatory reactions of leg muscles during walking. Exp Brain Res161:474-85.
57.
Misiaszek JE, Stephens MJ, Yang JF, Pearson KG2000. Early corrective reactions of the leg to perturbations at the torso during walking in humans. Exp Brain Res131:511-23.
58.
Mori F., Nakajima K., Tachibana A., Mori S.2006. Obstacle clearance and prevention from falling in the bipedally walking Japanese monkey, Macaca fuscata. Age Ageing35(Suppl 2):ii19-23.
59.
Mori F., TachibanaA,Takasu C., Nakajima K., Mori S.2001. Bipedal locomotion by the normally quadrupedal Japanese monkey, M. Fuscata: strategies for obstacle clearance and recovery from stumbling. Acta Physiol Pharmacol Bulg26:147-50.
60.
Nashner LM, Forssberg H.1986. Phase-dependent organization of postural adjustments associated with arm movements while walking. J Neurophysiol55:1382-94.
61.
Nielsen JB, Petersen N., Fedirchuk B.1997. Evidence suggesting a transcortical pathway from cutaneous foot afferents to tibialis anterior motoneurons in man. J Physiol501:473-84.
62.
Norton JA, Gorassini MA2006. Changes in cortically related intermuscular coherence accompanying improvements in locomotor skills in incomplete spinal cord injury . J Neurophysiol95: 2580-9.
63.
Oates AR, Patla AE, Frank JS, Greig MA2005. Control of dynamic stability during gait termination on a slippery surface. J Neurophysiol93:64-70.
64.
Owings TM, Pavol MJ, Grabiner MD2001. Mechanisms of failed recovery following postural perturbations on a motorized treadmill mimic those associated with an actual forward trip . Clin Biomech16:813-9.
65.
Patla AE2003. Strategies for dynamic stability during adaptive human locomotion. IEEE Eng Med Biol Mag22:48-52.
66.
Peacock B.1966. A myographic and photographic study of walking with crutches . Physiotherapy52:264-68
67.
Petersen N., Christensen LOD, Morita H., Sinkjaer T., Nielsen JB1998. Evidence that a transcortical pathway contributes to stretch reflexes in the tibialis anterior muscle in man. J Physiol512:267-76.
68.
Pijnappels M., Bobbert MF, van Dieën JH2004. Contribution of the support limb in control of angular momentum after tripping. J Biomech37:1811-8.
69.
Pijnappels M., Bobbert MF, van Dieën JH2005a. How early reactions in the support limb contribute to balance recovery after tripping. J Biomech38:627-34.
70.
Pijnappels M., Bobbert MF, van Dieën JH2005b. Push-off reactions in recovery after tripping discriminate young subjects, older non-fallers and older fallers. Gait Posture21:388-94.
71.
Pijnappels M., Van Wezel BMH, Colombo G., Dietz V., Duysens J.1998. Cortical facilitation of cutaneous reflexes in leg muscle during human gait. Brain Res787:149-53.
72.
Rietdyk S., Patla AE1998. Context-dependent reflex control: some insights into the role of balance. Exp Brain Res119:251-9.
73.
Robinovitch SN, Normandin SC, Stotz P., Maurer JD2005. Time requirement for young and elderly women to move into a position for breaking a fall with outstretched hands. J Gerontol A Biol Sci Med Sci60A:1553-7.
74.
Roos PE, McGuigan MP, Kerwin DG, Trewartha G.2008. The role of arm movement in early trip recovery in younger and older adults. Gait Posture27:352-6.
75.
Samara RF, Currie SN2008. Location of spinal cord pathways that control hindlimb movement amplitude and interlimb coordination during voluntary swimming in turtles. J Neurophysiol99:1953-68.
76.
Schillings AM, van Wezel BMH, Mulder TH, Duysens J.2000. Muscular responses and movement strategies during stumbling over obstacles. J Neurophysiol83:2093-102.
77.
Skinner RD, Adams RJ, Remmel RS1980. Responses of long descending propriospinal neurons to natural and electrical types of stimuli in cat. Brain Res196:387-403.
78.
Talelli P., Rothwell J.2006. Does brain stimulation after stroke have a future ? Curr Opin Neurol19:543-50.
79.
Tang P.-F., Woollacott MH, Chong RKY.1998. Control of reactive balance adjustments in perturbed human walking: roles of proximal and distal postural muscle activity. Exp Brain Res119:141-52.
80.
Thies SB, Richardson JK, Ashton-Miller JA2005. Effects of surface irregularity and lighting on step variability during gait: a study in healthy young and older women. Gait Posture22:26-31.
81.
Thomas SL, Gorassini MA2005. Increases in corticospinal tract function by treadmill training after incomplete spinal cord injury. J Neurophysiol94:2844-55.
82.
van der Linden MH, Marigold DS, Gabreëls FJM, Duysens J.2007. Muscle reflexes and synergies triggered by an unexpected support surface height during walking. J Neurophysiol97:3639-50.
83.
Wannier T., Bastiaanse CM, Colombo G., Dietz V.2001. Arm to leg coordination in humans during walking, creeping and swimming activities. Exp Brain Res141:375-9.
84.
Weerdesteyn V., Rijken H., Geurts ACH, Smits-Engelsman BCM, Mulder TH, Duysens J.2006. A five-week exercise program can reduce falls and improve obstacle avoidance in the elderly. Gerontology52:131-41.
85.
Winter DA2005. Biomechanics and motor control of human movement . 3rd ed. Hoboken (NJ): John Wiley & Sons.
86.
Wittenberg GF, Chen R., Ishii K., Bushara KO, Eckloff S., Croarkin E., and others.2003. Constraint-induced therapy in stroke: magnetic-stimulation motor maps and cerebral activation. Neurorehabil Neural Repair17:48-57.
87.
Yen CL, Wang RY, Liao KK, Huang CC, Yang YR2008. Gait training induced change in corticomotor excitability in patients with chronic stroke. Neurorehabil Neural Repair22:22-30.
88.
You J.-Y., Chou Y.-L., Lin C.-J., Su F-C.2001. Effect of slip on movement of body center of mass relative to base of support. Clin Biomech16:167-73.
89.
Zehr EP, Duysens J.2004. Regulation of arm and leg movement during human locomotion . Neuroscientist10:347-61.
90.
Zehr EP, Klimstra M., Dragert K., Barzi Y., Bowden MG, Javan B., Phadke C.2007. Enhancement of arm and leg locomotor coupling with augmented cutaneous feedback from the hand. J Neurophysiol98:1810-4.
