Older adults tend to learn at a lesser extent and slower rate than younger individuals. This is especially problematic for older adults at risk to injury or neurological disease who require therapy to learn and relearn motor skills. There is evidence that the reticulospinal system is critical to motor learning and that deficits in the reticulospinal system may be responsible, at least in part, for learning deficits in older adults. Specifically, delays in the reticulospinal system (measured via the startle reflex) are related to poor motor learning and retention in older adults. However, the mechanism underlying these delays in the reticulospinal system is currently unknown.

Along with aging, sleep deprivation is correlated with learning deficits. Research has shown that a lack of sleep negatively impacts motor skill learning and consolidation. Since there is a link between sleep and learning, as well as learning and the reticulospinal system, these observations raise the question: does sleep deprivation underlie reticulospinal delays? We hypothesized that sleep deprivation was correlated to a slower startle response, indicating a delayed reticulospinal system. Our objectives were to observe the impact of sleep deprivation on 1) the startle response (characterized by muscle onset latency and percentage of startle responses elicited) and 2) functional performance (to determine whether subjects were sufficiently sleep deprived).

21 young adults participated in two experimental sessions: one control session (8-10 hour time in bed opportunity for at least 3 nights prior) and one sleep deprivation session (0 hour time in bed opportunity for one night prior). The same protocol was conducted during each session. First, subjects were randomly exposed to 15 loud, startling acoustic stimuli of 120 dB. Electromyography (EMG) data measured muscle activity from the left and right sternocleidomastoid (LSCM and RSCM), biceps brachii, and triceps brachii. To assess functional performance, cognitive, balance, and motor tests were also administered. The EMG data were analyzed in MATLAB. A generalized linear mixed model was performed on LSCM and RSCM onset latencies. Paired t-tests were performed on the percentage of startle responses elicited and functional performance metrics. A p-value of less than 0.05 indicated significance.

Thirteen out of 21 participants displayed at least one startle response during their control and sleep deprived sessions and were further analyzed. No differences were found in onset latency (RSCM: control = 75.87 ± 21.94ms, sleep deprived = 82.06 ± 27.47ms; LSCM: control = 79.53 ± 17.85ms, sleep deprived = 78.48 ± 20.75ms) and percentage of startle responses elicited (control = 84.10 ± 15.53%; sleep deprived = 83.59 ± 18.58%) between the two sessions. However, significant differences were observed in reaction time, TUG with Dual time, and average balance time with the right leg up. Our data did not support our hypothesis; no significant differences were seen between subjects’ startle responses during the control and sleep deprived sessions. However, sleep deprivation was indicated with declines were observed in functional performance. Therefore, we concluded that sleep deprivation may not affect the startle response and underlie delays in the reticulospinal system.

Motor skill acquisition, the process by which individuals practice and consolidate
movement to become faster, more accurate and efficient, declines with age. Initial skill acquisition is dominated by cortical structures; however as learning proceeds, literature from
rodents and songbirds suggests that there is a transition away from cortical execution. Recent
evidence indicates that the reticulospinal system plays an important role in integration and
retention of learned motor skills. The brainstem has known age-rated deficits including cell
shrinkage & death. Given the role of the reticulospinal system in skill acquisition and older
adult’s poor capacity to learn, it begs the question: are delays in the reticulospinal system
associated with older adult’s poor capacity to learn?
Our objective was to evaluate if delays in the reticulospinal system (measured via the
startle reflex) and corticospinal system (measured via Transcranial Magnetic Stimulation (TMS) are correlated to impairment of motor learning in older adults. We found that individuals with fast startle responses resembling those of younger adults show the most improvement and retention while individuals with delayed startle responses show the least. We also found that there was no relationship between MEP latencies and improvement and retention. Moreover, linear regression analysis indicated that startle onset latency exists within a continuum of learning outcomes suggesting that startle onset latency may be a sensitive measure to predict learning deficits in older adults. As there exists no method to determine an individual’s relative learning capacity, these results open the possibility of startle, which is an easy and inexpensive behavioral measure and can be used to determine learning deficits in older adults to facilitate better dosing during rehabilitation therapy.

This dissertation aimed to evaluate the effectiveness and drawbacks of promising fall prevention strategies in individuals with stroke by rigorously analyzing the biomechanics of laboratory falls and compensatory movements required to prevent a fall. Ankle-foot-orthoses (AFOs) and functional electrical stimulators (FESs) are commonly prescribed to treat foot drop. Despite well-established positive impacts of AFOs and FES devices on balance and gait, AFO and FES users fall at a high rate. In chapter 2 (as a preliminary study), solely mechanical impacts of a semi-rigid AFO on the compensatory stepping response of young healthy individuals following trip-like treadmill perturbations were evaluated. It was found that a semi-rigid AFO on the stepping leg diminished the propulsive impulse of the compensatory step which led to decreased trunk movement control, shorter step length, and reduced center of mass (COM) stability. These results highlight the critical role of plantarflexors in generating an effective compensatory stepping response. In chapter 3, the underlying biomechanical mechanisms leading to high fall risk in long-term AFO and FES users with chronic stroke were studied. It was found that AFO and FES users fall more than Non-users because they have a more impaired lower limb that is not fully addressed by AFO/FES, therefore leading to a more impaired compensatory stepping response characterized by increased inability to generate a compensatory step with paretic leg and decreased trunk movement control. An ideal future AFO that provides dorsiflexion assistance during the swing phase and plantarflexion assistance during the push-off phase of gait is suggested to enhance the compensatory stepping response and reduce more falls. In chapter 4, the effects of a single-session trip-specific training on the compensatory stepping response of individuals with stroke were evaluated. Trunk movement control was improved after a single session of training suggesting that this type of training is a viable option to enhance compensatory stepping response and reduce falls in individuals with stroke. Finally, a future powered AFO with plantarflexion assistance complemented by a trip-specific training program is suggested to enhance the compensatory stepping response and decrease falls in individuals with stroke.

Falls are the leading cause of fatal and non-fatal injuries in the older adult population with more than 27,000 fall related deaths reported every year[1]. Adults suffering from lower extremity arthritis have more than twice the likelihood of experiencing multiple falls resulting in increased fall-related injuries compared to healthy adults. People with lower extremity end-stage osteoarthritis(KOA), experience a number of fall risk factors such as knee instability, poor mobility, and knee pain/stiffness. At end-stage knee OA, the space between the bones in the joint of the knee is significantly reduced, resulting in bone to bone frictional wearing causing bone deformation. In addition, an impaired stepping response during a postural perturbation is seen in people with OA related knee instability. The most common treatment for end-stage knee osteoarthritis is a surgical procedure called, total knee replacement (TKR). It is known that TKR significantly reduces pain, knee stiffness, and restores musculoskeletal functions such as range of motion. Despite studies concluding that knee OA increases fall-risk, it remains unknown if standard treatments, such as TKR, can effectively decrease fall-risk. Analyzing the compensatory step response during a fall is a significant indicator of whether a fall or a recovery will occur in the event of a postural disturbance and is key to determining fall risk among people. Studies have shown reduced trunk stability and step length, as well as increased trunk velocities, correspond to an impaired compensatory step. This study looks at these populations to determine whether TKR significantly enhances compensatory stepping response by analyzing trunk velocities and flexions among other kinematic/kinetic variable analysis during treadmill induced perturbations and clinical assessments.

In this experiment, three cats walked freely in four different conditions (walking on a flat surface in the dark, walking on a flat surface in the light, along a horizontal ladder, and a stone-cluttered pathway) while gaze was recorded. Four gaze behaviors were identified based upon head and eye velocity parameters relative to the walking velocity of the cat: constant gaze, fixation, gaze shift away, and gaze shift toward (see Methods). The objective of the study was to determine whether speed influences the phase that these gaze behaviors occur, where phase is defined as the degree from 0-360 of the step cycle. In the step cycle, 0 degrees is defined as the start of swing of the right forelimb. Additionally, speed’s influence on the uniformity of gaze behaviors to the step cycle was investigated in the three cats. The cats performed complex walking tasks, or conditions, as well as simple tasks to determine if speed has a greater effect on gaze behavior timing when walking terrain was difficult. I hypothesized that 1) gaze-stride coordination would be influenced by speed, 2) faster steps would show improved gaze behavior uniformity between subjects, and 3) fast steps during complex walking tasks would show further improvement of gaze behavior uniformity between subjects. To, this end, recorded steps were first split into fast and slow steps based upon step duration parameters (see Methods). These fast and slow steps were confirmed as significantly different from one another using a one-way ANOVA test on a linear mixed effects model (Table 3). Then, a linear mixed effects model was made per walking condition to account for subject effects, and a two-way ANOVA test was performed on the model to compare the phases of gaze behaviors to the speed when they occurred. It was found that speed does not influence the phase that gaze behaviors occur, except for walking on a flat surface in the dark. However, post-hoc tests could not be run to determine which behaviors were affected by speed. (see Discussion). The insignificance of speed suggests that speed is accounted for by the visual center responsible for the control of gaze behavior (see Discussion). Aside from speed’s influence on phase, uniformity was examined using standard deviation (Figure 3 ). It was found that faster steps tend to adopt a “gaze stepping” behavior described in a previous paper (Rivers et al. 2014). In future studies, it would be useful to increase the number of subjects for a similar experiment to improve the robustness of the results to determine if the relationship between speed and gaze behaviors reported in this paper is accurately depicted.

Motor skill acquisition, the process by which individuals practice and consolidate movement to become faster, more accurate and efficient, declines with age. Initial skill acquisition is dominated by cortical structures; however as learning proceeds, literature from rodents and songbirds suggests that there is a transition away from cortical execution. Recent evidence indicates that the reticulospinal system plays an important role in integration and retention of learned motor skills. The brainstem has known age-rated deficits including cell shrinkage & death. Given the role of the reticulospinal system in skill acquisition and older adult’s poor capacity to learn, it begs the question: are delays in the reticulospinal system associated with older adult’s poor capacity to learn?
Our objective was to evaluate if delays in the reticulospinal system (measured via the startle reflex) are correlated to impairment of motor learning in older adults. We found that individuals with fast startle responses resembling those of younger adults show the most learning and retention of that learning while individuals with delayed startle responses show the least. Moreover, linear regression analysis indicated that startle onset latency exists within a continuum of learning outcomes suggesting that startle onset latency may be a sensitive measure to predict learning deficits in older adults. As there exists no method to determine an individual’s relative learning capacity, these results open the possibility of startle, which is an easy and inexpensive behavioral measure, being used to predict learning deficits in older adults to facilitate better dosing during rehabilitation therapy.

Adapting to one novel condition of a motor task has been shown to generalize to other naïve conditions (i.e., motor generalization). In contrast, learning one task affects the proficiency of another task that is altogether different (i.e. motor transfer). Much more is known about motor generalization than about motor transfer, despite of decades of behavioral evidence. Moreover, motor generalization is studied as a probe to understanding how movements in any novel situations are affected by previous experiences. Thus, one could assume that mechanisms underlying transfer from trained to untrained tasks may be same as the ones known to be underlying motor generalization. However, the direct relationship between transfer and generalization has not yet been shown, thereby limiting the assumption that transfer and generalization rely on the same mechanisms. The purpose of this study was to test whether there is a relationship between motor generalization and motor transfer. To date, ten healthy young adult subjects were scored on their motor generalization ability and motor transfer ability on various upper extremity tasks. Although our current sample size is too small to clearly identify whether there is a relationship between generalization and transfer, Pearson product-moment correlation results and a priori power analysis suggest that a significant relationship will be observed with an increased sample size by 30%. If so, this would suggest that the mechanisms of transfer may be similar to those of motor generalization.

Most daily living tasks consist of pairing a series of sequential movements, e.g., reaching to a cup, grabbing the cup, lifting and returning the cup to your mouth. The process by which we control and mediate the smooth progression of these tasks is not well understood. One method which we can use to further evaluate these motions is known as Startle Evoked Movements (SEM). SEM is an established technique to probe the motor learning and planning processes by detecting muscle activation of the sternocleidomastoid muscles of the neck prior to 120ms after a startling stimulus is presented. If activation of these muscles was detected following a stimulus in the 120ms window, the movement is classified as Startle+ whereas if no sternocleidomastoid activation is detected after a stimulus in the allotted time the movement is considered Startle-. For a movement to be considered SEM, the activation of movements for Startle+ trials must be faster than the activation of Startle- trials. The objective of this study was to evaluate the effect that expertise has on sequential movements as well as determining if startle can distinguish when the consolidation of actions, known as chunking, has occurred. We hypothesized that SEM could distinguish words that were solidified or chunked. Specifically, SEM would be present when expert typists were asked to type a common word but not during uncommon letter combinations. The results from this study indicated that the only word that was susceptible to SEM, where Startle+ trials were initiated faster than Startle-, was an uncommon task "HET" while the common words "AND" and "THE" were not. Additionally, the evaluation of the differences between each keystroke for common and uncommon words showed that Startle was unable to distinguish differences in motor chunking between Startle+ and Startle- trials. Explanations into why these results were observed could be related to hand dominance in expert typists. No proper research has been conducted to evaluate the susceptibility of the non-dominant hand's fingers to SEM, and the results of future studies into this as well as the results from this study can impact our understanding of sequential movements.

Progressive gait disorder in Parkinson's disease (PD) is usually exhibited as reduced step/stride length and gait speed. People with PD also exhibit stooped posture, which can contribute to reduced step length and arm swing. Since gait and posture deficits in people with PD do not respond well to pharmaceutical and surgical treatments, novel rehabilitative therapies to alleviate these impairments are necessary. Many studies have confirmed that people with PD can improve their walking patterns when external cues are presented. Only a few studies have provided explicit real-time feedback on performance, but they did not report how well people with PD can follow the cues on a step-by-step basis. In a single-session study using a novel-treadmill based paradigm, our group had previously demonstrated that people with PD could follow step-length and back angle feedback and improve their gait and posture during treadmill walking. This study investigated whether a long-term (6-week, 3 sessions/week) real-time feedback training (RTFT) program can improve overground gait, upright posture, balance, and quality of life. Three subjects (mean age 70 ± 2 years) with mild to moderate PD (Hoehn and Yahr stage III or below) were enrolled and participated in the program. The RTFT sessions involved walking on a treadmill while following visual feedback of step length and posture (one at any given time) displayed on a monitor placed in front of the subject at eye-level. The target step length was set between 110-120% of the step length obtained during a baseline non-feedback walking trial and the target back angle was set at the maximum upright posture exhibited during a quiet standing task. Two subjects were found to significantly improve their posture and overground walking at post-training and these changes were retained six weeks after RTFT (follow-up) and the third subject improved his upright posture and gait rhythmicity. Furthermore, the magnitude of the improvements observed in these subjects was greater than the improvements observed in reports on other neuromotor interventions. These results provide preliminary evidence that real-time feedback training can be used as an effective rehabilitative strategy to improve gait and upright posture in people with PD.

Fall accident is a significant problem associated with our society both in terms of economic losses and human suffering [1]. In 2016, more than 800,000 people were hospitalized and over 33,000 deaths resulted from falling. Health costs associated with falling in 2016 yielded at 33% of total medical expenses in the US- mounting to approximately $31 billion per year. As such, it is imperative to find intervention strategies to mitigate deaths and injuries associated with fall accidents. In order for this goal to be realized, it is necessary to understand the mechanisms associated with fall accidents and more specifically, the movement profiles that may represent the cogent behavior of the locomotor system that may be amendable to rehabilitation and intervention strategies. In this light, this Thesis is focused on better understanding the factors influencing dynamic stability measure (as measured by Lyapunov exponents) during over-ground ambulation utilizing wireless Inertial Measurement Unit (IMU).

Four pilot studies were conducted: the First study was carried out to verify if IMU system was sophisticated enough to determine different load-carrying conditions. Second, to test the effects of walking inclinations, three incline levels on gait dynamic stability were examined. Third, tested whether different sections from the total gait cycle can be stitched together to assess LDS using the laboratory collected data. Finally, the fourth study examines the effect of “stitching” the data on dynamic stability measure from a longitudinally assessed (3-day continuous data collection) data to assess the effects of free-range data on assessment of dynamic stability.

Results indicated that load carrying significantly influenced dynamic stability measure but not for the floor inclination levels – indicating that future use of such measure should further implicate normalization of dynamic stability measures associated with different activities and terrain conditions. Additionally, stitching method was successful in obtaining dynamic stability measure utilizing free-living IMU data.