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Ascending Stairs: Task Related Determinants
- 1. Ascending Stairs: Task RelatedDeterminants By: Jessie Brown and Chelsea Zemmin
- 2. Cycle Defined By: •Initiation: • Toe off of first step • Termination: • Ipsilateral foot toe off of second step (Looking at the R leg)
- 3. Stability Coordination Force Production Alignment Speed Center ofMass Base of Support Control Maintenance Foot placement Transition Symmetry Body position Balance Our Process 1. LE Force Production 2. Dynamic Postural Stability 3. LE Coordination 4. Alignment 5. Range of Motion
- 4. 1. LE ForceProduction • Contraction of muscles that allow the center of mass to be moved over the base of support in a superior and anterior direction • Most important muscles needed for the production of force that allows execution of task: • Quadriceps • Hip Extensors • Ankle Dorsiflexors
- 5. 1. LE ForceProduction • Mcclelland et. al. • Patients post TKA with decreased quadriceps strength • reduced flexion moment and an earlier change in moment direction from flexion • compensate for decreased quadriceps strength. • Result: abnormal stair ascent patterns
- 6. 1. LE ForceProduction • Tiedemann et al. • Linear relationship between strength of hip and knee extensors and ankle dorsiflexors and speed • Gender and age correlation with strength
- 7. 2. Dynamic PosturalStability • Single limb stance • Postural Stability: maintenance of center of mass within the base of support
- 8. 2. Dynamic PosturalStability • Anterior-Posterior Axis • Maintain COM within BOS, lateral direction • Butler et al. • Hand rail use • 52% older adults
- 9. 2. Dynamic PosturalStability • Hurley, M.V. et al. • Combination of proprioception, strength, and integration of sensory information for maintaining postural stability
- 10. 3. LE Coordination •Simultaneous hip and knee movement • Advances the center of mass over the base of support
- 11. 3. LE Coordination •Lin et al. • Stance phase • Greater required peak moments at the knee and ankle joints (first half) • Hip extension moment present throughout the entire stance phase. This coordination of simultaneous hip and knee extension is critical in transferring momentum of body up the stair.
- 12.
- 13. 4. Alignment • Positionof adjacent body segments in relation to each other • Stairs: • Torso • Hip • Knee • Ankle
- 14. 4. Alignment • Positionof the foot in relation to the stair surface
- 15. 4. Alignment • Saariet. al. • Patients with knee osteoarthritis had knee instability. • Joint laxity and excessive motion leads to instability during dynamic and functional activities such as stair climbing. • Inability to control motion in the sagittal plane during stair accent and difficulty completing the task of stair climbing correctly.
- 16. 5. Range ofMotion • Hip • Extension to Flexion: 1-0-66˚ • Knee • Flexion: 93-105˚ • Extension: 0˚ (ideally) • Ankle • DF to PF: 20-0-30˚ • Protopapadaki et al.
- 17. 5. Range ofMotion • Knee Mean Flexion: 83-105˚ • Dependent on height of person and stair
- 18. 5. Range ofMotion • Hip • Torque angle profiles of the hip extensor muscles • Movement into hip extension, not range into extension
- 19. Conclusion 1. LE ForceProduction 2. Dynamic Postural Stability 3. LE Coordination 4. Alignment 5. Range of Motion
Editor's Notes
- #3 Add video slow mo
- #6 Mcclelland et. al. determined that proper force production of the quadriceps is needed for proper stair accent. They measured the knee flexion and extension moments and compared control group with patients post TKA. All participants generated a knee flexion moment that changed direction to an extension moment during stair ascent. However, for patients post TKA who presented with decreased quadriceps strength, the moment pattern was characterised by a reduction in the magnitude of the flexion moment and a change in moment direction from flexion to extension that occurred earlier in the step cycle to compensate for decreased quadriceps strength. When force production of quadriceps is absent, this results in abnormal stair climb patterns and compensations as measured in the study by Mcclelland et. al.
- #7 Age 75-98 – community dwelling adults 8 stairs. Allowed to use the hand rail and gait aid if they desired Gender difference : 4.8 +/- 2.2 men ; 6.0 +/- 3.4 women Moderate correlated with age
- #8 Postural Orientation
- #9 50 participants 20-39yrs 684 participants 75-98yrs Only one of the younger participants used the rail while ascending the stairs while 52% of the older adult population used the rail. This instability could be the result of sensorimotor deficits that come with age. It could also be secondary to a lack of strength causing the instability. Regardless of the source, this supports the fact that stability in the A/P axis is required in order to ascend stairs.
- #10 Hurley MV et al found that the increase in time it takes older patients to ascend a flight is due not only to strength but also to proprioception and sensory information which together make up postural stability. All of these things add together to decrease confidence which cause longer times for older people when going up a flight of stairs. Since these factors affected stair ascention times, we can conclude that postural stability, which includes sensory and proprioception information are required to ascend stairs. When these factors are impaired, the person has difficulty and takes longer to go up the stairs.
- #11 During ascending and forward motion of the body from one step to the next step, hip extension and knee extension during the execution phase of the task occur simultaneously to allow for advancement of center of mass.
- #12 In a study by Lin et al. Stair required greater peak moments at the knee and ankle joints in the first half of the stance phase. During stair ascent a hip extension moment was present throughout the stance phase. This coordination of hip and knee extension simultaneously is critical in transferring momentum of body up the stair.
- #13 videos
- #15 Foot placement on the step is also important factor to allow for proper alignment during stair accent. The placement of the entire foot on the step is important for allowing for the ankle, knee and hip to align above in to support the COM over the narrow BOS.
- #16 In a study by Saari et. al. looking at patients with knee osteoarthritis patients with knee OA also had knee instability. Joint laxity and excessive motion leads to instability during dynamic and functional activities such as stair climbing. People with knee instability will not be able to control the motion in the sagittal plane during stair accent and have difficulty completing the task correctly.
- #17 Protopapadaki et al. looked at the kinematics of stair ascention and descention in young healthy adults. The maximal ranges stated here occurred during the swing phase of stair climbing. The necessary range of motion varies greatly but the study concluded that large ranges of ankle motion were not as important when compared to knee and hip ranges.
- #18 The data was collected for a stair height of 18cm and a tread length of 28.5cm which is important because the stair height can change the necessary angles produced by the body. The maximal knee flexion occurs during swing phase which is represented here as the section after 60%. This is necessary in order to clear the previous step and to place the foot on the next step.
- #19 The majority of the hip range of motion is in flexion, the majority of the moment is into extension. You can also see in the ROM graph that the hip does not usually need to go past neutral in order to ascend the stairs. This is different than walking where the hip needs to go into at least 10 degrees of extension to have a normal pattern.