Perturbations During Gait on a Split-Belt Treadmill: A Scoping Review
Source abstract
Abstract
Background: Humans encounter disturbances like slips, pushes, and trips while walking, mainly from external forces. Technological advances have improved methods to study these impacts on gait, with split-belt treadmills being particularly effective. This scoping review aims to examine the types of perturbations used during split-belt treadmill gait, explore the methods used to induce them, and consolidate current knowledge on the effects of split-belt treadmill-induced gait perturbations. Methods: The review included publications from January 2015 to May 2024, as searched via PubMed, EBSCO, and ScienceDirect. Results: The review examined 33 studies on split-belt treadmills, focusing on perturbations like slip-like, trip-like, lateral displacements, and tilts, with speed changes being the most common. Perturbations were mainly applied during initial contact. The results show that young, healthy adults adapt quickly to anticipatory and reactive adjustments, while older adults and those with neurological impairments use less efficient strategies like increased muscular co-contraction. Asymmetrical gait adaptations persist after perturbations, highlighting motor learning and the role of the central nervous system and sensory feedback. Conclusions: Despite their precision, split-belt and tilting treadmills may not fully replicate real-world walking complexities. The review highlights the strengths and limitations of split-belt treadmills, emphasizing the need to integrate diverse methods to enhance rehabilitation and improve gait stability.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Balance, Gait, and Falls Prevention · Cerebral Palsy and Movement Disorders · Prosthetics and Rehabilitation Robotics
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
PhD School, The Józef Piłsudski University of Physiscal Education in Warsaw, 00-968 Warsaw, Poland
Faculty of Rehabilitation, The Józef Piłsudski University of Physiscal Education in Warsaw, 00-968 Warsaw, Poland
Funding
Józef Piłsudski University of Physical Education in Warsaw
References (73)
Show source-provided references
1. Bartsch-Jimenez, A., Błażkiewicz, M., Azadjou, H., Novotny, R., and Valero-Cuevas, F.J. (2023). “Fine synergies” describe motor adaptation in people with drop foot in a way that supplements traditional “coarse synergies”. Front. Sports Act. Living, 5.10.3389/fspor.2023.1080170 ↗
2. Błażkiewicz, M., and Hadamus, A. (2024). Influence of Perturbation’s Type and Location on Treadmill Gait Regularity. Appl. Sci., 14.10.3390/app14020493 ↗
3. Mechanisms of compensation in the gait of patients with drop foot10.1016/j.clinbiomech.2016.12.014 ↗
4. Ciunelis, K., Borkowski, R., and Błażkiewicz, M. (2024). The Impact of Induced Acceleration Perturbations in Selected Phases of the Gait Cycle on Kinematic and Kinetic Parameters. Appl. Sci., 14.10.20944/preprints202404.1022.v1 ↗
5. Bender, C., and Orszag, S. (1999). Advanced Mathematical Methods for Scientists and Engineers: Asymptotic Methods and Perturbation Theory, Springer.10.1007/978-1-4757-3069-2 ↗
6. Holmes, M.H. (2013). Introduction to Perturbation Methods, Springer.10.1007/978-1-4614-5477-9 ↗
7. Chapter 5—Balance perturbations10.1016/B978-0-444-63916-5.00005-7 ↗
8. Locomotor stability and adaptation during perturbed walking across the adult female lifespan10.1016/j.jbiomech.2016.02.051 ↗
9. Gait stability in response to platform, belt, and sensory perturbations in young and older adults10.1007/s11517-018-1855-7 ↗
10. Corrective reactions to stumbling in man: Neuronal co-ordination of bilateral leg muscle activity during gait10.1113/jphysiol.1984.sp015492 ↗
11. EMG feedback tasks reduce reflexive stiffness during force and position perturbations10.1007/s00221-011-2776-y ↗
12. Lower extremity kinematics during forward heel-slip
13. Arena, S.L., Davis, J.L., Grant, J.W., and Madigan, M.L. (2016). Tripping Elicits Earlier and Larger Deviations in Linear Head Acceleration Compared to Slipping. PLoS ONE, 11.10.1371/journal.pone.0165670 ↗
14. Degenerative cervical myelopathy delays responses to lateral balance perturbations regardless of predictability10.1152/jn.00159.2021 ↗
15. The comparison of stepping responses following perturbations applied to pelvis during overground and treadmill walking
16. Sensory reweighting of proprioceptive information of the left and right leg during human balance control10.1152/jn.01008.2011 ↗
17. Seeing is believing: Effects of visual contextual cues on learning and transfer of locomotor adaptation10.1523/JNEUROSCI.4205-10.2010 ↗
18. Responses in knee joint muscle activation patterns to different perturbations during gait in healthy subjects10.1016/j.jelekin.2021.102572 ↗
19. Lower extremity joint power and work during recovery following trip-induced perturbations10.1016/j.gaitpost.2023.09.005 ↗
20. Comparison of over-ground and treadmill perturbations for simulation of real-world slips and trips: A systematic review10.1016/j.gaitpost.2022.12.015 ↗
21. Borkowski, R., and Błażkiewicz, M. (2023). Postural Reactions to External Mediolateral Perturbations: A Review. Appl. Sci., 13.10.3390/app13031696 ↗
22. Assessing the stability of human locomotion: A review of current measures10.1098/rsif.2012.0999 ↗
23. Interlimb coordination during locomotion: What can be adapted and stored?10.1152/jn.00089.2005 ↗
24. Split-belt treadmill training poststroke: A case study10.1097/NPT.0b013e3181fd5eab ↗
25. A passive exoskeleton can assist split-belt adaptation10.1007/s00221-022-06314-w ↗
26. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis10.1002/cl2.1230 ↗
27. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews10.1136/bmj.n71 ↗
28. Munn, Z., Peters, M.D.J., Stern, C., Tufanaru, C., McArthur, A., and Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med. Res. Methodol., 18.10.1186/s12874-018-0611-x ↗
29. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions10.1136/jech.52.6.377 ↗
30. Aprigliano, F., Martelli, D., Tropea, P., Micera, S., and Monaco, V. (2015, January 25–29). Effects of slipping-like perturbation intensity on the dynamical stability. Proceedings of the 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Milan, Italy.10.1109/EMBC.2015.7319586 ↗
31. Aging does not affect the intralimb coordination elicited by slip-like perturbation of different intensities10.1152/jn.00844.2016 ↗
32. Stability against backward balance loss: Age-related modifications following slip-like perturbations of multiple amplitudes10.1016/j.gaitpost.2017.02.002 ↗
33. van den Bogaart, M., Bruijn, S.M., van Dieën, J.H., and Meyns, P. (2020). The effect of anteroposterior perturbations on the control of the center of mass during treadmill walking. J. Biomech., 103.10.1016/j.jbiomech.2020.109660 ↗
34. Swart, S.B., den Otter, R., and Lamoth, C.J.C. (2020). Anticipatory control of human gait following simulated slip exposure. Sci. Rep., 10.10.1038/s41598-020-66305-1 ↗
35. Debelle, H., Harkness-Armstrong, C., Hadwin, K., Maganaris, C.N., and O’Brien, T.D. (2020). Recovery From a Forward Falling Slip: Measurement of Dynamic Stability and Strength Requirements Using a Split-Belt Instrumented Treadmill. Front. Sports Act. Living, 2.10.3389/fspor.2020.00082 ↗
36. Relationship Between the Walking Velocity Relative to the Slip Velocity and the Corrective Response10.1007/s40846-020-00527-6 ↗
37. Golyski, P.R., Vazquez, E., Leestma, J.K., and Sawicki, G.S. (2022). Onset timing of treadmill belt perturbations influences stability during walking. J. Biomech., 130.10.1016/j.jbiomech.2021.110800 ↗
38. Ren, X., Kebbach, M., Bruhn, S., Yang, Q., Lin, H., Bader, R., Tischer, T., and Lutter, C. (2022). Barefoot walking is more stable in the gait of balance recovery in older adults. BMC Geriatr., 22.10.1186/s12877-022-03628-w ↗
39. Young adults use whole-body feedback and ankle proprioception to perceive small locomotor disturbances10.1016/j.humov.2023.103084 ↗
40. Neuromuscular response of the trunk to sudden gait disturbances: Forward vs. backward perturbation10.1016/j.jelekin.2016.07.005 ↗
41. The Body’s Compensatory Responses to Unpredictable Trip and Slip Perturbations Induced by a Programmable Split-Belt Treadmill10.1109/TNSRE.2019.2921710 ↗
42. Ren, X., Lutter, C., Kebbach, M., Bruhn, S., Bader, R., and Tischer, T. (2022). Lower extremity joint compensatory effects during the first recovery step following slipping and stumbling perturbations in young and older subjects. BMC Geriatr., 22.10.1186/s12877-022-03354-3 ↗
43. Ren, X., Lutter, C., Kebbach, M., Bruhn, S., Yang, Q., Bader, R., and Tischer, T. (2022). Compensatory Responses During Slip-Induced Perturbation in Patients with Knee Osteoarthritis Compared with Healthy Older Adults: An Increased Risk of Falls?. Front. Bioeng. Biotechnol., 10.10.3389/fbioe.2022.893840 ↗
44. Shokouhi, S., Sritharan, P., and Lee, P.V. (2024). Recovering whole-body angular momentum and margin of stability after treadmill-induced perturbations during sloped walking in healthy young adults. Sci. Rep., 14.10.1038/s41598-024-54890-4 ↗
45. Effects of repeated waist-pull perturbations on gait stability in subjects with cerebellar ataxia10.1186/s12984-019-0522-z ↗
46. Mediolateral angular momentum changes in persons with amputation during perturbed walking10.1016/j.gaitpost.2015.02.008 ↗
47. Afschrift, M., Pitto, L., Aerts, W., van Deursen, R., Jonkers, I., and De Groote, F. (2018). Modulation of gluteus medius activity reflects the potential of the muscle to meet the mechanical demands during perturbed walking. Sci. Rep., 8.10.1038/s41598-018-30139-9 ↗
48. Muscle activation profile is modulated by unexpected balance loss in walking10.1016/j.gaitpost.2022.01.013 ↗
49. Motor adaptation to cognitive challenges and walking perturbations in healthy young adults10.1016/j.gaitpost.2021.11.030 ↗
50. Speeding up: Discrete mediolateral perturbations increased self-paced walking speed in young and older adults10.1016/j.gaitpost.2023.04.003 ↗
51. Molina, L.K., Small, G.H., and Neptune, R.R. (2023). The influence of step width on balance control and response strategies during perturbed walking in healthy young adults. J. Biomech., 157.10.1016/j.jbiomech.2023.111731 ↗
52. Responses to gait perturbations in stroke survivors who prospectively experienced falls or no falls10.1016/j.jbiomech.2017.02.010 ↗
53. Chien, J.E., and Hsu, W.L. (2018). Effects of Dynamic Perturbation-Based Training on Balance Control of Community-Dwelling Older Adults. Sci. Rep., 8.10.1038/s41598-018-35644-5 ↗
54. Effectiveness of a Robot-Mediated Strategy While Counteracting Multidirectional Slippages10.1017/S0263574719000626 ↗
55. Rieger, M.M., Papegaaij, S., Pijnappels, M., Steenbrink, F., and van Dieën, J.H. (2020). Transfer and retention effects of gait training with anterior-posterior perturbations to postural responses after medio-lateral gait perturbations in older adults. Clin. Biomech., 75.10.1016/j.clinbiomech.2020.104988 ↗
56. Rosenblum, U., Kribus-Shmiel, L., Zeilig, G., Bahat, Y., Kimel-Naor, S., Melzer, I., and Plotnik, M. (2020). Novel methodology for assessing total recovery time in response to unexpected perturbations while walking. PLoS ONE, 15.10.1371/journal.pone.0233510 ↗
57. Intersegmental coordination elicited by unexpected multidirectional slipping-like perturbations resembles that adopted during steady locomotion10.1152/jn.00327.2015 ↗
58. Onushko, T., Boerger, T., Van Dehy, J., and Schmit, B.D. (2019). Dynamic stability and stepping strategies of young healthy adults walking on an oscillating treadmill. PLoS ONE, 14.10.1371/journal.pone.0212207 ↗
59. Gerards, M., Marcellis, R., Senden, R., Poeze, M., de Bie, R., Meijer, K., and Lenssen, A. (2023). The effect of perturbation-based balance training on balance control and fear of falling in older adults: A single-blind randomised controlled trial. BMC Geriatr., 23.10.1186/s12877-023-03988-x ↗
60. During walking elders increase efforts at proximal joints and keep low kinetics at the ankle10.1016/j.clinbiomech.2009.04.004 ↗
61. Froude and the contribution of naval architecture to our understanding of bipedal locomotion10.1016/j.gaitpost.2004.01.011 ↗
62. Age-related intrinsic limitations in preventing a trip and regaining balance after a trip10.1016/j.ssci.2005.08.008 ↗
63. Human balance and posture control during standing and walking10.1016/0966-6362(96)82849-9 ↗
64. Foot Trajectory in Human Gait: A Precise and Multifactorial Motor Control Task10.1093/ptj/72.1.45 ↗
65. Lockhart, T. (2013). Biomechanics of Human Gait—Slip and Fall Analysis, Elsevier.10.1016/B978-0-12-382165-2.00151-3 ↗
66. Age-related joint moment characteristics during normal gait and successful reactive-recovery from unexpected slip perturbations10.1016/j.gaitpost.2009.04.005 ↗
67. Rasmussen, C.M., and Hunt, N.H. (2021). Unconstrained slip mechanics and stepping reactions depend on slip onset timing. J. Biomech., 125.10.1016/j.jbiomech.2021.110572 ↗
68. Effects of age related sensory degradation on perception of floor slipperiness and associated slip parameters10.1016/S0925-7535(01)00067-4 ↗
69. Biomechanical characteristics of slipping during unconstrained walking, turning, gait initiation and termination10.1080/00140139.2013.787122 ↗
70. How early reactions in the support limb contribute to balance recovery after tripping10.1016/j.jbiomech.2004.03.029 ↗
71. Stumbling corrective responses in healthy human subjects to rapid reversal of treadmill direction10.1016/S1050-6411(98)00027-3 ↗
72. The effects of forward and backward walking according to treadmill inclination in children with cerebral palsy10.1589/jpts.28.1569 ↗
73. Effects of perturbation magnitude on dynamic stability when walking in destabilizing environments10.1016/j.jbiomech.2012.05.039 ↗