Age-related erosion of obstacle avoidance reflexes evoked with electrical stimulation of tibial nerve during walking

Abstract

In young healthy adults, characteristic obstacle avoidance reflexes have been demonstrated in response to electrical stimulation of cutaneous afferents of the foot during walking. It is unknown whether there is an age-related erosion of this obstacle avoidance reflex evoked with stimulation to the tibial nerve innervating the sole of the foot. The purpose of this study was to identify age-dependent differences in obstacle avoidance reflexes evoked with electrical stimulation of the tibial nerve at the ankle during walking in healthy young and older (70 yr and older) adults with no history of falls. Toe clearance, ankle and knee joint displacement and angular velocity, and electromyograms (EMG) of the tibialis anterior, medial gastrocnemius, biceps femoris, and vastus lateralis were measured. A significant erosion of kinematic and EMG obstacle avoidance reflexes was seen in the older adults compared with the young. Specifically, during swing phase, there was reduced toe clearance, ankle dorsiflexion, and knee flexion angular displacement in older adults compared with the young as well as changes in muscle activation. These degraded reflexes were superimposed on altered kinematics seen during unperturbed walking in the older adults including reduced toe clearance and knee flexion and increased ankle dorsiflexion compared with the young. Notably, during mid-swing the toe clearance was reduced in the older adults compared with the young by 2 cm overall, resulting from a combination of 1-cm reduced reflex response in the older adults superimposed on 1-cm less toe clearance during unperturbed walking. Together, these age-related differences could represent the prodromal phase of fall risk. NEW & NOTEWORTHY This study demonstrated age-dependent erosion of obstacle avoidance reflexes evoked with electrical stimulation of the tibial nerve at the ankle during walking. There was significant reduction in toe clearance, ankle dorsiflexion, and knee flexion reflexes as well as changes in muscle activation during swing phase in older adults with no history of falls compared with the young. These degraded reflexes, superimposed on altered kinematics seen during unperturbed walking, likely represent the prodromal phase of fall risk.