Increasing Gait Automaticity in Older Adults by Exploiting Locomotor Adaptation

NCT ID: NCT04934956

Last Updated: 2025-08-03

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 42 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-11-08
• Study Completion Date: 2026-06-01

Brief Summary

The investigators will test the following: 1) the extent of locomotor adaptation improvement in individuals aged 65 years and older; 2) the association between initial walking automaticity (i.e. less PFC activity while walking with a cognitive load) and prefrontal-subcortical function (measured via neuropsychological testing); and 3) whether improvements in locomotor adaptability result in improvements in the Functional Gait Assessment (FGA), a clinically relevant indicator of dynamic balance and mobility in older adults. To answer these questions, the investigators will combine innovative techniques from multiple laboratories at the University of Pittsburgh. Automatic motor control (Dr. Rosso's expertise) will be assessed by wireless functional near-infrared spectroscopy (fNIRS) of the PFC during challenged walking conditions (walking on an uneven surface and walking while reciting every other letter of the alphabet). fNIRS allows for real-time assessment of cortical activity while a participant is upright and moving by way of light-based measurements of changes in oxygenated and deoxygenated hemoglobin. Locomotor adaptation (Dr. Torres-Oviedo's expertise) will be evaluated with a split-belt walking protocol (i.e., legs moving at different speeds) that the investigators and others have used to robustly quantify motor adaptation capacity in older individuals and have shown to be reliant on cerebellar and basal ganglia function. The investigators will focus on two important aspects of locomotor adaptation that the investigators have quantified before: (Aim 1) rate at which individuals adapt to the new (split) walking environment and (Aim 2) capacity to transition between distinct walking patterns (i.e., the split-belt and the overground walking patterns), defined as motor switching. Adaptation rate and motor switching are quantified using step length asymmetry, which is the difference between a step length taken with one leg vs. the other. The investigators will focus on this gait parameter because it robustly characterizes gait adaptation evoked by split-belt walking protocols. Finally, the investigators will quantify participant's cognitive function (Dr. Weinstein's expertise) through neuropsychological battery sensitive to prefrontal-subcortical function. The investigators will mainly focus on evaluating 1) learning capacity reliant on cerebellar structures and 2) assessing executive function heavily reliant on PFC and, to a lesser extent, the basal ganglia.

Detailed Description

Restrictions in community mobility, the ability to move outside of one's home, are common in older ages and contribute to disability, institutionalization, and poor quality of life. Successful community mobility requires rapid integration of information from both external (e.g. surface quality, distances) and internal (e.g. fatigue, pain) to the individual. Under normal conditions, integration of these inputs occurs in subcortical-frontal (e.g., basal ganglia and cerebellum to primary motor cortex) networks and favors automatic motor control with few demands on the attention- related networks that primarily reside in the prefrontal cortex (PFC). As gait automaticity diminishes in older adults6, activation of the PFC during walking tasks increases. Lack of gait automaticity can interfere with community mobility, as the PFC is no longer free to process other information for navigating community environments. Another potential contributor to reduced community mobility is diminished locomotor adaptation. Specifically, older adults are slower at adjusting their movements while interacting with a new environment and have more difficulty switching motor patterns when transitioning across distinct walking conditions. This difficulty in switching motor patterns is related to cognitive switching ability, which is reliant upon similar subcortical-frontal processes that underlie motor control. While locomotor adaptation is reduced in normal aging, data from our lab indicates that older adults maintain plasticity and can improve locomotor adaptation. Our central hypothesis is that the ability to improve locomotor adaptation is greater in those with higher gait automaticity and greater integrity of the prefrontal-subcortical connections.

The extent of gait automaticity can be tested by increasing the cognitive load during walking (e.g., completing a cognitive task while walking) and measuring the related PFC response. Small changes in PFC activity and motor performance in response to the imposed cognitive load indicate intact gait automaticity. Conversely, a large change in PFC activity to maintain motor performance with addition of a cognitive load indicates diminished gait automaticity. Locomotor adaptability can be measured by manipulating walking context on a split-belt treadmill where the legs are moving at different speeds. Adaptation rate to the split-belt environment can be measured as well as the ability to switch motor patterns from the split-belt to overground walking. Promising data from our labs (n=8) indicate that older participants improve locomotor adaptation after experiencing multiple transitions between the split condition (belts' speed ratio 2:1) and regular walking (belts' speed ratio 1:1). However, neither the underlying mechanisms nor the clinical relevance of such improvements are known.

The investigators will test the following: 1) the extent of locomotor adaptation improvement in individuals aged 65 years and older; 2) the association between initial walking automaticity (i.e. less PFC activity while walking with a cognitive load) and prefrontal-subcortical function (measured via neuropsychological testing); and 3) whether improvements in locomotor adaptability result in improvements in the Functional Gait Assessment (FGA), a clinically relevant indicator of dynamic balance and mobility in older adults. To answer these questions, the investigators will combine innovative techniques from multiple laboratories at the University of Pittsburgh. Automatic motor control (Dr. Rosso's expertise) will be assessed by wireless functional near-infrared spectroscopy (fNIRS) of the PFC during challenged walking conditions (walking on an uneven surface and walking while reciting every other letter of the alphabet). fNIRS allows for real-time assessment of cortical activity while a participant is upright and moving by way of light-based measurements of changes in oxygenated and deoxygenated hemoglobin. Locomotor adaptation (Dr. Torres-Oviedo's expertise) will be evaluated with a split-belt walking protocol (i.e., legs moving at different speeds) that the investigators and others have used to robustly quantify motor adaptation capacity in older individuals and have shown to be reliant on cerebellar and basal ganglia function. The investigators will focus on two important aspects of locomotor adaptation that the investigators have quantified before: (Aim 1) rate at which individuals adapt to the new (split) walking environment and (Aim 2) capacity to transition between distinct walking patterns (i.e., the split-belt and the overground walking patterns), defined as motor switching. Adaptation rate and motor switching are quantified using step length asymmetry, which is the difference between a step length taken with one leg vs. the other. The investigators will focus on this gait parameter because it robustly characterizes gait adaptation evoked by split-belt walking protocols. Finally, the investigators will quantify participant's cognitive function (Dr. Weinstein's expertise) through neuropsychological battery sensitive to prefrontal-subcortical function. The investigators will mainly focus on evaluating 1) learning capacity reliant on cerebellar structures and 2) assessing executive function heavily reliant on PFC and, to a lesser extent, the basal ganglia.

With this data, the investigators will be able to address the following Aims:

Aim 1. Determine the association between improved locomotor adaptation rate and 1) individuals' gait automaticity and 2) cognitive function. Hypothesis: changes in adaptation rate will be predicted by initial walking automaticity and cerebellar-mediated learning capacity. This is predicated on the evidence that motor adjustments during split-belt walking depend on basal ganglia and cerebellar function.

Aim 2. Determine the association between improved locomotor switching and individuals' gait automaticity and cognitive function. Hypothesis: initial walking automaticity and executive control will predict improvements in locomotor switching. This is predicated on the evidence that motor switching is directly associated with basal ganglia-dependent cognitive tasks such as set-shifting.

Aim 3. Determine the extent to which improved locomotor adaptability could improve mobility. Hypothesis: changes in locomotor adaptability will not be exclusive to the laboratory context but will generalize to other locomotor tasks that require adaptability, as measured in the Functional Gait Assessment.

These results will provide strong preliminary data for a future study to explore these associations in a larger sample with more comprehensive measures of mobility contributors, neuroimaging for integrity of key brain regions, and objective measures of community mobility. These results will identify novel contributors to loss of community mobility in older adults and could identify novel therapeutic targets for interventions that improve gait adaptation to prevent falls and enhance independence.

Conditions

Community Mobility of Older Adults; Locomotor Adaptability; Gait Automaticity

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: NONE

Study Groups

Intervention: Split-belt walking; Multiple transitions between split-belt and tied-belt walking

Split-belt walking will be used in all experiments and consists of a time period during which the legs move at different speeds (0.5 m/s vs. 1 m/s). The investigators select those speeds since the investigators have observed in our preliminary data and published study (Sombric et al. 2017) that older individuals adapted at these speeds exhibit large deficits at motor switching when transitioning to overground walking. This large reference signal will facilitate the detection of a change in motor switching (Aim 2) following the Intervention.

This second intervention consists of multiple short adaptation blocks (i.e., 6 blocks of 200 strides each) interleaved with short de-adaptation blocks (i.e., 5 blocks of 200 strides of tied-belt walking each). It was designed based on several studies showing improvements in adaptation rate in young adults with a similar protocol (Malone et al. 2011; Day et al. 2018; Leech et al. 2018).

Group Type: EXPERIMENTAL

Split-belt walking

Intervention Type: OTHER

These will be used in all experiments and consists of a time period during which the legs move at different speeds (0.5 m/s vs. 1 m/s). The investigators select those speeds since the investigators have observed in our preliminary data and published study (Sombric et al. 2017) that older individuals adapted at these speeds exhibit large deficits at motor switching when transitioning to overground walking. This large reference signal will facilitate the detection of a change in motor switching (Aim 2) following the Intervention.

Multiple transitions between split-belt and tied-belt walking

Intervention Type: OTHER

This intervention consists of multiple short adaptation blocks (i.e., 6 blocks of 200 strides each) interleaved with short de-adaptation blocks (i.e., 5 blocks of 200 strides of tied-belt walking each). It was designed based on several studies showing improvements in adaptation rate in young adults with a similar protocol (Malone et al. 2011; Day et al. 2018; Leech et al. 2018).

Interventions

Split-belt walking

These will be used in all experiments and consists of a time period during which the legs move at different speeds (0.5 m/s vs. 1 m/s). The investigators select those speeds since the investigators have observed in our preliminary data and published study (Sombric et al. 2017) that older individuals adapted at these speeds exhibit large deficits at motor switching when transitioning to overground walking. This large reference signal will facilitate the detection of a change in motor switching (Aim 2) following the Intervention.

Intervention Type: OTHER

Multiple transitions between split-belt and tied-belt walking

This intervention consists of multiple short adaptation blocks (i.e., 6 blocks of 200 strides each) interleaved with short de-adaptation blocks (i.e., 5 blocks of 200 strides of tied-belt walking each). It was designed based on several studies showing improvements in adaptation rate in young adults with a similar protocol (Malone et al. 2011; Day et al. 2018; Leech et al. 2018).

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• 19 years old or older.
• Body Mass Index of 35 or less. Muscle activities will be recorded for distinct muscles in the legs and fatty tissue could interfere with these measurements.
• Able to walk without a hand held device
• Able to walk for 5 minutes at their self-paced speed

Exclusion Criteria

• Any past or present history of neurological disorders, heart or respiratory disease, brain injury, seizures, spinal cord surgery, or strokes.
• Pregnancy.
• Unable to follow two part commands;
• Uncorrected vision or severe visual impairment with visual acuity < 20/70 with best correction;
• Cognitive impairments defined as modified mini-mental score <84;
• orthopedic or pain conditions (lower extremity pain, back pain, calf pain);
• refuse to walk on a treadmill;
• hospitalized 6 months prior to the study for acute illness or surgery, other than minor surgical procedures;
• lower extremity orthopedic surgery within 1 year;
• uncontrolled hypertension (> 190/110 mmHg);
• diagnosed dementia;
• dyspnea at rest or during daily leaving activities;
• use supplemental oxygen, resting heart rate> 100 or <40 beats per minute;
• fixed or fused hip, knee, or ankle joints;
• progressive movement disorder such as Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), or Parkinson's disease

• Minimum Eligible Age: 19 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

National Institute of Neurological Disorders and Stroke (NINDS)

NIH

Sponsor Role: collaborator

National Institute on Aging (NIA)

NIH

Sponsor Role: collaborator

U.S. National Science Foundation

FED

Sponsor Role: collaborator

Central Research Development Fund

UNKNOWN

Sponsor Role: collaborator

University of Pittsburgh Momentum Fund

UNKNOWN

Sponsor Role: collaborator

University of Pittsburgh

OTHER

Sponsor Role: lead

Responsible Party

Gelsy Torres-Oviedo

Associate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Gelsy Torres-Oviedo, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

Sensorimotor Learning Laboratory, Schenley Place Suite 110

Pittsburgh, Pennsylvania, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Gelsy Torres-Oviedo, Ph.D.

Role: CONTACT

gelsyto@pitt.edu

412-624-2660

Facility Contacts

Gelsy Torres-Oviedo, Ph.D.

Role: primary

gelsyto@pitt.edu

412-624-2660

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Other Identifiers

K01NS092785-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

NSF 1535036

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

NSF 1847891

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

P30AG024827

Identifier Type: NIH

Identifier Source: secondary_id

View Link

CRDF 4.30204

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

3455

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

STUDY19060017

Identifier Type: -

Identifier Source: org_study_id