Balance control in stepping down expected and unexpected level changes

Stepping down an elevation in ongoing gait is a common task that can cause falls when the level change is unexpected. The aim of this study was to compare expected and unexpected stepping down. We hypothesized that unexpected stepping would lead to loss of control over the movement and potentially falls due to buckling of the leading leg at landing. Ten male subjects repeatedly walked over a platform on which they stepped down an expected 10-cm height difference. In 5 out of 50 trials, the height difference was encountered unexpectedly early. Kinematics and ground reaction forces under both feet were measured during the stride in which the height difference was negotiated. Stepping down involved a substantial increase in forward horizontal and angular momenta (approximately 40Ns and 20Nms). In expected stepping down, step length was significantly increased (17%), which allowed control of these forward horizontal and angular momenta immediately following landing. In unexpected stepping down, the time between expected ground contact and actual ground contact (110ms) appeared too short to substantially adjust leg movement and increase step length. Although buckling of the leg did not occur, presumably due to its more vertical orientation at landing, momentum could not be sufficiently attenuated at landing, but a fall was prevented by a rapid step of the trailing limb. The lack of control of momentum might cause a fall, when the capacity to make such a rapid step falls short, as in the elderly, or when the height difference is larger