Falling poses a major threat to the steadily growing population of the elderly in modern-day society. A major challenge in the prevention of falls is the identification of individuals who are at risk of falling owing to an unstable gait. At present, several methods are available for estimating gait stability, each with its own advantages and disadvantages. In this paper, we review the currently available measures: the maximum Lyapunov exponent ( λ _S and λ _L ), the maximum Floquet multiplier, variability measures, long-range correlations, extrapolated centre of mass, stabilizing and destabilizing forces, foot placement estimator, gait sensitivity norm and maximum allowable perturbation. We explain what these measures represent and how they are calculated, and we assess their validity, divided up into construct validity, predictive validity in simple models, convergent validity in experimental studies, and predictive validity in observational studies. We conclude that (i) the validity of variability measures and λ _S is best supported across all levels, (ii) the maximum Floquet multiplier and λ _L have good construct validity, but negative predictive validity in models, negative convergent validity and (for λ _L ) negative predictive validity in observational studies, (iii) long-range correlations lack construct validity and predictive validity in models and have negative convergent validity, and (iv) measures derived from perturbation experiments have good construct validity, but data are lacking on convergent validity in experimental studies and predictive validity in observational studies. In closing, directions for future research on dynamic gait stability are discussed.

During human walking, the centre of mass (CoM) is outside the base of support for most of the time, which poses a challenge to stabilizing the gait pattern. Nevertheless, most of us are able to walk without substantial problems. In this review, we aim to provide an integrative overview of how humans cope with an underactuated gait pattern. A central idea that emerges from the literature is that foot placement is crucial in maintaining a stable gait pattern. In this review, we explore this idea; we first describe mechanical models and concepts that have been used to predict how foot placement can be used to control gait stability. These concepts, such as for instance the extrapolated CoM concept, the foot placement estimator concept and the capture point concept, provide explicit predictions on where to place the foot relative to the body at each step, such that gait is stabilized. Next, we describe empirical findings on foot placement during human gait in unperturbed and perturbed conditions. We conclude that humans show behaviour that is largely in accordance with the aforementioned concepts, with foot placement being actively coordinated to body CoM kinematics during the preceding step. In this section, we also address the requirements for such control in terms of the sensory information and the motor strategies that can implement such control, as well as the parts of the central nervous system that may be involved. We show that visual, vestibular and proprioceptive information contribute to estimation of the state of the CoM. Foot placement is adjusted to variations in CoM state mainly by modulation of hip abductor muscle activity during the swing phase of gait, and this process appears to be under spinal and supraspinal, including cortical, control. We conclude with a description of how control of foot placement can be impaired in humans, using ageing as a primary example and with some reference to pathology, and we address alternative strategies available to stabilize gait, which include modulation of ankle moments in the stance leg and changes in body angular momentum, such as rapid trunk tilts. Finally, for future research, we believe that especially the integration of consideration of environmental constraints on foot placement with balance control deserves attention.

SUMMARY: Arm swing during human gait has been shown to reduce both angular momentum about the vertical and energy expenditure, and has been hypothesized to enhance gait stability. To examine this hypothesis, we studied the effect of arm swing on the local and global stability of steady-state gait, as well as the ability to perform adequate recovery actions following a perturbation. Trunk kinematics of 11 male subjects was measured in treadmill walking with normal and with restricted arm swing. In half of the trials, gait was perturbed by a position-controlled forward pull to the trunk. We constructed state spaces using data recorded from the unperturbed steady-state walking trials, and quantified local gait stability by calculating maximum Lyapunov exponents. In addition, we analyzed perturbation forces, the distance from the unperturbed gait pattern, and the return toward the normal gait pattern following an external perturbation. Walking without arm swing led to a non-significantly lower Lyapunov exponent (P=0.06), significantly higher perturbation forces (P<0.05), and significantly slower movements away from the attractor (P<0.01). These results suggest that gait without arm swing is characterized by similar local stability to gait with arm swing and a higher perturbation resistance. However, return towards the normal gait pattern was significantly slower (P<0.05) when walking with restricted arms, suggesting that the arms play an important role in the recovery from a perturbation. Collectively, the results suggest that arm swing as such does not enhance gait stability, but rather that recovery movements of the arms contribute to the overall stability of human gait.