Day, BL; Bancroft, MJ; (2018) Voluntary steps and gait initiation. Handbook of Clinical Neurology , 159 pp. 107-118. 10.1016/B978-0-444-63916-5.00006-9.

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Abstract

This chapter explores mechanisms that control goal-directed steps for the purpose of reorienting the body or initiating gait. A key issue concerns the control of balance. We argue that standing balance is relinquished while the stepping foot is in the air thus allowing the body to fall under gravity. The falling body's trajectory is largely controlled by motor activity that occurs before the stepping foot leaves the ground (the throw), and is finely tuned to where and when the foot is planned to land (the catch). This close coupling between the throw and catch is paramount for achieving the stepping goal while simultaneously ensuring balance is regained at the end of the step. Nonetheless, there is some scope for making midstep adjustments by modifying the body's trajectory and/or the stepping leg's movement. The magnitude of midstep adjustment is severely limited by mechanical and balance constraints, but can occur at remarkably short latency in response to new visual information, possibly controlled by subcortical neural networks. We conclude that taking a step is a highly predictive and coordinated action that is vulnerable to errors leading to falls, particularly in the face of neural and muscular degeneration associated with aging or neurologic disease.

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