<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.4 20241031//EN"
        "https://jats.nlm.nih.gov/publishing/1.4/JATS-journalpublishing1-4.dtd">
<article  article-type="research-article"        dtd-version="1.4">
            <front>

                <journal-meta>
                                    <journal-id></journal-id>
            <journal-title-group>
                                                                                    <journal-title>Journal of Exercise Therapy and Rehabilitation</journal-title>
            </journal-title-group>
                                        <issn pub-type="epub">2148-8819</issn>
                                                                                            <publisher>
                    <publisher-name>Yavuz YAKUT</publisher-name>
                </publisher>
                    </journal-meta>
                <article-meta>
                                        <article-id pub-id-type="doi">10.15437/jetr.1649620</article-id>
                                                                <article-categories>
                                            <subj-group  xml:lang="en">
                                                            <subject>Physiotherapy</subject>
                                                            <subject>Implementation Science and Evaluation</subject>
                                                    </subj-group>
                                            <subj-group  xml:lang="tr">
                                                            <subject>Fizyoterapi</subject>
                                                            <subject>Uygulama Bilimi ve Değerlendirme</subject>
                                                    </subj-group>
                                    </article-categories>
                                                                                                                                                        <title-group>
                                                                                                                        <trans-title-group xml:lang="tr">
                                    <trans-title>Tökezleme sonrası toparlama sürecinde uygulanan yükseltme ve alçaltma stratejilerinin öngörücü benzetimleri</trans-title>
                                </trans-title-group>
                                                                                                                                                                                                <article-title>Predictive simulations of elevating and lowering strategies in human stumble recovery</article-title>
                                                                                                    </title-group>
            
                                                    <contrib-group content-type="authors">
                                                                        <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0001-9920-1571</contrib-id>
                                                                <name>
                                    <surname>Seven</surname>
                                    <given-names>Oğuz Faik</given-names>
                                </name>
                                                                    <aff>GAZI UNIVERSITY, FACULTY OF ENGINEERING, DEPARTMENT OF MECHANICAL ENGINEERING</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-9491-2080</contrib-id>
                                                                <name>
                                    <surname>Bicer</surname>
                                    <given-names>Metin</given-names>
                                </name>
                                                                    <aff>HACETTEPE UNIVERSITY, INSTITUTE OF INFORMATICS</aff>
                                                            </contrib>
                                                    <contrib contrib-type="author">
                                                                    <contrib-id contrib-id-type="orcid">
                                        https://orcid.org/0000-0002-3223-064X</contrib-id>
                                                                <name>
                                    <surname>Adlı</surname>
                                    <given-names>Mehmet Arif</given-names>
                                </name>
                                                                    <aff>GAZI UNIVERSITY, FACULTY OF ENGINEERING, DEPARTMENT OF MECHANICAL ENGINEERING</aff>
                                                            </contrib>
                                                                                </contrib-group>
                        
                                        <pub-date pub-type="pub" iso-8601-date="20260416">
                    <day>04</day>
                    <month>16</month>
                    <year>2026</year>
                </pub-date>
                                        <volume>13</volume>
                                        <issue>1</issue>
                                        <fpage>57</fpage>
                                        <lpage>66</lpage>
                        
                        <history>
                                    <date date-type="received" iso-8601-date="20250302">
                        <day>03</day>
                        <month>02</month>
                        <year>2025</year>
                    </date>
                                                    <date date-type="accepted" iso-8601-date="20250520">
                        <day>05</day>
                        <month>20</month>
                        <year>2025</year>
                    </date>
                            </history>
                                        <permissions>
                    <copyright-statement>Copyright © 2013, Journal of Exercise Therapy and Rehabilitation</copyright-statement>
                    <copyright-year>2013</copyright-year>
                    <copyright-holder>Journal of Exercise Therapy and Rehabilitation</copyright-holder>
                </permissions>
            
                                                                                                <trans-abstract xml:lang="tr">
                            <p>Amaç: Düşme riski, yaşlılar ve dengeyi etkileyen nöromüsküler bozuklukları olan hastalar başta olmak üzere pek çok bireyin karşı karşıya olduğu bir durumdur. Tökezleme sonrası etkili toparlama stratejilerinin rehabilitasyon programlarına dahil edilmesi ile bu risk azaltılabilir. Ancak bu stratejilerin deneysel yöntemlerle incelenmesi, yaralanma riski ve harekette ortaya çıkabilecek kısıtlılıklar nedeniyle zordur. Bu zorlukları gidermek için, bu çalışma, öngörücü nöromekanik simülasyonlar kullanarak insanların anterior yönlü pertürbasyonlar sonrası ürettiği toparlanma hareketini analiz etmeyi amaçlamaktadır.Yöntem: Basitleştirilmiş bir kas-iskelet modeli ve refleks tabanlı bir sinirsel denetleyici kullanılarak, erken (%20) ve geç (%60) salınım fazlarında meydana gelen pertürbasyonlara yönelik iki ayrı senaryonun simülasyonu gerçekleştirildi. Salınım fazındaki kalça, diz ve ayak bileği bilek eklem açıları tökezleme sonrası kurtarma hareketiyle benzerlik açısından analiz edildi. Ayrıca, pertürbasyonun ardından salınım fazındaki bacağın ayak parmağının izlediği yörünge takip edilerek modelin kullandığı kurtarma stratejileri belirlendi.Bulgular: Erken salınım fazında uygulanan pertürbasyon, engeli aşmak için kalça ve diz fleksiyonunda artış ile karakterize bir yükseltme stratejisi ortaya çıkarırken, geç salınım fazında uygulanan pertürbasyon, dengeyi yeniden sağlamak amacıyla salınım fazındaki ayağın hızla yere indirilmesi ile karakterize bir alçaltma stratejisini tetikledi. Özellikle ayak bileği dorsifleksiyonunda ve salınım fazı süresinde deneysel verilerden küçük sapmalar gözlendi.Sonuç: Bu çalışma, öngörücü nöromekanik simülasyonların tökezleme sonrası doğal kurtarma hareketini analiz etmedeki etkinliğini vurgulamaktadır. Gerçekleştirilen simülasyonlar, tökezleme sonrası ana toparlanma mekanizmalarını başarılı bir şekilde taklit etmiştir. Öngörücü benzetimlerle elde edilen verilerin rehabilitasyon programlarının geliştirilmesinde, yardımcı cihaz tasarımlarında ve mobiliteyi artırarak yaralanma riskini azaltmayı amaçlayan düşmeyi önleyici stratejilerin geliştirilmesinde önemli bir potansiyele sahip olduğunu göstermektedir.</p></trans-abstract>
                                                                                                                                    <abstract><p>Purpose: Older adults and individuals with neuromuscular impairments face a high risk of falls, which can be mitigated by identifying effective stumble recovery strategies for rehabilitation. Studying stumble recovery through empirical methods is challenging due to injury risks and constraints on natural movement, whereas predictive neuromechanical simulations offer a viable alternative. This study aimed to use a musculoskeletal model within a predictive simulation framework to analyze human stumble recovery following anteriorly directed perturbations.Methods: Using a simplified musculoskeletal model and a reflex-based neural controller, two different scenarios for perturbations occurring in the early (20%) and late (60%) swing phases were simulated. The kinematics of the swing leg, including hip, knee, and ankle joint angles were analyzed for similarity to real human stumble recovery. Additionally, recovery strategies were identified by tracking the swing leg’s toe trajectory following perturbation.Results: Early swing perturbations elicited an elevating strategy, increasing hip and knee flexion to clear the obstacle, while late swing perturbations triggered a lowering strategy, rapidly placing the foot to restore stability. Minor deviations from experimental data were observed, particularly in ankle dorsiflexion and swing phase duration.Conclusion: This study highlights the effectiveness of predictive neuromechanical simulations in analyzing stumble recovery. The framework successfully replicated key recovery mechanisms, demonstrating its potential for rehabilitation, assistive device design, and fall prevention strategies aimed at enhancing mobility and reducing injury risk in vulnerable populations.</p></abstract>
                                                            
            
                                                                                        <kwd-group>
                                                    <kwd>Stumbling</kwd>
                                                    <kwd>  Simulation</kwd>
                                                    <kwd>  Falls</kwd>
                                                    <kwd>  Biomechanics.</kwd>
                                            </kwd-group>
                            
                                                <kwd-group xml:lang="tr">
                                                    <kwd>Tökezleme</kwd>
                                                    <kwd>  Simülasyon</kwd>
                                                    <kwd>  Düşme</kwd>
                                                    <kwd>  Biyomekanik.</kwd>
                                            </kwd-group>
                                                                                                                                        </article-meta>
    </front>
    <back>
                            <ref-list>
                                    <ref id="ref1">
                        <label>1</label>
                        <mixed-citation publication-type="journal">Falls: World Health Organization; 2021. [Available from: https://www.who.int/news-room/fact-sheets/detail/falls.]</mixed-citation>
                    </ref>
                                    <ref id="ref2">
                        <label>2</label>
                        <mixed-citation publication-type="journal">Homann B, Plaschg A, Grundner M, et al. The impact of neurological disorders on the risk for falls in the community dwelling elderly: a case-controlled study. BMJ. 2013:3;e003367.</mixed-citation>
                    </ref>
                                    <ref id="ref3">
                        <label>3</label>
                        <mixed-citation publication-type="journal">Whitney DG, Dutt-Mazumder A, Peterson MD, et al. Fall risk in stroke survivors: Effects of stroke plus dementia and reduced motor functional capacity. J Neurol Sci. 2019:401;95-100.</mixed-citation>
                    </ref>
                                    <ref id="ref4">
                        <label>4</label>
                        <mixed-citation publication-type="journal">Peel NM. Epidemiology of falls in older age. Can J Aging. 2011:30;7-19.</mixed-citation>
                    </ref>
                                    <ref id="ref5">
                        <label>5</label>
                        <mixed-citation publication-type="journal">Vieira ER, Palmer RC, Chaves PH. Prevention of falls in older people living in the community. BMJ. 2016:353;i1419.</mixed-citation>
                    </ref>
                                    <ref id="ref6">
                        <label>6</label>
                        <mixed-citation publication-type="journal">Sadowski CA. Prevention of falls in older adults. Can Pharm J. 2011:144;17-18.</mixed-citation>
                    </ref>
                                    <ref id="ref7">
                        <label>7</label>
                        <mixed-citation publication-type="journal">Khow KS, Visvanathan R. Falls in the aging population. Clin Geriatr Med. 2017:33;357-368.</mixed-citation>
                    </ref>
                                    <ref id="ref8">
                        <label>8</label>
                        <mixed-citation publication-type="journal">Nascimento MdM. An overview of fall risk factors, assessment measures and interventions in older adults. Geriatr. Gerontol. Aging. 2018:12;219-224.</mixed-citation>
                    </ref>
                                    <ref id="ref9">
                        <label>9</label>
                        <mixed-citation publication-type="journal">Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006:35;37-41.</mixed-citation>
                    </ref>
                                    <ref id="ref10">
                        <label>10</label>
                        <mixed-citation publication-type="journal">Sturnieks DL. Biomechanics of balance and falling. Falls in older people: Risk factors, strategies for prevention and implications for practice. Cambridge: Cambridge University Press; 2021.</mixed-citation>
                    </ref>
                                    <ref id="ref11">
                        <label>11</label>
                        <mixed-citation publication-type="journal">Park J, Choi J, Choi WJ. Understanding the biomechanical factors related to successful balance recovery and falls: a literature review. Phys Ther Korea. 2023:30;78-85.</mixed-citation>
                    </ref>
                                    <ref id="ref12">
                        <label>12</label>
                        <mixed-citation publication-type="journal">Eng JJ, Winter DA, Patla AE. Strategies for recovery from a trip in early and late swing during human walking. Exp Brain Res. 1994:102;339-349.</mixed-citation>
                    </ref>
                                    <ref id="ref13">
                        <label>13</label>
                        <mixed-citation publication-type="journal">Schillings AM, van Wezel BM, Mulder T, et al. Muscular responses and movement strategies during stumbling over obstacles. J Neurophysiol. 2000:83;2093-2102.</mixed-citation>
                    </ref>
                                    <ref id="ref14">
                        <label>14</label>
                        <mixed-citation publication-type="journal">De Groote F, Falisse A. Perspective on musculoskeletal modelling and predictive simulations of human movement to assess the neuromechanics of gait. Proc Biol Sci. 2021:288;20202432.</mixed-citation>
                    </ref>
                                    <ref id="ref15">
                        <label>15</label>
                        <mixed-citation publication-type="journal">Falisse A, Pitto L, Kainz H, et al. Physics-Based Simulations to Predict the Differential Effects of Motor Control and Musculoskeletal Deficits on Gait Dysfunction in Cerebral Palsy: A Retrospective Case Study. Front Hum Neurosci. 2020;14.</mixed-citation>
                    </ref>
                                    <ref id="ref16">
                        <label>16</label>
                        <mixed-citation publication-type="journal">Febrer-Nafría M, Nasr A, Ezati M, et al. Predictive multibody dynamic simulation of human neuromusculoskeletal systems: a review. Multibody Syst Dyn. 2022:58;299-339.</mixed-citation>
                    </ref>
                                    <ref id="ref17">
                        <label>17</label>
                        <mixed-citation publication-type="journal">Handford ML, Srinivasan M. Robotic lower limb prosthesis design through simultaneous computer optimizations of human and prosthesis costs. Sci Rep. 2016:6;19983.</mixed-citation>
                    </ref>
                                    <ref id="ref18">
                        <label>18</label>
                        <mixed-citation publication-type="journal">Veerkamp K, Waterval NFJ, Geijtenbeek T, et al. Evaluating cost function criteria in predicting healthy gait. J Biomech. 2021:123;110530.</mixed-citation>
                    </ref>
                                    <ref id="ref19">
                        <label>19</label>
                        <mixed-citation publication-type="journal">Geijtenbeek T. Scone: Open source software for predictive simulation of biological motion. J. Open Source Softw. 2019:4;1421.</mixed-citation>
                    </ref>
                                    <ref id="ref20">
                        <label>20</label>
                        <mixed-citation publication-type="journal">Delp SL, Anderson FC, Arnold AS, et al. OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng. 2007:5;1940-1950.</mixed-citation>
                    </ref>
                                    <ref id="ref21">
                        <label>21</label>
                        <mixed-citation publication-type="journal">Delp SL, Loan JP, Hoy et al. An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng. 1990:37;757-767.</mixed-citation>
                    </ref>
                                    <ref id="ref22">
                        <label>22</label>
                        <mixed-citation publication-type="journal">Grabiner MD, Feuerbach JW, Jahnigen DW. Measures of paraspinal muscle performance do not predict initial trunk kinematics after tripping. J Biomech. 1996:29;735-744.</mixed-citation>
                    </ref>
                                    <ref id="ref23">
                        <label>23</label>
                        <mixed-citation publication-type="journal">Geyer H, Herr H. A muscle-reflex model that encodes principles of legged mechanics produces human walking dynamics and muscle activities. IEEE Trans Neural Syst Rehabil Eng. 2010:18;263-273.</mixed-citation>
                    </ref>
                                    <ref id="ref24">
                        <label>24</label>
                        <mixed-citation publication-type="journal">Pijnappels M, Bobbert MF, van Dieen JH. Contribution of the support limb in control of angular momentum after tripping. J Biomech. 2004:37;1811-1818.</mixed-citation>
                    </ref>
                                    <ref id="ref25">
                        <label>25</label>
                        <mixed-citation publication-type="journal">Zhou X, Draganich LF, Amirouche F. A dynamic model for simulating a trip and fall during gait. Med Eng Phys. 2002:24;121-127.</mixed-citation>
                    </ref>
                                    <ref id="ref26">
                        <label>26</label>
                        <mixed-citation publication-type="journal">Forner-Cordero A, Ackermann M, de Lima Freitas M, editors. A method to simulate motor control strategies to recover from perturbations: Application to a stumble recovery during gait. In: Annu Int Conf IEEE Eng Med Biol Soc. 2011;7829-7832.</mixed-citation>
                    </ref>
                                    <ref id="ref27">
                        <label>27</label>
                        <mixed-citation publication-type="journal">Shirota C, Simon AM, Kuiken TA. Trip recovery strategies following perturbations of variable duration. J Biomech. 2014:47;2679-2684.</mixed-citation>
                    </ref>
                            </ref-list>
                    </back>
    </article>
