Orbital stability analysis in biomechanics: a systematic review of a nonlinear technique to detect instability of motor tasks.

Falls represent a heavy economic and clinical burden on society. The identification of individual chronic characteristics associated with falling is of fundamental importance for the clinicians; in particular, the stability of daily motor tasks is one of the main factors that the clinicians look for during assessment procedures. Various methods for the assessment of stability in human movement are present in literature, and methods coming from stability analysis of nonlinear dynamic systems applied to biomechanics recently showed promise. One of these techniques is orbital stability analysis via Floquet multipliers. This method allows to measure orbital stability of periodic nonlinear dynamic systems and it seems a promising approach for the definition of a reliable motor stability index, taking into account for the whole task cycle dynamics. Despite the premises, its use in the assessment of fall risk has been deemed controversial. The aim of this systematic review was therefore to provide a critical evaluation of the literature on the topic of applications of orbital stability analysis in biomechanics, with particular focus to methodologic aspects. Four electronic databases have been searched for articles relative to the topic; 23 articles were selected for review. Quality of the studies present in literature has been assessed with a customised quality assessment tool. Overall quality of the literature in the field was found to be high. The most critical aspect was found to be the lack of uniformity in the implementation of the analysis to biomechanical time series, particularly in the choice of state space and number of cycles to include in the analysis.