Control of Walking Speed in Children With Cerebral Palsy.

PubMed

Davids, Jon R; Cung, Nina Q; Chen, Suzy; Sison-Williamson, Mitell; Bagley, Anita M

2017-03-21

Children's ability to control the speed of gait is important for a wide range of activities. It is thought that the ability to increase the speed of gait for children with cerebral palsy (CP) is common. This study considered 3 hypotheses: (1) most ambulatory children with CP can increase gait speed, (2) the characteristics of free (self-selected) and fast walking are related to motor impairment level, and (3) the strategies used to increase gait speed are distinct among these levels. A retrospective review of time-distance parameters (TDPs) for 212 subjects with CP and 34 typically developing subjects walking at free and fast speeds was performed. Only children who could increase their gait speed above the minimal clinically important difference were defined as having a fast walk. Analysis of variance was used to compare TDPs of children with CP, among Gross Motor Function Classification System (GMFCS) levels, and children in typically developing group. Eight-five percent of the CP group (GMFCS I, II, III; 96%, 99%, and 34%, respectively) could increase gait speed on demand. At free speed, children at GMFCS I and II were significantly faster than children at GMFCS level III. At free speed, children at GMFCS I and II had significantly greater stride length than those at GMFCS levels III. At free speed, children at GMFCS level III had significantly lower cadence than those at GMFCS I and II. There were no significant differences in cadence among GMFCS levels at fast speeds. There were no significant differences among GMFCS levels for percent change in any TDP between free and fast walking. Almost all children with CP at GMFCS levels I and II can control the speed of gait, however, only one-third at GMFCS III level have this ability. This study suggests that children at GMFCS III level can be divided into 2 groups based on their ability to control gait speed; however, the prognostic significance of such categorization remains to be determined. Diagnostic level II.

Clinical Gait Evaluation of Patients with Lumbar Spine Stenosis.

PubMed

Sun, Jun; Liu, Yan-Cheng; Yan, Song-Hua; Wang, Sha-Sha; Lester, D Kevin; Zeng, Ji-Zhou; Miao, Jun; Zhang, Kuan

2018-02-01

The third generation Intelligent Device for Energy Expenditure and Activity (IDEEA3, MiniSun, CA) has been developed for clinical gait evaluation, and this study was designed to evaluate the accuracy and reliability of IDEEA3 for the gait measurement of lumbar spinal stenosis (LSS) patients. Twelve healthy volunteers were recruited to compare gait cycle, cadence, step length, velocity, and number of steps between a motion analysis system and a high-speed video camera. Twenty hospitalized LSS patients were recruited for the comparison of the five parameters between the IDEEA3 and GoPro camera. Paired t-test, intraclass correlation coefficient, concordance correlation coefficient, and Bland-Altman plots were used for the data analysis. The ratios of GoPro camera results to motion analysis system results, and the ratios of IDEEA3 results to GoPro camera results were all around 1.00. All P-values of paired t-tests for gait cycle, cadence, step length, and velocity were greater than 0.05, while all the ICC and CCC results were above 0.950 with P < 0.001. The measurements for gait cycle, cadence, step length, velocity, and number of steps with the GoPro camera are highly consistent with the measurements with the motion analysis system. The measurements for IDEEA3 are consistent with those for the GoPro camera. IDEEA3 can be effectively used in the gait measurement of LSS patients. © 2018 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Spinal fusion limits upper body range of motion during gait without inducing compensatory mechanisms in adolescent idiopathic scoliosis patients.

PubMed

Holewijn, R M; Kingma, I; de Kleuver, M; Schimmel, J J P; Keijsers, N L W

2017-09-01

Previous studies show a limited alteration of gait at normal walking speed after spinal fusion surgery for adolescent idiopathic scoliosis (AIS), despite the presumed essential role of spinal mobility during gait. This study analyses how spinal fusion affects gait at more challenging walking speeds. More specifically, we investigated whether thoracic-pelvic rotations are reduced to a larger extent at higher gait speeds and whether compensatory mechanisms above and below the stiffened spine are present. 18 AIS patients underwent gait analysis at increasing walking speeds (0.45 to 2.22m/s) before and after spinal fusion. The range of motion (ROM) of the upper (thorax, thoracic-pelvic and pelvis) and lower body (hip, knee and ankle) was determined in all three planes. Spatiotemporal parameters of interest were stride length and cadence. Spinal fusion diminished transverse plane thoracic-pelvic ROM and this difference was more explicit at higher walking speeds. Transversal pelvis ROM was also decreased but this effect was not affected by speed. Lower body ROM, step length and cadence remained unaffected. Despite the reduction of upper body ROM after spine surgery during high speed gait, no altered spatiotemporal parameters or increased compensatory ROM above or below the fusion (i.e. in the shoulder girdle or lower extremities) was identified. Thus, it remains unclear how patients can cope so well with such major surgery. Future studies should focus on analyzing the kinematics of individual spinal levels above and below the fusion during gait to investigate possible compensatory mechanisms within the spine. Copyright © 2017 Elsevier B.V. All rights reserved.

30 min of treadmill walking at self-selected speed does not increase gait variability in independent elderly.

PubMed

Da Rocha, Emmanuel S; Kunzler, Marcos R; Bobbert, Maarten F; Duysens, Jacques; Carpes, Felipe P

2018-06-01

Walking is one of the preferred exercises among elderly, but could a prolonged walking increase gait variability, a risk factor for a fall in the elderly? Here we determine whether 30 min of treadmill walking increases coefficient of variation of gait in elderly. Because gait responses to exercise depend on fitness level, we included 15 sedentary and 15 active elderly. Sedentary participants preferred a lower gait speed and made smaller steps than the actives. Step length coefficient of variation decreased ~16.9% by the end of the exercise in both the groups. Stride length coefficient of variation decreased ~9% after 10 minutes of walking, and sedentary elderly showed a slightly larger step width coefficient of variation (~2%) at 10 min than active elderly. Active elderly showed higher walk ratio (step length/cadence) than sedentary in all times of walking, but the times did not differ in both the groups. In conclusion, treadmill gait kinematics differ between sedentary and active elderly, but changes over time are similar in sedentary and active elderly. As a practical implication, 30 min of walking might be a good strategy of exercise for elderly, independently of the fitness level, because it did not increase variability in step and stride kinematics, which is considered a risk of fall in this population.

Meaningful improvement in gait speed in hip fracture recovery.

PubMed

Alley, Dawn E; Hicks, Gregory E; Shardell, Michelle; Hawkes, William; Miller, Ram; Craik, Rebecca L; Mangione, Kathleen K; Orwig, Denise; Hochberg, Marc; Resnick, Barbara; Magaziner, Jay

2011-09-01

To estimate meaningful improvements in gait speed observed during recovery from hip fracture and to evaluate the sensitivity and specificity of gait speed changes in detecting change in self-reported mobility. Secondary longitudinal data analysis from two randomized controlled trials Twelve hospitals in the Baltimore, Maryland, area. Two hundred seventeen women admitted with hip fracture. Usual gait speed and self-reported mobility (ability to walk 1 block and climb 1 flight of stairs) measured 2 and 12 months after fracture. Effect size-based estimates of meaningful differences were 0.03 for small differences and 0.09 for substantial differences. Depending on the anchor (stairs vs walking) and method (mean difference vs regression), anchor-based estimates ranged from 0.10 to 0.17 m/s for small meaningful improvements and 0.17 to 0.26 m/s for substantial meaningful improvement. Optimal gait speed cutpoints yielded low sensitivity (0.39-0.62) and specificity (0.57-0.76) for improvements in self-reported mobility. Results from this sample of women recovering from hip fracture provide only limited support for the 0.10-m/s cut point for substantial meaningful change previously identified in community-dwelling older adults experiencing declines in walking abilities. Anchor-based estimates and cut points derived from receiver operating characteristic curve analysis suggest that greater improvements in gait speed may be required for substantial perceived mobility improvement in female hip fracture patients. Furthermore, gait speed change performed poorly in discriminating change in self-reported mobility. Estimates of meaningful change in gait speed may differ based on the direction of change (improvement vs decline) or between patient populations. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

Meaningful Improvement in Gait Speed in Hip Fracture Recovery

PubMed Central

Alley, Dawn E.; Hicks, Gregory E.; Shardell, Michelle; Hawkes, William; Miller, Ram; Craik, Rebecca L.; Mangione, Kathleen K.; Orwig, Denise; Hochberg, Marc; Resnick, Barbara; Magaziner, Jay

2011-01-01

OBJECTIVES To estimate meaningful improvements in gait speed observed during recovery from hip fracture and to evaluate the sensitivity and specificity of gait speed changes in detecting change in self-reported mobility. DESIGN Secondary longitudinal data analysis from two randomized controlled trials SETTING Twelve hospitals in the Baltimore, Maryland, area. PARTICIPANTS Two hundred seventeen women admitted with hip fracture. MEASUREMENTS Usual gait speed and self-reported mobility (ability to walk 1 block and climb 1 flight of stairs) measured 2 and 12 months after fracture. RESULTS Effect size–based estimates of meaningful differences were 0.03 for small differences and 0.09 for substantial differences. Depending on the anchor (stairs vs walking) and method (mean difference vs regression), anchor-based estimates ranged from 0.10 to 0.17 m/s for small meaningful improvements and 0.17 to 0.26 m/s for substantial meaningful improvement. Optimal gait speed cut-points yielded low sensitivity (0.39–0.62) and specificity (0.57–0.76) for improvements in self-reported mobility. CONCLUSION Results from this sample of women recovering from hip fracture provide only limited support for the 0.10-m/s cut point for substantial meaningful change previously identified in community-dwelling older adults experiencing declines in walking abilities. Anchor-based estimates and cut points derived from receiver operating characteristic curve analysis suggest that greater improvements in gait speed may be required for substantial perceived mobility improvement in female hip fracture patients. Furthermore, gait speed change performed poorly in discriminating change in self-reported mobility. Estimates of meaningful change in gait speed may differ based on the direction of change (improvement vs decline) or between patient populations. PMID:21883109

Development of a novel virtual reality gait intervention.

PubMed

Boone, Anna E; Foreman, Matthew H; Engsberg, Jack R

2017-02-01

Improving gait speed and kinematics can be a time consuming and tiresome process. We hypothesize that incorporating virtual reality videogame play into variable improvement goals will improve levels of enjoyment and motivation and lead to improved gait performance. To develop a feasible, engaging, VR gait intervention for improving gait variables. Completing this investigation involved four steps: 1) identify gait variables that could be manipulated to improve gait speed and kinematics using the Microsoft Kinect and free software, 2) identify free internet videogames that could successfully manipulate the chosen gait variables, 3) experimentally evaluate the ability of the videogames and software to manipulate the gait variables, and 4) evaluate the enjoyment and motivation from a small sample of persons without disability. The Kinect sensor was able to detect stride length, cadence, and joint angles. FAAST software was able to identify predetermined gait variable thresholds and use the thresholds to play free online videogames. Videogames that involved continuous pressing of a keyboard key were found to be most appropriate for manipulating the gait variables. Five participants without disability evaluated the effectiveness for modifying the gait variables and enjoyment and motivation during play. Participants were able to modify gait variables to permit successful videogame play. Motivation and enjoyment were high. A clinically feasible and engaging virtual intervention for improving gait speed and kinematics has been developed and initially tested. It may provide an engaging avenue for achieving thousands of repetitions necessary for neural plastic changes and improved gait. Copyright © 2016 Elsevier B.V. All rights reserved.

Good agreement between smart device and inertial sensor-based gait parameters during a 6-min walk.

PubMed

Proessl, F; Swanson, C W; Rudroff, T; Fling, B W; Tracy, B L

2018-05-28

Traditional laboratory-based kinetic and kinematic gait analyses are expensive, time-intensive, and impractical for clinical settings. Inertial sensors have gained popularity in gait analysis research and more recently smart devices have been employed to provide quantification of gait. However, no study to date has investigated the agreement between smart device and inertial sensor-based gait parameters during prolonged walking. Compare spatiotemporal gait metrics measured with a smart device versus previously validated inertial sensors. Twenty neurologically healthy young adults (7 women; age: 25.0 ± 3.7 years; BMI: 23.4 ± 2.9 kg/m 2 ) performed a 6-min walk test (6MWT) wearing inertial sensors and smart devices to record stride duration, stride length, cadence, and gait speed. Pearson correlations were used to assess associations between spatiotemporal measures from the two devices and agreement between the two methods was assessed with Bland-Altman plots and limits of agreement. All spatiotemporal gait metrics (stride duration, cadence, stride length and gait speed) showed strong (r>0.9) associations and good agreement between the two devices. Smart devices are capable of accurately reflecting many of the spatiotemporal gait metrics of inertial sensors. As the smart devices also accurately reflected individual leg output, future studies may apply this analytical strategy to clinical populations, to identify hallmarks of disability status and disease progression in a more ecologically valid environment. Copyright © 2018. Published by Elsevier B.V.

A new technique for simultaneous monitoring of electrocardiogram and walking cadence

NASA Technical Reports Server (NTRS)

Hausdorff, J. M.; Forman, D. E.; Pilgrim, D. M.; Rigney, D. R.; Wei, J. Y.; Goldberger, A. L. (Principal Investigator)

1992-01-01

A new technique for simultaneously recording continuous electrocardiographic (ECG) data and walking step rate (cadence) is described. The ECG and gait signals are recorded on 2 channels of an ambulatory Holter monitor. Footfall is detected using ultrathin, force-sensitive foot switches and is frequency modulated. The footfall signal provides an indication of the subject's activity (walking or standing), as well as the instantaneous walking rate. Twenty-three young and elderly subjects were studied to demonstrate the use of this ECG and gait recorder. High-quality gait signals were obtained in all subjects, and the effects of walking on the electrocardiogram were assessed. Initial investigation revealed the following findings: (1) Although walking rates were similar in young and elderly subjects, the elderly had both decreased heart rate (HR) variability (p < 0.005) and increased cadence variability (p < 0.0001). (2) Overall, there was an inverse relation between HR and cadence variability (r = -0.73). Three elderly subjects with no known cardiac disease had HR and cadence variability similar to those of the young, whereas elderly subjects with history of congestive heart failure were among those with the lowest HR variability and the highest cadence variability. (3) Low-frequency (approximately equal to 0.1 Hz) HR oscillations (frequently observed during standing) persisted during walking in all young subjects. (4) In some subjects, both step rate and HR oscillated at the same low frequency (approximately equal to 0.1 Hz) previously identified with autonomic control of the baroreflex.(ABSTRACT TRUNCATED AT 250 WORDS).

Examination of sustained gait speed during extended walking in individuals with chronic stroke.

PubMed

Altenburger, Peter A; Dierks, Tracy A; Miller, Kristine K; Combs, Stephanie A; Van Puymbroeck, Marieke; Schmid, Arlene A

2013-12-01

To determine if individuals with chronic stroke were able to sustain their peak gait speed during the 6-minute walk test (6MWT), and to explore this sustainability across community ambulation potential subgroups. Prospective cross-sectional study. University-based research laboratory, hospitals, and stroke support groups. A sample of individuals with chronic stroke (N=48) completed a series of questionnaires and physical outcome measures, including gait mat assessment, during a single visit. Not applicable; 1-time cross-sectional data collection. During the 6MWT, we measured peak gait speed and end gait speed to assess sustainability, along with beginning gait speed, total distance walked, and rating of perceived exertion. We also assessed maximum gait speed during the 10-meter walk test (10MWT). Finally, we examined these gait outcomes across the subgroups. During the 6MWT, peak gait speed declined from .89m/s (SD=.38) to an end speed of .82m/s (SD=.36), whereas perceived exertion increased from 7.7 (SD=2.6) to 11.8 (SD=3.6). This peak gait speed was slower than the 10MWT maximum speed of 1.06m/s (SD=.51), but faster than the 6MWT beginning speed of .81m/s (SD=.34). The unlimited community ambulator subgroup was the primary contributor to sustainability differences. Predicting community ambulation potential based on the discrete gait speed from the 10MWT and endurance based on the average from the 6MWT might be incomplete if gait speed sustainability is not also assessed. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Gait performance and foot pressure distribution during wearable robot-assisted gait in elderly adults.

PubMed

Lee, Su-Hyun; Lee, Hwang-Jae; Chang, Won Hyuk; Choi, Byung-Ok; Lee, Jusuk; Kim, Jeonghun; Ryu, Gyu-Ha; Kim, Yun-Hee

2017-11-28

A robotic exoskeleton device is an intelligent system designed to improve gait performance and quality of life for the wearer. Robotic technology has developed rapidly in recent years, and several robot-assisted gait devices were developed to enhance gait function and activities of daily living in elderly adults and patients with gait disorders. In this study, we investigated the effects of the Gait-enhancing Mechatronic System (GEMS), a new wearable robotic hip-assist device developed by Samsung Electronics Co, Ltd., Korea, on gait performance and foot pressure distribution in elderly adults. Thirty elderly adults who had no neurological or musculoskeletal abnormalities affecting gait participated in this study. A three-dimensional (3D) motion capture system, surface electromyography and the F-Scan system were used to collect data on spatiotemporal gait parameters, muscle activity and foot pressure distribution under three conditions: free gait without robot assistance (FG), robot-assisted gait with zero torque (RAG-Z) and robot-assisted gait (RAG). We found increased gait speed, cadence, stride length and single support time in the RAG condition. Reduced rectus femoris and medial gastrocnemius muscle activity throughout the terminal stance phase and reduced effort of the medial gastrocnemius muscle throughout the pre-swing phase were also observed in the RAG condition. In addition, walking with the assistance of GEMS resulted in a significant increase in foot pressure distribution, specifically in maximum force and peak pressure of the total foot, medial masks, anterior masks and posterior masks. The results of the present study reveal that GEMS may present an alternative way of restoring age-related changes in gait such as gait instability with muscle weakness, reduced step force and lower foot pressure in elderly adults. In addition, GEMS improved gait performance by improving push-off power and walking speed and reducing muscle activity in the lower

Factors associated with gait speed recovery after total knee arthroplasty: A longitudinal study.

PubMed

Pua, Yong-Hao; Seah, Felicia Jie-Ting; Clark, Ross Allan; Lian-Li Poon, Cheryl; Tan, John Wei-Ming; Chong, Hwei-Chi

2017-04-01

Gait speed limitations can remain significant issues after a total knee arthroplasty (TKA) but their associated factors are not well understood. This study aimed to identify the factors associated with acute gait speed recovery post-TKA. We performed a prospective longitudinal study of 1765 patients who underwent primary TKA between July 2013 and July 2015. At 4, 8, 12, and 16 weeks postsurgery, fast gait speed was measured. The factors associated with gait speed over time since TKA were identified using multivariable generalized least squares modeling. Lower postoperative quadriceps strength and knee flexion range of motion were closely associated with lower gait speed over time (0.084m/s, 0.064m/s, and 0.055m/s change in gait speed per interquartile range change in ipsilateral quadriceps strength, contralateral quadriceps strength, and knee flexion range of motion, respectively). Additional strong predictors of lower gait speed included older age (0.11m/s), lower levels of preoperative Short Form 36 physical function (0.066m/s), greater body mass (0.046m/s), and the preoperative use of a walking aid (overall P < 0.001). Patients who reported that they limited their daily activities due to a fear of falling also had poorer gait speed (0.033m/s and 0.054m/s slower gait speed for "Occasional" and "Often" categories, respectively, vs. "None"). Gait speed recovery post-TKA is driven by both physical and psychological factors, suggesting that identifying and treating the underlying physical and cognitive causes of gait speed limitations may be crucial to optimize functional recovery. Copyright © 2017 Elsevier Inc. All rights reserved.

Examination of factors affecting gait properties in healthy older adults: focusing on knee extension strength, visual acuity, and knee joint pain.

PubMed

Demura, Tomohiro; Demura, Shin-ichi; Uchiyama, Masanobu; Sugiura, Hiroki

2014-01-01

Gait properties change with age because of a decrease in lower limb strength and visual acuity or knee joint disorders. Gait changes commonly result from these combined factors. This study aimed to examine the effects of knee extension strength, visual acuity, and knee joint pain on gait properties of for 181 healthy female older adults (age: 76.1 (5.7) years). Walking speed, cadence, stance time, swing time, double support time, step length, step width, walking angle, and toe angle were selected as gait parameters. Knee extension strength was measured by isometric dynamometry; and decreased visual acuity and knee joint pain were evaluated by subjective judgment whether or not such factors created a hindrance during walking. Among older adults without vision problems and knee joint pain that affected walking, those with superior knee extension strength had significantly greater walking speed and step length than those with inferior knee extension strength (P < .05). Persons with visual acuity problems had higher cadence and shorter stance time. In addition, persons with pain in both knees showed slower walking speed and longer stance time and double support time. A decrease of knee extension strength and visual acuity and knee joint pain are factors affecting gait in the female older adults. Decreased knee extension strength and knee joint pain mainly affect respective distance and time parameters of the gait.

The feasibility of singing to improve gait in Parkinson disease

PubMed Central

Harrison, Elinor C.; McNeely, Marie E.; Earhart, Gammon M.

2017-01-01

Brain regions important for controlling movement are also responsible for rhythmic processing. In Parkinson disease (PD), defective internal timing within the brain has been linked to impaired beat discrimination, and may contribute to a loss of ability to maintain a steady gait rhythm. Less rhythmic gait is inherently less efficient, and this may lead to gait impairment including reduced speed, cadence, and stride length, as well as increased variability. While external rhythmic auditory stimulation (e.g. a metronome beat) is well-established as an effective tool to stabilize gait in PD, little is known about whether self-generated cues such as singing have the same beneficial effect on gait in PD. Thus, we compared gait patterns of 23 people with mild to moderate PD under five cued conditions: uncued, music only, singing only, singing with music, and a verbal dual-task condition. In our single session study, singing while walking did not significantly alter velocity, cadence, or stride length, indicating that it was not excessively demanding for people with PD. In addition, walking was less variable when singing than during other cued conditions. This was further supported by the comparison between singing trials and a verbal dual-task condition. In contrast to singing, the verbal dual-task negatively affected gait performance. These findings suggest that singing holds promise as an effective cueing technique that may be as good as or better than traditional cueing techniques for improving gait among people with PD. PMID:28226309

Using cadence to study free-living ambulatory behaviour.

PubMed

Tudor-Locke, Catrine; Rowe, David A

2012-05-01

The health benefits of a physically active lifestyle across a person's lifespan have been established. If there is any single physical activity behaviour that we should measure well and promote effectively, it is ambulatory activity and, more specifically, walking. Since public health physical activity guidelines include statements related to intensity of activity, it follows that we need to measure and promote free-living patterns of ambulatory activity that are congruent with this intent. The purpose of this review article is to present and summarize the potential for using cadence (steps/minute) to represent such behavioural patterns of ambulatory activity in free-living. Cadence is one of the spatio-temporal parameters of gait or walking speed. It is typically assessed using short-distance walks in clinical research and practice, but free-living cadence can be captured with a number of commercially available accelerometers that possess time-stamping technology. This presents a unique opportunity to use the same metric to communicate both ambulatory performance (assessed under testing conditions) and behaviour (assessed in the real world). Ranges for normal walking cadence assessed under laboratory conditions are 96-138 steps/minute for women and 81-135 steps/minute for men across their lifespan. The correlation between mean cadence and intensity (assessed with indirect calorimetry and expressed as metabolic equivalents [METs]) based on five treadmill/overground walking studies, is r = 0.93 and 100 steps/minute is considered to be a reasonable heuristic value indicative of walking at least at absolutely-defined moderate intensity (i.e. minimally, 3 METs) in adults. The weighted mean cadence derived from eight studies that have observed pedestrian cadence under natural conditions was 115.2 steps/minute, demonstrating that achieving 100 steps/minute is realistic in specific settings that occur in real life. However, accelerometer data collected in a large

The complex genetics of gait speed: genome-wide meta-analysis approach

PubMed Central

Lunetta, Kathryn L.; Smith, Jennifer A.; Eicher, John D.; Vered, Rotem; Deelen, Joris; Arnold, Alice M.; Buchman, Aron S.; Tanaka, Toshiko; Faul, Jessica D.; Nethander, Maria; Fornage, Myriam; Adams, Hieab H.; Matteini, Amy M.; Callisaya, Michele L.; Smith, Albert V.; Yu, Lei; De Jager, Philip L.; Evans, Denis A.; Gudnason, Vilmundur; Hofman, Albert; Pattie, Alison; Corley, Janie; Launer, Lenore J.; Knopman, Davis S.; Parimi, Neeta; Turner, Stephen T.; Bandinelli, Stefania; Beekman, Marian; Gutman, Danielle; Sharvit, Lital; Mooijaart, Simon P.; Liewald, David C.; Houwing-Duistermaat, Jeanine J.; Ohlsson, Claes; Moed, Matthijs; Verlinden, Vincent J.; Mellström, Dan; van der Geest, Jos N.; Karlsson, Magnus; Hernandez, Dena; McWhirter, Rebekah; Liu, Yongmei; Thomson, Russell; Tranah, Gregory J.; Uitterlinden, Andre G.; Weir, David R.; Zhao, Wei; Starr, John M.; Johnson, Andrew D.; Ikram, M. Arfan; Bennett, David A.; Cummings, Steven R.; Deary, Ian J.; Harris, Tamara B.; Kardia, Sharon L. R.; Mosley, Thomas H.; Srikanth, Velandai K.; Windham, Beverly G.; Newman, Ann B.; Walston, Jeremy D.; Davies, Gail; Evans, Daniel S.; Slagboom, Eline P.; Ferrucci, Luigi; Kiel, Douglas P.; Murabito, Joanne M.; Atzmon, Gil

2017-01-01

Emerging evidence suggests that the basis for variation in late-life mobility is attributable, in part, to genetic factors, which may become increasingly important with age. Our objective was to systematically assess the contribution of genetic variation to gait speed in older individuals. We conducted a meta-analysis of gait speed GWASs in 31,478 older adults from 17 cohorts of the CHARGE consortium, and validated our results in 2,588 older adults from 4 independent studies. We followed our initial discoveries with network and eQTL analysis of candidate signals in tissues. The meta-analysis resulted in a list of 536 suggestive genome wide significant SNPs in or near 69 genes. Further interrogation with Pathway Analysis placed gait speed as a polygenic complex trait in five major networks. Subsequent eQTL analysis revealed several SNPs significantly associated with the expression of PRSS16, WDSUB1 and PTPRT, which in addition to the meta-analysis and pathway suggested that genetic effects on gait speed may occur through synaptic function and neuronal development pathways. No genome-wide significant signals for gait speed were identified from this moderately large sample of older adults, suggesting that more refined physical function phenotypes will be needed to identify the genetic basis of gait speed in aging. PMID:28077804

Transcranial Direct Current Stimulation to Enhance Dual-Task Gait Training in Parkinson's Disease: A Pilot RCT.

PubMed

Schabrun, Siobhan M; Lamont, Robyn M; Brauer, Sandra G

2016-01-01

To investigate the feasibility and safety of a combined anodal transcranial direct current stimulation (tDCS) and dual task gait training intervention in people with Parkinson's Disease (PD) and to provide data to support a sample size calculation for a fully powered trial should trends of effectiveness be present. A pilot, randomized, double-blind, sham-controlled parallel group trial with 12 week follow-up. A university physiotherapy department. Sixteen participants diagnosed with PD received nine dual task gait training sessions over 3 weeks. Participants were randomized to receive either active or sham tDCS applied for the first 20 minutes of each session. The primary outcome was gait speed while undertaking concurrent cognitive tasks (word lists, counting, conversation). Secondary measures included step length, cadence, Timed Up and Go, bradykinesia and motor speed. Gait speed, step length and cadence improved in both groups, under all dual task conditions. This effect was maintained at follow-up. There was no difference between the active and sham tDCS groups. Time taken to perform the TUGwords also improved, with no difference between groups. The active tDCS group did however increase their correct cognitive response rate during the TUGwords and TUGcount. Bradykinesia improved after training in both groups. Three weeks of dual task gait training resulted in improved gait under dual task conditions, and bradykinesia, immediately following training and at 12 weeks follow-up. The only parameter enhanced by tDCS was the number of correct responses while performing the dual task TUG. tDCS applied to M1 may not be an effective adjunct to dual task gait training in PD. Australia-New Zealand Clinical Trials Registry ACTRN12613001093774.

Positive outcomes following gait therapy intervention for hip osteoarthritis: A longitudinal study.

PubMed

Solomonow-Avnon, Deborah; Herman, Amir; Levin, Daniel; Rozen, Nimrod; Peled, Eli; Wolf, Alon

2017-10-01

Footwear-generated biomechanical manipulation of lower-limb joints was shown to beneficially impact gait and quality of life in knee osteoarthritis patients, but has not been tested in hip osteoarthritis patients. We examined a customized gait treatment program using a biomechanical device shown in previous investigations to be capable of manipulating hip biomechanics via foot center of pressure (COP) modulation. The objective of this study was to assess the treatment program for hip osteoarthritis patients, enrolled in a 1-year prospective investigation, by means of objective gait and spatiotemporal parameters, and subjective quality of life measures. Gait analysis and completion of questionnaires were performed at the start of the treatment (baseline), and after 3, 6, and 12 months. Outcome parameters were evaluated over time using linear mixed effects models, and association between improvement in quality of life measures and change in objective outcomes was tested using mixed effect linear regression models. Quality of life measures improved compared to baseline, accompanied by increased gait speed and cadence. Sagittal-plane hip joint kinetics, kinematics, and spatiotemporal parameters changed throughout the study compared to baseline, in a manner suggesting improvement of gait. The most substantial improvement occurred within 3 months after treatment initiation, after which improvement approximately plateaued, but was sustained at 12 months. Speed and cadence, as well as several sagittal-plane gait parameters, were significant predictors of improvement in quality of life. Evidence suggests that a biomechanical gait therapy program improves subjective and objective outcomes measures and is a valid treatment option for hip osteoarthritis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2222-2232, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Gait characteristics, balance performance and falls in ambulant adults with cerebral palsy: An observational study.

PubMed

Morgan, P; Murphy, A; Opheim, A; McGinley, J

2016-07-01

The relationship between spatiotemporal gait parameters, balance performance and falls history was investigated in ambulant adults with cerebral palsy (CP). Participants completed a single assessment of gait using an instrumented walkway at preferred and fast speeds, balance testing (Balance Evaluation Systems Test; BESTest), and reported falls history. Seventeen ambulatory adults with CP, mean age 37 years, participated. Gait speed was typically slow at both preferred and fast speeds (mean 0.97 and 1.21m/s, respectively), with short stride length and high cadence relative to speed. There was a significant, large positive relationship between preferred gait speed and BESTest total score (ρ=0.573; p<0.05) and fast gait speed and BESTest total score (ρ=0.647, p<0.01). The stride lengths of fallers at both preferred and fast speeds differed significantly from non-fallers (p=0.032 and p=0.025, respectively), with those with a prior history of falls taking shorter strides. Faster gait speed was associated with better performance on tests of anticipatory and postural response components of the BESTest, suggesting potential therapeutic training targets to address either gait speed or balance performance. Future exploration of the implications of slow walking speed and reduced stride length on falls and community engagement, and the potential prognostic value of stride length on identifying falls risk is recommended. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Gait Speed Predicts Incident Disability: A Pooled Analysis

PubMed Central

Patel, Kushang V.; Rosano, Caterina; Rubin, Susan M.; Satterfield, Suzanne; Harris, Tamara; Ensrud, Kristine; Orwoll, Eric; Lee, Christine G.; Chandler, Julie M.; Newman, Anne B.; Cauley, Jane A.; Guralnik, Jack M.; Ferrucci, Luigi; Studenski, Stephanie A.

2016-01-01

Background. Functional independence with aging is an important goal for individuals and society. Simple prognostic indicators can inform health promotion and care planning, but evidence is limited by heterogeneity in measures of function. Methods. We performed a pooled analysis of data from seven studies of 27,220 community-dwelling older adults aged 65 or older with baseline gait speed, followed for disability and mortality. Outcomes were incident inability or dependence on another person in bathing or dressing; and difficulty walking ¼ – ½ mile or climbing 10 steps within 3 years. Results. Participants with faster baseline gait had lower rates of incident disability. In subgroups (defined by 0.2 m/s-wide intervals from <0.4 to ≥1.4 m/s) with increasingly greater gait speed, 3-year rates of bathing or dressing dependence trended from 10% to 1% in men, and from 15% to 1% in women, while mobility difficulty trended from 47% to 4% in men and 40% to 6% in women. The age-adjusted relative risk ratio per 0.1 m/s greater speed for bathing or dressing dependence in men was 0.68 (0.57–0.81) and in women: 0.74 (0.66–0.82); for mobility difficulty, men: 0.75 (0.68–0.82), women: 0.73 (0.67–0.80). Results were similar for combined disability and mortality. Effects were largely consistent across subgroups based on age, gender, race, body mass index, prior hospitalization, and selected chronic conditions. In the presence of multiple other risk factors for disability, gait speed significantly increased the area under the receiver operator characteristic curve. Conclusion. In older adults, gait speed predicts 3 year incidence of bathing or dressing dependence, mobility difficulty, and a composite outcome of disability and mortality. PMID:26297942

Multi-Objective Optimization for Speed and Stability of a Sony AIBO Gait

DTIC Science & Technology

2007-09-01

MULTI-OBJECTIVE OPTIMIZATION FOR SPEED AND STABILITY OF A SONY AIBO GAIT THESIS Christopher A. Patterson, Second Lieutenant, USAF AFIT/GCS...07-17 MULTI-OBJECTIVE OPTIMIZATION FOR SPEED AND STABILITY OF A SONY AIBO GAIT THESIS Presented to the Faculty Department of...MULTI-OBJECTIVE OPTIMIZATION FOR SPEED AND STABILITY OF A SONY AIBO GAIT Christopher A. Patterson, BS Second Lieutenant, USAF

Rising Energetic Cost of Walking Predicts Gait Speed Decline With Aging.

PubMed

Schrack, Jennifer A; Zipunnikov, Vadim; Simonsick, Eleanor M; Studenski, Stephanie; Ferrucci, Luigi

2016-07-01

Slow gait is a robust biomarker of health and a predictor of functional decline and death in older adults, yet factors contributing to the decline in gait speed with aging are not well understood. Previous research suggests that the energetic cost of walking at preferred speed is inversely associated with gait speed, but whether individuals with a rising energetic cost of walking experience a steeper rate of gait speed decline has not been investigated. In participants of the Baltimore Longitudinal Study of Aging, the energetic cost of overground walking at preferred speed (mL/kg/m) was assessed between 2007 and 2014 using a portable indirect calorimeter. The longitudinal association between the energetic cost of walking and usual gait speed over 6 meters (m/s) was assessed with multivariate linear regression models, and the risk of slow gait (<1.0 m/s) was analyzed using Cox proportional hazards models. The study population consisted of 457 participants aged 40 and older who contributed 1,121 person-visits to the analysis. In fully adjusted models, increases in the energetic cost of walking predicted the rate of gait speed decline in those older than 65 years (β = -0.008 m/s, p < .001). Moreover, those with a higher energetic cost of walking (>0.17mL/kg/m) had a 57% greater risk of developing slow gait compared with a normal energetic cost of walking (≤0.17mL/kg/m; adjusted hazard ratio = 1.57, 95% confidence interval: 1.01-2.46). These findings suggest that strategies to maintain walking efficiency hold significant implications for maintaining mobility in late life. Efforts to curb threats to walking efficiency should focus on therapies to treat gait and balance impairments, and reduce clinical disease burden. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Effects of Music Salience on the Gait Performance of Young Adults.

PubMed

de Bruin, Natalie; Kempster, Cody; Doucette, Angelica; Doan, Jon B; Hu, Bin; Brown, Lesley A

2015-01-01

The presence of a rhythmic beat in the form of a metronome tone or beat-accentuated original music can modulate gait performance; however, it has yet to be determined whether gait modulation can be achieved using commercially available music. The current study investigated the effects of commercially available music on the walking of healthy young adults. Specific aims were (a) to determine whether commercially available music can be used to influence gait (i.e., gait velocity, stride length, cadence, stride time variability), (b) to establish the effect of music salience on gait (i.e., gait velocity, stride length, cadence, stride time variability), and (c) to examine whether music tempi differentially effected gait (i.e., gait velocity, stride length, cadence, stride time variability). Twenty-five participants walked the length of an unobstructed walkway while listening to music. Music selections differed with respect to the salience or the tempo of the music. The genre of music and artists were self-selected by participants. Listening to music while walking was an enjoyable activity that influenced gait. Specifically, salient music selections increased measures of cadence, velocity, and stride length; in contrast, gait was unaltered by the presence of non-salient music. Music tempo did not differentially affect gait performance (gait velocity, stride length, cadence, stride time variability) in these participants. Gait performance was differentially influenced by music salience. These results have implications for clinicians considering the use of commercially available music as an alternative to the traditional rhythmic auditory cues used in rehabilitation programs. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The feasibility of singing to improve gait in Parkinson disease.

PubMed

Harrison, Elinor C; McNeely, Marie E; Earhart, Gammon M

2017-03-01

Brain regions important for controlling movement are also responsible for rhythmic processing. In Parkinson disease (PD), defective internal timing within the brain has been linked to impaired beat discrimination, and may contribute to a loss of ability to maintain a steady gait rhythm. Less rhythmic gait is inherently less efficient, and this may lead to gait impairment including reduced speed, cadence, and stride length, as well as increased variability. While external rhythmic auditory stimulation (e.g. a metronome beat) is well-established as an effective tool to stabilize gait in PD, little is known about whether self-generated cues such as singing have the same beneficial effect on gait in PD. Thus, we compared gait patterns of 23 people with mild to moderate PD under five cued conditions: uncued, music only, singing only, singing with music, and a verbal dual-task condition. In our single-session study, singing while walking did not significantly alter velocity, cadence, or stride length, indicating that it was not excessively demanding for people with PD. In addition, walking was less variable when singing than during other cued conditions. This was further supported by the comparison between singing trials and a verbal dual-task condition. In contrast to singing, the verbal dual-task negatively affected gait performance. These findings suggest that singing holds promise as an effective cueing technique that may be as good as or better than traditional cueing techniques for improving gait among people with PD. Copyright © 2017 Elsevier B.V. All rights reserved.

Immediate effects of a single session of robot-assisted gait training using Hybrid Assistive Limb (HAL) for cerebral palsy.

PubMed

Matsuda, Mayumi; Mataki, Yuki; Mutsuzaki, Hirotaka; Yoshikawa, Kenichi; Takahashi, Kazushi; Enomoto, Keiko; Sano, Kumiko; Mizukami, Masafumi; Tomita, Kazuhide; Ohguro, Haruka; Iwasaki, Nobuaki

2018-02-01

[Purpose] Robot-assisted gait training (RAGT) using Hybrid Assistive Limb (HAL, CYBERDYNE) was previously reported beneficial for stroke and spinal cord injury patients. Here, we investigate the immediate effect of a single session of RAGT using HAL on gait function for cerebral palsy (CP) patients. [Subjects and Methods] Twelve patients (average age: 16.2 ± 7.3 years) with CP received a single session of RAGT using HAL. Gait speed, step length, cadence, single-leg support per gait cycle, hip and knee joint angle in stance, and swing phase per gait cycle were assessed before, during, and immediately after HAL intervention. [Results] Compared to baseline values, single-leg support per gait cycle (64.5 ± 15.8% to 69.3 ± 12.1%), hip extension angle in mid-stance (149.2 ± 19.0° to 155.5 ± 20.1°), and knee extension angle in mid-stance (137.6 ± 20.2° to 143.1 ± 19.5°) were significantly increased immediately after intervention. Further, the knee flexion angle in mid-swing was significantly decreased immediately after treatment (112.0 ± 15.5° to 105.2 ± 17.1°). Hip flexion angle in mid-swing also decreased following intervention (137.2 ± 14.6° to 129.7 ± 16.6°), but not significantly. Conversely, gait speed, step length, and cadence were unchanged after intervention. [Conclusion] A single-time RAGT with HAL improved single-leg support per gait cycle and hip and knee joint angle during gait, therapeutically improving gait function in CP patients.

Underwater gait analysis in Parkinson's disease.

PubMed

Volpe, Daniele; Pavan, Davide; Morris, Meg; Guiotto, Annamaria; Iansek, Robert; Fortuna, Sofia; Frazzitta, Giuseppe; Sawacha, Zimi

2017-02-01

Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

A proof-of-concept study for measuring gait speed, steadiness, and dynamic balance under various footwear conditions outside of the gait laboratory.

PubMed

Wrobel, James S; Edgar, Sarah; Cozzetto, Dana; Maskill, James; Peterson, Paul; Najafi, Bijan

2010-01-01

This pilot study examined the effect of custom and prefabricated foot orthoses on self-selected walking speed, walking speed variability, and dynamic balance in the mediolateral direction. The gait of four healthy participants was analyzed with a body-worn sensor system across a distance of at least 30 m outside of the gait laboratory. Participants walked at their habitual speed in four conditions: barefoot, regular shoes, prefabricated foot orthoses, and custom foot orthoses. In the custom foot orthoses condition, gait speed was improved on average 13.5% over the barefoot condition and 9.8% over the regular shoe condition. The mediolateral range of motion of center of mass was reduced 55% and 56% compared with the shoes alone and prefabricated foot orthoses conditions, respectively. This may suggest better gait efficiency and lower energy cost with custom foot orthoses. This tendency remained after normalizing center of mass by gait speed, suggesting that irrespective of gait speed, custom foot orthoses improve center of mass motion in the mediolateral direction compared with other footwear conditions. Gait intercycle variability, measured by intercycle coefficient of variation of gait speed, was decreased on average by 25% and 19% compared with the barefoot and shoes-alone conditions, respectively. The decrease in gait unsteadiness after wearing custom foot orthoses may suggest improved proprioception from the increased contact area of custom foot orthoses versus the barefoot condition. These findings may open new avenues for objective assessment of the impact of prescribed footwear on dynamic balance and spatiotemporal parameters of gait and assess gait adaptation after use of custom foot orthoses.

A 12-Week Cycling Training Regimen Improves Gait and Executive Functions Concomitantly in People with Parkinson’s Disease

PubMed Central

Nadeau, Alexandra; Lungu, Ovidiu; Duchesne, Catherine; Robillard, Marie-Ève; Bore, Arnaud; Bobeuf, Florian; Plamondon, Réjean; Lafontaine, Anne-Louise; Gheysen, Freja; Bherer, Louis; Doyon, Julien

2017-01-01

Background: There is increasing evidence that executive functions and attention are associated with gait and balance, and that this link is especially prominent in older individuals or those who are afflicted by neurodegenerative diseases that affect cognition and/or motor functions. People with Parkinson’s disease (PD) often present gait disturbances, which can be reduced when PD patients engage in different types of physical exercise (PE), such as walking on a treadmill. Similarly, PE has also been found to improve executive functions in this population. Yet, no exercise intervention investigated simultaneously gait and non-motor symptoms (executive functions, motor learning) in PD patients. Objective: To assess the impact of aerobic exercise training (AET) using a stationary bicycle on a set of gait parameters (walking speed, cadence, step length, step width, single and double support time, as well as variability of step length, step width and double support time) and executive functions (cognitive inhibition and flexibility) in sedentary PD patients and healthy controls. Methods: Two groups, 19 PD patients (Hoehn and Yahr ≤2) and 20 healthy adults, matched on age and sedentary level, followed a 3-month stationary bicycle AET regimen. Results: Aerobic capacity, as well as performance of motor learning and on cognitive inhibition, increased significantly in both groups after the training regimen, but only PD patients improved their walking speed and cadence (all p < 0.05; with no change in the step length). Moreover, in PD patients, training-related improvements in aerobic capacity correlated positively with improvements in walking speed (r = 0.461, p < 0.05). Conclusion: AET using stationary bicycle can independently improve gait and cognitive inhibition in sedentary PD patients. Given that increases in walking speed were obtained through increases in cadence, with no change in step length, our findings suggest that gait improvements are specific to the type

Usual gait speed independently predicts mortality in very old people: a population-based study.

PubMed

Toots, Annika; Rosendahl, Erik; Lundin-Olsson, Lillemor; Nordström, Peter; Gustafson, Yngve; Littbrand, Håkan

2013-07-01

In older people, usual gait speed has been shown to independently predict mortality; however, less is known about whether usual gait speed is as informative in very old populations, in which prevalence of multimorbidity and disability is high. The aim of this study was to investigate if usual gait speed can independently predict all-cause mortality in very old people, and whether the prediction is influenced by dementia disorder, dependency in activities of daily living (ADL), or use of walking aids in the gait speed test. Prospective cohort study. Population-based study in northern Sweden and Finland (the Umeå 85+/GERDA Study). A total of 772 participants with a mean age of 89.6 years, 70% women, 33% with dementia disorders, 54% with ADL dependency, and 39% living in residential care facilities. Usual gait speed assessed over 2.4 meters and mortality followed-up for 5 years. The mean ± SD gait speed was 0.52 ± 0.21 m/s for the 620 (80%) participants able to complete the gait speed test. Cox proportional hazard regression analyses adjusted for potential confounders were performed. Compared with the fastest gait speed group (≥ 0.64 m/s), the hazard ratio for mortality was for the following groups: unable = 2.27 (P < .001), ≤ 0.36 m/s = 1.97 (P = .001), 0.37 to 0.49 m/s = 1.99 (P < .001), 0.50 to 0.63 m/s = 1.11 (P = .604). No interaction effects were found between gait speed and age, sex, dementia disorder, dependency in ADLs, or use of walking aids. Among people aged 85 or older, including people dependent in ADLs and with dementia disorders, usual gait speed was an independent predictor of 5-year all-cause mortality. Inability to complete the gait test or gait speeds slower than 0.5 m/s appears to be associated with higher mortality risk. Gait speed might be a useful clinical indicator of health status among very old people. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson's disease: A randomized controlled trial.

PubMed

Grobbelaar, Roné; Venter, Ranel; Welman, Karen Estelle

2017-10-01

Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson's disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0±8.8years; UPDRS-III 38.1±12.3; H&Y 2.7±0.5) were randomly assigned to either the control (FWG; n=14) or experimental group (BWG; n=15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p=0.03, d=0.35; BWG: p<0.01, d=0.35) and height-normalized gait speed (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57). Additionally, the BWG demonstrated improved cadence (p<0.01, d=0.67) and stride length (SL; p=0.02, d=0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community. Copyright © 2017 Elsevier B.V. All rights reserved.

Relationship Between Head-Turn Gait Speed and Lateral Balance Function in Community-Dwelling Older Adults.

PubMed

Singh, Harshvardhan; Sanders, Ozell; McCombe Waller, Sandy; Bair, Woei-Nan; Beamer, Brock; Creath, Robert A; Rogers, Mark W

2017-10-01

To determine and compare gait speed during head-forward and side-to-side head-turn walking in individuals with lower versus greater lateral balance. Cross-sectional study. University research laboratory. Older adults (N=93; 42 men, 51 women; mean age ± SD, 73 ± 6.08y) who could walk independently. (1) Balance tolerance limit (BTL), defined as the lowest perturbation intensity where a multistep balance recovery pattern was first evoked in response to randomized lateral waist-pull perturbations of standing balance to the left and right sides, at 6 different intensities (range from level 2: 4.5-cm displacement at 180cm/s 2 acceleration, to level 7: 22.5-cm displacement at 900cm/s 2 acceleration); (2) gait speed, determined using an instrumented gait mat; (3) balance, evaluated with the Activities-specific Balance Confidence Scale; and (4) mobility, determined with the Timed Up and Go (TUG). Individuals with low versus high BTL had a slower self-selected head-forward gait speed and head-turn gait speed (P=.002 and P<.001, respectively); the magnitude of difference was greater in head-turn gait speed than head-forward gait speed (Cohen's d=1.0 vs 0.6). Head-turn gait speed best predicted BTL. BTL was moderately and positively related (P=.003) to the ABC Scale and negatively related (P=.017) to TUG. Head-turn gait speed is affected to a greater extent than head-forward gait speed in older individuals with poorer lateral balance and at greater risk of falls. Moreover, head-turn gait speed can be used to assess the interactions of limitations in lateral balance function and gait speed in relation to fall risk in older adults. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Influence of Systematic Increases in Treadmill Walking Speed on Gait Kinematics After Stroke

PubMed Central

Tyrell, Christine M.; Roos, Margaret A.; Rudolph, Katherine S.

2011-01-01

Background Fast treadmill training improves walking speed to a greater extent than training at a self-selected speed after stroke. It is unclear whether fast treadmill walking facilitates a more normal gait pattern after stroke, as has been suggested for treadmill training at self-selected speeds. Given the massed stepping practice that occurs during treadmill training, it is important for therapists to understand how the treadmill speed selected influences the gait pattern that is practiced on the treadmill. Objective The purpose of this study was to characterize the effect of systematic increases in treadmill speed on common gait deviations observed after stroke. Design A repeated-measures design was used. Methods Twenty patients with stroke walked on a treadmill at their self-selected walking speed, their fastest speed, and 2 speeds in between. Using a motion capture system, spatiotemporal gait parameters and kinematic gait compensations were measured. Results Significant improvements in paretic- and nonparetic-limb step length and in single- and double-limb support were found. Asymmetry of these measures improved only for step length. Significant improvements in paretic hip extension, trailing limb position, and knee flexion during swing also were found as speed increased. No increases in circumduction or hip hiking were found with increasing speed. Limitations Caution should be used when generalizing these results to survivors of a stroke with a self-selected walking speed of less than 0.4 m/s. This study did not address changes with speed during overground walking. Conclusions Faster treadmill walking facilitates a more normal walking pattern after stroke, without concomitant increases in common gait compensations, such as circumduction. The improvements in gait deviations were observed with small increases in walking speed. PMID:21252308

Relative association of processing speed, short-term memory and sustained attention with task on gait speed: a study of community-dwelling people 50 years and older.

PubMed

Killane, Isabelle; Donoghue, Orna A; Savva, George M; Cronin, Hilary; Kenny, Rose Anne; Reilly, Richard B

2014-11-01

For single gait tasks, associations have been reported between gait speed and cognitive domains. However, few studies have evaluated if this association is altered in dual gait tasks given gait speed changes with complexity and nature of task. We evaluated relative contributions of specific elements of cognitive function (including sustained attention and processing speed) to dual task gait speed in a nationally representative population of community-dwelling adults over 50 years. Gait speed was obtained using the GaitRite walkway during three gait tasks: single, cognitive (alternate letters), and motor (carrying a filled glass). Linear regression models, adjusted for covariates, were constructed to predict the relative contributions of seven neuropsychological tests to gait speed differences and to investigate gait task effects. The mean age and gait speed of the population (n = 4,431, 55% women) was 62.4 years (SD = 8.2) and 135.85 cm/s (SD = 20.20, single task), respectively. Poorer processing speed, short-term memory, and sustained attention were major cognitive contributors to slower gait speed for all gait tasks. Both dual gait tasks were robust to covariate adjustment and had a significant additional executive function element not found for the single gait task. For community-dwelling older adults processing speed, short-term memory and sustained attention were independently associated with gait speed for all gait tasks. Dual gait tasks were found to highlight specific executive function elements. This result forms a baseline value for dual task gait speed. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Independent influence of gait speed and step length on stability and fall risk.

PubMed

Espy, D D; Yang, F; Bhatt, T; Pai, Y-C

2010-07-01

With aging, individuals' gaits become slower and their steps shorter; both are thought to improve stability against balance threats. Recent studies have shown that shorter step lengths, which bring the center of mass (COM) closer to the leading foot, improve stability against slip-related falls. However, a slower gait, hence lower COM velocity, does the opposite. Due to the inherent coupling of step length and speed in spontaneous gait, the extent to which the benefit of shorter steps can offset the slower speed is unknown. The purpose of this study was to investigate, through decoupling, the independent effects of gait speed and step length on gait stability and the likelihood of slip-induced falls. Fifty-seven young adults walked at one of three target gait patterns, two of equal speed and two of equal step length; at a later trial, they encountered an unannounced slip. The results supported our hypotheses that faster gait as well as shorter steps each ameliorates fall risk when a slip is encountered. This appeared to be attributable to the maintenance of stability from slip initiation to liftoff of the recovery foot during the slip. Successful decoupling of gait speed from step length reveals for the first time that, although slow gait in itself leads to instability and falls (a one-standard-deviation decrease in gait speed increases the odds of fall by 4-fold), this effect is offset by the related decrease in step length (the same one-standard-deviation decrease in step length lowers fall risk by 6 times). Copyright © 2010 Elsevier B.V. All rights reserved.

Intraindividual Variability in Executive Functions but Not Speed of Processing or Conflict Resolution Predicts Performance Differences in Gait Speed in Older Adults

PubMed Central

Mahoney, Jeannette; Verghese, Joe

2014-01-01

Background. The relationship between executive functions (EF) and gait speed is well established. However, with the exception of dual tasking, the key components of EF that predict differences in gait performance have not been determined. Therefore, the current study was designed to determine whether processing speed, conflict resolution, and intraindividual variability in EF predicted variance in gait performance in single- and dual-task conditions. Methods. Participants were 234 nondemented older adults (mean age 76.48 years; 55% women) enrolled in a community-based cohort study. Gait speed was assessed using an instrumented walkway during single- and dual-task conditions. The flanker task was used to assess EF. Results. Results from the linear mixed effects model showed that (a) dual-task interference caused a significant dual-task cost in gait speed (estimate = 35.99; 95% CI = 33.19–38.80) and (b) of the cognitive predictors, only intraindividual variability was associated with gait speed (estimate = −.606; 95% CI = −1.11 to −.10). In unadjusted analyses, the three EF measures were related to gait speed in single- and dual-task conditions. However, in fully adjusted linear regression analysis, only intraindividual variability predicted performance differences in gait speed during dual tasking (B = −.901; 95% CI = −1.557 to −.245). Conclusion. Among the three EF measures assessed, intraindividual variability but not speed of processing or conflict resolution predicted performance differences in gait speed. PMID:24285744

Effects of walking speed on asymmetry and bilateral coordination of gait

PubMed Central

Plotnik, Meir; Bartsch, Ronny P.; Zeev, Aviva; Giladi, Nir; Hausdorff, Jeffery M.

2013-01-01

The mechanisms regulating the bilateral coordination of gait in humans are largely unknown. Our objective was to study how bilateral coordination changes as a result of gait speed modifications during over ground walking. 15 young adults wore force sensitive insoles that measured vertical forces used to determine the timing of the gait cycle events under three walking conditions (i.e., usual-walking, fast and slow). Ground reaction force impact (GRFI) associated with heel-strikes was also quantified, representing the potential contribution of sensory feedback to the regulation of gait. Gait asymmetry (GA) was quantified based on the differences between right and left swing times and the bilateral coordination of gait was assessed using the phase coordination index (PCI), a metric that quantifies the consistency and accuracy of the anti-phase stepping pattern. GA was preserved in the three different gait speeds. PCI was higher (reduced coordination) in the slow gait condition, compared to usual-walking (3.51% vs. 2.47%, respectively, p=0.002), but was not significantly affected in the fast condition. GRFI values were lower in the slow walking as compared to usual-walking and higher in the fast walking condition (p<0.001). Stepwise regression revealed that slowed gait related changes in PCI were not associated with the slowed gait related changes in GRFI. The present findings suggest that left-right anti-phase stepping is similar in normal and fast walking, but altered during slowed walking. This behavior might reflect a relative increase in attention resources required to regulate a slow gait speed, consistent with the possibility that cortical function and supraspinal input influences the bilateral coordination of gait. PMID:23680424

Immediate effects of a single session of robot-assisted gait training using Hybrid Assistive Limb (HAL) for cerebral palsy

PubMed Central

Matsuda, Mayumi; Mataki, Yuki; Mutsuzaki, Hirotaka; Yoshikawa, Kenichi; Takahashi, Kazushi; Enomoto, Keiko; Sano, Kumiko; Mizukami, Masafumi; Tomita, Kazuhide; Ohguro, Haruka; Iwasaki, Nobuaki

2018-01-01

[Purpose] Robot-assisted gait training (RAGT) using Hybrid Assistive Limb (HAL, CYBERDYNE) was previously reported beneficial for stroke and spinal cord injury patients. Here, we investigate the immediate effect of a single session of RAGT using HAL on gait function for cerebral palsy (CP) patients. [Subjects and Methods] Twelve patients (average age: 16.2 ± 7.3 years) with CP received a single session of RAGT using HAL. Gait speed, step length, cadence, single-leg support per gait cycle, hip and knee joint angle in stance, and swing phase per gait cycle were assessed before, during, and immediately after HAL intervention. [Results] Compared to baseline values, single-leg support per gait cycle (64.5 ± 15.8% to 69.3 ± 12.1%), hip extension angle in mid-stance (149.2 ± 19.0° to 155.5 ± 20.1°), and knee extension angle in mid-stance (137.6 ± 20.2° to 143.1 ± 19.5°) were significantly increased immediately after intervention. Further, the knee flexion angle in mid-swing was significantly decreased immediately after treatment (112.0 ± 15.5° to 105.2 ± 17.1°). Hip flexion angle in mid-swing also decreased following intervention (137.2 ± 14.6° to 129.7 ± 16.6°), but not significantly. Conversely, gait speed, step length, and cadence were unchanged after intervention. [Conclusion] A single-time RAGT with HAL improved single-leg support per gait cycle and hip and knee joint angle during gait, therapeutically improving gait function in CP patients. PMID:29545679

Gait consistency over a 7-day interval in people with Parkinson's disease.

PubMed

Urquhart, D M; Morris, M E; Iansek, R

1999-06-01

To evaluate the consistency of temporal and spatial parameters of the walking pattern in subjects with idiopathic Parkinson's disease (PD) over a 7-day interval during the "on" phase of the levodopa medication cycle. Walking patterns were measured on a 12-meter walkway at the Kingston Gait Laboratory, Cheltenham, using a computerized stride analyzer. Sixteen subjects (7 women, 9 men) with PD recruited from the Movement Disorders Clinic at Kingston Centre. Speed of walking, stride length, cadence, and the percentage of the walking cycle spent in the double limb support phase of gait were measured, together with the level of disability as indexed by the modified Webster scale. Product-moment correlation coefficients and intraclass correlation coefficients (ICC 2,1) for repeat measures over a 7-day interval were high for speed (r = .90; ICC = .93), cadence (r = .90; ICC = .86), and stride length (r = 1.00; ICC = .97) and moderate for double limb support duration after removal of outliers (r = .75; ICC = .73); 95% confidence intervals for the change scores were within clinically acceptable limits for all variables. The mean modified Webster score was 11.4 on the first day and 10.1 7 days later. The gait pattern and level of disability in subjects with PD without severe motor fluctuations remained stable over a 1-week period when optimal medication prevailed.

Intraindividual variability in executive functions but not speed of processing or conflict resolution predicts performance differences in gait speed in older adults.

PubMed

Holtzer, Roee; Mahoney, Jeannette; Verghese, Joe

2014-08-01

The relationship between executive functions (EF) and gait speed is well established. However, with the exception of dual tasking, the key components of EF that predict differences in gait performance have not been determined. Therefore, the current study was designed to determine whether processing speed, conflict resolution, and intraindividual variability in EF predicted variance in gait performance in single- and dual-task conditions. Participants were 234 nondemented older adults (mean age 76.48 years; 55% women) enrolled in a community-based cohort study. Gait speed was assessed using an instrumented walkway during single- and dual-task conditions. The flanker task was used to assess EF. Results from the linear mixed effects model showed that (a) dual-task interference caused a significant dual-task cost in gait speed (estimate = 35.99; 95% CI = 33.19-38.80) and (b) of the cognitive predictors, only intraindividual variability was associated with gait speed (estimate = -.606; 95% CI = -1.11 to -.10). In unadjusted analyses, the three EF measures were related to gait speed in single- and dual-task conditions. However, in fully adjusted linear regression analysis, only intraindividual variability predicted performance differences in gait speed during dual tasking (B = -.901; 95% CI = -1.557 to -.245). Among the three EF measures assessed, intraindividual variability but not speed of processing or conflict resolution predicted performance differences in gait speed. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Improving Sensitivity to Detect Mild Cognitive Impairment: Cognitive Load Dual-Task Gait Speed Assessment.

PubMed

MacAulay, Rebecca K; Wagner, Mark T; Szeles, Dana; Milano, Nicholas J

2017-07-01

Longitudinal research indicates that cognitive load dual-task gait assessment is predictive of cognitive decline and thus might provide a sensitive measure to screen for mild cognitive impairment (MCI). However, research among older adults being clinically evaluated for cognitive concerns, a defining feature of MCI, is lacking. The present study investigated the effect of performing a cognitive task on normal walking speed in patients presenting to a memory clinic with cognitive complaints. Sixty-one patients with a mean age of 68 years underwent comprehensive neuropsychological testing, clinical interview, and gait speed (simple- and dual-task conditions) assessments. Thirty-four of the 61 patients met criteria for MCI. Repeated measure analyses of covariance revealed that greater age and MCI both significantly associated with slower gait speed, ps<.05. Follow-up analysis indicated that the MCI group had significantly slower dual-task gait speed but did not differ in simple-gait speed. Multivariate linear regression across groups found that executive attention performance accounted for 27.4% of the variance in dual-task gait speed beyond relevant demographic and health risk factors. The present study increases the external validity of dual-task gait assessment of MCI. Differences in dual-task gait speed appears to be largely attributable to executive attention processes. These findings have clinical implications as they demonstrate expected patterns of gait-brain behavior relationships in response to a cognitive dual task within a clinically representative population. Cognitive load dual-task gait assessment may provide a cost efficient and sensitive measure to detect older adults at high risk of a dementia disorder. (JINS, 2017, 23, 493-501).

Callosal hyperintensities and gait speed gain from two types of mobility interventions in older adults.

PubMed

Nadkarni, Neelesh K; Perera, Subashan; Studenski, Stephanie A; Rosano, Caterina; Aizenstein, Howard J; VanSwearingen, Jessie M

2015-06-01

To assess whether the volume of callosal hyperintensities in the genu and splenium of older adults with mobility impairment is differentially associated with the degree of gain in gait speed after 2 types of gait interventions. Single-blind randomized controlled trial of 2 types of gait exercises in older adults. Research center in an academic institution. Ambulatory adults (N=44) aged ≥65 years with a slow and variable gait. Twelve-week physical therapist-guided trial of a conventional walking, endurance, balance, and strength (WEBS) intervention (n=20) versus a timing and coordination of gait (TC) intervention (n=22). Gain in gait speed after the intervention and its relation to callosal hyperintensities in the genu and splenium of the corpus callosum. Gait speed improved in both the WEBS group (mean change, 0.16m/s) and the TC group (mean change, 0.21m/s; both P<.05). The volume of white matter hypertintensities (WMHs) in the genu was differentially associated with gait speed gain (group × genual WMH interaction, P=.05). Greater genual WMH volume was related to a smaller gait speed gain in the WEBS group (P=.01) but not in the TC (P=.10) group. Splenial WMH volume was not differentially associated with gait speed gain (interaction, P=.90). Callosal hyperintensities differentially influence gait speed gain by the type of gait rehabilitation. Mobility impaired older adults with genual hyperintensities may benefit from a rehabilitation program focused on motor skill learning rather than on strength and endurance training. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effect of step-synchronized vibration stimulation of soles on gait in Parkinson's disease: a pilot study

PubMed Central

Novak, Peter; Novak, Vera

2006-01-01

Background Previous studies have suggested that impaired proprioceptive processing in the striatum may contribute to abnormal gait in Parkinson's disease (PD). Methods This pilot study assessed the effects of enhanced proprioceptive feedback using step-synchronized vibration stimulation of the soles (S-VS) on gait in PD. S-VS was used in 8 PD subjects (3 women and 5 men, age range 44–79 years, on medication) and 8 age-matched healthy subjects (5 women and 3 men). PD subjects had mild or moderate gait impairment associated with abnormal balance, but they did not have gait freezing. Three vibratory devices (VDs) were embedded in elastic insoles (one below the heel and two below the forefoot areas) inserted into the shoes. Each VD operates independently and has a pressure switch that activates the underlying vibratory actuator. The VD delivered the 70-Hz suprathreshold vibration pulse upon touch by the heel or forefoot, and the vibration pulse was deactivated upon respective push-offs. Six-minute hallway walking was studied with and without S-VS. Gait characteristics were measured using the force-sensitive foot switches. The primary outcome was the stride variability expressed as a coefficient of variation (CV), a measure of gait steadiness. Secondary outcome measures were walking distance and speed, stride length and duration, cadence, stance, swing and double support duration, and respective CVs (if applicable). Results The walking speed (p < 0.04) and the CV of the stride interval (p < 0.02) differed between the groups and S-VS conditions. In the PD group, S-VS decreased stride variability (p < 0.002), increased walking speed (p < 0.0001), stride duration (p < 0.01), stride length (p < 0.0002), and cadence (p < 0.03). In the control group, S-VS decreased stride variability (p < 0.006) and increased gait speed (p < 0.03), but other locomotion parameters were not significantly altered. Conclusion Augmented sensory feedback improves parkinsonian gait steadiness in

Effect of step-synchronized vibration stimulation of soles on gait in Parkinson's disease: a pilot study.

PubMed

Novak, Peter; Novak, Vera

2006-05-04

Previous studies have suggested that impaired proprioceptive processing in the striatum may contribute to abnormal gait in Parkinson's disease (PD). This pilot study assessed the effects of enhanced proprioceptive feedback using step-synchronized vibration stimulation of the soles (S-VS) on gait in PD. S-VS was used in 8 PD subjects (3 women and 5 men, age range 44-79 years, on medication) and 8 age-matched healthy subjects (5 women and 3 men). PD subjects had mild or moderate gait impairment associated with abnormal balance, but they did not have gait freezing. Three vibratory devices (VDs) were embedded in elastic insoles (one below the heel and two below the forefoot areas) inserted into the shoes. Each VD operates independently and has a pressure switch that activates the underlying vibratory actuator. The VD delivered the 70-Hz suprathreshold vibration pulse upon touch by the heel or forefoot, and the vibration pulse was deactivated upon respective push-offs. Six-minute hallway walking was studied with and without S-VS. Gait characteristics were measured using the force-sensitive foot switches. The primary outcome was the stride variability expressed as a coefficient of variation (CV), a measure of gait steadiness. Secondary outcome measures were walking distance and speed, stride length and duration, cadence, stance, swing and double support duration, and respective CVs (if applicable). The walking speed (p < 0.04) and the CV of the stride interval (p < 0.02) differed between the groups and S-VS conditions. In the PD group, S-VS decreased stride variability (p < 0.002), increased walking speed (p < 0.0001), stride duration (p < 0.01), stride length (p < 0.0002), and cadence (p < 0.03). In the control group, S-VS decreased stride variability (p < 0.006) and increased gait speed (p < 0.03), but other locomotion parameters were not significantly altered. Augmented sensory feedback improves parkinsonian gait steadiness in the short-term setting. Because the

Preferred gait and walk-run transition speeds in ostriches measured using GPS-IMU sensors.

PubMed

Daley, Monica A; Channon, Anthony J; Nolan, Grant S; Hall, Jade

2016-10-15

The ostrich (Struthio camelus) is widely appreciated as a fast and agile bipedal athlete, and is a useful comparative bipedal model for human locomotion. Here, we used GPS-IMU sensors to measure naturally selected gait dynamics of ostriches roaming freely over a wide range of speeds in an open field and developed a quantitative method for distinguishing walking and running using accelerometry. We compared freely selected gait-speed distributions with previous laboratory measures of gait dynamics and energetics. We also measured the walk-run and run-walk transition speeds and compared them with those reported for humans. We found that ostriches prefer to walk remarkably slowly, with a narrow walking speed distribution consistent with minimizing cost of transport (CoT) according to a rigid-legged walking model. The dimensionless speeds of the walk-run and run-walk transitions are slower than those observed in humans. Unlike humans, ostriches transition to a run well below the mechanical limit necessitating an aerial phase, as predicted by a compass-gait walking model. When running, ostriches use a broad speed distribution, consistent with previous observations that ostriches are relatively economical runners and have a flat curve for CoT against speed. In contrast, horses exhibit U-shaped curves for CoT against speed, with a narrow speed range within each gait for minimizing CoT. Overall, the gait dynamics of ostriches moving freely over natural terrain are consistent with previous lab-based measures of locomotion. Nonetheless, ostriches, like humans, exhibit a gait-transition hysteresis that is not explained by steady-state locomotor dynamics and energetics. Further study is required to understand the dynamics of gait transitions. © 2016. Published by The Company of Biologists Ltd.

Parkinsonian gait ameliorated with a moving handrail, not with a banister.

PubMed

Rabin, Ely; Demin, Aleksandr; Pirrotta, Stefania; Chen, Jason; Patel, Hemal; Bhambri, Ankur; Noyola, Estella; Lackner, James R; DiZio, Paul; DiFrancisco-Donoghue, Joanne; Werner, William

2015-04-01

To determine whether haptic (touch and proprioception) cues from touching a moving handrail while walking can ameliorate the gait symptoms of Parkinson disease (PD), such as slowness and small stride length. Nonrandomized, controlled before-after trial. Physical therapy clinic. People with PD (n=16) and healthy age-matched control subjects (n=16) with no neurologic disorders volunteered. No participants withdrew. We compared gait using a moving handrail as a novel assistive aid (speed self-selected) versus a banister and unassisted walking. Participants with PD were tested on and off dopaminergic medication. Mean gait speed, stride length, stride duration, double-support duration, and medial-lateral excursion. With the moving handrail, participants with PD increased gait speed relative to unassisted gait by 16% (.166m/s, P=.009, d=.76; 95% confidence interval [CI], .054-.278m/s) and increased stride length by 10% (.053m, P=.022, d=.37; 95% CI, .009-.097m) without significantly changing stride or double-support duration. The banister reduced speed versus unassisted gait by 11% (-.097m/s, P=.040, d=.40; 95% CI, .002-.193m/s) and reduced stride length by 8% (.32m, P=.004, d=.26; 95% CI, .010-.054m), whereas it increased stride duration by 3% (.023s, P=.022, d=.21; 95% CI, .004-.041s) and double-support duration by 35% (.044s, P=.031, d=.58; 95% CI, .005-.083s). All medication × condition interactions were P>.05. Using haptic speed cues from the moving handrail, people with PD walked faster by spontaneously (ie, without specific instruction) increasing stride length without altering cadence; banisters slowed gait. Haptic cues from the moving handrail can be used by people with PD to engage biomechanical and neural mechanisms for interpreting tactile and proprioception changes related to gait speed to control gait better than static cues afforded by banisters. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effects of Two Years of Exercise on Gait Impairment in People with Parkinson’s Disease: The PRET-PD Randomized Trial

PubMed Central

Rafferty, Miriam R.; Prodoehl, Janey; Robichaud, Julie A.; David, Fabian J.; Poon, Cynthia; Goelz, Lisa C.; Vaillancourt, David E.; Kohrt, Wendy M.; Comella, Cynthia L.; Corcos, Daniel M.

2016-01-01

Background and Purpose This study presents a secondary analysis from the Progressive Resistance Exercise Training in Parkinson disease (PRET-PD) trial investigating the effects of progressive resistance exercise (PRE) and a PD-specific multimodal exercise program, modified Fitness Counts (mFC), on spatial, temporal, and stability-related gait impairments in people with Parkinson disease (PD). Methods Forty-eight people with PD were randomized to participate in PRE or mFC 2×/week for 24 months; 38 completed the study. Gait velocity, stride length, cadence, and double support time were measured under 4 walking conditions (off/on medication, comfortable/fast speed). Ankle strength was also measured off and on medication. Twenty-four healthy controls provided comparison data at one time point. Results At 24 months, there were no significant differences between exercise groups. Both groups improved fast gait velocity off medication, cadence in all conditions, and plantarflexion strength off/on medication. Both groups with PD had more gait measures that approximated the heathy controls at 24 months than at baseline. Plantarflexion strength was significantly associated with gait velocity and stride length in people with PD at baseline and 24 months, but changes in strength were not associated with changes in gait. Discussion and Conclusions Twenty-four months of PRE and mFC were associated with improved off medication fast gait velocity and improved cadence in all conditions, which is important because temporal gait measures can be resistant to medications. Spatial and stability-related measures were resistant to long-term improvements, but did not decline over 24 months. Strength gains did not appear to transfer to gait. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1). PMID:27977518

Influence of gait speed on stability: recovery from anterior slips and compensatory stepping.

PubMed

Bhatt, T; Wening, J D; Pai, Y-C

2005-02-01

Falls precipitated by slipping are a major health concern, with the majority of all slip-related falls occurring during gait. Recent evidence shows that a faster and/or more anteriorly positioned center of mass (COM) is more stable against backward balance loss, and that compensatory stepping is the key to recovering stability upon balance loss. The purposes of this paper were to determine whether walking speed affected gait stability for backward balance loss at slip onset and touchdown of compensatory stepping, and whether compensatory stepping response resembled the regular gait pattern. Forty-seven young subjects were slipped unexpectedly either at a self-selected fast, natural or slow speed. Speed-related differences in stability at slip onset and touchdown of the subsequent compensatory step were analyzed using the COM position-velocity state. The results indicate that gait speed highly correlated with stability against backward balance loss at slip onset. The low COM velocity of the slow group was not sufficiently compensated for by a more anteriorly positioned COM associated with a shorter step length at slip onset. At touchdown of the compensatory step, the speed-related differences in stability diminished, due to the continued advantage of anterior COM positioning from a short compensatory step retained by the slow group, coupled with an increase in COM velocity. Compensatory step length and relative COM position altered as a function of gait speed, indicating the motor program for gait regulation may play a role in modulating the compensatory step.

Physical Inactivity Predicts Slow Gait Speed in an Elderly Multi-Ethnic Cohort Study: The Northern Manhattan Study.

PubMed

Willey, Joshua Z; Moon, Yeseon P; Kulick, Erin R; Cheung, Ying Kuen; Wright, Clinton B; Sacco, Ralph L; Elkind, Mitchell S V

2017-01-01

Gait speed is associated with multiple adverse outcomes of aging. We hypothesized that physical inactivity would be prospectively inversely associated with gait speed independently of white matter hyperintensity volume and silent brain infarcts on MRI. Participants in the Northern Manhattan Study MRI sub-study had physical activity assessed when they were enrolled into the study. A mean of 5 years after the MRI, participants had gait speed measured via a timed 5-meter walk test. Physical inactivity was defined as reporting no leisure-time physical activity. Multi-variable logistic and quantile regression was performed to examine the associations between physical inactivity and future gait speed adjusted for confounders. Among 711 participants with MRI and gait speed measures (62% women, 71% Hispanic, mean age 74.1 ± 8.4), the mean gait speed was 1.02 ± 0.26 m/s. Physical inactivity was associated with a greater odds of gait speed in the lowest quartile (<0.85 m/s, adjusted OR 1.90, 95% CI 1.17-3.08), and in quantile regression with 0.06 m/s slower gait speed at the lowest 20 percentile (p = 0.005). Physical inactivity is associated with slower gait speed independently of osteoarthritis, grip strength, and subclinical ischemic brain injury. Modifying sedentary behavior poses a target for interventions aimed at reducing decline in mobility. © 2017 S. Karger AG, Basel.

The Effect of Auditory Cueing on the Spatial and Temporal Gait Coordination in Healthy Adults.

PubMed

Almarwani, Maha; Van Swearingen, Jessie M; Perera, Subashan; Sparto, Patrick J; Brach, Jennifer S

2017-12-27

Walk ratio, defined as step length divided by cadence, indicates the coordination of gait. During free walking, deviation from the preferential walk ratio may reveal abnormalities of walking patterns. The purpose of this study was to examine the impact of rhythmic auditory cueing (metronome) on the neuromotor control of gait at different walking speeds. Forty adults (mean age 26.6 ± 6.0 years) participated in the study. Gait characteristics were collected using a computerized walkway. In the preferred walking speed, there was no significant difference in walk ratio between uncued (walk ratio = .0064 ± .0007 m/steps/min) and metronome-cued walking (walk ratio = .0064 ± .0007 m/steps/min; p = .791). A higher value of walk ratio at the slower speed was observed with metronome-cued (walk ratio = .0071 ± .0008 m/steps/min) compared to uncued walking (walk ratio = .0068 ± .0007 m/steps/min; p < .001). The walk ratio was less at faster speed with metronome-cued (walk ratio = .0060 ± .0009 m/steps/min) compared to uncued walking (walk ratio = .0062 ± .0009 m/steps/min; p = .005). In healthy adults, the metronome cues may become an attentional demanding task, and thereby disrupt the spatial and temporal integration of gait at nonpreferred speeds.

A Behavioral Mechanism of How Increases in Leg Strength Improve Old Adults’ Gait Speed

PubMed Central

Uematsu, Azusa; Tsuchiya, Kazushi; Kadono, Norio; Kobayashi, Hirofumi; Kaetsu, Takamasa; Hortobágyi, Tibor; Suzuki, Shuji

2014-01-01

We examined a behavioral mechanism of how increases in leg strength improve healthy old adults’ gait speed. Leg press strength training improved maximal leg press load 40% (p = 0.001) and isometric strength in 5 group of leg muscles 32% (p = 0.001) in a randomly allocated intervention group of healthy old adults (age 74, n = 15) but not in no-exercise control group (age 74, n = 8). Gait speed increased similarly in the training (9.9%) and control (8.6%) groups (time main effect, p = 0.001). However, in the training group only, in line with the concept of biomechanical plasticity of aging gait, hip extensors and ankle plantarflexors became the only significant predictors of self-selected and maximal gait speed. The study provides the first behavioral evidence regarding a mechanism of how increases in leg strength improve healthy old adults’ gait speed. PMID:25310220

Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia

PubMed Central

2012-01-01

Background Previous studies demonstrated that stroke survivors have a limited capacity to increase their walking speeds beyond their self-selected maximum walking speed (SMWS). The purpose of this study was to determine the capacity of stroke survivors to reach faster speeds than their SMWS while walking on a treadmill belt or while being pushed by a robotic system (i.e. “push mode”). Methods Eighteen chronic stroke survivors with hemiplegia were involved in the study. We calculated their self-selected comfortable walking speed (SCWS) and SMWS overground using a 5-meter walk test (5-MWT). Then, they were exposed to walking at increased speeds, on a treadmill and while in “push mode” in an overground robotic device, the KineAssist, until they were tested at a speed that they could not sustain without losing balance. We recorded the time and number of steps during each trial and calculated gait speed, average cadence and average step length. Results Maximum walking speed in the “push mode” was 13% higher than the maximum walking speed on the treadmill and both were higher (“push mode”: 61%; treadmill: 40%) than the maximum walking speed overground. Subjects achieved these faster speeds by initially increasing both step length and cadence and, once individuals stopped increasing their step length, by only increasing cadence. Conclusions With post-stroke hemiplegia, individuals are able to walk at faster speeds than their SMWS overground, when provided with a safe environment that provides external forces that requires them to attempt dynamic stability maintenance at higher gait speeds. Therefore, this study suggests the possibility that, given the appropriate conditions, people post-stroke can be trained at higher speeds than previously attempted. PMID:23057500

Effects of Indoor Footwear on Balance and Gait Patterns in Community-Dwelling Older Women.

PubMed

Menz, Hylton B; Auhl, Maria; Munteanu, Shannon E

2017-01-01

Footwear worn indoors is generally less supportive than outdoor footwear and may increase the risk of falls. To evaluate balance ability and gait patterns in older women while wearing different styles of indoor footwear: a backless slipper and an enclosed slipper designed to optimise balance. Older women (n = 30) aged 65-83 years (mean 74.4, SD 5.6) performed a series of laboratory tests of balance ability (postural sway, limits of stability, and tandem walking, measured with the NeuroCom® Balance Master) and gait patterns (walking speed, cadence, and step length, measured with the GAITRite® walkway) while wearing (1) socks, (2) backless slippers with a soft sole, and (3) enclosed slippers with a firm sole and Velcro® fastening. Perceptions of the footwear were also documented using a structured questionnaire. Significant overall effects of footwear were observed for postural sway, the limits of stability test (directional control), the tandem walk test (step width and end sway), and temporospatial gait patterns (walking speed, cadence, and step length). No footwear effects were observed for maximum excursion when performing the limits of stability test or for speed when performing the tandem walk test. Post hoc tests indicated that performances were best while wearing the enclosed slippers, intermediate with socks, and worst with backless slippers. The enclosed slippers were perceived to be more attractive, comfortable, and well fitted, but heavier than the backless slippers. Most participants (n = 23; 77%) reported that they would consider wearing the enclosed slippers to reduce their risk of falling. Indoor footwear with an enclosed heel, Velcro® fastening, and a firm sole optimises balance and gait compared to backless slippers, and is therefore recommended to reduce the risk of falling. © 2016 The Author(s) Published by S. Karger AG, Basel.

Association between gait characteristics and endothelial oxidative stress and inflammation in patients with symptomatic peripheral artery disease.

PubMed

Gardner, Andrew W; Montgomery, Polly S; Casanegra, Ana I; Silva-Palacios, Federico; Ungvari, Zoltan; Csiszar, Anna

2016-06-01

The aim of the study was to determine whether gait characteristics were associated with endothelial cell inflammation, oxidative stress, and apoptosis and with circulating biomarkers of inflammation and antioxidant capacity in older patients with symptomatic peripheral artery disease (PAD). Gait measurements of 231 symptomatic men and women with PAD were assessed during a 4-m walk test. Patients were further characterized on endothelial effects of circulating factors present in the sera using a cell culture-based bioassay on primary human arterial endothelial cells and on circulating inflammatory and vascular biomarkers. In a multivariate regression model for gait speed, the significant independent variables were age (p < 0.001), intercellular cell adhesion molecule-1 (ICAM-1) (p < 0.001), diabetes (p = 0.003), sex (p = 0.003), and history of cerebrovascular accidents (p = 0.021). In multivariate analyses for gait cadence, the significant independent predictors included high-sensitivity C-reactive protein (HsCRP) (p < 0.001), diabetes (p = 0.001), and hypertension (p = 0.001). In a multivariate regression model for gait stride length, the significant independent variables were HsCRP (p < 0.001), age (p < 0.001), ICAM-1 (p < 0.001), hypertension (p = 0.002), cellular reactive oxygen species production (p = 0.007), and sex (p = 0.008). Higher levels of circulating biomarkers of inflammation and endothelial cell oxidative stress were associated with slower gait speed, slower cadence, and shorter stride length in older symptomatic patients with PAD. Additionally, this profile of impaired gait was more evident in older patients, in women, and in those with diabetes, hypertension, and history of cerebrovascular accidents.

Increased Anterior Pelvic Angle Characterizes the Gait of Children with Attention Deficit/Hyperactivity Disorder (ADHD).

PubMed

Naruse, Hiroaki; Fujisawa, Takashi X; Yatsuga, Chiho; Kubota, Masafumi; Matsuo, Hideaki; Takiguchi, Shinichiro; Shimada, Seiichiro; Imai, Yuto; Hiratani, Michio; Kosaka, Hirotaka; Tomoda, Akemi

2017-01-01

Children with attention deficit/hyperactivity disorder (ADHD) frequently have motor problems. Previous studies have reported that the characteristic gait in children with ADHD is immature and that subjects demonstrate higher levels of variability in gait characteristics for the lower extremities than healthy controls. However, little is known about body movement during gait in children with ADHD. The purpose of this study was to identify the characteristic body movements associated with ADHD symptoms in children with ADHD. Using a three-dimensional motion analysis system, we compared gait variables in boys with ADHD (n = 19; mean age, 9.58 years) and boys with typical development (TD) (n = 21; mean age, 10.71 years) to determine the specific gait characteristics related to ADHD symptoms. We assessed spatiotemporal gait variables (i.e. speed, stride length, and cadence), and kinematic gait variables (i.e. angle of pelvis, hip, knee, and ankle) to measure body movement when walking at a self-selected pace. In comparison with the TD group, the ADHD group demonstrated significantly higher values in cadence (t = 3.33, p = 0.002) and anterior pelvic angle (t = 3.08, p = 0.004). In multiple regression analysis, anterior pelvic angle was associated with the ADHD rating scale hyperactive/impulsive scores (β = 0.62, t = 2.58, p = 0.025), but not other psychiatric symptoms in the ADHD group. Our results suggest that anterior pelvic angle represents a specific gait variable related to ADHD symptoms. Our kinematic findings could have potential implications for evaluating the body movement in boys with ADHD.

Overground body-weight-supported gait training for children and youth with neuromuscular impairments.

PubMed

Kurz, Max J; Stuberg, Wayne; Dejong, Stacey; Arpin, David J

2013-08-01

The aim of this investigation was to determine if body-weight-supported (BWS) overground gait training has the potential to improve the walking abilities of children and youth with childhood onset motor impairments and intellectual disabilities. Eight participants (mean age of 16.3 years) completed 12 weeks of BWS overground gait training that was performed two times a week. BWS was provided during the training sessions by an overhead harness system that rolls overground. There was a significant improvement in the preferred walking speed after the training (p < .01; pre = 0.51 ± 0.2 m/s; post = 0.67 ± 0.3 m/s; Cohen's d = 0.80) and cadence (p = .04; pre = 37 ± 7 steps/min; post = 43 ± 8 steps/min; Cohen's d = 0.94). Our results indicate that overground BWS gait training may be an effective treatment strategy for improving the preferred walking speed of children and youth with motor impairments.

Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis

PubMed Central

Bodkin, Amy Winter; Bjornson, Kristie; Hobbs, Amy; Soileau, Mallary; Lahasky, Kay

2016-01-01

Background Children with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear. Purpose The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP. Data Sources MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014. Study Selection The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure. Data Extraction Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded. Data Synthesis Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=−0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category. Limitations Gait speed was the only outcome measure analyzed. Conclusions Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in

Gray matter volume covariance patterns associated with gait speed in older adults: a multi-cohort MRI study.

PubMed

Blumen, Helena M; Brown, Lucy L; Habeck, Christian; Allali, Gilles; Ayers, Emmeline; Beauchet, Olivier; Callisaya, Michele; Lipton, Richard B; Mathuranath, P S; Phan, Thanh G; Pradeep Kumar, V G; Srikanth, Velandai; Verghese, Joe

2018-04-09

Accelerated gait decline in aging is associated with many adverse outcomes, including an increased risk for falls, cognitive decline, and dementia. Yet, the brain structures associated with gait speed, and how they relate to specific cognitive domains, are not well-understood. We examined structural brain correlates of gait speed, and how they relate to processing speed, executive function, and episodic memory in three non-demented and community-dwelling older adult cohorts (Overall N = 352), using voxel-based morphometry and multivariate covariance-based statistics. In all three cohorts, we identified gray matter volume covariance patterns associated with gait speed that included brain stem, precuneus, fusiform, motor, supplementary motor, and prefrontal (particularly ventrolateral prefrontal) cortex regions. Greater expression of these gray matter volume covariance patterns linked to gait speed were associated with better processing speed in all three cohorts, and with better executive function in one cohort. These gray matter covariance patterns linked to gait speed were not associated with episodic memory in any of the cohorts. These findings suggest that gait speed, processing speed (and to some extent executive functions) rely on shared neural systems that are subject to age-related and dementia-related change. The implications of these findings are discussed within the context of the development of interventions to compensate for age-related gait and cognitive decline.

The effect of three different types of walking aids on spatio-temporal gait parameters in community-dwelling older adults.

PubMed

Härdi, Irene; Bridenbaugh, Stephanie A; Gschwind, Yves J; Kressig, Reto W

2014-04-01

Gait and balance impairments lead to falls and injuries in older people. Walking aids are meant to increase gait safety and prevent falls, yet little is known about how their use alters gait parameters. This study aimed to quantify gait in older adults during walking without and with different walking aids and to compare gait parameters to matched controls. This retrospective study included 65 older (≥60 years) community dwellers who used a cane, crutch or walker and 195 independently mobile-matched controls. Spatio-temporal gait parameters were measured with an electronic walkway system during normal walking. When walking unaided or aided, walking aid users had significantly worse gait than matched controls. Significant differences between the walking aid groups were found for stride time variability (cane vs. walker) in walking unaided only. Gait performances significantly improved when assessed with vs. without the walking aid for the cane (increased stride time and length, decreased cadence and stride length variability), crutch (increased stride time and length, decreased cadence, stride length variability and double support) and walker (increased gait speed and stride length, decreased base of support and double support) users. Gait in older adults who use a walking aid is more irregular and unstable than gait in independently mobile older adults. Walking aid users have better gait when using their walking aid than when walking without it. The changes in gait were different for the different types of walking aids used. These study results may help better understand gait in older adults and differentiate between pathological gait changes and compensatory gait changes due to the use of a walking aid.

Quantitative Gait Markers and Incident Fall Risk in Older Adults

PubMed Central

Holtzer, Roee; Lipton, Richard B.; Wang, Cuiling

2009-01-01

Background Identifying quantitative gait markers of falls in older adults may improve diagnostic assessments and suggest novel intervention targets. Methods We studied 597 adults aged 70 and older (mean age 80.5 years, 62% women) enrolled in an aging study who received quantitative gait assessments at baseline. Association of speed and six other gait markers (cadence, stride length, swing, double support, stride length variability, and swing time variability) with incident fall rate was studied using generalized estimation equation procedures adjusted for age, sex, education, falls, chronic illnesses, medications, cognition, disability as well as traditional clinical tests of gait and balance. Results Over a mean follow-up period of 20 months, 226 (38%) of the 597 participants fell. Mean fall rate was 0.44 per person-year. Slower gait speed (risk ratio [RR] per 10 cm/s decrease 1.069, 95% confidence interval [CI] 1.001–1.142) was associated with higher risk of falls in the fully adjusted models. Among six other markers, worse performance on swing (RR 1.406, 95% CI 1.027–1.926), double-support phase (RR 1.165, 95% CI 1.026–1.321), swing time variability (RR 1.007, 95% CI 1.004–1.010), and stride length variability (RR 1.076, 95% CI 1.030–1.111) predicted fall risk. The associations remained significant even after accounting for cognitive impairment and disability. Conclusions Quantitative gait markers are independent predictors of falls in older adults. Gait speed and other markers, especially variability, should be further studied to improve current fall risk assessments and to develop new interventions. PMID:19349593

Kinematics gait disorder in men with fibromyalgia.

PubMed

Heredia-Jimenez, Jose M; Soto-Hermoso, Victor M

2014-01-01

The aim of this study was to assess the kinematics disorder of gait in men with fibromyalgia. We studied 12 male with fibromyalgia and 14 healthy men. Each participant of the study walked five trials along a 18.6-m walkway. Fibromyalgia patients completed a Spanish version of Fibromyalgia Impact Questionnaire. Significant differences between fibromyalgia and control groups were found in velocity, stride length, and cadence. Gait parameters of men affected by fibromyalgia were impaired when compared to those of healthy group due to bradykinesia. According to previous studies to assess gait variables in female patients, the male with fibromyalgia also showed lower values of velocity, cadence, and stride length than healthy group but not reported significant differences in swing, stance, single, or double support phase.

A Wearable Magneto-Inertial System for Gait Analysis (H-Gait): Validation on Normal Weight and Overweight/Obese Young Healthy Adults

PubMed Central

Gastaldi, Laura; Rosso, Valeria; Knaflitz, Marco; Tadano, Shigeru

2017-01-01

Background: Wearable magneto-inertial sensors are being increasingly used to obtain human motion measurements out of the lab, although their performance in applications requiring high accuracy, such as gait analysis, are still a subject of debate. The aim of this work was to validate a gait analysis system (H-Gait) based on magneto-inertial sensors, both in normal weight (NW) and overweight/obese (OW) subjects. The validation is performed against a reference multichannel recording system (STEP32), providing direct measurements of gait timings (through foot-switches) and joint angles in the sagittal plane (through electrogoniometers). Methods: Twenty-two young male subjects were recruited for the study (12 NW, 10 OW). After positioning body-fixed sensors of both systems, each subject was asked to walk, at a self-selected speed, over a 14-m straight path for 12 trials. Gait signals were recorded, at the same time, with the two systems. Spatio-temporal parameters, ankle, knee, and hip joint kinematics were extracted analyzing an average of 89 ± 13 gait cycles from each lower limb. Intraclass correlation coefficient and Bland-Altmann plots were used to compare H-Gait and STEP32 measurements. Changes in gait parameters and joint kinematics of OW with respect NW were also evaluated. Results: The two systems were highly consistent for cadence, while a lower agreement was found for the other spatio-temporal parameters. Ankle and knee joint kinematics is overall comparable. Joint ROMs values were slightly lower for H-Gait with respect to STEP32 for the ankle (by 1.9° for NW, and 1.6° for OW) and for the knee (by 4.1° for NW, and 1.8° for OW). More evident differences were found for hip joint, with ROMs values higher for H-Gait (by 6.8° for NW, and 9.5° for OW). NW and OW showed significant differences considering STEP32 (p = 0.0004), but not H-Gait (p = 0.06). In particular, overweight/obese subjects showed a higher cadence (55.0 vs. 52.3 strides/min) and a lower hip

The Effect of Cognitive-Task Type and Walking Speed on Dual-Task Gait in Healthy Adults.

PubMed

Wrightson, James G; Ross, Emma Z; Smeeton, Nicholas J

2016-01-01

In a number of studies in which a dual-task gait paradigm was used, researchers reported a relationship between cognitive function and gait. However, it is not clear to what extent these effects are dependent on the type of cognitive and walking tasks used in the dual-task paradigm. This study examined whether stride-time variability (STV) and trunk range of motion (RoM) are affected by the type of cognitive task and walking speed used during dual-task gait. Participants walked at both their preferred walking speed and at 25% of their preferred walking speed and performed a serial subtraction and a working memory task at both speeds. Although both tasks significantly reduced STV at both walking speeds, there was no difference between the two tasks. Trunk RoM was affected by the walking speed and type of cognitive task used during dual-task gait: Mediolateral trunk RoM was increased at the slow walking speed, and anterior-posterior trunk RoM was higher only when performing the serial subtraction task at the slow walking speed. The reduction of STV, regardless of cognitive-task type, suggests that healthy adults may redirect cognitive processes away from gait toward cognitive-task performance during dual-task gait.

Physiotherapy Effects in Gait Speed in Patients with Knee Osteoarthritis.

PubMed

Tani, Klejda; Kola, Irena; Dhamaj, Fregen; Shpata, Vjollca; Zallari, Kiri

2018-03-15

Knee osteoarthritis is a chronic degenerative disease, known as the most common cause of difficulty walking in older adults and subsequently is associated with slow walking. Also one of the main symptoms is a degenerative and mechanics type of pain. Pain is very noticeable while walking in rugged terrain, during ascent and descent of stairs, when changing from sitting to standing position as well as staying in one position for a long time. Many studies have shown that the strength of the quadriceps femoris muscle can affect gait, by improving or weakening it. Kinesio Tape is a physiotherapeutic technique, which reduces pain and increases muscular strength by irritating the skin receptors. The aims of this study was first to verify if the application of Kinesio Tape on quadriceps femoris muscle increases gait speed in patients with knee osteoarthritis and secondly if applying Kinesio Tape on quadriceps femoris muscle reduces pain while walking. Seventy-four patients with primary knee osteoarthritis, aged 50 - 73 years, participated in this study. Firstly we observed the change of gait speed, while walking for 10 meters at normal speed for each patient, before, one day and three days after the application of Kinesio Tape on quadriceps femoris muscle, with the help of the 10 - meter walk test. Secondly, we observed the change of pain, while walking for 10 meters at normal speed for each patient, before, one day and three days after the application, with the help of Numerical Pain Rating Scale - NRS. Our results indicated that there was a significant increase in gait speed while walking for 10 meters one day and also three days after application of Kinesio Tape on quadriceps femoris muscle. Also, there was a significant reduction of pain level 1 and 3 days after application of Kinesio Tape, compared to the level of pain before its application. Our results indicated that there was a significant decrease in pain and increase of gait speed while walking for 10 meters

Balance and gait in children with dyslexia.

PubMed

Moe-Nilssen, Rolf; Helbostad, Jorunn L; Talcott, Joel B; Toennessen, Finn Egil

2003-05-01

Tests of postural stability have provided some evidence of a link between deficits in gross motor skills and developmental dyslexia. The ordinal-level scales used previously, however, have limited measurement sensitivity, and no studies have investigated motor performance during walking in participants with dyslexia. The purpose of this study was to investigate if continuous-scaled measures of standing balance and gait could discriminate between groups of impaired and normal readers when investigators were blind to group membership during testing. Children with dyslexia ( n=22) and controls ( n=18), aged 10-12 years, performed walking tests at four different speeds (slow-preferred-fast-very fast) on an even and an uneven surface, and tests of unperturbed and perturbed body sway during standing. Body movements were registered by a triaxial accelerometer over the lower trunk, and measures of reaction time, body sway, walking speed, step length and cadence were calculated. Results were controlled for gender differences. Tests of standing balance with eyes closed did not discriminate between groups. All unperturbed standing tests with eyes open showed significant group differences ( P<0.05) and classified correctly 70-77.5% of the subjects into their respective groups. Mean walking speed during very fast walking on both flat and uneven surface was > or =0.2 m/s ( P< or =0.01) faster for controls than for the group with dyslexia. This test classified 77.5% and 85% of the subjects correctly on flat and uneven surface, respectively. Cadence at preferred or very fast speed did not differ statistically between groups, but revealed significant group differences when all subjects were compared at a normalised walking speed ( P< or =0.04). Very fast walking speed as well as cadence at a normalised speed discriminated better between groups when subjects were walking on an uneven surface compared to a flat floor. Continuous-scaled walking tests performed in field settings may be

Spontaneous Entrainment of Running Cadence to Music Tempo.

PubMed

Van Dyck, Edith; Moens, Bart; Buhmann, Jeska; Demey, Michiel; Coorevits, Esther; Dalla Bella, Simone; Leman, Marc

beneficial in the prevention and treatment of common running-related injuries, this finding could be especially relevant for treatment purposes, such as exercise prescription and gait retraining. Music tempo can spontaneously impact running cadence.A basin for unsolicited entrainment of running cadence to music tempo was discovered.The effect of music tempo on running cadence proves to be stronger for women than for men.

Walking smoothness is associated with self-reported function after accounting for gait speed.

PubMed

Lowry, Kristin A; Vanswearingen, Jessie M; Perera, Subashan; Studenski, Stephanie A; Brach, Jennifer S

2013-10-01

Gait speed has shown to be an indicator of functional status in older adults; however, there may be aspects of physical function not represented by speed but by the quality of movement. The purpose of this study was to determine the relations between walking smoothness, an indicator of the quality of movement based on trunk accelerations, and physical function. Thirty older adults (mean age, 77.7±5.1 years) participated. Usual gait speed was measured using an instrumented walkway. Walking smoothness was quantified by harmonic ratios derived from anteroposterior, vertical, and mediolateral trunk accelerations recorded during overground walking. Self-reported physical function was recorded using the function subscales of the Late-Life Function and Disability Instrument. Anteroposterior smoothness was positively associated with all function components of the Late-Life Function and Disability Instrument, whereas mediolateral smoothness exhibited negative associations. Adjusting for gait speed, anteroposterior smoothness remained associated with the overall and lower extremity function subscales, whereas mediolateral smoothness remained associated with only the advanced lower extremity subscale. These findings indicate that walking smoothness, particularly the smoothness of forward progression, represents aspects of the motor control of walking important for physical function not represented by gait speed alone.

[Gait characteristics of women with fibromyalgia: a premature aging pattern].

PubMed

Góes, Suelen M; Leite, Neiva; de Souza, Ricardo M; Homann, Diogo; Osiecki, Ana C V; Stefanello, Joice M F; Rodacki, André L F

2014-01-01

Fibromyalgia is a condition which involves chronic pain. Middle-aged individuals with fibromyalgia seem to exhibit changes in gait pattern, which may prematurely expose them to a gait pattern which resembles that found in the elderly population. To determine the 3D spatial (linear and angular) gait parameters of middle-aged women with fibromyalgia and compare to elderly women without this condition. 25 women (10 in the fibromyalgia group and 15 in the elderly group) volunteered to participate in the study. Kinematics was performed using an optoelectronic system, and linear and angular kinematic variables were determined. There was no difference in walking speed, stride length, cadence, hip, knee and ankle joints range of motion between groups, except the pelvic rotation, in which the fibromyalgia group showed greater rotation (P<0.05) compared to the elderly group. Also, there was a negative correlation with pelvic rotation and gluteus pain (r = -0.69; P<0.05), and between pelvic obliquity and greater trochanter pain (r = -0.69; P<0.05) in the fibromyalgia group. Middle-aged women with fibromyalgia showed gait pattern resemblances to elderly, women, which is characterized by reduced lower limb ROM, stride length and walking speed. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

RISK FACTORS FOR SLOW GAIT SPEED: A NESTED CASE-CONTROL SECONDARY ANALYSIS OF THE MEXICAN HEALTH AND AGING STUDY.

PubMed

Pérez-Zepeda, M U; González-Chavero, J G; Salinas-Martinez, R; Gutiérrez-Robledo, L M

2015-01-01

Physical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described. To determine risk factors associated with slowness in Mexican older adults. A two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested, cohort case-control study. One representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up). A 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed. In the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed. Early identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline.

RISK FACTORS FOR SLOW GAIT SPEED: A NESTED CASE-CONTROL SECONDARY ANALYSIS OF THE MEXICAN HEALTH AND AGING STUDY

PubMed Central

Pérez-Zepeda, M.U.; González-Chavero, J.G.; Salinas-Martinez, R.; Gutiérrez-Robledo, L.M.

2016-01-01

Background Physical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described. Objectives To determine risk factors associated with slowness in Mexican older adults. Design A two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested, cohort case-control study. Setting, participants One representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up). Measurements A 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed. Results In the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed. Conclusions Early identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline. PMID:26889463

Differential effects of absent visual feedback control on gait variability during different locomotion speeds.

PubMed

Wuehr, M; Schniepp, R; Pradhan, C; Ilmberger, J; Strupp, M; Brandt, T; Jahn, K

2013-01-01

Healthy persons exhibit relatively small temporal and spatial gait variability when walking unimpeded. In contrast, patients with a sensory deficit (e.g., polyneuropathy) show an increased gait variability that depends on speed and is associated with an increased fall risk. The purpose of this study was to investigate the role of vision in gait stabilization by determining the effects of withdrawing visual information (eyes closed) on gait variability at different locomotion speeds. Ten healthy subjects (32.2 ± 7.9 years, 5 women) walked on a treadmill for 5-min periods at their preferred walking speed and at 20, 40, 70, and 80 % of maximal walking speed during the conditions of walking with eyes open (EO) and with eyes closed (EC). The coefficient of variation (CV) and fractal dimension (α) of the fluctuations in stride time, stride length, and base width were computed and analyzed. Withdrawing visual information increased the base width CV for all walking velocities (p < 0.001). The effects of absent visual information on CV and α of stride time and stride length were most pronounced during slow locomotion (p < 0.001) and declined during fast walking speeds. The results indicate that visual feedback control is used to stabilize the medio-lateral (i.e., base width) gait parameters at all speed sections. In contrast, sensory feedback control in the fore-aft direction (i.e., stride time and stride length) depends on speed. Sensory feedback contributes most to fore-aft gait stabilization during slow locomotion, whereas passive biomechanical mechanisms and an automated central pattern generation appear to control fast locomotion.

The influence of the Re-Link Trainer on gait symmetry in healthy adults.

PubMed

Ward, Sarah; Wiedemann, Lukas; Stinear, Cathy; Stinear, James; McDaid, Andrew

2017-07-01

Walking function post-stroke is characterized by asymmetries in gait cycle parameters and joint kinematics. The Re-Link Trainer is designed to provide kinematic constraint to the paretic lower limb, to guide a physiologically normal and symmetrical gait pattern. The purpose of this pilot study was to assess the immediate influence of the Re-Link Trainer on measures of gait symmetry in healthy adults. Participants demonstrated a significantly lower cadence and a 62% reduction in walking speed in the Re-Link Trainer compared to normal walking. The step length ratio had a significant increase from 1.0 during normal walking to 2.5 when walking in the Re-Link Trainer. The results from this pilot study suggest in its current iteration the Re-Link Trainer imposes an asymmetrical constraint on lower limb kinematics.

Combining Gait Speed and Recall Memory to Predict Survival in Late Life: Population-Based Study

PubMed Central

Marengoni, Alessandra; Bandinelli, Stefania; Maietti, Elisa; Guralnik, Jack; Zuliani, Giovanni; Ferrucci, Luigi; Volpato, Stefano

2017-01-01

OBJECTIVES To evaluate the relationship between gait speed, recall memory, and mortality. DESIGN A cohort study (last follow-up December 2009). SETTING Tuscany, Italy. PARTICIPANTS Individual data from 1,014 community-dwelling older adults aged 60 years or older with baseline gait speed and recall memory measurements and follow-up for a median time of 9.10 (IQR 7.1;9.3) years. Participants were a mean (SD) age of 73.9 (7.3) years, and 55.8% women. Participants walking faster than 0.8 m/s were defined as fast walkers; good recall memory was defined as a score of 2 or 3 in the 3-word delayed recall section of the Mini-Mental State Examination. MEASUREMENTS All-cause mortality. RESULTS There were 302 deaths and the overall 100 person-year death rate was 3.77 (95% CI: 3.37–4.22). Both low gait speed and poor recall memory were associated with mortality when analysed separately (HR = 2.47; 95% CI: 1.87–3.27 and HR = 1.47; 95% CI: 1.16–1.87, respectively). When we grouped participants according to both recall and gait speed, death rates (100 person-years) progressively increased from those with both good gait speed and memory (2.0; 95% CI: 1.6–2.5), to those with fast walk but poor memory (3.4; 95% CI: 2.8–4.2), to those with slow walk and good memory (8.8; 95% CI: 6.4–12.1), to those with both slow walk and poor memory (13.0; 95% CI: 10.6–16.1). In multivariate analysis, poor memory significantly increases mortality risk among persons with fast gait speed (HR = 1.40; 95% CI: 1.04–1.89). CONCLUSION In older persons, gait speed and recall memory are independent predictors of expected survival. Information on memory function might better stratify mortality risk among persons with fast gait speed. PMID:28029688

Combining Gait Speed and Recall Memory to Predict Survival in Late Life: Population-Based Study.

PubMed

Marengoni, Alessandra; Bandinelli, Stefania; Maietti, Elisa; Guralnik, Jack; Zuliani, Giovanni; Ferrucci, Luigi; Volpato, Stefano

2017-03-01

To evaluate the relationship between gait speed, recall memory, and mortality. A cohort study (last follow-up December 2009). Tuscany, Italy. Individual data from 1,014 community-dwelling older adults aged 60 years or older with baseline gait speed and recall memory measurements and follow-up for a median time of 9.10 (IQR 7.1;9.3) years. Participants were a mean (SD) age of 73.9 (7.3) years, and 55.8% women. Participants walking faster than 0.8 m/s were defined as fast walkers; good recall memory was defined as a score of 2 or 3 in the 3-word delayed recall section of the Mini-Mental State Examination. All-cause mortality. There were 302 deaths and the overall 100 person-year death rate was 3.77 (95% CI: 3.37-4.22). Both low gait speed and poor recall memory were associated with mortality when analysed separately (HR = 2.47; 95% CI: 1.87-3.27 and HR = 1.47; 95% CI: 1.16-1.87, respectively). When we grouped participants according to both recall and gait speed, death rates (100 person-years) progressively increased from those with both good gait speed and memory (2.0; 95% CI: 1.6-2.5), to those with fast walk but poor memory (3.4; 95% CI: 2.8-4.2), to those with slow walk and good memory (8.8; 95% CI: 6.4-12.1), to those with both slow walk and poor memory (13.0; 95% CI: 10.6-16.1). In multivariate analysis, poor memory significantly increases mortality risk among persons with fast gait speed (HR = 1.40; 95% CI: 1.04-1.89). In older persons, gait speed and recall memory are independent predictors of expected survival. Information on memory function might better stratify mortality risk among persons with fast gait speed. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

[Gait speed and the appearance of neurocognitive disorders in older adults: Results of a Peruvian cohort].

PubMed

Parodi, José F; Nieto-Gutierrez, Wendy; Tellez, Walter A; Ventocilla-Gonzales, Iris; Runzer-Colmenares, Fernando M; Taype-Rondan, Alvaro

The prevention and management of neurocognitive disorders (NCD) among older adults can be improved by early identification of risk factors such as walking speed. The objective of the study is to assess the association between gait speed and NCD onset in a population of Peruvian older adults. Cohort conducted in older adults who attended the geriatrics service of Naval Medical Center (Callao, Peru). During the baseline assessment, participants' gait speed was recorded. Subsequently, participants were followed-up annually for 5 years, with a mean of 21 months. NCD onset was defined as the occurrence of a score ≤24 points on the Mini Mental State Examination (screening test) during follow-up. The hazard ratios (HR) and their 95% confidence intervals (95% CI) were calculated using Cox regression. The study included 657 participants, with a mean age of 73.4±9.2 (SD) years, of whom 47.0% were male, 47.8% had a gait speed <0.8 m/s, and 20.1% developed NCD during the follow up. It was found that older adults who had gait speed <0.8 m/s at baseline were more likely to develop NCD than those who had a gait speed ≥0.8 m/s (adjusted HR=1.41, 95% CI=1.34-1.47). A longitudinal association was found between decreased gait speed and NCD onset, suggesting that gait speed could be useful to identify patients at risk of NCD onset. Copyright © 2017 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.

Listenmee and Listenmee smartphone application: synchronizing walking to rhythmic auditory cues to improve gait in Parkinson's disease.

PubMed

Lopez, William Omar Contreras; Higuera, Carlos Andres Escalante; Fonoff, Erich Talamoni; Souza, Carolina de Oliveira; Albicker, Ulrich; Martinez, Jairo Alberto Espinoza

2014-10-01

Evidence supports the use of rhythmic external auditory signals to improve gait in PD patients (Arias & Cudeiro, 2008; Kenyon & Thaut, 2000; McIntosh, Rice & Thaut, 1994; McIntosh et al., 1997; Morris, Iansek, & Matyas, 1994; Thaut, McIntosh, & Rice, 1997; Suteerawattananon, Morris, Etnyre, Jankovic, & Protas , 2004; Willems, Nieuwboer, Chavert, & Desloovere, 2006). However, few prototypes are available for daily use, and to our knowledge, none utilize a smartphone application allowing individualized sounds and cadence. Therefore, we analyzed the effects on gait of Listenmee®, an intelligent glasses system with a portable auditory device, and present its smartphone application, the Listenmee app®, offering over 100 different sounds and an adjustable metronome to individualize the cueing rate as well as its smartwatch with accelerometer to detect magnitude and direction of the proper acceleration, track calorie count, sleep patterns, steps count and daily distances. The present study included patients with idiopathic PD presented gait disturbances including freezing. Auditory rhythmic cues were delivered through Listenmee®. Performance was analyzed in a motion and gait analysis laboratory. The results revealed significant improvements in gait performance over three major dependent variables: walking speed in 38.1%, cadence in 28.1% and stride length in 44.5%. Our findings suggest that auditory cueing through Listenmee® may significantly enhance gait performance. Further studies are needed to elucidate the potential role and maximize the benefits of these portable devices. Copyright © 2014 Elsevier B.V. All rights reserved.

Multidirectional walk test in individuals with Parkinson's disease: a validity study.

PubMed

Bryant, Mon S; Workman, Craig D; Jackson, George R

2015-03-01

Gait parameters of forward, backward, and sideways walk were studied when the participants walked overground in four directions at their self-selected speed and were compared with walking in the four directions on an instrumented GAITRite walkway. Intraclass correlation coefficients between the overground walk test measures and the instrumented walkway measures of gait speed, cadence, and stride length for the forward walk were 0.85, 0.88, and 0.87, respectively. For the backward walk, the coefficients were 0.91 for gait speed, 0.75 for cadence, and 0.93 for stride length. For the sideways walk, the coefficients were 0.92 for gait speed, 0.93 for cadence, and 0.94 for stride length. Gait parameters of forward, backward, and sideways walk obtained by the overground walk test had excellent agreement with those obtained by the instrumented walkway. The quick timed test provided quantitative data for gait evaluation and was valid for clinical use.

Effects of Aging on Arm Swing during Gait: The Role of Gait Speed and Dual Tasking.

PubMed

Mirelman, Anat; Bernad-Elazari, Hagar; Nobel, Tomer; Thaler, Avner; Peruzzi, Agnese; Plotnik, Meir; Giladi, Nir; Hausdorff, Jeffrey M

2015-01-01

Healthy walking is characterized by pronounced arm swing and axial rotation. Aging effects on gait speed, stride length and stride time variability have been previously reported, however, less is known about aging effects on arm swing and axial rotation and their relationship to age-associated gait changes during usual walking and during more challenging conditions like dual tasking. Sixty healthy adults between the ages of 30-77 were included in this study designed to address this gap. Lightweight body fixed sensors were placed on each wrist and lower back. Participants walked under 3 walking conditions each of 1 minute: 1) comfortable speed, 2) walking while serially subtracting 3's (Dual Task), 3) walking at fast speed. Aging effects on arm swing amplitude, range, symmetry, jerk and axial rotation amplitude and jerk were compared between decades of age (30-40; 41-50; 51-60; 61-77 years). As expected, older adults walked slower (p = 0.03) and with increased stride variability (p = 0.02). Arm swing amplitude decreased with age under all conditions (p = 0.04). In the oldest group, arm swing decreased during dual task and increased during the fast walking condition (p<0.0001). Similarly, arm swing asymmetry increased during the dual task in the older groups (p<0.004), but not in the younger groups (p = 0.67). Significant differences between groups and within conditions were observed in arm swing jerk (p<0.02), axial rotation amplitude (p<0.02) and axial jerk (p<0.001). Gait speed, arm swing amplitude of the dominant arm, arm swing asymmetry and axial rotation jerk were all independent predictors of age in a multivariate model. These findings suggest that the effects of gait speed and dual tasking on arm swing and axial rotation during walking are altered among healthy older adults. Follow-up work is needed to examine if these effects contribute to reduced stability in aging.

Effects of Aging on Arm Swing during Gait: The Role of Gait Speed and Dual Tasking

PubMed Central

Mirelman, Anat; Bernad-Elazari, Hagar; Nobel, Tomer; Thaler, Avner; Peruzzi, Agnese; Plotnik, Meir; Giladi, Nir; Hausdorff, Jeffrey M.

2015-01-01

Healthy walking is characterized by pronounced arm swing and axial rotation. Aging effects on gait speed, stride length and stride time variability have been previously reported, however, less is known about aging effects on arm swing and axial rotation and their relationship to age-associated gait changes during usual walking and during more challenging conditions like dual tasking. Sixty healthy adults between the ages of 30–77 were included in this study designed to address this gap. Lightweight body fixed sensors were placed on each wrist and lower back. Participants walked under 3 walking conditions each of 1 minute: 1) comfortable speed, 2) walking while serially subtracting 3’s (Dual Task), 3) walking at fast speed. Aging effects on arm swing amplitude, range, symmetry, jerk and axial rotation amplitude and jerk were compared between decades of age (30–40; 41–50; 51–60; 61–77 years). As expected, older adults walked slower (p = 0.03) and with increased stride variability (p = 0.02). Arm swing amplitude decreased with age under all conditions (p = 0.04). In the oldest group, arm swing decreased during dual task and increased during the fast walking condition (p<0.0001). Similarly, arm swing asymmetry increased during the dual task in the older groups (p<0.004), but not in the younger groups (p = 0.67). Significant differences between groups and within conditions were observed in arm swing jerk (p<0.02), axial rotation amplitude (p<0.02) and axial jerk (p<0.001). Gait speed, arm swing amplitude of the dominant arm, arm swing asymmetry and axial rotation jerk were all independent predictors of age in a multivariate model. These findings suggest that the effects of gait speed and dual tasking on arm swing and axial rotation during walking are altered among healthy older adults. Follow-up work is needed to examine if these effects contribute to reduced stability in aging. PMID:26305896

Combined effects of speed and directional change on postural adjustments during gait initiation.

PubMed

Corbeil, Philippe; Anaka, Evelyn

2011-10-01

The study of gait initiation (GI) has primarily focused on gait initiated in a forward direction, however, in everyday life, GI is often combined with a directional change. Ten young adults initiated gait with their right foot in four directions (to the left: -15°, straight ahead: 0°, to the right: 15° and 30°) at self-selected and fast gait speeds. The relationship between starting direction of GI and the lateral center of foot pressure displacement for normal (r(2)=0.57) and fast gait speed (r(2)=0.75) indicated that the lateral component plays an important role with regards to controlling the desired direction of gait. At the first step of the swing limb, the progression velocity of the center of mass (CM) remained slower for the 30° condition only, whereas no difference was found between directions for CM velocity perpendicular to the intended direction. These results suggest that postural adjustments are scaled to initiate gait in a predetermined direction. By the first step, the orientation of CM is toward the intended direction of gait, however, when gait is initiated in combination with a large change in direction, additional adjustments may be required to reach the intended progression velocity. Copyright © 2011 Elsevier Ltd. All rights reserved.

The impact of obesity in the kinematic parameters of gait in young women

PubMed Central

da Silva-Hamu, Tânia Cristina Dias; Formiga, Cibelle Kayenne Martins Roberto; Gervásio, Flávia Martins; Ribeiro, Darlan Martins; Christofoletti, Gustavo; de França Barros, Jônatas

2013-01-01

Background The prevalence of obesity is increasing in the population, particularly in women. Obesity has an impact on the musculoskeletal system, leading to knee and ankle overexertion, difficulty with balance, and functional disability. The aim of this study was to identify changes in kinematic parameters of gait in obese young women. Methods A case-control study with 24 obese women (mean age 35.20 ± 9.9 years and mean body mass index of 31.85 ± 2.94 kg/m2) and 24 eutrophic women (mean age of 36.33 ± 11.14 and mean body mass index of 21.82 ± 1.58 kg/m2). The gait of women was evaluated by the system Vicon Motus® 9.2. The linear parameters of speed, cadence, right and left step, and stride lengths were studied, as well as the angular parameters of knee and ankle. Results There was a decrease in linear gait parameters (P < 0.001), speed, cadence, right and left step, and stride lengths. In regard to the angular parameters of the knee and ankle, there were also differences between the analyses (P < 0.001). At the knee joint, obese women have delayed onset of the second wave of flexion, exacerbating such movement in order to compensate. In regard to the ankle, both groups showed curves of normal plantar flexion and dorsiflexion, but there was a delay in the path graph in the ankle of obese women indicating a reduced range of motion and possible over-exertion of the pretibial muscles and soleus muscles simultaneously. Conclusion The results of this study revealed that obesity is a factor that negatively influences the kinematic parameters of gait of young women. PMID:23837005

Estimation of spatial-temporal gait parameters using a low-cost ultrasonic motion analysis system.

PubMed

Qi, Yongbin; Soh, Cheong Boon; Gunawan, Erry; Low, Kay-Soon; Thomas, Rijil

2014-08-20

In this paper, a low-cost motion analysis system using a wireless ultrasonic sensor network is proposed and investigated. A methodology has been developed to extract spatial-temporal gait parameters including stride length, stride duration, stride velocity, stride cadence, and stride symmetry from 3D foot displacements estimated by the combination of spherical positioning technique and unscented Kalman filter. The performance of this system is validated against a camera-based system in the laboratory with 10 healthy volunteers. Numerical results show the feasibility of the proposed system with average error of 2.7% for all the estimated gait parameters. The influence of walking speed on the measurement accuracy of proposed system is also evaluated. Statistical analysis demonstrates its capability of being used as a gait assessment tool for some medical applications.

Phenotypic Characterization of Speed-Associated Gait Changes in Mice Reveals Modular Organization of Locomotor Networks

PubMed Central

Bellardita, Carmelo; Kiehn, Ole

2015-01-01

SUMMARY Studies of locomotion in mice suggest that circuits controlling the alternating between left and right limbs may have a modular organization with distinct locomotor circuits being recruited at different speeds. It is not clear, however, whether such a modular organization reflects specific behavioral outcomes expressed at different speeds of locomotion. Here, we use detailed kinematic analyses to search for signatures of a modular organization of locomotor circuits in intact and genetically modified mice moving at different speeds of locomotion. We show that wild-type mice display three distinct gaits: two alternating, walk and trot, and one synchronous, bound. Each gait is expressed in distinct ranges of speed with phenotypic inter-limb and intra-limb coordination. A fourth gait, gallop, closely resembled bound in most of the locomotor parameters but expressed diverse inter-limb coordination. Genetic ablation of commissural V0V neurons completely removed the expression of one alternating gait, trot, but left intact walk, gallop, and bound. Ablation of commissural V0V and V0D neurons led to a loss of walk, trot, and gallop, leaving bound as the default gait. Our study provides a benchmark for studies of the neuronal control of locomotion in the full range of speeds. It provides evidence that gait expression depends upon selection of different modules of neuronal ensembles. PMID:25959968

Socioeconomic disparities in gait speed and associated characteristics in early old age.

PubMed

Plouvier, S; Carton, M; Cyr, D; Sabia, S; Leclerc, A; Zins, M; Descatha, A

2016-04-23

A few studies have documented associations between socioeconomic position and gait speed, but the knowledge about factors from various domains (personal factors, lifestyle, occupation…) which contribute to these disparities is limited. Our objective was to assess socioeconomic disparities in usual gait speed in a general population in early old age in France, and to identify potential contributors to the observed disparities, including occupational factors. The study population comprised 397 men and 339 women, aged 55 to 69, recruited throughout France for the field pilot of the CONSTANCES cohort. Gait speed was measured in meters/second. Socioeconomic position was based on self-reported occupational class. Information on personal characteristics, lifestyle, comorbidities and past or current occupational physical exposure came either from the health examination, from interview or from self-administered questionnaire. Four groups were considered according to sex-specific distributions of speed (the two slowest thirds versus the fastest third, for each gender). Logistic regression models adjusted for health screening center and age allowed to the study of cross-sectional associations between: 1- slower speed and occupational class; 2- slower speed and each potential contributor; 3- occupational class and selected potential contributors. The association between speed and occupational class was then further adjusted for the factors significantly associated both with speed and occupational class, in order to assess the potential contribution of these factors to disparities. With reference to managers/executives, gait speed was reduced in less skilled categories among men (OR 1.21 [0.72-2.05] for Intermediate/Tradesmen, 1.95 [0.80-4.76] for Clerks, Sale/service workers, 2.09 [1.14-3.82] for Blue collar/Craftsmen) and among women (OR 1.12 [0.55-2.28] for Intermediate/Tradesmen, 2.33 [1.09-4.97] for Clerks, 2.48 [1.18-5.24] for Sale/service workers/Blue collar

Influence of the amount of body weight support on lower limb joints' kinematics during treadmill walking at different gait speeds: Reference data on healthy adults to define trajectories for robot assistance.

PubMed

Ferrarin, Maurizio; Rabuffetti, Marco; Geda, Elisabetta; Sirolli, Silvia; Marzegan, Alberto; Bruno, Valentina; Sacco, Katiuscia

2018-06-01

Several robotic devices have been developed for the rehabilitation of treadmill walking in patients with movement disorders due to injuries or diseases of the central nervous system. These robots induce coordinated multi-joint movements aimed at reproducing the physiological walking or stepping patterns. Control strategies developed for robotic locomotor training need a set of predefined lower limb joint angular trajectories as reference input for the control algorithm. Such trajectories are typically taken from normative database of overground unassisted walking. However, it has been demonstrated that gait speed and the amount of body weight support significantly influence joint trajectories during walking. Moreover, both the speed and the level of body weight support must be individually adjusted according to the rehabilitation phase and the residual locomotor abilities of the patient. In this work, 10 healthy participants (age range: 23-48 years) were asked to walk in movement analysis laboratory on a treadmill at five different speeds and four different levels of body weight support; besides, a trial with full body weight support, that is, with the subject suspended on air, was performed at two different cadences. The results confirm that lower limb kinematics during walking is affected by gait speed and by the amount of body weight support, and that on-air stepping is radically different from treadmill walking. Importantly, the results provide normative data in a numerical form to be used as reference trajectories for controlling robot-assisted body weight support walking training. An electronic addendum is provided to easily access to such reference data for different combinations of gait speeds and body weight support levels.

The influence of gait speed on the stability of walking among the elderly.

PubMed

Fan, Yifang; Li, Zhiyu; Han, Shuyan; Lv, Changsheng; Zhang, Bo

2016-06-01

Walking speed is a basic factor to consider when walking exercises are prescribed as part of a training programme. Although associations between walking speed, step length and falling risk have been identified, the relationship between spontaneous walking pattern and falling risk remains unclear. The present study, therefore, examined the stability of spontaneous walking at normal, fast and slow speed among elderly (67.5±3.23) and young (21.4±1.31) individuals. In all, 55 participants undertook a test that involved walking on a plantar pressure platform. Foot-ground contact data were used to calculate walking speed, step length, pressure impulse along the plantar-impulse principal axis and pressure record of time series along the plantar-impulse principal axis. A forward dynamics method was used to calculate acceleration, velocity and displacement of the centre of mass in the vertical direction. The results showed that when the elderly walked at different speeds, their average step length was smaller than that observed among the young (p=0.000), whereas their anterior/posterior variability and lateral variability had no significant difference. When walking was performed at normal or slow speed, no significant between-group difference in cadence was found. When walking at a fast speed, the elderly increased their stride length moderately and their cadence greatly (p=0.012). In summary, the present study found no correlation between fast walking speed and instability among the elderly, which indicates that healthy elderly individuals might safely perform fast-speed walking exercises. Copyright © 2016 Elsevier B.V. All rights reserved.

A machine learning approach for gait speed estimation using skin-mounted wearable sensors: From healthy controls to individuals with multiple sclerosis.

PubMed

McGinnis, Ryan S; Mahadevan, Nikhil; Moon, Yaejin; Seagers, Kirsten; Sheth, Nirav; Wright, John A; DiCristofaro, Steven; Silva, Ikaro; Jortberg, Elise; Ceruolo, Melissa; Pindado, Jesus A; Sosnoff, Jacob; Ghaffari, Roozbeh; Patel, Shyamal

2017-01-01

Gait speed is a powerful clinical marker for mobility impairment in patients suffering from neurological disorders. However, assessment of gait speed in coordination with delivery of comprehensive care is usually constrained to clinical environments and is often limited due to mounting demands on the availability of trained clinical staff. These limitations in assessment design could give rise to poor ecological validity and limited ability to tailor interventions to individual patients. Recent advances in wearable sensor technologies have fostered the development of new methods for monitoring parameters that characterize mobility impairment, such as gait speed, outside the clinic, and therefore address many of the limitations associated with clinical assessments. However, these methods are often validated using normal gait patterns; and extending their utility to subjects with gait impairments continues to be a challenge. In this paper, we present a machine learning method for estimating gait speed using a configurable array of skin-mounted, conformal accelerometers. We establish the accuracy of this technique on treadmill walking data from subjects with normal gait patterns and subjects with multiple sclerosis-induced gait impairments. For subjects with normal gait, the best performing model systematically overestimates speed by only 0.01 m/s, detects changes in speed to within less than 1%, and achieves a root-mean-square-error of 0.12 m/s. Extending these models trained on normal gait to subjects with gait impairments yields only minor changes in model performance. For example, for subjects with gait impairments, the best performing model systematically overestimates speed by 0.01 m/s, quantifies changes in speed to within 1%, and achieves a root-mean-square-error of 0.14 m/s. Additional analyses demonstrate that there is no correlation between gait speed estimation error and impairment severity, and that the estimated speeds maintain the clinical significance

Walking to the beat of different drums: practical implications for the use of acoustic rhythms in gait rehabilitation.

PubMed

Roerdink, Melvyn; Bank, Paulina J M; Peper, C Lieke E; Beek, Peter J

2011-04-01

Acoustic rhythms are frequently used in gait rehabilitation, with positive instantaneous and prolonged transfer effects on various gait characteristics. The gait modifying ability of acoustic rhythms depends on how well gait is tied to the beat, which can be assessed with measures of relative timing of auditory-motor coordination. We examined auditory-motor coordination in 20 healthy elderly individuals walking to metronome beats with pacing frequencies slower than, equal to, and faster than their preferred cadence. We found that more steps were required to adjust gait to the beat, the more the metronome rate deviated from the preferred cadence. Furthermore, participants anticipated the beat with their footfalls to various degrees, depending on the metronome rate; the faster the tempo, the smaller the phase advance or phase lead. Finally, the variability in the relative timing between footfalls and the beat was smaller for metronome rates closer to the preferred cadence, reflecting superior auditory-motor coordination. These observations have three practical implications. First, instantaneous effects of acoustic stimuli on gait characteristics may typically be underestimated given the considerable number of steps required to attune gait to the beat in combination with the usual short walkways. Second, a systematic phase lead of footfalls to the beat does not necessarily reflect a reduced ability to couple gait to the metronome. Third, the efficacy of acoustic rhythms to modify gait depends on metronome rate. Gait is coupled best to the beat for metronome rates near the preferred cadence. Copyright © 2011 Elsevier B.V. All rights reserved.

Does a single gait training session performed either overground or on a treadmill induce specific short-term effects on gait parameters in patients with hemiparesis? A randomized controlled study.

PubMed

Bonnyaud, Céline; Pradon, Didier; Zory, Raphael; Bensmail, Djamel; Vuillerme, Nicolas; Roche, Nicolas

2013-01-01

Gait training for patients with hemiparesis is carried out independently overground or on a treadmill. Several studies have shown differences in hemiparetic gait parameters during overground versus treadmill walking. However, few studies have compared the effects of these 2 gait training conditions on gait parameters, and no study has compared the short-term effects of these techniques on all biomechanical gait parameters. To determine whether a gait training session performed overground or on a treadmill induces specific short-term effects on biomechanical gait parameters in patients with hemiparesis. Twenty-six subjects with hemiparesis were randomly assigned to a single session of either overground or treadmill gait training. The short-term effects on spatiotemporal, kinematic, and kinetic gait parameters were assessed using gait analysis before and immediately after the training and after a 20-minute rest. Speed, cadence, percentage of single support phase, peak knee extension, peak propulsion, and braking on the paretic side were significantly increased after the gait training session. However, there were no specific changes dependent on the type of gait training performed (overground or on a treadmill). A gait training session performed by subjects with hemiparesis overground or on a treadmill did not induce specific short-term effects on biomechanical gait parameters. The increase in gait velocity that followed a gait training session seemed to reflect specific modifications of the paretic lower limb and adaptation of the nonparetic lower limb.

Target of physiological gait: Realization of speed adaptive control for a prosthetic knee during swing flexion.

PubMed

Cao, Wujing; Yu, Hongliu; Zhao, Weiliang; Li, Jin; Wei, Xiaodong

2018-01-01

Prosthetic knee is the most important component of lower limb prosthesis. Speed adaptive for prosthetic knee during swing flexion is the key method to realize physiological gait. This study aims to discuss the target of physiological gait, propose a speed adaptive control method during swing flexion and research the damping adjustment law of intelligent hydraulic prosthetic knee. According to the physiological gait trials of healthy people, the control target during swing flexion is defined. A new prosthetic knee with fuzzy logical control during swing flexion is designed to realize the damping adjustment automatically. The function simulation and evaluation system of intelligent knee prosthesis is provided. Speed adaptive control test of the intelligent prosthetic knee in different velocities are researched. The maximum swing flexion of the knee angle is set between sixty degree and seventy degree as the target of physiological gait. Preliminary experimental results demonstrate that the prosthetic knee with fuzzy logical control is able to realize physiological gait under different speeds. The faster the walking, the bigger the valve closure percentage of the hydraulic prosthetic knee. The proposed fuzzy logical control strategy and intelligent hydraulic prosthetic knee are effective for the amputee to achieve physiological gait.

Design and Validation of a Radio-Frequency Identification-Based Device for Routinely Assessing Gait Speed in a Geriatrics Clinic.

PubMed

Barry, Lisa C; Hatchman, Laura; Fan, Zhaoyan; Guralnik, Jack M; Gao, Robert X; Kuchel, George A

2018-05-01

To evaluate the feasibility, acceptability, and validity of a radio-frequency identification (RFID)-based system to measure gait speed in a clinical setting as a first step to using unobtrusive gait speed assessment in routine clinical care. Feasibility study comparing gait speed assessed using an RFID-based system with gait speed assessed using handheld stopwatch, the criterion standard. Outpatient geriatrics clinic at a Connecticut-based academic medical center. Clinic attendees who could walk independently with or without an assistive device (N=50) and healthcare providers (N=9). Gait speed was measured in twice using 2 methods each time before participants entered an examination room. Participants walked at their usual pace while gait speed was recorded simultaneously using the RFID-based system and a handheld stopwatch operated by a trained study investigator. After 2 trials, participants completed a brief survey regarding their experience. At the end of the study period, clinic healthcare providers completed a separate survey. Test-retest reliability of the RFID-based system was high (intraclass correlation coefficient = 0.953). The mean difference ± standard deviation in gait speed between the RFID-based system and the stopwatch was -0.003±0.035 m/s (p=.53) and did not differ significantly according to age, sex, or use of an assistive walking aid. Acceptability of the device was high, and 8 of 9 providers indicated that measuring gait speed using the RFID-based system should be a part of routine clinical care. RFID technology may offer a practical means of overcoming barriers to routine measurement of gait speed in real-world outpatient clinical settings. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

The Importance of Mid-to-Late-Life Body Mass Index Trajectories on Late-Life Gait Speed.

PubMed

Windham, B Gwen; Griswold, Michael E; Wang, Wanmei; Kucharska-Newton, Anna; Demerath, Ellen W; Gabriel, Kelley Pettee; Pompeii, Lisa A; Butler, Kenneth; Wagenknecht, Lynne; Kritchevsky, Stephen; Mosley, Thomas H

2017-08-01

Prior studies suggest being overweight may be protective against poor functional outcomes in older adults. Body mass index (BMI, kg/m2) was measured over 25 years across five visits (1987-2011) among Atherosclerosis Risk in Communities Study participants (baseline Visit 1 n = 15,720, aged 45-64 years). Gait speed was measured at Visit 5 ("late-life", aged ≥65 years, n = 6,229). BMI trajectories were examined using clinical cutpoints and continuous mixed models to estimate effects of patterns of BMI change on gait speed, adjusting for demographics and comorbidities. Mid-life BMI (baseline visit; 55% women; 27% black) was associated with late-life gait speed 25 years later; gait speeds were 94.3, 89.6, and 82.1 cm/s for participants with baseline normal BMI (<25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30) (p < .001). In longitudinal analyses, late-life gait speeds were 96.9, 88.8, and 81.3 cm/s for participants who maintained normal, overweight, and obese weight status, respectively, across 25 years (p < .01). Increasing BMI over 25 years was associated with poorer late-life gait speeds; a 1%/year BMI increase for a participant with a baseline BMI of 22.5 (final BMI 28.5) was associated with a 4.6-cm/s (95% confidence interval: -7.0, -1.8) slower late-life gait speed than a participant who maintained a baseline BMI of 22.5. Being overweight in older age was not protective of mobility function. Maintaining a normal BMI in mid- and late-life may help preserve late-life mobility. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Carotid flow pulsatility is higher in women with greater decrement in gait speed during multi-tasking.

PubMed

Gonzales, Joaquin U; James, C Roger; Yang, Hyung Suk; Jensen, Daniel; Atkins, Lee; Al-Khalil, Kareem; O'Boyle, Michael

2017-05-01

Central arterial hemodynamics is associated with cognitive impairment. Reductions in gait speed during walking while performing concurrent tasks known as dual-tasking (DT) or multi-tasking (MT) is thought to reflect the cognitive cost that exceeds neural capacity to share resources. We hypothesized that central vascular function would associate with decrements in gait speed during DT or MT. Gait speed was measured using a motion capture system in 56 women (30-80y) without mild-cognitive impairment. Dual-tasking was considered walking at a fast-pace while balancing a tray. Multi-tasking was the DT condition plus subtracting by serial 7's. Applanation tonometry was used for measurement of aortic stiffness and central pulse pressure. Doppler-ultrasound was used to measure blood flow velocity and β-stiffness index in the common carotid artery. The percent change in gait speed was larger for MT than DT (14.1±11.2 vs. 8.7±9.6%, p <0.01). Tertiles were formed based on the percent change in gait speed for each condition. No vascular parameters differed across tertiles for DT. In contrast, carotid flow pulsatility (1.85±0.43 vs. 1.47±0.42, p=0.02) and resistance (0.75±0.07 vs. 0.68±0.07, p=0.01) indices were higher in women with more decrement (third tertile) as compared to women with less decrement (first tertile) in gait speed during MT after adjusting for age, gait speed, and task error. Carotid pulse pressure and β-stiffness did not contribute to these tertile differences. Elevated carotid flow pulsatility and resistance are characteristics found in healthy women that show lower cognitive capacity to walk and perform multiple concurrent tasks. Copyright © 2017 Elsevier B.V. All rights reserved.

Are the average gait speeds during the 10meter and 6minute walk tests redundant in Parkinson disease?

PubMed

Duncan, Ryan P; Combs-Miller, Stephanie A; McNeely, Marie E; Leddy, Abigail L; Cavanaugh, James T; Dibble, Leland E; Ellis, Terry D; Ford, Matthew P; Foreman, K Bo; Earhart, Gammon M

2017-02-01

We investigated the relationships between average gait speed collected with the 10Meter Walk Test (Comfortable and Fast) and 6Minute Walk Test (6MWT) in 346 people with Parkinson disease (PD) and how the relationships change with increasing disease severity. Pearson correlation and linear regression analyses determined relationships between 10Meter Walk Test and 6MWT gait speed values for the entire sample and for sub-samples stratified by Hoehn & Yahr (H&Y) stage I (n=53), II (n=141), III (n=135) and IV (n=17). We hypothesized that redundant tests would be highly and significantly correlated (i.e. r>0.70, p<0.05) and would have a linear regression model slope of 1 and intercept of 0. For the entire sample, 6MWT gait speed was significantly (p<0.001) related to the Comfortable 10 Meter Walk Test (r=0.75) and Fast 10Meter Walk Test (r=0.79) gait speed, with 56% and 62% of the variance in 6MWT gait speed explained, respectively. The regression model of 6MWT gait speed predicted by Comfortable 10 Meter Walk gait speed produced slope and intercept values near 1 and 0, respectively, especially for participants in H&Y stages II-IV. In contrast, slope and intercept values were further from 1 and 0, respectively, for the Fast 10Meter Walk Test. Comfortable 10 Meter Walk Test and 6MWT gait speeds appeared to be redundant in people with moderate to severe PD, suggesting the Comfortable 10 Meter Walk Test can be used to estimate 6MWT distance in this population. Copyright © 2016 Elsevier B.V. All rights reserved.

Are the Average Gait Speeds During the 10 Meter and 6 Minute Walk Tests Redundant in Parkinson Disease?

PubMed Central

Duncan, Ryan P.; Combs-Miller, Stephanie A.; McNeely, Marie E.; Leddy, Abigail L.; Cavanaugh, James T.; Dibble, Leland E.; Ellis, Terry D.; Ford, Matthew P.; Foreman, K. Bo; Earhart, Gammon M.

2016-01-01

We investigated the relationships between average gait speed collected with the 10 Meter Walk Test (Comfortable and Fast) and 6 Minute Walk Test (6MWT) in 346 people with Parkinson disease (PD) and how the relationships change with increasing disease severity. Pearson correlation and linear regression analyses determined relationships between 10 Meter Walk Test and 6MWT gait speed values for the entire sample and for sub-samples stratified by Hoehn & Yahr (H&Y) stage I (n=53), II (n=141), III (n=135) and IV (n=17). We hypothesized that redundant tests would be highly and significantly correlated (i.e. r > 0.70, p < 0.05) and would have a linear regression model slope of 1 and intercept of 0. For the entire sample, 6MWT gait speed was significantly (p<0.001) related to the Comfortable 10 Meter Walk Test (r=0.75) and Fast 10 Meter Walk Test (r=0.79) gait speed, with 56% and 62% of the variance in 6MWT gait speed explained, respectively. The regression model of 6MWT gait speed predicted by Comfortable 10 Meter Walk gait speed produced slope and intercept values near 1 and 0, respectively, especially for participants in H&Y stages II–IV. In contrast, slope and intercept values were further from 1 and 0, respectively, for the Fast 10 Meter Walk Test. Comfortable 10 Meter Walk Test and 6MWT gait speeds appeared to be redundant in people with moderate to severe PD, suggesting the Comfortable 10 Meter Walk Test can be used to estimate 6MWT distance in this population. PMID:27915221

Effects of different heel-raise-lower exercise interventions on the strength of plantarflexion, balance, and gait parameters in stroke survivors.

PubMed

Lee, Seung-Mi; Cynn, Heon-Seock; Yoon, Tae-Lim; Lee, Ji-Hyun

2017-09-01

The objective of this study was to investigate the effects of Heel-Raise-Lower Exercise (HRLE) interventions on the strength of plantarflexion, balance, and gait parameters in people with stroke. Specifically, this study compared the two different HRLEs to identify whether heels raise-lower with forefoot on a block (HRB) is more effective or ineffective to enhance strength and functional capacities than heels raise-lower on a level floor (HRL) exercise in people with stroke. Repetitive heel raise-lower is a common exercise for improving the strength and power of ankle plantarflexors. It is a simple movement, requires no equipment, and can be performed at home. Each group of 10 people with stroke was given either HRB training or HRL training. The subjects performed the exercise 100 times per day, 5 days per week for 6 weeks. The strength of plantarflexors, static/dynamic balance, and gait parameters were measured using the manual muscle test (MMT), a Biodex Balance System (BBS) SD, and the GAITRite system. After 6 weeks of treatment, there were significant increases in the plantarflexors strength in both groups: by 34% in the HRB group and by 21% in the HRL group. Static and dynamic balance and gait speed also increased significantly in both groups. However, cadence, the paretic side single limb support period (SLSP), paretic side step length, and paretic side stride length significantly increased only in the HRB group. The HRB improved significantly the plantar flexor strength of the paretic side, gait speed, and cadence compared to the HRL.

Surface Peroneal Nerve Stimulation in Lower Limb Hemiparesis: Effect on Quantitative Gait Parameters

PubMed Central

Sheffler, Lynne R.; Taylor, Paul N.; Bailey, Stephanie Nogan; Gunzler, Douglas D.; Buurke, Jaap H.; IJzerman, Maarten J.; Chae, John

2015-01-01

Objective To evaluate possible mechanisms for functional improvement and compare ambulation training with surface peroneal nerve stimulation (PNS) versus usual care (UC) via quantitative gait analysis. Design Randomized controlled clinical trial. Setting Teaching hospital of academic medical center. Participants 110 chronic stroke survivors (> 12-wks post-stroke) with unilateral hemiparesis. Interventions Subjects were randomized to a surface PNS device or UC intervention. Subjects were treated for 12-wks and followed for 6-months post-treatment. Main Outcome Measures Spatiotemporal, kinematic, and kinetic parameters of gait. Results Cadence (F3,153=5.81, p=.012), stride length (F3,179=20.01, p<.001), walking speed (F3,167=18.2, p<.001), anterior posterior ground reaction force (F3,164=6.61, p=.004), peak hip power in pre-swing (F3,156=8.76, p<.001), and peak ankle power at push-off (F3,149=6.38, p=.005) all improved with respect to time. However, peak ankle DF in swing (F3,184=4.99, p=.031) worsened. In general, the greatest change for all parameters occurred during the treatment period. There was no significant treatment group by time interaction effects for any of the spatiotemporal, kinematic, or kinetic parameters. Conclusions Gait training with PNS and usual care was associated with improvements in peak hip power in pre-swing and peak ankle power at push-off, which may have resulted in improved cadence, stride length, and walking speed; however, there were no differences between treatment groups. Both treatment groups also experienced a decrease in peak ankle DF in swing, though the clinical implications of this finding are unclear. PMID:25802966

An electromechanical gait trainer for restoration of gait in hemiparetic stroke patients: preliminary results.

PubMed

Hesse, S; Werner, C; Uhlenbrock, D; von Frankenberg, S; Bardeleben, A; Brandl-Hesse, B

2001-01-01

Modern concepts of gait rehabilitation after stroke favor a task-specific repetitive approach. In practice, the required physical effort of the therapists limits the realization of this approach. Therefore, a mechanized gait trainer enabling nonambulatory patients to have the repetitive practice of a gait-like movement without overstraining therapists was constructed. This preliminary study investigated whether an additional 4-week daily therapy on the gait trainer could improve gait ability in 14 chronic wheelchair-bound hemiparetic subjects. The 4 weeks of physiotherapy and gait-trainer therapy resulted in a relevant improvement of gait ability in all subjects. Velocity, cadence, and stride length improved significantly (p < 0.01). The kinesiologic electromyogram of selected lower-limb muscles revealed a more physiologic pattern. The confounding influence of spontaneous recovery, the lack of a control group, and the double amount of therapy limit the clinical relevance of this study. Nevertheless, the gait trainer seems feasible as an adjunctive tool in gait rehabilitation after stroke; further studies are needed.

The value of the NDT-Bobath method in post-stroke gait training.

PubMed

Mikołajewska, Emilia

2013-01-01

Stroke is perceived a major cause of disability, including gait disorders. Looking for more effective methods of gait reeducation in post-stroke survivors is one of the most important issues in contemporary neurorehabilitation. Following a stroke, patients suffer from gait disorders. The aim of this paper is to present the outcomes of a study of post-stroke gait reeducation using the NeuroDevelopmental Treatment-Bobath (NDT-Bobath) method. The research was conducted among 60 adult patients who had undergone ischemic stroke. These patients were treated using the NDT-Bobath method. These patients' gait reeducation was assessed using spatio-temporal gait parameters (gait velocity, cadence and stride length). Measurements of these parameters were conducted by the same therapist twice: on admission, and after the tenth session of gait reeducation. Among the 60 patients involved in the study, the results were as follows: in terms of gait velocity, recovery was observed in 39 cases (65%), in terms of cadence, recovery was observed in 39 cases (65%), in terms of stride length, recovery was observed in 50 cases (83.33%). Benefits were observed after short-term therapy, reflected by measurable statistically significant changes in the patients' gait parameters.

The Use of Cuff Weights for Aquatic Gait Training in People Post-Stroke with Hemiparesis.

PubMed

Nishiyori, Ryota; Lai, Byron; Lee, Do Kyeong; Vrongistinos, Konstantinos; Jung, Taeyou

2016-03-01

This study aimed to examine how spatiotemporal and kinematic gait variables are influenced by the application of a cuff weight during aquatic walking in people post-stroke. The secondary purpose was to compare the differences in gait responses between the placements of cuff weights on the proximal (knee weight) and distal end (ankle weight) of the shank. Twenty-one participants post-stroke with hemiparesis aged 66.3 ± 11.3 years participated in a cross-sectional comparative study. Participants completed two aquatic walking trials at their self-selected maximum walking speed across an 8-m walkway under each of the three conditions: 1) walking with a knee weight; 2) walking with an ankle weight; and 3) walking with no weight. Cuff weights were worn on the paretic leg of each participant. Gait speed, cadence, step width and joint kinematics of the hip, knee and ankle joints were recorded by a customized three-dimensional underwater motion analysis system. Mean aquatic walking speeds significantly increased with the use of cuff weights when compared to walking with no weight. Changes in gait variables were found in the non-paretic leg with the addition of weight, while no significant changes were found in the paretic leg. The results suggest that the use of additional weight can be helpful if the goal of gait training is to improve walking speed of people post-stroke during pool floor walking. However, it is interesting to note that changes in gait variables were not found in the paretic limb where favourable responses were expected to occur. Copyright © 2014 John Wiley & Sons, Ltd.

Task-Specific and Functional Effects of Speed-Focused Elliptical or Motor-Assisted Cycle Training in Children With Bilateral Cerebral Palsy: Randomized Clinical Trial.

PubMed

Damiano, Diane L; Stanley, Christopher J; Ohlrich, Laurie; Alter, Katharine E

2017-08-01

Locomotor training using treadmills or robotic devices is commonly utilized to improve gait in cerebral palsy (CP); however, effects are inconsistent and fail to exceed those of equally intense alternatives. Possible limitations of existing devices include fixed nonvariable rhythm and too much limb or body weight assistance. To quantify and compare effectiveness of a motor-assisted cycle and a novel alternative, an elliptical, in CP to improve interlimb reciprocal coordination through intensive speed-focused leg training. A total of 27 children with bilateral CP, 5 to 17 years old, were randomized to 12 weeks of 20 minutes, 5 days per week home-based training (elliptical = 14; cycle = 13) at a minimum of 40 revolutions per minute, with resistance added when speed target was achieved. Primary outcomes were self-selected and fastest voluntary cadence on the devices and gait speed. Secondary outcomes included knee muscle strength, and selective control and functional mobility measures. Cadence on trained but not nontrained devices increased, demonstrating task specificity of training and increased exercise capability. Mean gait speed did not increase in either group, nor did parent-reported functional mobility. Knee extensor strength increased in both. An interaction between group and time was seen in selective control with scores slightly increasing for the elliptical and decreasing for the cycle, possibly related to tighter limb coupling with cycling. Task-specific effects were similarly positive across groups, but no transfer was seen to gait or function. Training dose was low (≤20 hours) compared with intensive upper-limb training recommendations and may be insufficient to produce appreciable clinical change.

Generating high-speed dynamic running gaits in a quadruped robot using an evolutionary search.

PubMed

Krasny, Darren P; Orin, David E

2004-08-01

Over the past several decades, there has been a considerable interest in investigating high-speed dynamic gaits for legged robots. While much research has been published, both in the biomechanics and engineering fields regarding the analysis of these gaits, no single study has adequately characterized the dynamics of high-speed running as can be achieved in a realistic, yet simple, robotic system. The goal of this paper is to find the most energy-efficient, natural, and unconstrained gallop that can be achieved using a simulated quadrupedal robot with articulated legs, asymmetric mass distribution, and compliant legs. For comparison purposes, we also implement the bound and canter. The model used here is planar, although we will show that it captures much of the predominant dynamic characteristics observed in animals. While it is not our goal to prove anything about biological locomotion, the dynamic similarities between the gaits we produce and those found in animals does indicate a similar underlying dynamic mechanism. Thus, we will show that achieving natural, efficient high-speed locomotion is possible even with a fairly simple robotic system. To generate the high-speed gaits, we use an efficient evolutionary algorithm called set-based stochastic optimization. This algorithm finds open-loop control parameters to generate periodic trajectories for the body. Several alternative methods are tested to generate periodic trajectories for the legs. The combined solutions found by the evolutionary search and the periodic-leg methods, over a range of speeds up to 10.0 m/s, reveal "biological" characteristics that are emergent properties of the underlying gaits.

Gender-related Differences in Maximum Gait Speed and Daily Physical Activity in Elderly Hospitalized Cardiac Inpatients

PubMed Central

Izawa, Kazuhiro P.; Watanabe, Satoshi; Hirano, Yasuyuki; Matsushima, Shinya; Suzuki, Tomohiro; Oka, Koichiro; Kida, Keisuke; Suzuki, Kengo; Osada, Naohiko; Omiya, Kazuto; Brubaker, Peter H.; Shimizu, Hiroyuki; Akashi, Yoshihiro J.

2015-01-01

Abstract Maximum gait speed and physical activity (PA) relate to mortality and morbidity, but little is known about gender-related differences in these factors in elderly hospitalized cardiac inpatients. This study aimed to determine differences in maximum gait speed and daily measured PA based on sex and the relationship between these measures in elderly cardiac inpatients. A consecutive 268 elderly Japanese cardiac inpatients (mean age, 73.3 years) were enrolled and divided by sex into female (n = 75, 28%) and male (n = 193, 72%) groups. Patient characteristics and maximum gait speed, average step count, and PA energy expenditure (PAEE) in kilocalorie per day for 2 days assessed by accelerometer were compared between groups. Gait speed correlated positively with in-hospital PA measured by average daily step count (r = 0.46, P < 0.001) and average daily PAEE (r = 0.47, P < 0.001) in all patients. After adjustment for left ventricular ejection fraction, step counts and PAEE were significantly lower in females than males (2651.35 ± 1889.92 vs 4037.33 ± 1866.81 steps, P < 0.001; 52.74 ± 51.98 vs 99.33 ± 51.40 kcal, P < 0.001), respectively. Maximum gait speed was slower and PA lower in elderly female versus male inpatients. Minimum gait speed and step count values in this study might be minimum target values for elderly male and female Japanese cardiac inpatients. PMID:25789953

Walking Aids Moderate Exercise Effects on Gait Speed in People With Dementia: A Randomized Controlled Trial.

PubMed

Toots, Annika; Littbrand, Håkan; Holmberg, Henrik; Nordström, Peter; Lundin-Olsson, Lillemor; Gustafson, Yngve; Rosendahl, Erik

2017-03-01

To investigate the effects of exercise on gait speed, when tested using walking aids and without, and whether effects differed according to amount of support in the test. A cluster-randomized controlled trial. The Umeå Dementia and Exercise (UMDEX) study was set in 16 nursing homes in Umeå, Sweden. One hundred forty-one women and 45 men (mean age 85 years) with dementia, of whom 145 (78%) habitually used walking aids. Participants were randomized to the high-intensity functional exercise program or a seated attention control activity. Blinded assessors measured 4-m usual gait speed with walking aids if any gait speed (GS), and without walking aids and with minimum amount of support, at baseline, 4 months (on intervention completion), and 7 months. Linear mixed models showed no between-group effect in either gait speed test at 4 or 7 months. In interaction analyses exercise effects differed significantly between participants who walked unsupported compared with when walking aids or minimum support was used. Positive between-group exercise effects on gait speed (m/s) were found in subgroups that walked unsupported at 4 and 7 months (GS: 0.07, P = .009 and 0.13, P < .001; and GS test without walking aids: 0.05, P = .011 and 0.07, P = .029, respectively). In people with dementia living in nursing homes exercise had positive effects on gait when tested unsupported compared with when walking aids or minimum support was used. The study suggests that the use of walking aids in gait speed tests may conceal exercise effects. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

The Combined Effects of Body Weight Support and Gait Speed on Gait Related Muscle Activity: A Comparison between Walking in the Lokomat Exoskeleton and Regular Treadmill Walking

PubMed Central

Van Kammen, Klaske; Boonstra, Annemarijke; Reinders-Messelink, Heleen; den Otter, Rob

2014-01-01

Background For the development of specialized training protocols for robot assisted gait training, it is important to understand how the use of exoskeletons alters locomotor task demands, and how the nature and magnitude of these changes depend on training parameters. Therefore, the present study assessed the combined effects of gait speed and body weight support (BWS) on muscle activity, and compared these between treadmill walking and walking in the Lokomat exoskeleton. Methods Ten healthy participants walked on a treadmill and in the Lokomat, with varying levels of BWS (0% and 50% of the participants’ body weight) and gait speed (0.8, 1.8, and 2.8 km/h), while temporal step characteristics and muscle activity from Erector Spinae, Gluteus Medius, Vastus Lateralis, Biceps Femoris, Gastrocnemius Medialis, and Tibialis Anterior muscles were recorded. Results The temporal structure of the stepping pattern was altered when participants walked in the Lokomat or when BWS was provided (i.e. the relative duration of the double support phase was reduced, and the single support phase prolonged), but these differences normalized as gait speed increased. Alternations in muscle activity were characterized by complex interactions between walking conditions and training parameters: Differences between treadmill walking and walking in the exoskeleton were most prominent at low gait speeds, and speed effects were attenuated when BWS was provided. Conclusion Walking in the Lokomat exoskeleton without movement guidance alters the temporal step regulation and the neuromuscular control of walking, although the nature and magnitude of these effects depend on complex interactions with gait speed and BWS. If normative neuromuscular control of gait is targeted during training, it is recommended that very low speeds and high levels of BWS should be avoided when possible. PMID:25226302

Effects of human running cadence and experimental validation of the bouncing ball model

NASA Astrophysics Data System (ADS)

Bencsik, László; Zelei, Ambrus

2017-05-01

The biomechanical analysis of human running is a complex problem, because of the large number of parameters and degrees of freedom. However, simplified models can be constructed, which are usually characterized by some fundamental parameters, like step length, foot strike pattern and cadence. The bouncing ball model of human running is analysed theoretically and experimentally in this work. It is a minimally complex dynamic model when the aim is to estimate the energy cost of running and the tendency of ground-foot impact intensity as a function of cadence. The model shows that cadence has a direct effect on energy efficiency of running and ground-foot impact intensity. Furthermore, it shows that higher cadence implies lower risk of injury and better energy efficiency. An experimental data collection of 121 amateur runners is presented. The experimental results validate the model and provides information about the walk-to-run transition speed and the typical development of cadence and grounded phase ratio in different running speed ranges.

[Calf circumference and its association with gait speed in elderly participants at Peruvian Naval Medical Center].

PubMed

Díaz Villegas, Gregory Mishell; Runzer Colmenares, Fernando

2015-01-01

To evaluate the association between calf circumference and gait speed in elderly patients 65 years or older at Geriatric day clinic at Peruvian Centro Médico Naval. Cross-sectional, retrospective study. We assessed 139 participants, 65 years or older at Peruvian Centro Médico Naval including calf circumference, gait speed and Short Physical Performance Battery. With bivariate analyses and logistic regression model we search for association between variables. The age mean was 79.37 years old (SD: 8.71). 59.71% were male, the 30.97% had a slow walking speed and the mean calf circumference was 33.42cm (SD: 5.61). After a bivariate analysis, we found a calf circumference mean of 30.35cm (SD: 3.74) in the slow speed group and, in normal gait group, a mean of 33.51cm (SD: 3.26) with significantly differences. We used logistic regression to analyze association with slow gait speed, founding statistically significant results adjusting model by disability and age. Low calf circumference is associated with slow speed walk in population over 65 years old. Copyright © 2014. Published by Elsevier Espana.

Effects of visual focus and gait speed on walking balance in the frontal plane.

PubMed

Goodworth, Adam; Perrone, Kathryn; Pillsbury, Mark; Yargeau, Michelle

2015-08-01

We investigated how head position and gait speed influenced frontal plane balance responses to external perturbations during gait. Thirteen healthy participants walked on a treadmill at three different gait speeds. Visual conditions included either focus downward on lower extremities and walking surface only or focus forward on a stationary scene with horizontal and vertical lines. The treadmill was positioned on a platform that was stationary (non-perturbed) or moving in a pattern that appeared random to the subjects (perturbed). In non-perturbed walking, medial-lateral upper body motion was very similar between visual conditions. However, in perturbed walking, there was significantly less body motion when focus was on the stationary visual scene, suggesting visual feedback of stationary vertical and horizontal cues are particularly important when balance is challenged. Sensitivity of body motion to perturbations was significantly decreased by increasing gait speed, suggesting that faster walking was less sensitive to frontal plane perturbations. Finally, our use of external perturbations supported the idea that certain differences in balance control mechanisms can only be detected in more challenging situations, which is an important consideration for approaches to investigating sensory contribution to balance during gait. Copyright © 2015 Elsevier B.V. All rights reserved.

Restricted Arm Swing Affects Gait Stability and Increased Walking Speed Alters Trunk Movements in Children with Cerebral Palsy

PubMed Central

Delabastita, Tijs; Desloovere, Kaat; Meyns, Pieter

2016-01-01

Observational research suggests that in children with cerebral palsy, the altered arm swing is linked to instability during walking. Therefore, the current study investigates whether children with cerebral palsy use their arms more than typically developing children, to enhance gait stability. Evidence also suggests an influence of walking speed on gait stability. Moreover, previous research highlighted a link between walking speed and arm swing. Hence, the experiment aimed to explore differences between typically developing children and children with cerebral palsy taking into account the combined influence of restricting arm swing and increasing walking speed on gait stability. Spatiotemporal gait characteristics, trunk movement parameters and margins of stability were obtained using three dimensional gait analysis to assess gait stability of 26 children with cerebral palsy and 24 typically developing children. Four walking conditions were evaluated: (i) free arm swing and preferred walking speed; (ii) restricted arm swing and preferred walking speed; (iii) free arm swing and high walking speed; and (iv) restricted arm swing and high walking speed. Double support time and trunk acceleration variability increased more when arm swing was restricted in children with bilateral cerebral palsy compared to typically developing children and children with unilateral cerebral palsy. Trunk sway velocity increased more when walking speed was increased in children with unilateral cerebral palsy compared to children with bilateral cerebral palsy and typically developing children and in children with bilateral cerebral palsy compared to typically developing children. Trunk sway velocity increased more when both arm swing was restricted and walking speed was increased in children with bilateral cerebral palsy compared to typically developing children. It is proposed that facilitating arm swing during gait rehabilitation can improve gait stability and decrease trunk movements in

Use of Visual and Proprioceptive Feedback to Improve Gait Speed and Spatiotemporal Symmetry Following Chronic Stroke: A Case Series

PubMed Central

Feasel, Jeff; Wentz, Erin; Brooks, Frederick P.; Whitton, Mary C.

2012-01-01

Background and Purpose Persistent deficits in gait speed and spatiotemporal symmetry are prevalent following stroke and can limit the achievement of community mobility goals. Rehabilitation can improve gait speed, but has shown limited ability to improve spatiotemporal symmetry. The incorporation of combined visual and proprioceptive feedback regarding spatiotemporal symmetry has the potential to be effective at improving gait. Case Description A 60-year-old man (18 months poststroke) and a 53-year-old woman (21 months poststroke) each participated in gait training to improve gait speed and spatiotemporal symmetry. Each patient performed 18 sessions (6 weeks) of combined treadmill-based gait training followed by overground practice. To assist with relearning spatiotemporal symmetry, treadmill-based training for both patients was augmented with continuous, real-time visual and proprioceptive feedback from an immersive virtual environment and a dual belt treadmill, respectively. Outcomes Both patients improved gait speed (patient 1: 0.35 m/s improvement; patient 2: 0.26 m/s improvement) and spatiotemporal symmetry. Patient 1, who trained with step-length symmetry feedback, improved his step-length symmetry ratio, but not his stance-time symmetry ratio. Patient 2, who trained with stance-time symmetry feedback, improved her stance-time symmetry ratio. She had no step-length asymmetry before training. Discussion Both patients made improvements in gait speed and spatiotemporal symmetry that exceeded those reported in the literature. Further work is needed to ascertain the role of combined visual and proprioceptive feedback for improving gait speed and spatiotemporal symmetry after chronic stroke. PMID:22228605

Effects of walking speed and age on the muscle forces of unimpaired gait subjects

NASA Astrophysics Data System (ADS)

Fliger, Carlos G.; Crespo, Marcos J.; Braidot, Ariel A.; Ravera, Emiliano P.

2016-04-01

Clinical gait analysis provides great contributions to the understanding of gait disorders and also provides a mean for a more comprehensive treatment plan. However, direct measures of muscle forces are difficult to obtain in clinical settings because it generally requires invasive techniques. Techniques of musculoskeletal modeling have been used for several decades to improve the benefits of clinical gait analysis, but many of the previous studies were focused on analyzing separately the muscle forces distribution of children or adult subjects with only one condition of walking speed. For these reason, the present study aims to enhance the current literature by describing the age and speed gait effects on muscle forces during walking. We used a musculoskeletal model with 23 degrees of freedom and 92 musculotendon actuators to represent 76 muscles in the lower extremities and torso. The computed muscle control algorithm was used to estimate the muscle forces from the kinematics and to adjust the model obtained in the residual reduction algorithm. We find that hamstrings has an important peak in the mid-stance phase in the adult group but this peak disappears in the children group with the same walking speed condition. Furthermore, the rectus femoris presents an increase in the muscle force during the pre- and mid-swing in concordance with the increment in the walking speed of subjects. This behavior could be associated with the role that the rectus femoris has in the acceleration of the knee joint. Finally, we show that the soleus is the muscle that perform the major force throughout the gait cycle regardless of age and walking speed.

Effects of auditory cues on gait initiation and turning in patients with Parkinson's disease.

PubMed

Gómez-González, J; Martín-Casas, P; Cano-de-la-Cuerda, R

2016-12-08

To review the available scientific evidence about the effectiveness of auditory cues during gait initiation and turning in patients with Parkinson's disease. We conducted a literature search in the following databases: Brain, PubMed, Medline, CINAHL, Scopus, Science Direct, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Library Plus, CENTRAL, Trip Database, PEDro, DARE, OTseeker, and Google Scholar. We included all studies published between 2007 and 2016 and evaluating the influence of auditory cues on independent gait initiation and turning in patients with Parkinson's disease. The methodological quality of the studies was assessed with the Jadad scale. We included 13 studies, all of which had a low methodological quality (Jadad scale score≤2). In these studies, high-intensity, high-frequency auditory cues had a positive impact on gait initiation and turning. More specifically, they 1) improved spatiotemporal and kinematic parameters; 2) decreased freezing, turning duration, and falls; and 3) increased gait initiation speed, muscle activation, and gait speed and cadence in patients with Parkinson's disease. We need studies of better methodological quality to establish the Parkinson's disease stage in which auditory cues are most beneficial, as well as to determine the most effective type and frequency of the auditory cue during gait initiation and turning in patients with Parkinson's disease. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Quantitative assessment of gait and neurochemical correlation in a classical murine model of Parkinson's disease.

PubMed

Wang, Xiao Hong; Lu, Gang; Hu, Xiang; Tsang, Kam Sze; Kwong, Wing Hang; Wu, Feng Xia; Meng, Hai Wei; Jiang, Shu; Liu, Shu Wei; Ng, Ho Keung; Poon, Wai Sang

2012-11-14

Gait deficits are important clinical symptoms of Parkinson's disease (PD). However, existing behavioral tests for the detection of motor impairments in rodents with systemic dopamine depletion only measure akinesia and dyskinesia, and data focusing on gait are scarce. We evaluated gait changes in the methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced C57BL/6 murine model of PD by using a computer-assisted CatWalk system. Correlations of gait parameters with tyrosine hydroxylase (TH) protein levels in the substantia nigra (SN) were also investigated. The gait readouts, including the walking duration, variation of walking speed, step cycle, duty cycle, stance, initial dual stance, terminal dual stance, three- and four-point supports, and the base of support between hind limbs was noted to increase significantly one week after MPTP injection. In contrast, values of the stride length, cadence, swing speed, and diagonal dual support decreased substantially following MPTP treatment (p < 0.05). All of these changes lasted for three weeks after the last MPTP administration. Except for the stance in the fore limbs and the swing speed in the hind limbs, the gait variability in the PD mice showed a closer correlation with the protein levels of TH in the SN than the walking distances in the conventional open field test. Coordination parameters of the regularity index and step pattern were not affected in mice treated with MPTP. Data of the study suggest that the computer-assisted CatWalk system can provide reliable and objective criteria to stratify gait changes arising from MPTP-induced bilateral lesions in C57/BL6 mice. The extent of gait changes was noted to correlate with the expression of the biomarker for dopaminergic neurons. This novel analytical method may hold promise in the study of disease progression and new drug screening in a murine PD model.

Interaction of obstructive sleep apnoea and cognitive impairment with slow gait speed in middle-aged and older adults.

PubMed

Lee, Sunghee; Shin, Chol

2017-07-01

to investigate whether slow gait speed is associated with cognitive impairment and further whether the association is modified by obstructive sleep apnoea (OSA). in total, 2,222 adults aged 49-80 years, free from dementia, stroke and head injury were asked to walk a 4-m course at fast and usual gait speeds. The time taken to walk was measured. All participants completed the Korean Mini-Mental State Examination, which was validated in the Korean language, to assess cognitive function. Additionally, the participants completed a polysomnography test to ascertain OSA (defined as an apnoea-hypopnoea index ≥15). Multivariable linear regression models were utilised to test the associations. time taken to walk 4 m showed significant inverse associations with cognitive scores (P value = 0.001 at fast gait speed and P = 0.002 at usual gait speed). Furthermore, a significant interaction according to OSA on the association between time to walk and cognitive impairment was found (P value for interaction = 0.003 at fast gait speed and P value for interaction = 0.007 at usual gait speed). we found that the inverse association between the time taken to walk 4 m and a cognitive score became significantly stronger, if an individual had OSA. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Improvement of walking speed and gait symmetry in older patients after hip arthroplasty: a prospective cohort study.

PubMed

Rapp, Walter; Brauner, Torsten; Weber, Linda; Grau, Stefan; Mündermann, Annegret; Horstmann, Thomas

2015-10-12

Retraining walking in patients after hip or knee arthroplasty is an important component of rehabilitation especially in older persons whose social interactions are influenced by their level of mobility. The objective of this study was to test the effect of an intensive inpatient rehabilitation program on walking speed and gait symmetry in patients after hip arthroplasty (THA) using inertial sensor technology. Twenty-nine patients undergoing a 4-week inpatient rehabilitation program following THA and 30 age-matched healthy subjects participated in this study. Walking speed and gait symmetry parameters were measured using inertial sensor device for standardized walking trials (2*20.3 m in a gym) at their self-selected normal and fast walking speeds on postoperative days 15, 21, and 27 in patients and in a single session in control subjects. Walking speed was measured using timing lights. Gait symmetry was determined using autocorrelation calculation of the cranio-caudal (CC) acceleration signals from an inertial sensor placed at the lower spine. Walking speed and gait symmetry improved from postoperative days 15-27 (speed, female: 3.2 and 4.5 m/s; male: 4.2 and 5.2 m/s; autocorrelation, female: 0.77 and 0.81; male: 0.70 and 0.79; P <0.001 for all). After the 4-week rehabilitation program, walking speed and gait symmetry were still lower than those in control subjects (speed, female 4.5 m/s vs. 5.7 m/s; male: 5.2 m/s vs. 5.3 m/s; autocorrelation, female: 0.81 vs. 0.88; male: 0.79 vs. 0.90; P <0.001 for all). While patients with THA improved their walking capacity during a 4-week inpatient rehabilitation program, subsequent intensive gait training is warranted for achieving normal gait symmetry. Inertial sensor technology may be a useful tool for evaluating the rehabilitation process during the post-inpatient period.

Concurrent validity and reliability of wireless instrumented insoles measuring postural balance and temporal gait parameters.

PubMed

Oerbekke, Michiel S; Stukstette, Mirelle J; Schütte, Kurt; de Bie, Rob A; Pisters, Martijn F; Vanwanseele, Benedicte

2017-01-01

The OpenGo seems promising to take gait analysis out of laboratory settings due to its capability of long-term measurements and mobility. However, the OpenGo's concurrent validity and reliability need to be assessed to determine if the instrument is suitable for validation in patient samples. Twenty healthy volunteers participated. Center of pressure data were collected under eyes open and closed conditions with participants performing unilateral stance trials on the gold standard (AMTI OR6-7 force plate) while wearing the OpenGo. Temporal gait data (stance time, gait cycle time, and cadence) were collected at a self-selected comfortable walking speed with participants performing test-retest trials on an instrumented treadmill while wearing the OpenGo. Validity was assessed using Bland-Altman plots. Reliability was assessed with Intraclass Correlation Coefficient (2,1) and smallest detectable changes were calculated. Negative means of differences were found in all measured parameters, illustrating lower scores for the OpenGo on average. The OpenGo showed negative upper limits of agreement in center of pressure parameters on the mediolateral axis. Temporal reliability ICCs ranged from 0.90-0.93. Smallest detectable changes for both stance times were 0.04 (left) and 0.05 (right) seconds, for gait cycle time 0.08s, and for cadence 4.5 steps per minute. The OpenGo is valid and reliable for the measurement of temporal gait parameters during walking. Measurements of center of pressure parameters during unilateral stance are not considered valid. The OpenGo seems a promising instrument for clinically screening and monitoring temporal gait parameters in patients, however validation in patient populations is needed. Copyright © 2016 Elsevier B.V. All rights reserved.

The effect of environment and task on gait parameters after stroke: A randomized comparison of measurement conditions.

PubMed

Lord, Susan E; Rochester, Lynn; Weatherall, Mark; McPherson, Kathryn M; McNaughton, Harry K

2006-07-01

To assess the effect of environment and a secondary task on gait parameters in community ambulant stroke survivors and to assess the contribution of clinical symptoms to gait performance. A 2x3 randomized factorial design with 2 main factors: task (no task, motor task, cognitive task) and environment (clinic, suburban street, shopping mall). Subjects were assessed in 1 of 3 settings: 2 in the community (a suburban street and shopping mall) and 1 clinical environment. Twenty-seven people with stroke (mean age, 61+/-11.6y; mean time since stroke onset, 45.8+/-34.2mo), living at home, were recruited from community stroke groups and from a local rehabilitation unit. Selection criteria included the following: ability to give informed consent, unilateral first ever or recurrent stroke at least 6 months previously, walking independently in the community, a gait speed between 24 and 50 m/min, Mini-Mental State Examination score of 24 or higher, and no severe comorbidity. Not applicable. Gait speed (in m/min), cadence, and step length were assessed by using an accelerometer with adjustable thresholds. Clinical measures hypothesized to influence gait parameters in community environments were also assessed including fatigue, anxiety and depression, and attentional deficit. Twenty-seven people with a mean baseline gait speed of 42.2+/-5.9 m/min were randomly allocated to 1 of 9 conditions in which the setting and distraction were manipulated. Analysis of variance showed a significant main effect for environment (P = .046) but not for task (P = .37). The interaction between task and environment was not significant (P = .73). Adjusting for baseline gait speed, people walked on average 8.8m/min faster in the clinic (95% confidence interval, 0.3-17.3m/min) than in the mall. Scores for fatigue, anxiety and depression, and attentional deficit were higher than normative values but did not influence gait performance. This study suggests that people with chronic stroke cope well with

Gait and energy consumption in adolescent idiopathic scoliosis: A literature review.

PubMed

Daryabor, Aliyeh; Arazpour, Mokhtar; Sharifi, Guive; Bani, Monireh Ahmadi; Aboutorabi, Atefeh; Golchin, Navid

2017-04-01

Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. The disease can modify human gait. We aimed to review articles describing the measurement of gait parameters and energy consumption in AIS during walking without any intervention. Literature review. The search strategy was based on the Population Intervention Comparison Outcome method and included all relevant articles published from 1996 to 2015. Articles were searched in MEDLINE via PubMed, Science Direct, Google Scholar, and ISI Web of Knowledge databases. We selected 33 studies investigating the effect of scoliosis deformity on gait parameters and energy expenditure during walking. Most of the studies concluded no significant differences in walking speed, cadence and step width in scoliosis patients and normal participants. However, patients showed decreased hip and pelvic motion, excessive energy cost of walking, stepping pattern asymmetry and ground reaction force asymmetry. We lack consistent evidence of the effect of scoliosis on temporal spatial and kinematic parameters in AIS patients as compared with normal people. However, further research is needed to assess the effect of scoliosis on gait and energy consumption. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Quantitative assessment of gait and neurochemical correlation in a classical murine model of Parkinson’s disease

PubMed Central

2012-01-01

Background Gait deficits are important clinical symptoms of Parkinson’s disease (PD). However, existing behavioral tests for the detection of motor impairments in rodents with systemic dopamine depletion only measure akinesia and dyskinesia, and data focusing on gait are scarce. We evaluated gait changes in the methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced C57BL/6 murine model of PD by using a computer-assisted CatWalk system. Correlations of gait parameters with tyrosine hydroxylase (TH) protein levels in the substantia nigra (SN) were also investigated. Results The gait readouts, including the walking duration, variation of walking speed, step cycle, duty cycle, stance, initial dual stance, terminal dual stance, three- and four-point supports, and the base of support between hind limbs was noted to increase significantly one week after MPTP injection. In contrast, values of the stride length, cadence, swing speed, and diagonal dual support decreased substantially following MPTP treatment (p < 0.05). All of these changes lasted for three weeks after the last MPTP administration. Except for the stance in the fore limbs and the swing speed in the hind limbs, the gait variability in the PD mice showed a closer correlation with the protein levels of TH in the SN than the walking distances in the conventional open field test. Coordination parameters of the regularity index and step pattern were not affected in mice treated with MPTP. Conclusion Data of the study suggest that the computer-assisted CatWalk system can provide reliable and objective criteria to stratify gait changes arising from MPTP-induced bilateral lesions in C57/BL6 mice. The extent of gait changes was noted to correlate with the expression of the biomarker for dopaminergic neurons. This novel analytical method may hold promise in the study of disease progression and new drug screening in a murine PD model. PMID:23151254

Gait Speed rather than Dynapenia Is a Simple Indicator for Complex Care Needs: A Cross-sectional Study Using Minimum Data Set.

PubMed

Huang, Tzu-Ya; Liang, Chih-Kuang; Shen, Hsiu-Chu; Chen, Hon-I; Liao, Mei-Chen; Chou, Ming-Yueh; Lin, Yu-Te; Chen, Liang-Kung

2017-08-21

The impact of dynapenia on the complexity of care for residents of long-term care facilities (LTCF) remains unclear. The present study evaluated associations between dynapenia, care problems and care complexity in 504 residents of Veterans Care Homes (VCHs) in Taiwan. Subjects with dynapenia, defined as low muscle strength (handgrip strength <26 kg), were older adults with lower body mass index (BMI), slow gait speed, and higher numbers of Resident Assessment Protocol (RAP) triggers. After adjusting for age, education, BMI, and Charlson's comorbidity index (CCI), only age, education, BMI and gait speed were independently associated with higher numbers of RAP triggers, but not dynapenia or handgrip strength (kg). Dividing subjects into groups based on quartiles of gait speed, those with gait speed ≤0.803 m/s were significantly associated with higher complexity of care needs (defined as ≥4 RAP triggers) compared to the reference group (gait speed >1 m/s). Significantly slow gait speed was associated with RAP triggers, including cognitive loss, poor communication ability, rehabilitation needs, urinary incontinence, depressed mood, falls, pressure ulcers, and use of psychotropic drugs. In conclusion, slow gait speed rather than dynapenia is a simple indicator for higher complexity of care needs of older male LTCF residents.

Effects of toe-out and toe-in gait with varying walking speeds on knee joint mechanics and lower limb energetics.

PubMed

Khan, Soobia Saad; Khan, Saad Jawaid; Usman, Juliana

2017-03-01

Toe-out/-in gait has been prescribed in reducing knee joint load to medial knee osteoarthritis patients. This study focused on the effects of toe-out/-in at different walking speeds on first peak knee adduction moment (fKAM), second peak KAM (sKAM), knee adduction angular impulse (KAAI), net mechanical work by lower limb as well as joint-level contribution to the total limb work during level walking. Gait analysis of 20 healthy young adults was done walking at pre-defined normal (1.18m/s), slow (0.85m/s) and fast (1.43m/s) walking speeds with straight-toe (natural), toe-out (15°>natural) and toe-in (15°gait increased fKAM at all walking speeds (highest at normal speed) while toe-in gait reduced fKAM at all speeds (highest at fast walking speed). Toeing-in reduced KAAI at all speeds while toeing-out affected KAAI only at normal speed. Increasing walking speed generally increased fKAM for all foot positions, but it did not affect sKAM considerably. Slowing down the speed, increased KAAI significantly at all foot positions except for toe-in. At slow walking speed, hip and knee joints were found to be major energy contributors for toe-in and toe-out respectively. At higher walking speeds, these contributions were switched. The ankle joint remained unaffected by changing walking speeds and foot progression angles. Toe-out/-in gait modifications affected knee joint kinetics and lower limb energetics at all walking speeds. However, their effects were inconsistent at different speeds. Therefore, walking speed should be taken into account when prescribing toe-out/-in gait. Copyright © 2017 Elsevier B.V. All rights reserved.

[Gait speed, grip strength and self-rated health among the elderly: data from the FIBRA Campinas network, São Paulo, Brazil].

PubMed

Bez, Joelita Pessoa de Oliveira; Neri, Anita Liberalesso

2014-08-01

The article seeks to investigate patterns of performance and relationships between grip strength, gait speed and self-rated health, and investigate the relationships between them, considering the variables of gender, age and family income. This was conducted in a probabilistic sample of community-dwelling elderly aged 65 and over, members of a population study on frailty. A total of 689 elderly people without cognitive deficit suggestive of dementia underwent tests of gait speed and grip strength. Comparisons between groups were based on low, medium and high speed and strength. Self-related health was assessed using a 5-point scale. The males and the younger elderly individuals scored significantly higher on grip strength and gait speed than the female and oldest did; the richest scored higher than the poorest on grip strength and gait speed; females and men aged over 80 had weaker grip strength and lower gait speed; slow gait speed and low income arose as risk factors for a worse health evaluation. Lower muscular strength affects the self-rated assessment of health because it results in a reduction in functional capacity, especially in the presence of poverty and a lack of compensatory factors.

New utility for an old tool: can a simple gait speed test predict ambulatory surgical discharge outcomes?

PubMed

Odonkor, Charles A; Schonberger, Robert B; Dai, Feng; Shelley, Kirk H; Silverman, David G; Barash, Paul G

2013-10-01

The primary aims of this study were to design prediction models based on a functional marker (preoperative gait speed) to predict readiness for home discharge time of 90 mins or less and to identify those at risk for unplanned admissions after elective ambulatory surgery. This prospective observational cohort study evaluated all patients scheduled for elective ambulatory surgery. Home discharge readiness and unplanned admissions were the primary outcomes. Independent variables included preoperative gait speed, heart rate, and total anesthesia time. The relationship between all predictors and each primary outcome was determined in separate multivariable logistic regression models. After adjustment for covariates, gait speed with adjusted odds ratio of 3.71 (95% confidence interval, 1.21-11.26), P = 0.02, was independently associated with early home discharge readiness of 90 mins or less. Importantly, gait speed dichotomized as greater or less than 1 m/sec predicted unplanned admissions, with odds ratio of 0.35 (95% confidence interval, 0.16-0.76, P = 0.008) for those with speeds 1 m/sec or greater in comparison with those with speeds less than 1 m/sec. In a separate model, history of cardiac surgery with adjusted odds ratio of 7.5 (95% confidence interval, 2.34-24.41; P = 0.001) was independently associated with unplanned admissions after elective ambulatory surgery, when other covariates were held constant. This study demonstrates the use of novel prediction models based on gait speed testing to predict early home discharge and to identify those patients at risk for unplanned admissions after elective ambulatory surgery.

Gender-related differences in maximum gait speed and daily physical activity in elderly hospitalized cardiac inpatients: a preliminary study.

PubMed

Izawa, Kazuhiro P; Watanabe, Satoshi; Hirano, Yasuyuki; Matsushima, Shinya; Suzuki, Tomohiro; Oka, Koichiro; Kida, Keisuke; Suzuki, Kengo; Osada, Naohiko; Omiya, Kazuto; Brubaker, Peter H; Shimizu, Hiroyuki; Akashi, Yoshihiro J

2015-03-01

Maximum gait speed and physical activity (PA) relate to mortality and morbidity, but little is known about gender-related differences in these factors in elderly hospitalized cardiac inpatients. This study aimed to determine differences in maximum gait speed and daily measured PA based on sex and the relationship between these measures in elderly cardiac inpatients.A consecutive 268 elderly Japanese cardiac inpatients (mean age, 73.3 years) were enrolled and divided by sex into female (n = 75, 28%) and male (n = 193, 72%) groups. Patient characteristics and maximum gait speed, average step count, and PA energy expenditure (PAEE) in kilocalorie per day for 2 days assessed by accelerometer were compared between groups.Gait speed correlated positively with in-hospital PA measured by average daily step count (r = 0.46, P < 0.001) and average daily PAEE (r = 0.47, P < 0.001) in all patients. After adjustment for left ventricular ejection fraction, step counts and PAEE were significantly lower in females than males (2651.35 ± 1889.92 vs 4037.33 ± 1866.81 steps, P < 0.001; 52.74 ± 51.98 vs 99.33 ± 51.40 kcal, P < 0.001), respectively.Maximum gait speed was slower and PA lower in elderly female versus male inpatients. Minimum gait speed and step count values in this study might be minimum target values for elderly male and female Japanese cardiac inpatients.

Improvement in gait following combined ankle and subtalar arthrodesis.

PubMed

Tenenbaum, Shay; Coleman, Scott C; Brodsky, James W

2014-11-19

This study assessed the hypothesis that arthrodesis of both the ankle and the hindfoot joints produces an objective improvement of function as measured by gait analysis of patients with severe ankle and hindfoot arthritis. Twenty-one patients with severe ankle and hindfoot arthritis who underwent unilateral tibiotalocalcaneal arthrodesis with an intramedullary nail were prospectively studied with three-dimensional (3D) gait analysis at a minimum of one year postoperatively. The mean age at the time of the operation was fifty-nine years, and the mean duration of follow-up was seventeen months (range, twelve to thirty-one months). Temporospatial measurements included cadence, step length, walking velocity, and total support time. The kinematic parameters were sagittal plane motion of the ankle, knee, and hip. The kinetic parameters were sagittal plane ankle power and moment and hip power. Symmetry of gait was analyzed by comparing the step lengths on the affected and unaffected sides. There was significant improvement in multiple parameters of postoperative gait as compared with the patients' own preoperative function. Temporospatial data showed significant increases in cadence (p = 0.03) and walking speed (p = 0.001) and decreased total support time (p = 0.02). Kinematic results showed that sagittal plane ankle motion had decreased, from 13.2° preoperatively to 10.2° postoperatively, in the operatively treated limb (p = 0.02), and increased from 22.2° to 24.1° (p = 0.01) in the contralateral limb. Hip motion on the affected side increased from 39° to 43° (p = 0.007), and knee motion increased from 56° to 60° (p = 0.054). Kinetic results showed significant increases in ankle moment (p < 0.0001) of the operatively treated limb, ankle power of the contralateral limb (p = 0.009), and hip power on the affected side (p = 0.005) postoperatively. There was a significant improvement in gait symmetry (p = 0.01). There was a small loss of sagittal plane motion in the

Effect of rhythmic auditory cueing on gait in people with Alzheimer disease.

PubMed

Wittwer, Joanne E; Webster, Kate E; Hill, Keith

2013-04-01

To determine whether rhythmic music and metronome cues alter spatiotemporal gait measures and gait variability in people with Alzheimer disease (AD). A repeated-measures study requiring participants to walk under different cueing conditions. University movement laboratory. Of the people (N=46) who met study criteria (a diagnosis of probable AD and ability to walk 100m) at routine medical review, 30 (16 men; mean age ± SD, 80±6y; revised Addenbrooke's Cognitive Examination range, 26-79) volunteered to participate. Participants walked 4 times over an electronic walkway synchronizing to (1) rhythmic music and (2) a metronome set at individual mean baseline comfortable speed cadence. Gait spatiotemporal measures and gait variability (coefficient of variation [CV]). Data from individual walks under each condition were combined. A 1-way repeated-measures analysis of variance was used to compare uncued baseline, cued, and retest measures. Gait velocity decreased with both music and metronome cues compared with baseline (baseline, 110.5cm/s; music, 103.4cm/s; metronome, 105.4cm/s), primarily because of significant decreases in stride length (baseline, 120.9cm; music, 112.5cm; metronome, 114.8cm) with both cue types. This was coupled with increased stride length variability compared with baseline (baseline CV, 3.4%; music CV, 4.3%; metronome CV, 4.5%) with both cue types. These changes did not persist at (uncued) retest. Temporal variability was unchanged. Rhythmic auditory cueing at comfortable speed tempo produced deleterious effects on gait in a single session in this group with AD. The deterioration in spatial gait parameters may result from impaired executive function associated with AD. Further research should investigate whether these instantaneous cue effects are altered with more practice or with learning methods tailored to people with cognitive impairment. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights

The Association between Dual-Task Gait after Concussion and Prolonged Symptom Duration.

PubMed

Howell, David R; Brilliant, Anna; Berkstresser, Brant; Wang, Francis; Fraser, Joana; Meehan, William P

2017-12-01

Quantitative gait measurements can identify persistent postconcussion impairments. However, their prognostic utility after injury to identify the likelihood of prolonged concussion symptoms remains unknown. Our objective was to examine if dual-task gait performance measures are independently associated with persistent (> 28 days) concussion symptoms among a sample of athletes. Sixty individuals diagnosed with a sport-related concussion were assessed within 10 days of their injury. Each participant completed a postconcussion symptom scale, an injury history questionnaire, and a single/dual-task gait examination. They were followed until they no longer reported symptoms, and the duration of time required for symptom resolution was calculated. A binary multivariable logistic regression model determined the independent association between dual-task gait and symptom duration (≤ 28 days vs. >28 days) while controlling for the effect of gender, age, symptom severity, injury-to-examination time, and history of concussion. Seventeen (28%) participants reported a symptom duration >28 days. The dual-task cost for average gait speed (-25.9 ± 9.5% vs. -19.8 ± 8.9%; p = 0.027) and cadence (-18.0 ± 2.9% vs. -12.0 ± 7.7%; p = 0.029) was significantly greater among participants who experienced symptoms for >28 days. After adjusting for potential confounding variables, greater dual-task average gait speed costs were independently associated with prolonged symptom duration (aOR = 0.908; 95% CI = 0.835-0.987). Examinations of dual-task gait may provide useful information during multifaceted concussion examinations. Quantitative assessments that simultaneously test multiple domains, such as dual tasks, may be clinically valuable after a concussion to identify those more likely to experience symptoms for >28 days after injury.

Insect-computer hybrid legged robot with user-adjustable speed, step length and walking gait.

PubMed

Cao, Feng; Zhang, Chao; Choo, Hao Yu; Sato, Hirotaka

2016-03-01

We have constructed an insect-computer hybrid legged robot using a living beetle (Mecynorrhina torquata; Coleoptera). The protraction/retraction and levation/depression motions in both forelegs of the beetle were elicited by electrically stimulating eight corresponding leg muscles via eight pairs of implanted electrodes. To perform a defined walking gait (e.g., gallop), different muscles were individually stimulated in a predefined sequence using a microcontroller. Different walking gaits were performed by reordering the applied stimulation signals (i.e., applying different sequences). By varying the duration of the stimulation sequences, we successfully controlled the step frequency and hence the beetle's walking speed. To the best of our knowledge, this paper presents the first demonstration of living insect locomotion control with a user-adjustable walking gait, step length and walking speed. © 2016 The Author(s).

Insect–computer hybrid legged robot with user-adjustable speed, step length and walking gait

PubMed Central

Cao, Feng; Zhang, Chao; Choo, Hao Yu

2016-01-01

We have constructed an insect–computer hybrid legged robot using a living beetle (Mecynorrhina torquata; Coleoptera). The protraction/retraction and levation/depression motions in both forelegs of the beetle were elicited by electrically stimulating eight corresponding leg muscles via eight pairs of implanted electrodes. To perform a defined walking gait (e.g. gallop), different muscles were individually stimulated in a predefined sequence using a microcontroller. Different walking gaits were performed by reordering the applied stimulation signals (i.e. applying different sequences). By varying the duration of the stimulation sequences, we successfully controlled the step frequency and hence the beetle's walking speed. To the best of our knowledge, this paper presents the first demonstration of living insect locomotion control with a user-adjustable walking gait, step length and walking speed. PMID:27030043

Restoration of gait for spinal cord injury patients using HAL with intention estimator for preferable swing speed.

PubMed

Tsukahara, Atsushi; Hasegawa, Yasuhisa; Eguchi, Kiyoshi; Sankai, Yoshiyuki

2015-03-01

This paper proposes a novel gait intention estimator for an exoskeleton-wearer who needs gait support owing to walking impairment. The gait intention estimator not only detects the intention related to the start of the swing leg based on the behavior of the center of ground reaction force (CoGRF), but also infers the swing speed depending on the walking velocity. The preliminary experiments categorized into two stages were performed on a mannequin equipped with the exoskeleton robot [Hybrid Assistive Limb: (HAL)] including the proposed estimator. The first experiment verified that the gait support system allowed the mannequin to walk properly and safely. In the second experiment, we confirmed the differences in gait characteristics attributed to the presence or absence of the proposed swing speed profile. As a feasibility study, we evaluated the walking capability of a severe spinal cord injury patient supported by the system during a 10-m walk test. The results showed that the system enabled the patient to accomplish a symmetrical walk from both spatial and temporal standpoints while adjusting the speed of the swing leg. Furthermore, the critical differences of gait between our system and a knee-ankle-foot orthosis were obtained from the CoGRF distribution and the walking time. Through the tests, we demonstrated the effectiveness and practical feasibility of the gait support algorithms.

Gait speed using powered robotic exoskeletons after spinal cord injury: a systematic review and correlational study.

PubMed

Louie, Dennis R; Eng, Janice J; Lam, Tania

2015-10-14

Powered robotic exoskeletons are an emerging technology of wearable orthoses that can be used as an assistive device to enable non-ambulatory individuals with spinal cord injury (SCI) to walk, or as a rehabilitation tool to improve walking ability in ambulatory individuals with SCI. No studies to date have systematically reviewed the literature on the efficacy of powered exoskeletons on restoring walking function. Our objective was to systematically review the literature to determine the gait speed attained by individuals with SCI when using a powered exoskeleton to walk, factors influencing this speed, and characteristics of studies involving a powered exoskeleton (e.g. inclusion criteria, screening, and training processes). A systematic search in computerized databases was conducted to identify articles that reported on walking outcomes when using a powered exoskeleton. Individual gait speed data from each study was extracted. Pearson correlations were performed between gait speed and 1) age, 2) years post-injury, 3) injury level, and 4) number of training sessions. Fifteen articles met inclusion criteria, 14 of which investigated the powered exoskeleton as an assistive device for non-ambulatory individuals and one which used it as a training intervention for ambulatory individuals with SCI. The mean gait speed attained by non-ambulatory participants (n = 84) while wearing a powered exoskeleton was 0.26 m/s, with the majority having a thoracic-level motor-complete injury. Twelve articles reported individual data for the non-ambulatory participants, from which a positive correlation was found between gait speed and 1) age (r = 0.27, 95 % CI 0.02-0.48, p = 0.03, 63 participants), 2) injury level (r = 0.27, 95 % CI 0.02-0.48, p = 0.03, 63 participants), and 3) training sessions (r = 0.41, 95 % CI 0.16-0.61, p = 0.002, 55 participants). In conclusion, powered exoskeletons can provide non-ambulatory individuals with thoracic-level motor

Early presentation of gait impairment in Wolfram Syndrome

PubMed Central

2012-01-01

Background Classically characterized by early onset insulin-dependent diabetes mellitus, optic atrophy, deafness, diabetes insipidus, and neurological abnormalities, Wolfram syndrome (WFS) is also associated with atypical brainstem and cerebellar findings in the first decade of life. As such, we hypothesized that gait differences between individuals with WFS and typically developing (TD) individuals may be detectable across the course of the disease. Methods Gait was assessed for 13 individuals with WFS (min 6.4 yrs, max 25.8 yrs) and 29 age-matched, typically developing individuals (min 5.6 yrs, max 28.5 yrs) using a GAITRite ® walkway system. Velocity, cadence, step length, base of support and double support time were compared between groups. Results Across all tasks, individuals with WFS walked slower (p = 0.03), took shorter (p ≤ 0.001) and wider (p ≤ 0.001) steps and spent a greater proportion of the gait cycle in double support (p = 0.03) compared to TD individuals. Cadence did not differ between groups (p = 0.62). Across all tasks, age was significantly correlated with cadence and double support time in the TD group but only double support time was correlated with age in the WFS group and only during preferred pace forward (rs= 0.564, p = 0.045) and dual task forward walking (rs= 0.720, p = 0.006) tasks. Individuals with WFS also had a greater number of missteps during tandem walking (p ≤ 0.001). Within the WFS group, spatiotemporal measures of gait did not correlate with measures of visual acuity. Balance measures negatively correlated with normalized gait velocity during fast forward walking (rs = −0.59, p = 0.03) and percent of gait cycle in double support during backward walking (rs = −0.64, p = 0.03). Conclusions Quantifiable gait impairments can be detected in individuals with WFS earlier than previous clinical observations suggested. These impairments are not fully accounted for by the visual or balance deficits associated with WFS

The effects of running cadence manipulation on plantar loading in healthy runners.

PubMed

Wellenkotter, J; Kernozek, T W; Meardon, S; Suchomel, T

2014-08-01

Our purpose was to evaluate effects of cadence manipulation on plantar loading during running. Participants (n=38) ran on a treadmill at their preferred speed in 3 conditions: preferred, 5% increased, and 5% decreased while measured using in-shoe sensors. Data (contact time [CT], peak force [PF], force time integral [FTI], pressure time integral [PTI] and peak pressure [PP]) were recorded for 30 right footfalls. Multivariate analysis was performed to detect differences in loading between cadences in the total foot and 4 plantar regions. Differences in plantar loading occurred between cadence conditions. Total foot CT and PF were lower with a faster cadence, but no total foot PP differences were observed. Faster cadence reduced CT, pressure and force variables in both the heel and metatarsal regions. Increasing cadence did not elevate metatarsal loads; rather, total foot and all regions were reduced when healthy runners increased their cadence. If a 5% increase in cadence from preferred were maintained over each mile run the impulse at the heel would be reduced by an estimated 565 body weights*s (BW*s) and the metatarsals 140-170 BW*s per mile run despite the increased steps taken. Increasing cadence may benefit overuse injuries associated with elevated plantar loading. © Georg Thieme Verlag KG Stuttgart · New York.

Correlations between Berg balance scale and gait speed in individuals with stroke wearing ankle-foot orthoses - a pilot study.

PubMed

Kobayashi, Toshiki; Leung, Aaron K L; Akazawa, Yasushi; Hutchins, Stephen W

2016-01-01

The Berg balance scale (BBS) is commonly used to assess balancing ability in patients with stroke. The BBS may be a good candidate for clinical assessment prior to orthotic intervention, if it correlates well with outcome measures such as gait speed. The purpose of this study was to investigate the correlation between the BBS measured prior to walking with an ankle-foot orthosis (AFO) and specific temporal-spatial parameters of gait when walking with an AFO donned. Eight individuals with chronic stroke participated in this study. Balancing ability was assessed using the BBS, while temporal-spatial parameters of gait (gait speed, bilateral step length, stride length and step width) were measured using a three-dimensional motion analysis system. The correlations between the BBS and gait parameters were investigated using a non-parametric Kendall's Tau (τ) correlation analysis. The BBS showed correlations with gait speed (τ = 0.64, p < 0.05), the step length of the affected side (τ = 0.74, p < 0.05), and the stride length (τ = 0.64, p < 0.05). Assessment of the BBS prior to AFO prescription may potentially help clinicians to estimate the gait speed achievable following orthotic intervention in patients with stroke. Implications for Rehabilitation Assessment of the BBS prior to AFO prescription may help orthotists to estimate the gait speed following an orthotic intervention in patients with stroke. Assessment of the BBS prior to AFO prescription may help orthotists to understand overall balance and postural control abilities in patients with stroke. A larger scale multifactorial analysis is warranted to confirm the results of this pilot study.

Validity and repeatability of inertial measurement units for measuring gait parameters.

PubMed

Washabaugh, Edward P; Kalyanaraman, Tarun; Adamczyk, Peter G; Claflin, Edward S; Krishnan, Chandramouli

2017-06-01

Inertial measurement units (IMUs) are small wearable sensors that have tremendous potential to be applied to clinical gait analysis. They allow objective evaluation of gait and movement disorders outside the clinic and research laboratory, and permit evaluation on large numbers of steps. However, repeatability and validity data of these systems are sparse for gait metrics. The purpose of this study was to determine the validity and between-day repeatability of spatiotemporal metrics (gait speed, stance percent, swing percent, gait cycle time, stride length, cadence, and step duration) as measured with the APDM Opal IMUs and Mobility Lab system. We collected data on 39 healthy subjects. Subjects were tested over two days while walking on a standard treadmill, split-belt treadmill, or overground, with IMUs placed in two locations: both feet and both ankles. The spatiotemporal measurements taken with the IMU system were validated against data from an instrumented treadmill, or using standard clinical procedures. Repeatability and minimally detectable change (MDC) of the system was calculated between days. IMUs displayed high to moderate validity when measuring most of the gait metrics tested. Additionally, these measurements appear to be repeatable when used on the treadmill and overground. The foot configuration of the IMUs appeared to better measure gait parameters; however, both the foot and ankle configurations demonstrated good repeatability. In conclusion, the IMU system in this study appears to be both accurate and repeatable for measuring spatiotemporal gait parameters in healthy young adults. Copyright © 2017 Elsevier B.V. All rights reserved.

Quantification of gait changes in subjects with visual height intolerance when exposed to heights.

PubMed

Schniepp, Roman; Kugler, Günter; Wuehr, Max; Eckl, Maria; Huppert, Doreen; Huth, Sabrina; Pradhan, Cauchy; Jahn, Klaus; Brandt, Thomas

2014-01-01

Visual height intolerance (vHI) manifests as instability at heights with apprehension of losing balance or falling. We investigated contributions of visual feedback and attention on gait performance of subjects with vHI. Sixteen subjects with vHI walked over a gait mat (GAITRite®) on a 15-m-high balcony and at ground-level. Subjects walked at different speeds (slow, preferred, fast), during changes of the visual input (gaze straight/up/down; eyes open/closed), and while doing a cognitive task. An rmANOVA with the factors "height situation" and "gait condition" was performed. Subjects were also asked to estimate the height of the balcony over ground level. The individual estimates were used for correlations with the gait parameters. Study participants walked slower at heights, with reduced cadence and stride length. The double support phases were increased (all p < 0.01), which correlated with the estimated height of the balcony (R (2) = 0.453, p < 0.05). These changes were still present when walking with upward gaze or closure of the eyes. Under the conditions walking and looking down to the floor of the balcony, during dual-task and fast walking, there were no differences between the gait performance on the balcony and at ground-level. The found gait changes are features of a cautious gait control. Internal, cognitive models with anxiety play an important role for vHI; gait was similarly affected when the visual perception of the depth was prevented. Improvement by dual task at heights may be associated by a reduction of the anxiety level. It is conceivable that mental distraction by dual task or increasing the walking speed might be useful recommendations to reduce the imbalance during locomotion in subjects susceptible to vHI.

Quantification of gait changes in subjects with visual height intolerance when exposed to heights

PubMed Central

Schniepp, Roman; Kugler, Günter; Wuehr, Max; Eckl, Maria; Huppert, Doreen; Huth, Sabrina; Pradhan, Cauchy; Jahn, Klaus; Brandt, Thomas

2014-01-01

Introduction: Visual height intolerance (vHI) manifests as instability at heights with apprehension of losing balance or falling. We investigated contributions of visual feedback and attention on gait performance of subjects with vHI. Materials and Methods: Sixteen subjects with vHI walked over a gait mat (GAITRite®) on a 15-m-high balcony and at ground-level. Subjects walked at different speeds (slow, preferred, fast), during changes of the visual input (gaze straight/up/down; eyes open/closed), and while doing a cognitive task. An rmANOVA with the factors “height situation” and “gait condition” was performed. Subjects were also asked to estimate the height of the balcony over ground level. The individual estimates were used for correlations with the gait parameters. Results: Study participants walked slower at heights, with reduced cadence and stride length. The double support phases were increased (all p < 0.01), which correlated with the estimated height of the balcony (R2 = 0.453, p < 0.05). These changes were still present when walking with upward gaze or closure of the eyes. Under the conditions walking and looking down to the floor of the balcony, during dual-task and fast walking, there were no differences between the gait performance on the balcony and at ground-level. Discussion: The found gait changes are features of a cautious gait control. Internal, cognitive models with anxiety play an important role for vHI; gait was similarly affected when the visual perception of the depth was prevented. Improvement by dual task at heights may be associated by a reduction of the anxiety level. Conclusion: It is conceivable that mental distraction by dual task or increasing the walking speed might be useful recommendations to reduce the imbalance during locomotion in subjects susceptible to vHI. PMID:25538595

The effects of additional arm weights on arm-swing magnitude and gait patterns in Parkinson's disease.

PubMed

Yoon, Jiyeon; Park, Jinse; Park, Kunbo; Jo, Geunyeol; Kim, Haeyu; Jang, Wooyoung; Kim, Ji Sun; Youn, Jinyoung; Oh, Eung Seok; Kim, Hee-Tae; Youm, Chang Hong

2016-01-01

Recently, arm facilitation has been interested in gait rehabilitation. However, there have been few studies concerning arm facilitation in patients with Parkinson's disease (PD). The aim of our study was to investigate the effect of increasing arm weights on gait pattern in patients with PD. Twenty-seven patients with PD were enrolled, and they underwent gait analysis using a three-dimensional motion capture system. Sandbags were applied to the distal forearms in all participants. We compared gait parameters including arm swing, pelvic motion, spatiotemporal data, and relative rotational angle between the weighted and unweighted gaits. The total arm-swing amplitude and pelvic rotation were significantly higher when walking with additional arm weights than without arm weights. Cadence, walking speed, stride length, and swing phase were significantly higher, whereas stride time, double-support time, and stance phase were significantly lower, when walking with additional arm weights than without arm weights. We conclude that adding weights to the arm during walking may facilitate arm and pelvic movements, which results in changes to gait patterns. The therapeutic use of additional arm weights could be considered for gait rehabilitation in PD to improve gait impairment. Arm-swing facilitation using weight load improved gait in Parkinson's disease. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Walking Speed Influences the Effects of Implicit Visual Feedback Distortion on Modulation of Gait Symmetry

PubMed Central

Maestas, Gabrielle; Hu, Jiyao; Trevino, Jessica; Chunduru, Pranathi; Kim, Seung-Jae; Lee, Hyunglae

2018-01-01

The use of visual feedback in gait rehabilitation has been suggested to promote recovery of locomotor function by incorporating interactive visual components. Our prior work demonstrated that visual feedback distortion of changes in step length symmetry entails an implicit or unconscious adaptive process in the subjects’ spatial gait patterns. We investigated whether the effect of the implicit visual feedback distortion would persist at three different walking speeds (slow, self-preferred and fast speeds) and how different walking speeds would affect the amount of adaption. In the visual feedback distortion paradigm, visual vertical bars portraying subjects’ step lengths were distorted so that subjects perceived their step lengths to be asymmetric during testing. Measuring the adjustments in step length during the experiment showed that healthy subjects made spontaneous modulations away from actual symmetry in response to the implicit visual distortion, no matter the walking speed. In all walking scenarios, the effects of implicit distortion became more significant at higher distortion levels. In addition, the amount of adaptation induced by the visual distortion was significantly greater during walking at preferred or slow speed than at the fast speed. These findings indicate that although a link exists between supraspinal function through visual system and human locomotion, sensory feedback control for locomotion is speed-dependent. Ultimately, our results support the concept that implicit visual feedback can act as a dominant form of feedback in gait modulation, regardless of speed. PMID:29632481

The Time Course of Knee Swelling Post Total Knee Arthroplasty and Its Associations with Quadriceps Strength and Gait Speed.

PubMed

Pua, Yong-Hao

2015-07-01

This study examines the time course of knee swelling post total knee arthroplasty (TKA) and its associations with quadriceps strength and gait speed. Eighty-five patients with unilateral TKA participated. Preoperatively and on post-operative days (PODs) 1, 4, 14, and 90, knee swelling was measured using bioimpedance spectrometry. Preoperatively and on PODs 14 and 90, quadriceps strength was measured using isokinetic dynamometry while fast gait speed was measured using the timed 10-meter walk. On POD1, knee swelling increased ~35% from preoperative levels after which, knee swelling reduced but remained at ~11% above preoperative levels on POD90. In longitudinal, multivariable analyses, knee swelling was associated with quadriceps weakness (P<0.01) and slower gait speed (P=0.03). Interventions to reduce post-TKA knee swelling may be indicated to improve quadriceps strength and gait speed. Copyright © 2015 Elsevier Inc. All rights reserved.

Energy Expenditure of Trotting Gait Under Different Gait Parameters

NASA Astrophysics Data System (ADS)

Chen, Xian-Bao; Gao, Feng

2017-07-01

Robots driven by batteries are clean, quiet, and can work indoors or in space. However, the battery endurance is a great problem. A new gait parameter design energy saving strategy to extend the working hours of the quadruped robot is proposed. A dynamic model of the robot is established to estimate and analyze the energy expenditures during trotting. Given a trotting speed, optimal stride frequency and stride length can minimize the energy expenditure. However, the relationship between the speed and the optimal gait parameters is nonlinear, which is difficult for practical application. Therefore, a simplified gait parameter design method for energy saving is proposed. A critical trotting speed of the quadruped robot is found and can be used to decide the gait parameters. When the robot is travelling lower than this speed, it is better to keep a constant stride length and change the cycle period. When the robot is travelling higher than this speed, it is better to keep a constant cycle period and change the stride length. Simulations and experiments on the quadruped robot show that by using the proposed gait parameter design approach, the energy expenditure can be reduced by about 54% compared with the 100 mm stride length under 500 mm/s speed. In general, an energy expenditure model based on the gait parameter of the quadruped robot is built and the trotting gait parameters design approach for energy saving is proposed.

Speed-Dependent Modulation of the Locomotor Behavior in Adult Mice Reveals Attractor and Transitional Gaits.

PubMed

Lemieux, Maxime; Josset, Nicolas; Roussel, Marie; Couraud, Sébastien; Bretzner, Frédéric

2016-01-01

Locomotion results from an interplay between biomechanical constraints of the muscles attached to the skeleton and the neuronal circuits controlling and coordinating muscle activities. Quadrupeds exhibit a wide range of locomotor gaits. Given our advances in the genetic identification of spinal and supraspinal circuits important to locomotion in the mouse, it is now important to get a better understanding of the full repertoire of gaits in the freely walking mouse. To assess this range, young adult C57BL/6J mice were trained to walk and run on a treadmill at different locomotor speeds. Instead of using the classical paradigm defining gaits according to their footfall pattern, we combined the inter-limb coupling and the duty cycle of the stance phase, thus identifying several types of gaits: lateral walk, trot, out-of-phase walk, rotary gallop, transverse gallop, hop, half-bound, and full-bound. Out-of-phase walk, trot, and full-bound were robust and appeared to function as attractor gaits (i.e., a state to which the network flows and stabilizes) at low, intermediate, and high speeds respectively. In contrast, lateral walk, hop, transverse gallop, rotary gallop, and half-bound were more transient and therefore considered transitional gaits (i.e., a labile state of the network from which it flows to the attractor state). Surprisingly, lateral walk was less frequently observed. Using graph analysis, we demonstrated that transitions between gaits were predictable, not random. In summary, the wild-type mouse exhibits a wider repertoire of locomotor gaits than expected. Future locomotor studies should benefit from this paradigm in assessing transgenic mice or wild-type mice with neurotraumatic injury or neurodegenerative disease affecting gait.

An innovative training program based on virtual reality and treadmill: effects on gait of persons with multiple sclerosis.

PubMed

Peruzzi, Agnese; Zarbo, Ignazio Roberto; Cereatti, Andrea; Della Croce, Ugo; Mirelman, Anat

2017-07-01

In this single blind randomized controlled trial, we examined the effect of a virtual reality-based training on gait of people with multiple sclerosis. Twenty-five individuals with multiple sclerosis with mild to moderate disability were randomly assigned to either the control group (n = 11) or the experimental group (n = 14). The subjects in the control group received treadmill training. Subjects in the experimental group received virtual reality based treadmill training. Clinical measures and gait parameters were evaluated. Subjects in both the groups significantly improved the walking endurance and speed, cadence and stride length, lower limb joint ranges of motion and powers, during single and dual task gait. Moreover, subjects in the experimental group also improved balance, as indicated by the results of the clinical motor tests (p < 0.05). Between-group comparisons revealed that the experimental group improved significantly more than control group in hip range of motion and hip generated power at terminal stance at post-training. Our results support the perceived benefits of training programs that incorporate virtual reality to improve gait measures in individuals with multiple sclerosis. Implication of rehabilitation Gait deficits are common in multiple sclerosis (85%) and worsen during dual task activities. Intensive and progressive treadmill training, with and without virtual reality, is effective on dual task gait in persons with multiple sclerosis. Virtual reality-based treadmill training requiring obstacle negotiation increases the range of motion and the power generated at the hip, consequently allowing longer stride length and, consequently, higher gait speed.

Specific smartphone usage and cognitive performance affect gait characteristics during free-living and treadmill walking.

PubMed

Niederer, Daniel; Bumann, Anke; Mühlhauser, Yvonne; Schmitt, Mareike; Wess, Katja; Engeroff, Tobias; Wilke, Jan; Vogt, Lutz; Banzer, Winfried

2018-05-01

Mobile phone tasks like texting, typing, and dialling during walking are known to impact gait characteristics. Beyond that, the effects of performing smartphone-typical actions like researching and taking self-portraits (selfie) on gait have not been investigated yet. We aimed to investigate the effects of smartphone usage on relevant gait characteristics and to reveal potential association of basic cognitive and walking plus smartphone dual-task abilities. Our cross-sectional, cross-over study on physically active, healthy participants was performed on two days, interrupted by a 24-h washout in between. Assessments were: 1) Cognitive testing battery consisting of the trail making test (TMT A and B) and the Stroop test 2) Treadmill walking under five smartphone usage conditions: no use (control condition), reading, dialling, internet searching and taking a selfie in randomized order. Kinematic and kinetic gait characteristics were assessed to estimate conditions influence. In our sample of 36 adults (24.6 ± 1 years, 23 female, 13 male), ANCOVAs followed by post-hoc t-tests revealed that smartphone usage impaired all tested gait characteristics: gait speed (decrease, all conditions): F = 54.7, p < 0.001; cadence (increase, all): F = 38.3, p < 0.001; double stride length (decrease, all): F = 33.8, p < 0.001; foot external rotation (increase during dialling, researching, selfie): F = 16.7, p < 0.001; stride length variability (increase): F = 11.7, p < 0.001; step width variability (increase): F = 5.3, p < 0.001; step width (Friedmann test and Wilcoxon Bonferroni-Holm-corrected post-hoc analyses, increase): Z = -2.3 to -2.9; p < 0.05); plantar pressure proportion (increase during reading and researching) (Z = -2.9; p < 0.01). The ability to keep usual gait quality during smartphone usage was systematically associated with the TMT B time regarding cadence and double stride length for reading (r�

A 9-Week Jaques-Dalcroze Eurhythmics Intervention Improves Single and Dual-Task Gait Speed in Community-Dwelling Older People.

PubMed

Ferguson-Stegall, Lisa; Vang, Mandy; Wolfe, Anthony S; Thomsen, Kathy M

2017-09-01

Falls are a major public health concern among older adults, and most occur while walking, especially under dualtask conditions. Jaques-Dalcroze eurhythmics (JDE) is a music-based movement training program that emphasizes multitask coordinated movement. A previous 6-mo JDE study in older people demonstrated improved gait and balance; however, the effects of short-term JDE interventions on fall risk-related outcomes are largely unknown. We conducted a preliminary investigation on whether a 9-week JDE intervention improved gait and stability in a community-dwelling older cohort, hypothesizing that improvements would occur in all outcome measures. Nine participants (78.9 ± 12.3 y) completed the supervised JDE intervention (once/week for 60 min). Gait speed was determined by the 6-m timed walk test (6MTW); dual-task gait speed was determined by another 6MTW while counting backward from 50 aloud; and coordinated stability was assessed using a Swaymeter-like device. Gait speed (0.92 ± 0.11 vs 1.04 ± 0.12 m/sec, P = .04) and dual-task gait speed (0.77 ± 0.09 vs 0.92 ± 0.11 m/sec, P = .0005) significantly improved. This novel intervention is an effective short-term physical activity option for those that plan physical activity or fall-risk reduction programs for the older people.

Factors associated with lower gait speed among the elderly living in a developing country: a cross-sectional population-based study.

PubMed

Busch, Telma de Almeida; Duarte, Yeda Aparecida; Pires Nunes, Daniella; Lebrão, Maria Lucia; Satya Naslavsky, Michel; dos Santos Rodrigues, Anelise; Amaro, Edson

2015-04-01

Among community-dwelling older adults, mean values for gait speed vary substantially depending not only on the population studied, but also on the methodology used. Despite the large number of studies published in developed countries, there are few population-based studies in developing countries with socioeconomic inequality and different health conditions, and this is the first study with a representative sample of population. To explore this, the association of lower gait speed with sociodemographic, anthropometric factors, mental status and physical health was incorporated participants' weight (main weight) in the analysis of population of community-dwelling older adults living in a developing country. This was a cross-sectional population based on a sample of 1112 older adults aged 60 years and over from Health, Wellbeing and Aging Study cohort 2010. Usual gait speed (s) to walk 3 meters was stratified by sex and height into quartiles. Multiple regression analysis was performed to investigate the independent effect of each factor associated with a slower usual gait speed. The average walking speed of the elderly was 0.81 m/s-0.78 m/s among women and 0.86 m/s among men. In the final model, the factors associated with lower gait speed were age (OR = 3.56), literacy (OR = 3.20), difficulty in one or more IADL (OR = 2.74), presence of cardiovascular disease (OR = 2.15) and sedentarism. When we consider the 50% slower, we can add the variables handgrip strength, and the presence of COPD. Gait speed is a clinical marker and an important measure of functional capacity among the elderly. Our findings suggest that lower walking speed is associated with age, education, but especially with modifiable factors such as impairment of IADL, physical inactivity and cardiovascular disease. These results reinforce how important it is for the elderly to remain active and healthy.

The Influence of Video Game Training with and without Subpatelar Bandage in Mobility and Gait Speed on Elderly Female Fallers.

PubMed

de Carvalho, Isabela Feitosa; Leme, Gianluca Loyolla Montanari; Scheicher, Marcos Eduardo

2018-01-01

The aim of the study was to investigate the effect of balance training with Nintendo Wii technology, with and without the use of additional sensory information (subpatellar bandage), in the functional mobility and gait speed of elderly female fallers. Twenty elderly women were divided into two groups: group I: trained with the use of the Nintendo Wii; group II: trained using the Nintendo Wii and the addition of sensory information (subpatellar bandage). The functional mobility was assessed with the Timed up and Go test (TUG) and gait speed with the 10 m test. The tests were carried out with and without the use of the subpatellar bandage. The training was carried out within sessions of 30 minutes, twice a week, using three different games ( Penguin Slide , Table Tilt , and Tightrope ). There was an increase in the gait speed and a decrease in the TUG time in both groups, independently of the sensory condition used ( p < 0.05). In the short term, the subpatellar bandage improved the TUG time ( p < 0.05) and the gait speed ( p < 0.01). The training for postural balance with virtual reality was effective for improving functional mobility and gait speed of elderly female fallers. The subpatellar bandage did not maximize the effect of training.

Gait Parameter Adjustments for Walking on a Treadmill at Preferred, Slower, and Faster Speeds in Older Adults with Down Syndrome

PubMed Central

Smith, Beth A.; Kubo, Masayoshi; Ulrich, Beverly D.

2012-01-01

The combined effects of ligamentous laxity, hypotonia, and decrements associated with aging lead to stability-enhancing foot placement adaptations during routine overground walking at a younger age in adults with Down syndrome (DS) compared to their peers with typical development (TD). Our purpose here was to examine real-time adaptations in older adults with DS by testing their responses to walking on a treadmill at their preferred speed and at speeds slower and faster than preferred. We found that older adults with DS were able to adapt their gait to slower and faster than preferred treadmill speeds; however, they maintained their stability-enhancing foot placements at all speeds compared to their peers with TD. All adults adapted their gait patterns similarly in response to faster and slower than preferred treadmill-walking speeds. They increased stride frequency and stride length, maintained step width, and decreased percent stance as treadmill speed increased. Older adults with DS, however, adjusted their stride frequencies significantly less than their peers with TD. Our results show that older adults with DS have the capacity to adapt their gait parameters in response to different walking speeds while also supporting the need for intervention to increase gait stability. PMID:22693497

Kinematic Validation of a Multi-Kinect v2 Instrumented 10-Meter Walkway for Quantitative Gait Assessments.

PubMed

Geerse, Daphne J; Coolen, Bert H; Roerdink, Melvyn

2015-01-01

Walking ability is frequently assessed with the 10-meter walking test (10MWT), which may be instrumented with multiple Kinect v2 sensors to complement the typical stopwatch-based time to walk 10 meters with quantitative gait information derived from Kinect's 3D body point's time series. The current study aimed to evaluate a multi-Kinect v2 set-up for quantitative gait assessments during the 10MWT against a gold-standard motion-registration system by determining between-systems agreement for body point's time series, spatiotemporal gait parameters and the time to walk 10 meters. To this end, the 10MWT was conducted at comfortable and maximum walking speed, while 3D full-body kinematics was concurrently recorded with the multi-Kinect v2 set-up and the Optotrak motion-registration system (i.e., the gold standard). Between-systems agreement for body point's time series was assessed with the intraclass correlation coefficient (ICC). Between-systems agreement was similarly determined for the gait parameters' walking speed, cadence, step length, stride length, step width, step time, stride time (all obtained for the intermediate 6 meters) and the time to walk 10 meters, complemented by Bland-Altman's bias and limits of agreement. Body point's time series agreed well between the motion-registration systems, particularly so for body points in motion. For both comfortable and maximum walking speeds, the between-systems agreement for the time to walk 10 meters and all gait parameters except step width was high (ICC ≥ 0.888), with negligible biases and narrow limits of agreement. Hence, body point's time series and gait parameters obtained with a multi-Kinect v2 set-up match well with those derived with a gold standard in 3D measurement accuracy. Future studies are recommended to test the clinical utility of the multi-Kinect v2 set-up to automate 10MWT assessments, thereby complementing the time to walk 10 meters with reliable spatiotemporal gait parameters obtained

Kinematic Validation of a Multi-Kinect v2 Instrumented 10-Meter Walkway for Quantitative Gait Assessments

PubMed Central

Geerse, Daphne J.; Coolen, Bert H.; Roerdink, Melvyn

2015-01-01

Walking ability is frequently assessed with the 10-meter walking test (10MWT), which may be instrumented with multiple Kinect v2 sensors to complement the typical stopwatch-based time to walk 10 meters with quantitative gait information derived from Kinect’s 3D body point’s time series. The current study aimed to evaluate a multi-Kinect v2 set-up for quantitative gait assessments during the 10MWT against a gold-standard motion-registration system by determining between-systems agreement for body point’s time series, spatiotemporal gait parameters and the time to walk 10 meters. To this end, the 10MWT was conducted at comfortable and maximum walking speed, while 3D full-body kinematics was concurrently recorded with the multi-Kinect v2 set-up and the Optotrak motion-registration system (i.e., the gold standard). Between-systems agreement for body point’s time series was assessed with the intraclass correlation coefficient (ICC). Between-systems agreement was similarly determined for the gait parameters’ walking speed, cadence, step length, stride length, step width, step time, stride time (all obtained for the intermediate 6 meters) and the time to walk 10 meters, complemented by Bland-Altman’s bias and limits of agreement. Body point’s time series agreed well between the motion-registration systems, particularly so for body points in motion. For both comfortable and maximum walking speeds, the between-systems agreement for the time to walk 10 meters and all gait parameters except step width was high (ICC ≥ 0.888), with negligible biases and narrow limits of agreement. Hence, body point’s time series and gait parameters obtained with a multi-Kinect v2 set-up match well with those derived with a gold standard in 3D measurement accuracy. Future studies are recommended to test the clinical utility of the multi-Kinect v2 set-up to automate 10MWT assessments, thereby complementing the time to walk 10 meters with reliable spatiotemporal gait parameters

Prospective dynamic functional evaluation of gait and spinal balance following spinal fusion in adolescent idiopathic scoliosis.

PubMed

Lenke, L G; Engsberg, J R; Ross, S A; Reitenbach, A; Blanke, K; Bridwell, K H

2001-07-15

Prospective evaluation of gait and spinal-pelvic balance parameters in patients with adolescent idiopathic scoliosis undergoing a spinal fusion. To evaluate changes in gait and three-dimensional alignment and balance of the spine relative to the pelvis as a consequence of spinal fusion. Preoperative and postoperative spinal radiographs have been the major forms of outcome analysis of adolescent idiopathic scoliosis fusions. The use of optoelectronic analysis for posture and gait has gained acceptance recently. However, there is a paucity of data quantifying, comparing, and correlating structural and functional changes in patients undergoing scoliosis fusion surgery including upright posture and gait. Thirty patients with adolescent idiopathic scoliosis undergoing an instrumented spinal fusion were prospectively evaluated. Coronal and sagittal vertical alignment was evaluated on radiographs (CVA-R, SVA-R), during upright posture (CVA-P and SVA-P), and during gait (CVA-G, SVA-G). Transverse plane alignment was evaluated by the acromion-pelvis angle during gait. Gait speed was significantly decreased (P < 0.05) between preoperative (129 +/- 16 cm/sec) and 2-year postoperative (119 +/- 16 cm/sec) testing sessions. Decreasing gait speed was the result of significantly reduced cadence and decreased stride length. There were no significant differences for lower extremity kinematics over the entire gait cycle. Spinal-pelvic balance parameters showed significant improvement in mean CVA-R, CVA-G (P < 0.05), then unchanged CVA-P at 2 years postoperation. CVA-P was relatively unchanged while the mean CVA-G also showed significant improvement from preoperation (2.2 +/- 2.4 cm) to 2 years postoperation (1.3 +/- 1.3 cm)(P < 0.05). The mean SVA-R, SVA-P, and SVA-G were unchanged at 2 years postoperation (P > 0.05). The acromion-pelvis angle during gait at maximum shoulder rotation was statistically improved at 1 year (P = 0.002) and 2 years (P = 0.001) after surgery. Importantly

Changes of cerebrospinal fluid protein concentrations and gait patterns in geriatric normal pressure hydrocephalus patients after ventriculoperitoneal shunting surgery.

PubMed

Chen, Carl P C; Huang, Yin-Cheng; Chang, Chen-Nen; Chen, Jean-Lon; Hsu, Chih-Chin; Lin, Wan-Ying

2018-06-01

Normal pressure hydrocephalus (NPH) was the first type of dementia ever described that can be treated using ventriculoperitoneal shunting surgery. Three typical clinical symptoms of NPH include gait disturbance, progressive cognitive dysfunction, and urinary incontinence. Although there are articles that have discovered several cerebrospinal fluid (CSF) protein biomarkers associated with NPH; however, studies examining individual and total protein concentrations from the ventricular CSF before and after shunting surgery are lacking. This study used proteomics to calculate the CSF individual and total protein concentrations before, and one week, one month and three months after the shunting surgery. Parameters of cadence, step length, walking speed, and percentages of single- and double-limb support in a gait cycle were measured. Protein concentrations associated with anti-oxidation, aging, and in the prevention of neurotoxic agent production increased by at least 2-folds after the surgery, indicating that the brain may become less susceptible to neurodegeneration. These proteins were alpha-1B-glycoprotein, apolipoproteins A-1 & A-IV, prostaglandin-H2 D-isomerase, alpha-1-antitrypsin, and serotransferrin. In gait analysis, lower cadence, decreased double-limb support, longer step length, and increased single-limb support were observed after the surgery, indicating a more stable walking balance. These changes lasted for a period of at least 3 months. As a result, shunting surgery may be recommended for geriatric patients with confirmed diagnosis of normal pressure hydrocephalus. Copyright © 2018 Elsevier Inc. All rights reserved.

Resting State Default Mode Network Connectivity, Dual Task Performance, Gait Speed, and Postural Sway in Older Adults with Mild Cognitive Impairment

PubMed Central

Crockett, Rachel A.; Hsu, Chun Liang; Best, John R.; Liu-Ambrose, Teresa

2017-01-01

Aging is associated with an increased risk of falling. In particular, older adults with mild cognitive impairment (MCI) are more vulnerable to falling compared with their healthy counterparts. Major contributors to this increased falls risk include a decline in dual task performance, gait speed, and postural sway. Recent evidence highlights the potential influence of the default mode network (DMN), the frontoparietal network (FPN), and the supplementary motor area (SMA) on dual task performance, gait speed, and postural sway. The DMN is active during rest and deactivates during task-oriented processes, to maintain attention and stay on task. The FPN and SMA are involved in top-down attentional control, motor planning, and motor execution. The DMN shows less deactivation during task in older adults with MCI. This lack of deactivation is theorized to increase competition for resources between the DMN and task-related brain regions (e.g., the FPN and SMA), increasing distraction from the task and reducing task performance. However, no study has yet investigated the relationship between the between-network connectivity of the DMN with these regions and dual task walking, gait speed or postural sway. We hypothesized that greater functional connectivity both within the DMN and between DMN–FPN and DMN–SMA, will be associated with poorer performance during dual task walking, slower gait speed, and greater postural sway in older adults with MCI. Forty older adults with MCI were measured on a dual task-walking paradigm, gait speed over a 4-m walk, and postural sway using a sway-meter. Greater within-DMN connectivity was significantly correlated with poorer dual task performance. Furthermore, greater inter-network connectivity between the DMN and SMA was significantly correlated with slower gait speed and greater postural sway on the eyes open floor sway task. Thus, greater resting state DMN functional connectivity may be an underlying neural mechanism for reduced dual

Resting State Default Mode Network Connectivity, Dual Task Performance, Gait Speed, and Postural Sway in Older Adults with Mild Cognitive Impairment.

PubMed

Crockett, Rachel A; Hsu, Chun Liang; Best, John R; Liu-Ambrose, Teresa

2017-01-01

Aging is associated with an increased risk of falling. In particular, older adults with mild cognitive impairment (MCI) are more vulnerable to falling compared with their healthy counterparts. Major contributors to this increased falls risk include a decline in dual task performance, gait speed, and postural sway. Recent evidence highlights the potential influence of the default mode network (DMN), the frontoparietal network (FPN), and the supplementary motor area (SMA) on dual task performance, gait speed, and postural sway. The DMN is active during rest and deactivates during task-oriented processes, to maintain attention and stay on task. The FPN and SMA are involved in top-down attentional control, motor planning, and motor execution. The DMN shows less deactivation during task in older adults with MCI. This lack of deactivation is theorized to increase competition for resources between the DMN and task-related brain regions (e.g., the FPN and SMA), increasing distraction from the task and reducing task performance. However, no study has yet investigated the relationship between the between-network connectivity of the DMN with these regions and dual task walking, gait speed or postural sway. We hypothesized that greater functional connectivity both within the DMN and between DMN-FPN and DMN-SMA, will be associated with poorer performance during dual task walking, slower gait speed, and greater postural sway in older adults with MCI. Forty older adults with MCI were measured on a dual task-walking paradigm, gait speed over a 4-m walk, and postural sway using a sway-meter. Greater within-DMN connectivity was significantly correlated with poorer dual task performance. Furthermore, greater inter-network connectivity between the DMN and SMA was significantly correlated with slower gait speed and greater postural sway on the eyes open floor sway task. Thus, greater resting state DMN functional connectivity may be an underlying neural mechanism for reduced dual task

Alternate rhythmic vibratory stimulation of trunk muscles affects walking cadence and velocity in Parkinson's disease.

PubMed

De Nunzio, Alessandro M; Grasso, Margherita; Nardone, Antonio; Godi, Marco; Schieppati, Marco

2010-02-01

During the administration of timed bilateral alternate vibration to homonymous leg or trunk muscles during quiet upright stance, Parkinsonian (PD) patients undergo cyclic antero-posterior and medio-lateral transfers of the centre of foot pressure. This event might be potentially exploited for improving gait in these patients. Here, we tested this hypothesis by applying alternate muscle vibration during walking in PD. Fifteen patients and 15 healthy subjects walked on an instrumented walkway under four conditions: no vibration (no-Vib), and vibration of tibialis anterior (TA-Vib), soleus (Sol-Vib) and erector spinae (ES-Vib) muscles of both sides. Trains of vibration (internal frequency 100 Hz) were delivered to right and left side at alternating frequency of 10% above preferred step cadence. During vibration, stride length, cadence and velocity increased in both patients and healthy subjects, significantly so for ES-Vib. Stance and swing time tended to decrease. Width of support base increased with Sol-Vib or TA-Vib, but was unaffected by ES-Vib. Alternate ES vibration enhances gait velocity in PD. The stronger effect of ES over leg muscle vibration might depend on the relevance of the proprioceptive inflow from the trunk muscles and on the absence of adverse effects on the support base width. Trunk control is defective in PD. The effect of timed vibratory stimulation on gait suggests the potential use of trunk proprioceptive stimulation for tuning the central pattern generators for locomotion in PD. Copyright (c) 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Impact of Gait Speed and Instrumental Activities of Daily Living on All-Cause Mortality in Adults ≥65 Years of Age with Heart Failure

PubMed Central

Lo, Alexander X.; Donnelly, John P.; McGwin, Gerald; Bittner, Vera; Ahmed, Ali; Brown, Cynthia J.

2015-01-01

Mobility and function are important predictors of survival. However, their combined impact on mortality in adults ≥65 years of age with heart failure (HF) is not well understood. This study examined the role of gait speed and instrumental activities of daily living (IADL) in all-cause mortality in a cohort of 1,119 community-dwelling Cardiovascular Health Study participants ≥65 years of age with incident HF. Data on HF and mortality were collected through annual examinations or contact during the 10-year follow-up period. Slower gait speed (<0.8m/s vs. ≥0.8m/s) and IADL impairment (≥1 vs. 0 areas of dependence) were determined from baseline and follow-up assessments. A total of 740 (66%) of the 1119 participants died during the follow-up period. Multivariate Cox proportional hazards models showed that impairments in either gait speed (hazard ratio 1.37, 95% CI 1.10-1.70; p=0.004) or IADL (HR 1.56, 95% CI 1.29-1.89; p<0.001), measured within 1 year before the diagnosis of incident HF, were independently associated with mortality, adjusting for socio-demographic and clinical characteristics. The combined presence of slower gait speed and IADL impairment was associated with a greater risk of mortality and suggested an additive relationship between gait speed and IADL. In conclusion, gait speed and IADL are important risk factors for mortality in adults ≥65 years of age with HF, but the combined impairments of both gait speed and IADL can have an especially important impact on mortality. PMID:25655868

Comparing the efficacy of metronome beeps and stepping stones to adjust gait: steps to follow!

PubMed

Bank, Paulina J M; Roerdink, Melvyn; Peper, C E

2011-03-01

Acoustic metronomes and visual targets have been used in rehabilitation practice to improve pathological gait. In addition, they may be instrumental in evaluating and training instantaneous gait adjustments. The aim of this study was to compare the efficacy of two cue types in inducing gait adjustments, viz. acoustic temporal cues in the form of metronome beeps and visual spatial cues in the form of projected stepping stones. Twenty healthy elderly (aged 63.2 ± 3.6 years) were recruited to walk on an instrumented treadmill at preferred speed and cadence, paced by either metronome beeps or projected stepping stones. Gait adaptations were induced using two manipulations: by perturbing the sequence of cues and by imposing switches from one cueing type to the other. Responses to these manipulations were quantified in terms of step-length and step-time adjustments, the percentage correction achieved over subsequent steps, and the number of steps required to restore the relation between gait and the beeps or stepping stones. The results showed that perturbations in a sequence of stepping stones were overcome faster than those in a sequence of metronome beeps. In switching trials, switching from metronome beeps to stepping stones was achieved faster than vice versa, indicating that gait was influenced more strongly by the stepping stones than the metronome beeps. Together these results revealed that, in healthy elderly, the stepping stones induced gait adjustments more effectively than did the metronome beeps. Potential implications for the use of metronome beeps and stepping stones in gait rehabilitation practice are discussed.

Does dance-based therapy increase gait speed in older adults with chronic lower extremity pain: a feasibility study.

PubMed

Krampe, Jean; Wagner, Joanne M; Hawthorne, Kelly; Sanazaro, Deborah; Wong-Anuchit, Choochart; Budhathoki, Chakra; Lorenz, Rebecca A; Raaf, Soren

2014-01-01

A decreased gait speed in older adults can lead to dependency when the individuals are no longer able to participate in activities or do things for themselves. Thirty-seven senior apartment residents (31 females; Mean age=80.6 years; SD=8.9) with lower extremity pain/stiffness participated in a feasibility and preliminary efficacy study of 12 weeks (24 sessions). Healthy-Steps dance therapy compared to a wait-list control group. Small improvements in gait speed ([ES]=0.33) were noted for participants completing 19-24 dance sessions. Improvements in gait speed measured by a 10 Meter Walk Test (0.0517 m/s) exceeded 0.05 m/s, a value deemed to be meaningful in community dwelling older adults. These feasibility study findings support the need for additional research using dance-based therapy for older adults with lower extremity pain. Copyright © 2014 Elsevier Inc. All rights reserved.

Effects of arm weight on gait performance in healthy subjects.

PubMed

Yang, Hyung Suk; James, C Roger; Atkins, Lee T; Sawyer, Steven F; Sizer, Phillip S; Kumar, Neeraj A; Kim, Jongyeol

2018-05-15

Previous studies have investigated how additional arm weights affect gait. Although light weights (0.45 kg) seemed to elicit performance improvements in Parkinsonian patients, it was not studied how light weights affect gait parameters in healthy individuals. It is important to understand normal responses in a healthy population so that clinical effects might be better understood. Therefore, the purpose of this study was to investigate the effects of arm weights on arm swing amplitude, gait performance, and muscle activity in healthy people. Twenty-two subjects walked overground at their preferred speed under different weight carriage conditions (C1: no weight; C2: unilateral arm weight; C3: bilateral arm weights; C4: waist weights). Gait speed increased in C2 (p = 0.018) and C4 (p = 0.013) when compared with C1(C1: 1.21 ± 0.08; C2: 1.25 ± 0.11; C3: 1.24 ± 0.11; C4: 1.25 ± 0.11 m/s) with an increase in cadence during C2 (p < 0.001), C3 (p = 0.008), and C4 (p < 0.001) (C1: 105.5 ± 5.2; C2: 108.5 ± 5.6; C3: 107.9 ± 5.6; C4: 108.5 ± 5.3 steps/min) and in tibialis anterior electromyographic activity on the unweighted side in C2 (p = 0.048) (C1: 21.05 ± 4.59; C2: 25.10 ± 6.10; C3: 23.93 ± 4.75; C4: 24.33 ± 6.32 μV). The results indicate that an additional sensory input with the application of the weights may result in an overcompensation with the whole body and facilitate faster walking speed when applied on one arm or around the waist. The locations of the weights and amount of the weights may elicit different responses. Various strategies of adding weights should be further investigated as a potential intervention to improve performance in individuals with various gait impairments. Although there is evidence for benefits of this intervention in Parkinsonian patients, further study is warranted in other patient populations, such as stroke patients, who might benefit from this

Does positive pressure body weight-support alter spatiotemporal gait parameters in healthy and parkinsonian individuals?

PubMed

Lander, Joshua J; Moran, Matthew F

2017-01-01

Evidence suggests treadmill training (TT) and body weight-supported treadmill training (BWSTT) are effective strategies to improve gait in Parkinson's disease (PD) patients. However, few researchers have investigated the spatiotemporal parameters during TT or BWSTT. The goal of this study is to determine gait adaptations in PD and healthy subjects during positive pressure BWSTT and post-intervention overground walking. Ten PD and ten healthy individuals participated in this study. Baseline spatiotemporal parameters were assessed using a six meter instrumented mat. A 10-min progressive BWSTT trial from 10% to 40% body weight support (BWS) was then completed. Video capture and analysis of 10-min BWSTT trials were performed to determine spatiotemporal gait parameters. Three (5-min, 10-min, and 15-min) post-intervention overground assessments were obtained. During positive pressure BWSTT there was a significant effect of BW support on step length(SL) increase (p < 0.01) and cadence decrease (p < 0.001) in the healthy group but not in the PD group (p = 0.45 SL, p = 0.21 cadence). In post-intervention assessments there was a significant effect of time on velocity (p < 0.002 non-PD, p < 0.001 PD) and cadence (p < 0.05 non-PD, p < 0.01 PD) in both groups. There appears to be a generalized effect of TT on overground gait mechanics after a single session of positive pressure BWSTT regardless of PD impairment.

The influence of water depth on kinematic and spatiotemporal gait parameters during aquatic treadmill walking.

PubMed

Jung, Taeyou; Kim, Yumi; Lim, Hyosok; Vrongistinos, Konstantinos

2018-01-16

The purpose of this study was to investigate kinematic and spatiotemporal variables of aquatic treadmill walking at three different water depths. A total of 15 healthy individuals completed three two-minute walking trials at three different water depths. The aquatic treadmill walking was conducted at waist-depth, chest-depth and neck-depth, while a customised 3-D underwater motion analysis system captured their walking. Each participant's self-selected walking speed at the waist level was used as a reference speed, which was applied to the remaining two test conditions. A repeated measures ANOVA showed statistically significant differences among the three walking conditions in stride length, cadence, peak hip extension, hip range of motion (ROM), peak ankle plantar flexion and ankle ROM (All p values < 0.05). The participants walked with increased stride length and decreased cadence during neck level as compared to waist and chest level. They also showed increased ankle ROM and decreased hip ROM as the water depth rose from waist and chest to the neck level. However, our study found no significant difference between waist and chest level water in all variables. Hydrodynamics, such as buoyancy and drag force, in response to changes in water depths, can affect gait patterns during aquatic treadmill walking.

Single-task and dual-task tandem gait test performance after concussion.

PubMed

Howell, David R; Osternig, Louis R; Chou, Li-Shan

2017-07-01

To compare single-task and dual-task tandem gait test performance between athletes after concussion with controls on observer-timed, spatio-temporal, and center-of-mass (COM) balance control measurements. Ten participants (19.0±5.5years) were prospectively identified and completed a tandem gait test protocol within 72h of concussion and again 1 week, 2 weeks, 1 month, and 2 months post-injury. Seven uninjured controls (20.0±4.5years) completed the same protocol in similar time increments. Tandem gait test trials were performed with (dual-task) and without (single-task) concurrently performing a cognitive test as whole-body motion analysis was performed. Outcome variables included test completion time, average tandem gait velocity, cadence, and whole-body COM frontal plane displacement. Concussion participants took significantly longer to complete the dual-task tandem gait test than controls throughout the first 2 weeks post-injury (mean time=16.4 [95% CI: 13.4-19.4] vs. 10.1 [95% CI: 6.4-13.7] seconds; p=0.03). Single-task tandem gait times were significantly lower 72h post-injury (p=0.04). Dual-task cadence was significantly lower for concussion participants than controls (89.5 [95% CI: 68.6-110.4] vs. 127.0 [95% CI: 97.4-156.6] steps/minute; p=0.04). Moderately-high to high correlations between tandem gait test time and whole-body COM medial-lateral displacement were detected at each time point during dual-task gait (r s =0.70-0.93; p=0.03-0.001). Adding a cognitive task during the tandem gait test resulted in longer detectable deficits post-concussion compared to the traditional single-task tandem gait test. As a clinical tool to assess dynamic motor function, tandem gait may assist with return to sport decisions after concussion. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Quantifying gait deviations in individuals with rheumatoid arthritis using the Gait Deviation Index.

PubMed

Esbjörnsson, A-C; Rozumalski, A; Iversen, M D; Schwartz, M H; Wretenberg, P; Broström, E W

2014-01-01

In this study we evaluated the usability of the Gait Deviation Index (GDI), an index that summarizes the amount of deviation in movement from a standard norm, in adults with rheumatoid arthritis (RA). The aims of the study were to evaluate the ability of the GDI to identify gait deviations, assess inter-trial repeatability, and examine the relationship between the GDI and walking speed, physical disability, and pain. Sixty-three adults with RA and 59 adults with typical gait patterns were included in this retrospective case-control study. Following a three-dimensional gait analysis (3DGA), representative gait cycles were selected and GDI scores calculated. To evaluate the effect of walking speed, GDI scores were calculated using both a free-speed and a speed-matched reference set. Physical disability was assessed using the Health Assessment Questionnaire (HAQ) and subjects rated their pain during walking. Adults with RA had significantly increased gait deviations compared to healthy individuals, as shown by lower GDI scores [87.9 (SD = 8.7) vs. 99.4 (SD = 8.3), p < 0.001]. This difference was also seen when adjusting for walking speed [91.7 (SD = 9.0) vs. 99.9 (SD = 8.6), p < 0.001]. It was estimated that a change of ≥ 5 GDI units was required to account for natural variation in gait. There was no evident relationship between GDI and low/high RA-related physical disability and pain. The GDI seems to useful for identifying and summarizing gait deviations in individuals with RA. Thus, we consider that the GDI provides an overall measure of gait deviation that may reflect lower extremity pathology and may help clinicians to understand the impact of RA on gait dynamics.

Use of harmonic ratios to examine the effect of cueing strategies on gait stability in persons with Parkinson's disease.

PubMed

Lowry, Kristin A; Carrel, Andrew J; McIlrath, Jessica M; Smiley-Oyen, Ann L

2010-04-01

To determine if gait stability, as measured by harmonic ratios (HRs) derived from trunk accelerations, is improved during 3 amplitude-based cueing strategies (visual cues, lines on the floor 20% longer than preferred step length; verbal cues, experimenter saying "big step" every third; cognitive cues, participants think "big step") in people with Parkinson's disease. Gait analysis with a triaxial accelerometer. University research laboratory. A volunteer sample of persons with Parkinson's disease (N=7) (Hoehn and Yahr stages 2-3). Not applicable Gait stability was quantified by anterior-posterior (AP), vertical, and mediolateral (ML) HRs; higher ratios indicated improved gait stability. Spatiotemporal parameters assessed were walking speed, stride length, cadence, and the coefficient of variation for stride time. Of the amplitude-based cues, verbal and cognitive resulted in the largest improvements in the AP HR (P=.018) with a trend in the vertical HR as well as the largest improvements in both stride length and velocity. None of the cues positively affected stability in the ML direction. Descriptively, all participants increased speed and stride length, but only those in Hoehn and Yahr stage 2 (not Hoehn and Yahr stage 3) showed improvements in HRs. Cueing for "big steps" is effective for improving gait stability in the AP direction with modest improvements in the vertical direction, but it is not effective in the ML direction. These data support the use of trunk acceleration measures in assessing the efficacy of common therapeutic interventions. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The influence of age, muscle strength and speed of information processing on recovery responses to external perturbations in gait.

PubMed

Senden, R; Savelberg, H H C M; Adam, J; Grimm, B; Heyligers, I C; Meijer, K

2014-01-01

Dynamic imbalance caused by external perturbations to gait can successfully be counteracted by adequate recovery responses. The current study investigated how the recovery response is moderated by age, walking speed, muscle strength and speed of information processing. The gait pattern of 50 young and 45 elderly subjects was repeatedly perturbed at 20% and 80% of the first half of the swing phase using the Timed Rapid impact Perturbation (TRiP) set-up. Recovery responses were identified using 2D cameras. Muscular factors (dynamometer) and speed of information processing parameters (computer-based reaction time task) were determined. The stronger, faster reacting and faster walking young subjects recovered more often by an elevating strategy than elderly subjects. Twenty three per cent of the differences in recovery responses were explained by a combination of walking speed (B=-13.85), reaction time (B=-0.82), maximum extension strength (B=0.01) and rate of extension moment development (B=0.19). The recovery response that subjects employed when gait was perturbed by the TRiP set-up was modified by several factors; the individual contribution of walking speed, muscle strength and speed of information processing was small. Insight into remaining modifying factors is needed to assist and optimise fall prevention programmes. Copyright © 2013 Elsevier B.V. All rights reserved.

The effects of pulsed auditory stimulation on various gait measurements in persons with Parkinson's Disease.

PubMed

Freedland, Robert L; Festa, Carmel; Sealy, Marita; McBean, Andrew; Elghazaly, Paul; Capan, Ariel; Brozycki, Lori; Nelson, Arthur J; Rothman, Jeffrey

2002-01-01

The purpose of this study was to examine the Functional Ambulation Performance Score (FAP; a quantitative gait measure) in persons with Parkinson's Disease (PD) using the auditory stimulation of a metronome (ASM). Participants (n = 16; 5F/11M; range 60--84 yrs.) had a primary diagnosis of PD and were all independent ambulators. Footfall data were collected while participants walked multiple times on an electronic walkway under the following conditions: 1) PRETEST: establishing baseline cadence, 2) ASM: metronome set to baseline cadence, 3) 10ASM: metronome set to 10% FAP scores increased between PRETEST and POSTTEST. PRE/POSTTEST comparisons also indicated decreases in cycle time and double support and increases in step length and step-extremity ratio (step length/leg length). The results confirm prior findings that auditory stimulation can be used to positively influence the gait of persons with PD and suggest beneficial effects of ASM as an adjunct to dopaminergic therapy to treat gait dysfunctions in PD.

Feasibility of external rhythmic cueing with the Google Glass for improving gait in people with Parkinson's disease.

PubMed

Zhao, Yan; Nonnekes, Jorik; Storcken, Erik J M; Janssen, Sabine; van Wegen, Erwin E H; Bloem, Bastiaan R; Dorresteijn, Lucille D A; van Vugt, Jeroen P P; Heida, Tjitske; van Wezel, Richard J A

2016-06-01

New mobile technologies like smartglasses can deliver external cues that may improve gait in people with Parkinson's disease in their natural environment. However, the potential of these devices must first be assessed in controlled experiments. Therefore, we evaluated rhythmic visual and auditory cueing in a laboratory setting with a custom-made application for the Google Glass. Twelve participants (mean age = 66.8; mean disease duration = 13.6 years) were tested at end of dose. We compared several key gait parameters (walking speed, cadence, stride length, and stride length variability) and freezing of gait for three types of external cues (metronome, flashing light, and optic flow) and a control condition (no-cue). For all cueing conditions, the subjects completed several walking tasks of varying complexity. Seven inertial sensors attached to the feet, legs and pelvis captured motion data for gait analysis. Two experienced raters scored the presence and severity of freezing of gait using video recordings. User experience was evaluated through a semi-open interview. During cueing, a more stable gait pattern emerged, particularly on complicated walking courses; however, freezing of gait did not significantly decrease. The metronome was more effective than rhythmic visual cues and most preferred by the participants. Participants were overall positive about the usability of the Google Glass and willing to use it at home. Thus, smartglasses like the Google Glass could be used to provide personalized mobile cueing to support gait; however, in its current form, auditory cues seemed more effective than rhythmic visual cues.

Influence of dual task and frailty on gait parameters of older community-dwelling individuals

PubMed Central

Guedes, Rita C.; Dias, Rosângela C.; Pereira, Leani S. M.; Silva, Sílvia L. A.; Lustosa, Lygia P.; Dias, João M. D.

2014-01-01

Background: Gait parameters such as gait speed (GS) are important indicators of functional capacity. Frailty Syndrome is closely related to GS and is also capable of predicting adverse outcomes. The cognitive demand of gait control is usually explored with dual-task (DT) methodology. Objective: To investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people and identify which variables relate to GS. Method: The presence of frailty was verified by Fried's Frailty Criteria. Cognitive function was evaluated with the Mini-Mental State Exam (MMSE) and gait parameters were analyzed through the GAITRite(r) system in the single-task and DT conditions. The Kolmogorov-Smirnov, ANOVA, and Pearson's Correlation tests were administered. Results: The participants were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). During the DT, the three groups showed a decrease in GS, cadence, and stride length and an increase in stride time (p<0.001). The reduction in the GS of the FG during the DT showed a positive correlation with the MMSE scores (r=730; p=0.001) and with grip strength (r=681; p=0.001). Conclusions: Gait parameters are more affected by the DT, especially in the frail older subjects. The reduction in GS in the FG is associated with lower grip strength and lower scores in the MMSE. The GS was able to discriminate the older adults in the three levels of frailty, being an important measure of the functional capacity in this population. PMID:25372007

Asymmetry in gait pattern following bicondylar tibial plateau fractures-A prospective one-year cohort study.

PubMed

Elsoe, Rasmus; Larsen, Peter

2017-07-01

Despite the high number of studies evaluating outcomes following tibial plateau fractures, the literature lacks studies including the objective assessment of gait pattern. The purpose of the present study was to evaluate asymmetry in gait patterns at 12 months after frame removal following ring fixation of a tibial plateau fracture. The study design was a prospective cohort study. The primary outcome measurement was the gait patterns 12 months after frame removal measured with a pressure-sensitive mat. The mat registers footprints and present gait speed, cadence, as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. Twenty-three patients were included with a mean age of 54.4 years (32-78 years). Patients presented with a shorter step-length of the injured leg compared to the non-injured leg (asymmetry of 11.3%). Analysis of single-support showed shorter support time of the injured leg compared to the non-injured leg (asymmetry of 8.7%). Moreover, analysis of swing-time showed increased swing-time of the injured leg (asymmetry of 8.9%). Compared to a healthy reference population, increased asymmetry in all gait patterns was observed. The association between asymmetry and health-related quality of life (HRQOL) showed moderate associations (single-support: R=0.50, P=0.03; step-length: R=0.43, P=0.07; swing-time: R=0.46, P=0.05). Compared to a healthy reference population, gait asymmetry is common 12 months after frame removal in patients treated with external ring fixation following a tibial plateau fracture of the tibia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effect of sports bra type and gait speed on breast discomfort, bra discomfort and perceived breast movement in Chinese women.

PubMed

Chen, Xiaona; Gho, Sheridan A; Wang, Jianping; Steele, Julie R

2016-01-01

This study investigated the effect of sports bra type (encapsulation versus compression) and gait speed on perceptions of breast discomfort, bra discomfort and breast movement reported by Chinese women. Visual analogue scales were used to evaluate breast discomfort, bra component discomfort and perceived breast movement of 21 Chinese participants when they wore an encapsulation or a compression sports bra, while static and while exercising at three different gait speeds. Participants perceived less breast discomfort and breast movement when wearing a compression bra compared to an encapsulation bra at a high gait speed, suggesting that compression bras are likely to provide the most effective support for Chinese women. However, significantly higher bra discomfort was perceived in the compression bra compared to the encapsulation bra when static and at the lower gait speed, implying that ways to modify the design of sports bras, particularly the straps, should be investigated to provide adequate and comfortable breast support. The compression sports bra provided more comfortable support than the encapsulation sports bra for these Chinese women when running on a treadmill. However, these women perceived higher bra discomfort when wearing the compression bra when stationary. Further research is needed to modify the design of sports bras, particularly the straps, to provide adequate and comfortable breast support.

Real-Time Gait Cycle Parameter Recognition Using a Wearable Accelerometry System

PubMed Central

Yang, Che-Chang; Hsu, Yeh-Liang; Shih, Kao-Shang; Lu, Jun-Ming

2011-01-01

This paper presents the development of a wearable accelerometry system for real-time gait cycle parameter recognition. Using a tri-axial accelerometer, the wearable motion detector is a single waist-mounted device to measure trunk accelerations during walking. Several gait cycle parameters, including cadence, step regularity, stride regularity and step symmetry can be estimated in real-time by using autocorrelation procedure. For validation purposes, five Parkinson’s disease (PD) patients and five young healthy adults were recruited in an experiment. The gait cycle parameters among the two subject groups of different mobility can be quantified and distinguished by the system. Practical considerations and limitations for implementing the autocorrelation procedure in such a real-time system are also discussed. This study can be extended to the future attempts in real-time detection of disabling gaits, such as festinating or freezing of gait in PD patients. Ambulatory rehabilitation, gait assessment and personal telecare for people with gait disorders are also possible applications. PMID:22164019

Cross-Cultural Investigation of Male Gait Perception in Relation to Physical Strength and Speed

PubMed Central

Fink, Bernhard; Wübker, Marieke; Ostner, Julia; Butovskaya, Marina L.; Mezentseva, Anna; Muñoz-Reyes, José Antonio; Sela, Yael; Shackelford, Todd K.

2017-01-01

Previous research documents that men and women can accurately judge male physical strength from gait, but also that the sexes differ in attractiveness judgments of strong and weak male walkers. Women’s (but not men’s) attractiveness assessments of strong male walkers are higher than for weak male walkers. Here, we extend this research to assessments of strong and weak male walkers in Chile, Germany, and Russia. Men and women judged videos of virtual characters, animated with the walk movements of motion-captured men, on strength and attractiveness. In two countries (Germany and Russia), these videos were additionally presented at 70% (slower) and 130% (faster) of their original speed. Stronger walkers were judged to be stronger and more attractive than weak walkers, and this effect was independent of country (but not sex). Women tended to provide higher attractiveness judgments to strong walkers, and men tended to provide higher attractiveness judgments to weak walkers. In addition, German and Russian participants rated strong walkers most attractive at slow and fast speed. Thus, across countries men and women can assess male strength from gait, although they tended to differ in attractiveness assessments of strong and weak male walkers. Attractiveness assessments of male gait may be influenced by society-specific emphasis on male physical strength. PMID:28878720

Gait Speed among Older Participants Enrolled in an Evidence-Based Fall Risk Reduction Program: A Subgroup Analysis.

PubMed

Cho, Jinmyoung; Smith, Matthew Lee; Shubert, Tiffany E; Jiang, Luohua; Ahn, SangNam; Ory, Marcia G

2015-01-01

Functional decline is a primary risk factor for institutionalization and mortality among older adults. Although community-based fall risk reduction programs have been widely disseminated, little is known about their impact on gait speed, a key indicator of functional performance. Changes in functional performance between baseline and post-intervention were examined by means of timed up and go (TUG), a standardized functional assessment test administered to participants enrolled in A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model, an evidence-based fall risk reduction program. This study included 71 participants enrolled in an AMOB/VLL program in the Brazos Valley and South Plain regions of Texas. Paired t-tests were employed to assess program effects on gait speed at baseline and post-intervention for all participants and by subgroups of age, sex, living status, delivery sites, and self-rated health. The Bonferroni correction was applied to adjust inflated Type I error rate associated with performing multiple t-tests, for which p-values <0.0042 (i.e., 0.5/12 comparisons) were deemed statistically significant. Overall, gait speed of enrolled participants improved from baseline to post-intervention (t = 3.22, p = 0.002). Significant changes in TUG scores were observed among participants who lived with others (t = 4.45, p < 0.001), rated their health as excellent, very good, or good (t = 3.05, p = 0.003), and attended program workshops at senior centers (t = 3.52, p = 0.003). Findings suggest community-based fall risk reduction programs can improve gait speed for older adults. More translational research is needed to understand factors related to the effectiveness of fall risk reduction programs in various populations and settings.

Cut-off Points for Muscle Mass - Not Grip Strength or Gait Speed - Determine Variations in Sarcopenia Prevalence.

PubMed

Masanés, F; Rojano I Luque, X; Salvà, A; Serra-Rexach, J A; Artaza, I; Formiga, F; Cuesta, F; López Soto, A; Ruiz, D; Cruz-Jentoft, A J

2017-01-01

The European Working Group on Sarcopenia in Older People (EWGSOP) has proposed different methods and cut-off points for the three parameters that define sarcopenia: muscle mass, muscle strength and physical performance. Although this facilitates clinical practice, it limits comparability between studies and leads to wide differences in published prevalence rates. The aim of this study was to assess how changes in cut-off points for muscle mass, gait speed and grip strength affected sarcopenia prevalence according to EWGSOP criteria. Cross-sectional analysis of elderly individuals recruited from outpatient clinics (n=298) and nursing homes (n=276). We measured muscle mass, grip strength and gait speed and assessed how changes in cut-off points changed sarcopenia prevalence in both populations. An increase from 5.45 kg/m2 to 6.68 kg/m2 in the muscle mass index for female outpatients and nursing-home residents increased sarcopenia prevalence from 4% to 23% and from 9% to 47%, respectively; for men, for an increase from 7.25 kg/m2 to 8.87 kg/m2, the corresponding increases were from 1% to 22% and from 6% to 41%, respectively. Changes in gait speed and grip strength had a limited impact on sarcopenia prevalence. The cut-off points used for muscle mass affect the reported prevalence rates for sarcopenia and, in turn, affect comparability between studies. The main factors influencing the magnitude of the change are muscle mass index distribution in the population and the absolute value of the cut-off points: the same difference between two references (e.g., 7.5 kg/m2 to 7.75 kg/m2 or 7.75 kg/m2 to 8 kg/m2) may produce different changes in prevalence. Changes in cut-off points for gait speed and grip strength had a limited impact on sarcopenia prevalence and on study comparability.

Comparison of spatiotemporal and energy cost of the use of 3 different walkers and unassisted walking in older adults.

PubMed

Protas, Elizabeth J; Raines, Mary Lynn; Tissier, Sandrine

2007-06-01

To compare temporal, spatial, and oxygen costs of gait while elderly subjects walked without an assistive device, with a new assistive device, and with 2 other commercially available assistive devices. Descriptive, repeated measures. University-based research laboratory. Thirteen healthy older subjects who could walk without an assistive device. Not applicable. Gait speed, normalized gait speed, cadence, stride lengths, 5-minute walk distance and gait speed, oxygen consumption (Vo2) per meter walked, respiratory exchange ratio (RER) per meter walked, and minute ventilation per meter walked. Gait speed, normalized gait speed, and stride lengths decreased when the Merry Walker device was used, compared with walking without an assistive device. Outcome measures when walking with either the wheeled walker or the WalkAbout did not differ significantly from walking without a device except for a faster cadence with the WalkAbout. The distance walked and gait speed were decreased and the RER and minute ventilation were increased during the 5-minute walk with the Merry Walker compared with normal walking. The Vo2 was higher with the wheeled walker and Merry Walker than when walking without an assistive device, but there was no difference when the WalkAbout was used. Older adults walked in the new assistive device, the WalkAbout, with parameters that did not differ significantly from their gait without a device. The oxygen demands of walking were similar to unassisted walking for the WalkAbout, but were higher for the wheeled walker and Merry Walker. These results may help guide the prescription of assistive devices for older adults.

Influence of crank length and crank width on maximal hand cycling power and cadence.

PubMed

Krämer, Christian; Hilker, Lutz; Böhm, Harald

2009-07-01

The effect of different crank lengths and crank widths on maximal hand cycling power, cadence and handle speed were determined. Crank lengths and crank widths were adapted to anthropometric data of the participants as the ratio to forward reach (FR) and shoulder breadth (SB), respectively. 25 able-bodied subjects performed maximal inertial load hand cycle ergometry using crank lengths of 19, 22.5 and 26% of FR and 72, 85 and 98% of SB. Maximum power ranged from 754 (246) W for the crank geometry short wide (crank length x crank width) to 873 (293) W for the combination long middle. Every crank length differed significantly (P < 0.05) from each other, whereas no significant effect of crank width to maximum power output was revealed. Optimal cadence decreased significantly (P < 0.001) with increasing crank length from 124.8 (0.9) rpm for the short to 107.5 (1.6) rpm for the long cranks, whereas optimal handle speed increased significantly (P < 0.001) with increasing crank length from 1.81 (0.01) m/s for the short to 2.13 (0.03) m/s for the long cranks. Crank width did neither influence optimal cadence nor optimal handle speed significantly. From the results of this study, for maximum hand cycling power, a crank length to FR ratio of 26% for a crank width to SB ratio of 85% is recommended.

Persistence of depressive symptoms and gait speed recovery in older adults after hip fracture.

PubMed

Rathbun, Alan M; Shardell, Michelle D; Stuart, Elizabeth A; Gruber-Baldini, Ann L; Orwig, Denise; Ostir, Glenn V; Hicks, Gregory E; Hochberg, Marc C; Magaziner, Jay

2018-07-01

Depression after hip fracture in older adults is associated with worse physical performance; however, depressive symptoms are dynamic, fluctuating during the recovery period. The study aim was to determine how the persistence of depressive symptoms over time cumulatively affects the recovery of physical performance. Marginal structural models estimated the cumulative effect of persistence of depressive symptoms on gait speed during hip fracture recovery among older adults (n = 284) enrolled in the Baltimore Hip Studies 7th cohort. Depressive symptoms at baseline and at 2-month and 6-month postadmission for hip fracture were evaluated by using the Center for Epidemiological Studies Depression Scale, and persistence of symptoms was assessed as a time-averaged severity lagged to standardized 3 m gait speed at 2, 6, and 12 months. A 1-unit increase in time-averaged Center for Epidemiological Studies Depression score was associated with a mean difference in gait speed of -0.0076 standard deviations (95% confidence interval [CI]: -0.0184, 0.0032; P = .166). The association was largest in magnitude from baseline to 6 months: -0.0144 standard deviations (95% CI: -0.0303, 0.0015; P = 0.076). Associations for the other time intervals were smaller: -0.0028 standard deviations (95% CI: -0.0138, 0.0083; P = .621) at 2 months and -0.0121 standard deviations (95% CI: -0.0324, 0.0082; P = .238) at 12 months. Although not statistically significant, the magnitude of the numerical estimates suggests that expressing more depressive symptoms during the first 6 months after hip fracture has a meaningful impact on functional recovery. Copyright © 2018 John Wiley & Sons, Ltd.

Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized-Controlled Study

PubMed Central

Schättin, Alexandra; Arner, Rendel; Gennaro, Federico; de Bruin, Eling D.

2016-01-01

During aging, the prefrontal cortex (PFC) undergoes age-dependent neuronal changes influencing cognitive and motor functions. Motor-learning interventions are hypothesized to ameliorate motor and cognitive deficits in older adults. Especially, video game-based physical exercise might have the potential to train motor in combination with cognitive abilities in older adults. The aim of this study was to compare conventional balance training with video game-based physical exercise, a so-called exergame, on the relative power (RP) of electroencephalographic (EEG) frequencies over the PFC, executive function (EF), and gait performance. Twenty-seven participants (mean age 79.2 ± 7.3 years) were randomly assigned to one of two groups. All participants completed 24 trainings including three times a 30 min session/week. The EEG measurements showed that theta RP significantly decreased in favor of the exergame group [L(14) = 6.23, p = 0.007]. Comparing pre- vs. post-test, EFs improved both within the exergame (working memory: z = −2.28, p = 0.021; divided attention auditory: z = −2.51, p = 0.009; divided attention visual: z = −2.06, p = 0.040; go/no-go: z = −2.55, p = 0.008; set-shifting: z = −2.90, p = 0.002) and within the balance group (set-shifting: z = −2.04, p = 0.042). Moreover, spatio-temporal gait parameters primarily improved within the exergame group under dual-task conditions (speed normal walking: z = −2.90, p = 0.002; speed fast walking: z = −2.97, p = 0.001; cadence normal walking: z = −2.97, p = 0.001; stride length fast walking: z = −2.69, p = 0.005) and within the balance group under single-task conditions (speed normal walking: z = −2.54, p = 0.009; speed fast walking: z = −1.98, p = 0.049; cadence normal walking: z = −2.79, p = 0.003). These results indicate that exergame training as well as balance training positively influence prefrontal cortex activity and/or function in varying proportion. PMID:27932975

Effect of total knee replacement surgery and postoperative 12 month home exercise program on gait parameters.

PubMed

Heikkilä, A; Sevander-Kreus, N; Häkkinen, A; Vuorenmaa, M; Salo, Petr; Konsta, P; Ylinen, J

2017-03-01

To evaluate the effects of surgery and a postoperative progressive home exercise program on gait parameters among individuals operated with total knee arthroplasty. Single blinded randomized controlled trial. 108 patients (84 females, 24 males, mean age 69 years). Patients were equally randomized into an exercise group (EG) and control group (CG). The 12-months progressive home exercise program starting two months postoperatively was compared to usual care. Gait analysis was performed using the Gaitrite electronic walkway system. In addition, knee extension and flexion strength were measured by a dynamometer preoperatively, and pain on visual analog scale (VAS) at two months and 14 months postoperatively. At the 12-month follow-up, maximal gait velocity (p=0.006), cadence (p=0.003) and stance time (p=0.039) showed a greater increase among EG than CG. All the other gait parameters improved among both groups, but with not statistically discernible difference between groups. Weak correlations were found between changes in maximal gait velocity and the knee extension (r=-0.31, p=0.002), flexion strength (r=0.28, p=0.004) and pain during loading (r=-0.27, p=0.005) values. The intervention produced statistically significant changes in maximal gait velocity, cadence and stance times in the exercise group compared to controls. Although the average change was small it is of importance that biggest changes occurred in those with low performance. Copyright © 2017 Elsevier B.V. All rights reserved.

True cadence and step accumulation are not equivalent: the effect of intermittent claudication on free-living cadence.

PubMed

Stansfield, B; Clarke, C; Dall, P; Godwin, J; Holdsworth, R; Granat, M

2015-02-01

'True cadence' is the rate of stepping during the period of stepping. 'Step accumulation' is the steps within an epoch of time (e.g. 1min). These terms have been used interchangeably in the literature. These outcomes are compared within a population with intermittent claudication (IC). Multiday, 24h stepping activity of those with IC (30) and controls (30) was measured objectively using the activPAL physical activity monitor. 'True cadence' and 'step accumulation' outcomes were calculated. Those with IC took fewer steps/d 6531±2712 than controls 8692±2945 (P=0.003). However, these steps were taken within approximately the same number of minute epochs (IC 301±100min/d; controls 300±70min/d, P=0.894) with only slightly lower true cadence (IC 69 (IQ 66,72) steps/min; controls 72 (IQ 68,76) steps/min, P=0.026), giving substantially lower step accumulation (IC 22 (IQ 19,24) steps/min; controls 30 (IQ 23,34) steps/min) (P<0.001). However, the true cadence of stepping within the blocks of the 1, 5, 20, 30 and 60min with the maximum number of steps accumulated was lower for those with IC than controls (P<0.05). Those with IC took 1300 steps fewer per day above a true cadence of 90 steps/min. True cadence and step accumulation outcomes were radically different for the outcomes examined. 'True cadence' and 'step accumulation' were not equivalent in those with IC or controls. The measurement of true cadence in the population of people with IC provides information about their stepping rate during the time they are stepping. True cadence should be used to correctly describe the rate of stepping as performed. Copyright © 2014 Elsevier B.V. All rights reserved.

Effects of emotionally charged auditory stimulation on gait performance in the elderly: a preliminary study.

PubMed

Rizzo, John-Ross; Raghavan, Preeti; McCrery, J R; Oh-Park, Mooyeon; Verghese, Joe

2015-04-01

To evaluate the effect of a novel divided attention task-walking under auditory constraints-on gait performance in older adults and to determine whether this effect was moderated by cognitive status. Validation cohort. General community. Ambulatory older adults without dementia (N=104). Not applicable. In this pilot study, we evaluated walking under auditory constraints in 104 older adults who completed 3 pairs of walking trials on a gait mat under 1 of 3 randomly assigned conditions: 1 pair without auditory stimulation and 2 pairs with emotionally charged auditory stimulation with happy or sad sounds. The mean age of subjects was 80.6±4.9 years, and 63% (n=66) were women. The mean velocity during normal walking was 97.9±20.6cm/s, and the mean cadence was 105.1±9.9 steps/min. The effect of walking under auditory constraints on gait characteristics was analyzed using a 2-factorial analysis of variance with a 1-between factor (cognitively intact and minimal cognitive impairment groups) and a 1-within factor (type of auditory stimuli). In both happy and sad auditory stimulation trials, cognitively intact older adults (n=96) showed an average increase of 2.68cm/s in gait velocity (F1.86,191.71=3.99; P=.02) and an average increase of 2.41 steps/min in cadence (F1.75,180.42=10.12; P<.001) as compared with trials without auditory stimulation. In contrast, older adults with minimal cognitive impairment (Blessed test score, 5-10; n=8) showed an average reduction of 5.45cm/s in gait velocity (F1.87,190.83=5.62; P=.005) and an average reduction of 3.88 steps/min in cadence (F1.79,183.10=8.21; P=.001) under both auditory stimulation conditions. Neither baseline fall history nor performance of activities of daily living accounted for these differences. Our results provide preliminary evidence of the differentiating effect of emotionally charged auditory stimuli on gait performance in older individuals with minimal cognitive impairment compared with those without minimal

Gait phenotypes in paediatric hereditary spastic paraplegia revealed by dynamic time warping analysis and random forests

PubMed Central

Martín-Gonzalo, Juan Andrés; Rodríguez-Andonaegui, Irene; López-López, Javier; Pascual-Pascual, Samuel Ignacio

2018-01-01

The Hereditary Spastic Paraplegias (HSP) are a group of heterogeneous disorders with a wide spectrum of underlying neural pathology, and hence HSP patients express a variety of gait abnormalities. Classification of these phenotypes may help in monitoring disease progression and personalizing therapies. This is currently managed by measuring values of some kinematic and spatio-temporal parameters at certain moments during the gait cycle, either in the doctor´s surgery room or after very precise measurements produced by instrumental gait analysis (IGA). These methods, however, do not provide information about the whole structure of the gait cycle. Classification of the similarities among time series of IGA measured values of sagittal joint positions throughout the whole gait cycle can be achieved by hierarchical clustering analysis based on multivariate dynamic time warping (DTW). Random forests can estimate which are the most important isolated parameters to predict the classification revealed by DTW, since clinicians need to refer to them in their daily practice. We acquired time series of pelvic, hip, knee, ankle and forefoot sagittal angular positions from 26 HSP and 33 healthy children with an optokinetic IGA system. DTW revealed six gait patterns with different degrees of impairment of walking speed, cadence and gait cycle distribution and related with patient’s age, sex, GMFCS stage, concurrence of polyneuropathy and abnormal visual evoked potentials or corpus callosum. The most important parameters to differentiate patterns were mean pelvic tilt and hip flexion at initial contact. Longer time of support, decreased values of hip extension and increased knee flexion at initial contact can differentiate the mildest, near to normal HSP gait phenotype and the normal healthy one. Increased values of knee flexion at initial contact and delayed peak of knee flexion are important factors to distinguish GMFCS stages I from II-III and concurrence of polyneuropathy

Effects of curved-walking training on curved-walking performance and freezing of gait in individuals with Parkinson's disease: A randomized controlled trial.

PubMed

Cheng, Fang-Yu; Yang, Yea-Ru; Wu, Yih-Ru; Cheng, Shih-Jung; Wang, Ray-Yau

2017-10-01

The purpose of this study was to investigate the effects of curved-walking training (CWT) on curved-walking performance and freezing of gait (FOG) in people with Parkinson's disease (PD). Twenty-four PD subjects were recruited and randomly assigned to the CWT group or control exercise (CE) group and received 12 sessions of either CWT with a turning-based treadmill or general exercise training for 30 min followed by 10 min of over-ground walking in each session for 4-6 weeks. The primary outcomes included curved-walking performance and FOG. All measurements were assessed at baseline, after training, and at 1-month follow-up. Our results showed significant improvements in curved-walking performance (speed, p = 0.007; cadence, p = 0.003; step length, p < 0.001) and FOG, measured by a FOG questionnaire (p = 0.004). The secondary outcomes including straight-walking performance (speed, cadence and step length, p < 0.001), timed up and go test (p = 0.014), functional gait assessment (p < 0.001), Unified Parkinson's disease Rating Scale III (p = 0.001), and quality of life (p < 0.001) were also improved in the experimental group. We further noted that the improvements were maintained for at least one month after training (p < 0.05). A 12-session CWT program can improve curved-walking ability, FOG, and other measures of functional walking performance in individuals with PD. Most of the improvements were sustained for at least one month after training. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effect of walking speed on the gait of king penguins: An accelerometric approach.

PubMed

Willener, Astrid S T; Handrich, Yves; Halsey, Lewis G; Strike, Siobhán

2015-12-21

Little is known about non-human bipedal gaits. This is probably due to the fact that most large animals are quadrupedal and that non-human bipedal animals are mostly birds, whose primary form of locomotion is flight. Very little research has been conducted on penguin pedestrian locomotion with the focus instead on their associated high energy expenditure. In animals, tri-axial accelerometers are frequently used to estimate physiological energy cost, as well as to define the behaviour pattern of a species, or the kinematics of swimming. In this study, we showed how an accelerometer-based technique could be used to determine the biomechanical characteristics of pedestrian locomotion. Eight king penguins, which represent the only family of birds to have an upright bipedal gait, were trained to walk on a treadmill. The trunk tri-axial accelerations were recorded while the bird was walking at four different speeds (1.0, 1.2, 1.4 and 1.6km/h), enabling the amplitude of dynamic body acceleration along the three axes (amplitude of DBAx, DBAy and DBAz), stride frequency, waddling and leaning amplitude, as well as the leaning angle to be defined. The magnitude of the measured variables showed a significant increase with increasing speed, apart from the backwards angle of lean, which decreased with increasing speed. The variability of the measured variables also showed a significant increase with speed apart from the DBAz amplitude, the waddling amplitude, and the leaning angle, where no significant effect of the walking speed was found. This paper is the first approach to describe 3D biomechanics with an accelerometer on wild animals, demonstrating the potential of this technique. Copyright © 2015 Elsevier Ltd. All rights reserved.

Imposed Faster and Slower Walking Speeds Influence Gait Stability Differently in Parkinson Fallers.

PubMed

Cole, Michael H; Sweeney, Matthew; Conway, Zachary J; Blackmore, Tim; Silburn, Peter A

2017-04-01

To evaluate the effect of imposed faster and slower walking speeds on postural stability in people with Parkinson disease (PD). Cross-sectional cohort study. General community. Patients with PD (n=84; 51 with a falls history; 33 without) and age-matched controls (n=82) were invited to participate via neurology clinics and preexisting databases. Of those contacted, 99 did not respond (PD=36; controls=63) and 27 were not interested (PD=18; controls=9). After screening, a further 10 patients were excluded; 5 had deep brain stimulation surgery and 5 could not accommodate to the treadmill. The remaining patients (N=30) completed all assessments and were subdivided into PD fallers (n=10), PD nonfallers (n=10), and age-matched controls (n=10) based on falls history. Not applicable. Three-dimensional accelerometers assessed head and trunk accelerations and allowed calculation of harmonic ratios and root mean square (RMS) accelerations to assess segment control and movement amplitude. Symptom severity, balance confidence, and medical history were established before participants walked on a treadmill at 70%, 100%, and 130% of their preferred speed. Head and trunk control was lower for PD fallers than PD nonfallers and older adults. Significant interactions indicated head and trunk control increased with speed for PD nonfallers and older adults, but did not improve at faster speeds for PD fallers. Vertical head and trunk accelerations increased with walking speed for PD nonfallers and older adults, while the PD fallers demonstrated greater anteroposterior RMS accelerations compared with both other groups. The results suggest that improved gait dynamics do not necessarily represent improved walking stability, and this must be respected when rehabilitating gait in patients with PD. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Foot pressure analysis of gait pattern in older Japanese females requiring different personal care support levels.

PubMed

Takayanagi, Naoto; Sudo, Motoki; Fujii, Masahiko; Sakai, Hirokazu; Morimoto, Keiko; Tomisaki, Masumi; Niki, Yoshifumi; Tokimitsu, Ichiro

2018-03-01

[Purpose] This study evaluated gait parameters and foot pressure in two regions of the feet among older females with different personal care support needs to analyze factors that contribute to higher support requirements. [Subjects and Methods] Thirty-two older females were divided into support-need and care-need level groups. Gait parameters (speed, cadence, step length, step width, gait angle, toe angle, double support phase, swing phase, and stance phase) and foot pressure during a 5-m walk were measured and analyzed in the two groups. [Results] The percentage of the double support phase on both feet and the right stance phase were significantly higher in the care-need level group, while that of the right swing phase was significantly lower than that of the support-need level group. Additionally, the phase showing peak pressure on the left rear foot was significantly delayed and the left forefoot pressure in the terminal stance was significantly lower in the care-need level group than in the support-need level group. [Conclusion] These findings show that the temporal duration parameters and foot pressure on a particular side were significantly different between the two groups and suggest that these differences were associated with a higher care level.

Gait Speed Predicts 30-Day Mortality After Transcatheter Aortic Valve Replacement: Results From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.

PubMed

Alfredsson, Joakim; Stebbins, Amanda; Brennan, J Matthew; Matsouaka, Roland; Afilalo, Jonathan; Peterson, Eric D; Vemulapalli, Sreekanth; Rumsfeld, John S; Shahian, David; Mack, Michael J; Alexander, Karen P

2016-04-05

Surgical risk scores do not include frailty assessments (eg, gait speed), which are of particular importance for patients with severe aortic stenosis considering transcatheter aortic valve replacement. We assessed the association of 5-m gait speed with outcomes in a cohort of 8039 patients who underwent transcatheter aortic valve replacement (November 2011-June 2014) and were included in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. We evaluated the association between continuous and categorical gait speed and 30-day all-cause mortality before and after adjustment for Society of Thoracic Surgeons-predicted risk of mortality score and key variables. Secondary outcomes included in-hospital mortality, bleeding, acute kidney injury, and stroke. The overall median gait speed was 0.63 m/s (25th-75th percentile, 0.47-0.79 m/s), with the slowest walkers (<0.5 m/s) constituting 28%, slow walkers (0.5-0.83 m/s) making up 48%, and normal walkers (>0.83 m/s) constituting 24% of the population. Thirty-day all-cause mortality rates were 8.4%, 6.6%, and 5.4% for the slowest, slow, and normal walkers, respectively (P<0.001). Each 0.2-m/s decrease in gait speed corresponded to an 11% increase in 30-day mortality (adjusted odds ratio, 1.11; 95% confidence interval, 1.01-1.22). The slowest walkers had 35% higher 30-day mortality than normal walkers (adjusted odds ratio, 1.35; 95% confidence interval, 1.01-1.80), significantly longer hospital stays, and a lower probability of being discharged to home. Gait speed is independently associated with 30-day mortality after transcatheter aortic valve replacement. Identification of frail patients with the slowest gait speeds facilitates preprocedural evaluation and anticipation of a higher level of postprocedural care. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01737528. © 2016 American Heart Association, Inc.

Immediate Effects of Mental Singing While Walking on Gait Disturbance in Hemiplegic Stroke Patients: A Feasibility Study

PubMed Central

2018-01-01

Objective To investigate the immediate therapeutic effects of mental singing while walking intervention on gait disturbances in hemiplegic stroke patients. Methods Eligible, post-stroke, hemiplegic patients were prospectively enrolled in this study. The inclusion criteria were a diagnosis of hemiplegia due to stroke, and ability to walk more than 10 m with or without gait aids. Each patient underwent structured music therapy sessions comprising 7 consecutive tasks, and were trained to sing in their mind (mental singing) while walking. Before, and after training sessions, gait ability was assessed using the 10-Meter Walk Test (10MWT), the Timed Up and Go test (TUG), gait velocity, cadence and stride length. Results Twenty patients were enrolled in the interventions. Following the mental singing while walking intervention, significant improvement was observed in the 10MWT (13.16±7.61 to 12.27±7.58; p=0.002) and the TUG test (19.36±15.37 to 18.42±16.43; p=0.006). Significant improvement was also seen in gait cadence (90.36±29.11 to 95.36±30.2; p<0.001), stride length (90.99±33.4 to 98.17±35.33; p<0.001) and velocity (0.66±0.45 to 0.71±0.47; p<0.002). Conclusion These results indicate the possible effects of mental singing while walking on gait in patients diagnosed with hemiplegic stroke. PMID:29560318

Multimodal exercise intervention improves frontal cognitive functions and gait in Alzheimer's disease: a controlled trial.

PubMed

Coelho, Flávia Gomes de Melo; Andrade, Larissa Pires; Pedroso, Renata Valle; Santos-Galduroz, Ruth Ferreira; Gobbi, Sebastião; Costa, José Luiz Riani; Gobbi, Lilian Teresa Bucken

2013-01-01

The objective of the present study was to investigate the effect of a multimodal exercise intervention on frontal cognitive functions and kinematic gait parameters in patients with Alzheimer's disease. A sample of elderly patients with Alzheimer's disease (n=27) were assigned to a training group (n=14; aged 78.0±7.3 years) and a control group (n=13; aged 77.1±7.4 years). Multimodal exercise intervention includes motor activities and cognitive tasks simultaneously. The participants attended a 1-h session three times a week for 16 weeks, and the control participants maintained their regular daily activities during the same period. The frontal cognitive functions were evaluated using the Frontal Assessment Battery, the Clock Drawing Test and the Symbol Search Subtest. The kinematic parameters of gait-cadence, stride length and stride speed were analyzed under two conditions: (i) free gait (single task); and (ii) gait with frontal cognitive task (walking and counting down from 20--dual task). The patients in the intervention group significantly increased the scores in frontal cognitive variables, Frontal Assessment Battery (P<0.001) and Symbol Search Subtest (P<0.001) after the 16-week period. The control group decreased the scores in the Clock Drawing Test (P=0.001) and increased the number of counting errors during the dual task (P=0.008) after the same period. The multimodal exercise intervention improved the frontal cognitive functions in patients with Alzheimer's disease. © 2012 Japan Geriatrics Society.

Reduced dual-task gait speed is associated with visual Go/No-Go brain network activation in children and adolescents with concussion.

PubMed

Howell, David R; Meehan, William P; Barber Foss, Kim D; Reches, Amit; Weiss, Michal; Myer, Gregory D

2018-05-31

To investigate the association between dual-task gait performance and brain network activation (BNA) using an electroencephalography (EEG)-based Go/No-Go paradigm among children and adolescents with concussion. Participants with a concussion completed a visual Go/No-Go task with collection of electroencephalogram brain activity. Data were treated with BNA analysis, which involves an algorithmic approach to EEG-ERP activation quantification. Participants also completed a dual-task gait assessment. The relationship between dual-task gait speed and BNA was assessed using multiple linear regression models. Participants (n = 20, 13.9 ± 2.3 years of age, 50% female) were tested at a mean of 7.0 ± 2.5 days post-concussion and were symptomatic at the time of testing (post-concussion symptom scale = 40.4 ± 21.9). Slower dual-task average gait speed (mean = 82.2 ± 21.0 cm/s) was significantly associated with lower relative time BNA scores (mean = 39.6 ± 25.8) during the No-Go task (β = 0.599, 95% CI = 0.214, 0.985, p = 0.005, R 2  = 0.405), while controlling for the effect of age and gender. Among children and adolescents with a concussion, slower dual-task gait speed was independently associated with lower BNA relative time scores during a visual Go/No-Go task. The relationship between abnormal gait behaviour and brain activation deficits may be reflective of disruption to multiple functional abilities after concussion.

Insights into gait disorders: walking variability using phase plot analysis, Parkinson's disease.

PubMed

Esser, Patrick; Dawes, Helen; Collett, Johnny; Howells, Ken

2013-09-01

Gait variability may have greater utility than spatio-temporal parameters and can, be an indication for risk of falling in people with Parkinson's disease (PD). Current methods rely on prolonged data collection in order to obtain large datasets which may be demanding to obtain. We set out to explore a phase plot variability analysis to differentiate typically developed adults (TDAs) from PD obtained from two 10 m walks. Fourteen people with PD and good mobility (Rivermead Mobility Index≥8) and ten aged matched TDA were recruited and walked over 10-m at self-selected walking speed. An inertial measurement unit was placed over the projected centre of mass (CoM) sampling at 100 Hz. Vertical CoM excursion was derived to determine modelled spatiotemporal data after which the phase plot analysis was applied producing a cloud of datapoints. SDA described the spread and SDB the width of the cloud with β the angular vector of the data points. The ratio (∀) was defined as SDA: SDB. Cadence (p=.342) and stride length (p=.615) did not show a significance between TDA and PD. A difference was found for walking speed (p=.041). Furthermore a significant difference was found for β (p=.010), SDA (p=.004) other than SDB (p=.385) or ratio ∀ (p=.830). Two sequential 10-m walks showed no difference in PD for cadence (p=.193), stride length (p=.683), walking speed (p=.684) and β (p=.194), SDA (p=.051), SDB (p=.145) or ∀ (p=.226). The proposed phase plot analysis, performed on CoM motion could be used to reliably differentiate PD from TDA over a 10-m walk. Copyright © 2013 Elsevier B.V. All rights reserved.

Pedometer accuracy in slow walking older adults.

PubMed

Martin, Jessica B; Krč, Katarina M; Mitchell, Emily A; Eng, Janice J; Noble, Jeremy W

2012-07-03

The purpose of this study was to determine pedometer accuracy during slow overground walking in older adults (Mean age = 63.6 years). A total of 18 participants (6 males, 12 females) wore 5 different brands of pedometers over 3 pre-set cadences that elicited walking speeds between 0.3 and 0.9 m/s and one self-selected cadence over 80 meters of indoor track. Pedometer accuracy decreased with slower walking speeds with mean percent errors across all devices combined of 56%, 40%, 19% and 9% at cadences of 50, 66, and 80 steps/min, and self selected cadence, respectively. Percent error ranged from 45.3% for Omron HJ105 to 66.9% for Yamax Digiwalker 200. Due to the high level of error across the slowest cadences of all 5 devices, the use of pedometers to monitor step counts in healthy older adults with slower gait speeds is problematic. Further research is required to develop pedometer mechanisms that accurately measure steps at slower walking speeds.

The gait disorder in downbeat nystagmus syndrome.

PubMed

Schniepp, Roman; Wuehr, Max; Huth, Sabrina; Pradhan, Cauchy; Schlick, Cornelia; Brandt, Thomas; Jahn, Klaus

2014-01-01

Downbeat nystagmus (DBN) is a common form of acquired fixation nystagmus with key symptoms of oscillopsia and gait disturbance. Gait disturbance could be a result of impaired visual feedback due to the involuntary ocular oscillations. Alternatively, a malfunction of cerebellar locomotor control might be involved, since DBN is considered a vestibulocerebellar disorder. Investigation of walking in 50 DBN patients (age 72 ± 11 years, 23 females) and 50 healthy controls (HS) (age 70 ± 11 years, 23 females) using a pressure sensitive carpet (GAITRite). The patient cohort comprised subjects with only ocular motor signs (DBN) and subjects with an additional limb ataxia (DBNCA). Gait investigation comprised different walking speeds and walking with eyes closed. In DBN, gait velocity was reduced (p<0.001) with a reduced stride length (p<0.001), increased base of support (p<0.050), and increased double support (p<0.001). Walking with eyes closed led to significant gait changes in both HS and DBN. These changes were more pronounced in DBN patients (p<0.001). Speed-dependency of gait variability revealed significant differences between the subgroups of DBN and DBNCA (p<0.050). (I) Impaired visual control caused by involuntary ocular oscillations cannot sufficiently explain the gait disorder. (II) The gait of patients with DBN is impaired in a speed dependent manner. (III) Analysis of gait variability allows distinguishing DBN from DBNCA: Patients with pure DBN show a speed dependency of gait variability similar to that of patients with afferent vestibular deficits. In DBNCA, gait variability resembles the pattern found in cerebellar ataxia.

Ground Reaction Force and Cadence during Stationary Running Sprint in Water and on Land.

PubMed

Fontana, H de Brito; Ruschel, C; Haupenthal, A; Hubert, M; Roesler, H

2015-06-01

This study was aimed at analyzing the cadence (Cadmax) and the peak vertical ground reaction force (Fymax) during stationary running sprint on dry land and at hip and chest level of water immersion. We hypothesized that both Fymax and Cadmax depend on the level of immersion and that differences in Cadmax between immersions do not affect Fymax during stationary sprint. 32 subjects performed the exercise at maximum cadence at each immersion level and data were collected with force plates. The results show that Cadmax and Fymax decrease 17 and 58% from dry land to chest immersion respectively, with no effect of cadence on Fymax. While previous studies have shown similar neuromuscular responses between aquatic and on land stationary sprint, our results emphasize the differences in Fymax between environments and levels of immersion. Additionally, the characteristics of this exercise permit maximum movement speed in water to be close to the maximum speed on dry land. The valuable combination of reduced risk of orthopedic trauma with similar neuromuscular responses is provided by the stationary sprint exercise in water. The results of this study support the rationale behind the prescription of stationary sprinting in sports training sessions as well as rehabilitation programs. © Georg Thieme Verlag KG Stuttgart · New York.

Do spatiotemporal parameters and gait variability differ across the lifespan of healthy adults? A systematic review.

PubMed

Herssens, Nolan; Verbecque, Evi; Hallemans, Ann; Vereeck, Luc; Van Rompaey, Vincent; Saeys, Wim

2018-06-12

Aging is often associated with changes in the musculoskeletal system, peripheral and central nervous system. These age-related changes often result in mobility problems influencing gait performance. Compensatory strategies are used as a way to adapt to these physiological changes. The aim of this review is to investigate the differences in spatiotemporal and gait variability measures throughout the healthy adult life. This systematic review was conducted according to the PRISMA guidelines and registered in the PROSPERO database (no. CRD42017057720). Databases MEDLINE (Pubmed), Web of Science (Web of Knowledge), Cochrane Library and ScienceDirect were systematically searched until March 2018. Eighteen of the 3195 original studies met the eligibility criteria and were included in this review. The majority of studies reported spatiotemporal and gait variability measures in adults above the age of 65, followed by the young adult population, information of middle-aged adults is lacking. Spatiotemporal parameters and gait variability measures were extracted from 2112 healthy adults between 18 and 98 years old and, in general, tend to deteriorate with increasing age. Variability measures were only reported in an elderly population and show great variety between studies. The findings of this review suggest that most spatiotemporal parameters significantly differ across different age groups. Elderly populations show a reduction of preferred walking speed, cadence, step and stride length, all related to a more cautious gait, while gait variability measures remain stable over time. A preliminary framework of normative reference data is provided, enabling insights into the influence of aging on spatiotemporal parameters, however spatiotemporal parameters of middle-aged adults should be investigated more thoroughly. Copyright © 2018 Elsevier B.V. All rights reserved.

Interrater reliability of videotaped observational gait-analysis assessments.

PubMed

Eastlack, M E; Arvidson, J; Snyder-Mackler, L; Danoff, J V; McGarvey, C L

1991-06-01

The purpose of this study was to determine the interrater reliability of videotaped observational gait-analysis (VOGA) assessments. Fifty-four licensed physical therapists with varying amounts of clinical experience served as raters. Three patients with rheumatoid arthritis who demonstrated an abnormal gait pattern served as subjects for the videotape. The raters analyzed each patient's most severely involved knee during the four subphases of stance for the kinematic variables of knee flexion and genu valgum. Raters were asked to determine whether these variables were inadequate, normal, or excessive. The temporospatial variables analyzed throughout the entire gait cycle were cadence, step length, stride length, stance time, and step width. Generalized kappa coefficients ranged from .11 to .52. Intraclass correlation coefficients (2,1) and (3,1) were slightly higher. Our results indicate that physical therapists' VOGA assessments are only slightly to moderately reliable and that improved interrater reliability of the assessments of physical therapists utilizing this technique is needed. Our data suggest that there is a need for greater standardization of gait-analysis training.

Dual-task gait differences in female and male adolescents following sport-related concussion.

PubMed

Howell, David R; Stracciolini, Andrea; Geminiani, Ellen; Meehan, William P

2017-05-01

Concussion may affect females and males differentially. Identification of gender-related differences after concussion, therefore, may help clinicians with individualized evaluations. We examined potential differences in dual-task gait between females and males after concussion. Thirty-five participants diagnosed with a concussion (49% female, mean age=15.0±2.1 years, 7.5±3.0 days post-injury) and 51 controls (51% female, mean age=14.4±2.1 years) completed a symptom inventory and single/dual-task gait assessment. The primary outcome variable, the dual-task cost, was calculated as the percent change between single-task and dual-task conditions to account for individual differences in spatio-temporal gait variables. No significant differences in symptom severity measured by the post-concussion symptom scale were observed between females (32.0±18.0) and males (27.8±18.2). Compared with males, adolescent females walked with significantly decreased cadence dual-task costs after concussion (-19.7%±10.0% vs. -11.3%±9.2%, p=0.007) when adjusted for age, height, and prior concussion history. No significant differences were found between female and male control groups on other dual-task cost gait measures. Females and males with concussion also walked with significantly shorter stride lengths than controls during single-task (females: 1.13±0.11m vs. 1.26±0.11m, p=0.001; males: 1.14±0.14m vs. 1.22±0.15m, p=0.04) and dual-task gait (females: 0.99±0.10m vs. 1.10±0.11m, p=0.001; males: 1.00±0.13m vs. 1.08±0.14m, p=0.04). Females demonstrated a significantly greater amount of cadence change between single-task and dual-task gait than males after a sport-related concussion. Thus, differential alterations may exist during gait among those with a concussion; gender may be one prominent factor affecting dual-task gait. Copyright © 2017 Elsevier B.V. All rights reserved.

47 CFR 10.530 - Common vibration cadence.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 1 2014-10-01 2014-10-01 false Common vibration cadence. 10.530 Section 10.530....530 Common vibration cadence. A Participating CMS Provider and equipment manufacturers may only market devices for public use under part 10 that include a vibration cadence capability that meets the...

47 CFR 10.530 - Common vibration cadence.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 1 2013-10-01 2013-10-01 false Common vibration cadence. 10.530 Section 10.530....530 Common vibration cadence. A Participating CMS Provider and equipment manufacturers may only market devices for public use under part 10 that include a vibration cadence capability that meets the...

Effect of ankle-foot orthoses on gait, balance and gross motor function in children with cerebral palsy: a systematic review and meta-analysis.

PubMed

Lintanf, Mael; Bourseul, Jean-Sébastien; Houx, Laetitia; Lempereur, Mathieu; Brochard, Sylvain; Pons, Christelle

2018-04-01

To determine the effects of ankle-foot orthoses (AFOs) on gait, balance, gross motor function and activities of daily living in children with cerebral palsy. Five databases were searched (Pubmed, Psycinfo, Web of Science, Academic Search Premier and Cochrane Library) before January 2018. Studies of the effect of AFOs on gait, balance, gross motor function and activities of daily living in children with cerebral palsy were included. Articles with a modified PEDRO score ≥ 5/9 were selected. Data regarding population, AFO, interventions and outcomes were extracted. When possible, standardized mean differences (SMDs) were calculated from the outcomes. Thirty-two articles, corresponding to 56 studies (884 children) were included. Fifty-one studies included children with spastic cerebral palsy. AFOs increased stride length (SMD = 0.88, P < 0.001) and gait speed (SMD = 0.28, P < 0.001), and decreased cadence (SMD = -0.72, P < 0.001). Gross motor function scores improved (Gross Motor Function Measure (GMFM) D (SMD = 0.30, P = 0.004), E (SMD = 0.28, P = 0.02), Pediatric Evaluation of Disability Inventory (PEDI) (SMD = 0.57, P < 0.001)). Data relating to balance and activities of daily living were insufficient to conclude. Posterior AFOs (solid, hinged, supra-malleolar, dynamic) increased ankle dorsiflexion at initial contact (SMD = 1.65, P < 0.001) and during swing (SMD = 1.34, P < 0.001), and decreased ankle power generation in stance (SMD = -0.72, P < 0.001) in children with equinus gait. In children with spastic cerebral palsy, there is strong evidence that AFOs induce small improvements in gait speed and moderate evidence that AFOs have a small to moderate effect on gross motor function. In children with equinus gait, there is strong evidence that posterior AFOs induce large changes in distal kinematics.

47 CFR 10.530 - Common vibration cadence.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Common vibration cadence. 10.530 Section 10.530... § 10.530 Common vibration cadence. A Participating CMS Provider and equipment manufacturers may only market devices for public use under part 10 that include a vibration cadence capability that meets the...

47 CFR 10.530 - Common vibration cadence.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 1 2012-10-01 2012-10-01 false Common vibration cadence. 10.530 Section 10.530... § 10.530 Common vibration cadence. A Participating CMS Provider and equipment manufacturers may only market devices for public use under part 10 that include a vibration cadence capability that meets the...

Gait patterns comparison of children with Duchenne muscular dystrophy to those of control subjects considering the effect of gait velocity.

PubMed

Gaudreault, Nathaly; Gravel, Denis; Nadeau, Sylvie; Houde, Sylvie; Gagnon, Denis

2010-07-01

3D analysis of the gait of children with Duchenne muscular dystrophy (DMD) was the topic of only a few studies and none of these considered the effect of gait velocity on the gait parameters of children with DMD. Gait parameters of 11 children with DMD were compared to those of 14 control children while considering the effect of gait velocity using 3D biomechanical analysis. Kinematic and kinetic gait parameters were measured using an Optotrak motion analysis system and AMTI force plates embedded in the floor. The data profiles of children with DMD walking at natural gait velocity were compared to those of the control children who walked at both natural and slow gait velocities. When both groups walked at similar velocity, children with DMD had higher cadence and shorter step length. They demonstrated a lower hip extension moment as well as a minimal or absent knee extension moment. At the ankle, a dorsiflexion moment was absent at heel strike due to the anterior location of the center of pressure. The magnitude of the medio-lateral ground reaction force was higher in children with DMD. Despite this increase, the hip abductor moment was lower. Hip power generation was also observed at the mid-stance in DMD children. These results suggest that most of the modifications observed are strategies used by children with DMD to cope with possible muscle weakness in order to provide support, propulsion and balance of the body during gait. Copyright © 2010 Elsevier B.V. All rights reserved.

Efficacy of corrective spinal orthoses on gait and energy consumption in scoliosis subjects: a literature review.

PubMed

Daryabor, Alieh; Arazpour, Mokhtar; Samadian, Mohammad; Veiskarami, Masoumeh; Ahmadi Bani, Monireh

2017-05-01

Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. As a consequence, AIS can modify human gait. Spinal orthoses are a commonly used conservative method for the treatment of AIS. This review evaluated the AIS spinal orthosis literature that involved gait and energy consumption evaluations. Literature review. According to the population intervention comparison outcome measure methods and based on selected keywords, 10 studies met the inclusion criteria. People with AIS who wore a spinal orthosis, compared with able-bodied participants, walked slower with decreased hip and pelvic movements, decreased hip mediolateral forces, ground reaction force asymmetry, and excessive energy cost. Pelvis and hip frontal plane motion decreased when wearing an orthosis. Hip and pelvis movement symmetry improved when using an orthosis. Ankle and foot kinematics did not change with orthotic intervention. People with AIS continued to have excessive energy expenditure with an orthosis. Spinal orthoses may be considered for improving the walking style, although energy cost does not decline following the orthotic intervention. Implications for Rehabilitations Problems related to scoliosis include reduced quality of life, disability, pain, postural alterations, sensory perturbations, standing instability and gait modifications. Wearing corrective spinal orthoses in AIS subjects produce a reduction in walking speed and cadence, increase in stride length and reduction of gait load asymmetry compared to without brace condition. Spinal orthoses do not decline excessive energy expenditure to walk versus without it.

Biomechanics of normal and pathological gait: implications for understanding human locomotor control.

PubMed

Winter, D A

1989-12-01

The biomechanical (kinetic) analysis of human gait reveals the integrated and detailed motor patterns that are essential in pinpointing the abnormal patterns in pathological gait. In a similar manner, these motor patterns (moments, powers, and EMGs) can be used to identify synergies and to validate theories of CNS control. Based on kinetic and EMG patterns for a wide range of normal subjects and cadences, evidence is presented that both supports and negates the central pattern generator theory of locomotion. Adaptive motor patterns that are evident in peripheral gait pathologies reinforce a strong peripheral rather than a central control. Finally, a three-component subtask theory of human gait is presented and is supported by reference to the motor patterns seen in a normal gait. The identified subtasks are (a) support (against collapse during stance); (b) dynamic balance of the upper body, also during stance; and (c) feedforward control of the foot trajectory to achieve safe ground clearance and a gentle heel contact.

The Gait Disorder in Downbeat Nystagmus Syndrome

PubMed Central

Schniepp, Roman; Wuehr, Max; Huth, Sabrina; Pradhan, Cauchy; Schlick, Cornelia; Brandt, Thomas; Jahn, Klaus

2014-01-01

Background Downbeat nystagmus (DBN) is a common form of acquired fixation nystagmus with key symptoms of oscillopsia and gait disturbance. Gait disturbance could be a result of impaired visual feedback due to the involuntary ocular oscillations. Alternatively, a malfunction of cerebellar locomotor control might be involved, since DBN is considered a vestibulocerebellar disorder. Methods Investigation of walking in 50 DBN patients (age 72±11 years, 23 females) and 50 healthy controls (HS) (age 70±11 years, 23 females) using a pressure sensitive carpet (GAITRite). The patient cohort comprised subjects with only ocular motor signs (DBN) and subjects with an additional limb ataxia (DBNCA). Gait investigation comprised different walking speeds and walking with eyes closed. Results In DBN, gait velocity was reduced (p<0.001) with a reduced stride length (p<0.001), increased base of support (p<0.050), and increased double support (p<0.001). Walking with eyes closed led to significant gait changes in both HS and DBN. These changes were more pronounced in DBN patients (p<0.001). Speed-dependency of gait variability revealed significant differences between the subgroups of DBN and DBNCA (p<0.050). Conclusions (I) Impaired visual control caused by involuntary ocular oscillations cannot sufficiently explain the gait disorder. (II) The gait of patients with DBN is impaired in a speed dependent manner. (III) Analysis of gait variability allows distinguishing DBN from DBNCA: Patients with pure DBN show a speed dependency of gait variability similar to that of patients with afferent vestibular deficits. In DBNCA, gait variability resembles the pattern found in cerebellar ataxia. PMID:25140517

Exoskeleton-assisted gait training to improve gait in individuals with spinal cord injury: a pilot randomized study.

PubMed

Chang, Shuo-Hsiu; Afzal, Taimoor; Berliner, Jeffrey; Francisco, Gerard E

2018-01-01

Robotic wearable exoskeletons have been utilized as a gait training device in persons with spinal cord injury. This pilot study investigated the feasibility of offering exoskeleton-assisted gait training (EGT) on gait in individuals with incomplete spinal cord injury (iSCI) in preparation for a phase III RCT. The objective was to assess treatment reliability and potential efficacy of EGT and conventional physical therapy (CPT). Forty-four individuals were screened, and 13 were eligible to participate in the study. Nine participants consented and were randomly assigned to receive either EGT or CPT with focus on gait. Subjects received EGT or CPT, five sessions a week (1 h/session daily) for 3 weeks. American Spinal Injury Association (ASIA) Lower Extremity Motor Score (LEMS), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Timed Up and Go (TUG) test, and gait characteristics including stride and step length, cadence and stance, and swing phase durations were assessed at the pre- and immediate post- training. Mean difference estimates with 95% confidence intervals were used to analyze the differences. After training, improvement was observed in the 6MWT for the EGT group. The CPT group showed significant improvement in the TUG test. Both the EGT and the CPT groups showed significant increase in the right step length. EGT group also showed improvement in the stride length. EGT could be applied to individuals with iSCI to facilitate gait recovery. The subjects were able to tolerate the treatment; however, exoskeleton size range may be a limiting factor in recruiting larger cohort of patients. Future studies with larger sample size are needed to investigate the effectiveness and efficacy of exoskeleton-assisted gait training as single gait training and combined with other gait training strategies. Clinicaltrials.org, NCT03011099, retrospectively registered on January 3, 2017.

Control of interjoint coordination during the swing phase of normal gait at different speeds

PubMed Central

Shemmell, Jonathan; Johansson, Jennifer; Portra, Vanessa; Gottlieb, Gerald L; Thomas, James S; Corcos, Daniel M

2007-01-01

Background It has been suggested that the control of unconstrained movements is simplified via the imposition of a kinetic constraint that produces dynamic torques at each moving joint such that they are a linear function of a single motor command. The linear relationship between dynamic torques at each joint has been demonstrated for multijoint upper limb movements. The purpose of the current study was to test the applicability of such a control scheme to the unconstrained portion of the gait cycle – the swing phase. Methods Twenty-eight neurologically normal individuals walked along a track at three different speeds. Angular displacements and dynamic torques produced at each of the three lower limb joints (hip, knee and ankle) were calculated from segmental position data recorded during each trial. We employed principal component (PC) analysis to determine (1) the similarity of kinematic and kinetic time series at the ankle, knee and hip during the swing phase of gait, and (2) the effect of walking speed on the range of joint displacement and torque. Results The angular displacements of the three joints were accounted for by two PCs during the swing phase (Variance accounted for – PC1: 75.1 ± 1.4%, PC2: 23.2 ± 1.3%), whereas the dynamic joint torques were described by a single PC (Variance accounted for – PC1: 93.8 ± 0.9%). Increases in walking speed were associated with increases in the range of motion and magnitude of torque at each joint although the ratio describing the relative magnitude of torque at each joint remained constant. Conclusion Our results support the idea that the control of leg swing during gait is simplified in two ways: (1) the pattern of dynamic torque at each lower limb joint is produced by appropriately scaling a single motor command and (2) the magnitude of dynamic torque at all three joints can be specified with knowledge of the magnitude of torque at a single joint. Walking speed could therefore be altered by modifying a

Characteristics of the gait adaptation process due to split-belt treadmill walking under a wide range of right-left speed ratios in humans

PubMed Central

Ogawa, Tetsuya; Yamamoto, Shin-Ichiro; Nakazawa, Kimitaka

2018-01-01

The adaptability of human bipedal locomotion has been studied using split-belt treadmill walking. Most of previous studies utilized experimental protocol under remarkably different split ratios (e.g. 1:2, 1:3, or 1:4). While, there is limited research with regard to adaptive process under the small speed ratios. It is important to know the nature of adaptive process under ratio smaller than 1:2, because systematic evaluation of the gait adaptation under small to moderate split ratios would enable us to examine relative contribution of two forms of adaptation (reactive feedback and predictive feedforward control) on gait adaptation. We therefore examined a gait behavior due to on split-belt treadmill adaptation under five belt speed difference conditions (from 1:1.2 to 1:2). Gait parameters related to reactive control (stance time) showed quick adjustments immediately after imposing the split-belt walking in all five speed ratios. Meanwhile, parameters related to predictive control (step length and anterior force) showed a clear pattern of adaptation and subsequent aftereffects except for the 1:1.2 adaptation. Additionally, the 1:1.2 ratio was distinguished from other ratios by cluster analysis based on the relationship between the size of adaptation and the aftereffect. Our findings indicate that the reactive feedback control was involved in all the speed ratios tested and that the extent of reaction was proportionally dependent on the speed ratio of the split-belt. On the contrary, predictive feedforward control was necessary when the ratio of the split-belt was greater. These results enable us to consider how a given split-belt training condition would affect the relative contribution of the two strategies on gait adaptation, which must be considered when developing rehabilitation interventions for stroke patients. PMID:29694404

Characteristics of the gait adaptation process due to split-belt treadmill walking under a wide range of right-left speed ratios in humans.

PubMed

Yokoyama, Hikaru; Sato, Koji; Ogawa, Tetsuya; Yamamoto, Shin-Ichiro; Nakazawa, Kimitaka; Kawashima, Noritaka

2018-01-01

The adaptability of human bipedal locomotion has been studied using split-belt treadmill walking. Most of previous studies utilized experimental protocol under remarkably different split ratios (e.g. 1:2, 1:3, or 1:4). While, there is limited research with regard to adaptive process under the small speed ratios. It is important to know the nature of adaptive process under ratio smaller than 1:2, because systematic evaluation of the gait adaptation under small to moderate split ratios would enable us to examine relative contribution of two forms of adaptation (reactive feedback and predictive feedforward control) on gait adaptation. We therefore examined a gait behavior due to on split-belt treadmill adaptation under five belt speed difference conditions (from 1:1.2 to 1:2). Gait parameters related to reactive control (stance time) showed quick adjustments immediately after imposing the split-belt walking in all five speed ratios. Meanwhile, parameters related to predictive control (step length and anterior force) showed a clear pattern of adaptation and subsequent aftereffects except for the 1:1.2 adaptation. Additionally, the 1:1.2 ratio was distinguished from other ratios by cluster analysis based on the relationship between the size of adaptation and the aftereffect. Our findings indicate that the reactive feedback control was involved in all the speed ratios tested and that the extent of reaction was proportionally dependent on the speed ratio of the split-belt. On the contrary, predictive feedforward control was necessary when the ratio of the split-belt was greater. These results enable us to consider how a given split-belt training condition would affect the relative contribution of the two strategies on gait adaptation, which must be considered when developing rehabilitation interventions for stroke patients.

A Pilot Study of Gait Function in Farmworkers in Eastern North Carolina.

PubMed

Nguyen, Ha T; Kritchevsky, Stephen B; Foxworth, Judy L; Quandt, Sara A; Summers, Phillip; Walker, Francis O; Arcury, Thomas A

2015-01-01

Farmworkers endure many job-related hazards, including fall-related work injuries. Gait analysis may be useful in identifying potential fallers. The goal of this pilot study was to explore differences in gait between farmworkers and non-farmworkers. The sample included 16 farmworkers and 24 non-farmworkers. Gait variables were collected using the portable GAITRite system, a 16-foot computerized walkway. Generalized linear regression models were used to examine group differences. All models were adjusted for two established confounders, age and body mass index. There were no significant differences in stride length, step length, double support time, and base of support; but farmworkers had greater irregularity of stride length (P = .01) and step length (P = .08). Farmworkers performed significantly worse on gait velocity (P = .003) and cadence (P < .001) relative to non-farmworkers. We found differences in gait function between farmworkers and non-farmworkers. These findings suggest that measuring gait with a portable walkway system is feasible and informative in farmworkers and may possibly be of use in assessing fall risk.

Spatial-temporal parameters of gait in women with fibromyalgia.

PubMed

Heredia Jiménez, José María; Aparicio García-Molina, Virginia A; Porres Foulquie, Jesús M; Delgado Fernández, Manuel; Soto Hermoso, Victor M

2009-05-01

The aim of the present study was to determine if there are differences in such parameters among patients affected by fibromyalgia (FM) and healthy subjects and whether the degree of affectation by FM can decrease the gait parameters. We studied 55 women with FM and 44 controls. Gait analysis was performed using an instrumented walkway for measurement of the kinematic parameters of gait (GAITRite system), and patients completed a Spanish version of Fibromyalgia Impact Questionnaire (FIQ). Significant differences (p < 0.001) between FM and control groups were found in velocity, stride length, cadence, single support ratio, double support ratio, stance phase ratio, and swing phase ratio. There were significant inverse correlations between FIQ and velocity, stride length, swing phase, and single support, whereas significant direct correlations were found with stance phase and double support. Gait parameters of women affected by FM were severely impaired when compared to those of healthy women. Different factors such as lack of physical activity, bradikinesia, overweight, fatigue, and pain together with a lower isometric force in the legs can be responsible for the alterations in gait and poorer life quality of women with FM.

The most economical cadence increases with increasing workload.

PubMed

Foss, Øivind; Hallén, Jostein

2004-08-01

Several studies have suggested that the most economical cadence in cycling increases with increasing workload. However, none of these studies have been able to demonstrate this relationship with experimental data. The purpose of this study was to test the hypothesis that the most economical cadence in elite cyclists increases with increasing workload and to explore the effect of cadence on performance. Six elite road cyclists performed submaximal and maximal tests at four different cadences (60, 80, 100 and 120 rpm) on separate days. Respiratory data was measured at 0, 50, 125, 200, 275 and 350 W during the submaximal test and at the end of the maximal test. The maximal test was carried out as an incremental test, conducted to reveal differences in maximal oxygen uptake and time to exhaustion (short-term performance) between cadences. The results showed that the lowest oxygen uptake, i.e. the best work economy, shifted from 60 rpm at 0 W to 80 rpm at 350 W ( P<0.05). No difference was found in maximal oxygen uptake among cadences ( P>0.05), while the best performance was attained at the same cadence that elicited the best work economy (80 rpm) at 350 W ( P<0.05). This study demonstrated that the most economical cadence increases with increasing workload in elite cyclists. It was further shown that work economy and performance are related during short efforts (approximately 5 min) over a wide range of cadences.

The effects of core stabilization exercise on dynamic balance and gait function in stroke patients.

PubMed

Chung, Eun-Jung; Kim, Jung-Hee; Lee, Byoung-Hee

2013-07-01

[Purpose] The purpose of this study was to determine the effects of core stabilization exercise on dynamic balance and gait function in stroke patients. [Subjects] The subjects were 16 stroke patients, who were randomly divided into two groups: a core stabilization exercise group of eight subjects and control group of eight subjects. [Methods] Subjects in both groups received general training five times per week. Subjects in the core stabilization exercise group practiced an additional core stabilization exercise program, which was performed for 30 minutes, three times per week, during a period of four weeks. All subjects were evaluated for dynamic balance (Timed Up and Go test, TUG) and gait parameters (velocity, cadence, step length, and stride length). [Results] Following intervention, the core exercise group showed a significant change in TUG, velocity, and cadence. The only significant difference observed between the core group and control group was in velocity. [Conclusion] The results of this study suggest the feasibility and suitability of core stabilization exercise for stroke patients.

Programmable Cadence Timer

NASA Technical Reports Server (NTRS)

Hall, William A.; Gilbert, John

1990-01-01

Electronic metronome paces users through wide range of exercise routines. Conceptual programmable cadence timer provides rhythmic aural and visual cues. Timer automatically changes cadence according to program entered by the user. It also functions as clock, stopwatch, or alarm. Modular pacer operated as single unit or as two units. With audiovisual module moved away from base module, user concentrates on exercise cues without distraction from information appearing on the liquid-crystal display. Variety of uses in rehabilitative medicine, experimental medicine, sports, and gymnastics. Used in intermittent positive-pressure breathing treatment, in which patient must rhythmically inhale and retain medication delivered under positive pressure; and in incentive spirometer treatment, in which patient must inhale maximally at regular intervals.

Differential effects of rhythmic auditory stimulation and neurodevelopmental treatment/Bobath on gait patterns in adults with cerebral palsy: a randomized controlled trial.

PubMed

Kim, Soo Ji; Kwak, Eunmi E; Park, Eun Sook; Cho, Sung-Rae

2012-10-01

To investigate the effects of rhythmic auditory stimulation (RAS) on gait patterns in comparison with changes after neurodevelopmental treatment (NDT/Bobath) in adults with cerebral palsy. A repeated-measures analysis between the pretreatment and posttreatment tests and a comparison study between groups. Human gait analysis laboratory. Twenty-eight cerebral palsy patients with bilateral spasticity participated in this study. The subjects were randomly allocated to either neurodevelopmental treatment (n = 13) or rhythmic auditory stimulation (n = 15). Gait training with rhythmic auditory stimulation or neurodevelopmental treatment was performed three sessions per week for three weeks. Temporal and kinematic data were analysed before and after the intervention. Rhythmic auditory stimulation was provided using a combination of a metronome beat set to the individual's cadence and rhythmic cueing from a live keyboard, while neurodevelopmental treatment was implemented following the traditional method. Temporal data, kinematic parameters and gait deviation index as a measure of overall gait pathology were assessed. Temporal gait measures revealed that rhythmic auditory stimulation significantly increased cadence, walking velocity, stride length, and step length (P < 0.05). Kinematic data demonstrated that anterior tilt of the pelvis and hip flexion during a gait cycle was significantly ameliorated after rhythmic auditory stimulation (P < 0.05). Gait deviation index also showed modest improvement in cerebral palsy patients treated with rhythmic auditory stimulation (P < 0.05). However, neurodevelopmental treatment showed that internal and external rotations of hip joints were significantly improved, whereas rhythmic auditory stimulation showed aggravated maximal internal rotation in the transverse plane (P < 0.05). Gait training with rhythmic auditory stimulation or neurodevelopmental treatment elicited differential effects on gait patterns in adults with cerebral palsy.

Human Gait and Postural Control after Unilateral Total Knee Arthroplasty

PubMed Central

STAN, Gabriel; ORBAN, Horia

2014-01-01

Introduction: This study assesses the changes in human gait in the early postoperative phase of unilateral TKA, by evaluating the variability of free moment. Materials and method: The study group consisted of 10 patients from the Orthopedic Department of the 'Elias' University Hospital in Bucharest who undergone unilateral knee arthroplasty with the same type of posterior cruciate ligament substituting prosthesis. For the evaluation of free moment an AMTI AccuGait force platform was used. Results: Regarding the free moment peaks, for the operated and non-operated limb, increased significantly (p <0.05) in the postoperative period. The stance time was higher post-surgery for both limbs. Discussion: In the early postoperative phase of unilateral TKA, free moment is higher on both the operated and the non-operated limbs, which means that the knees are subjected to higher torques. Shortly after TKA, patients tend to walk with lower speed, with small steps and reduced cadence. Stance time differences between the operated and the non-operated limbs can lead to overuse of the latter, worsening its condition. Conclusions: It is highly important to adopt a well-managed rehabilitation program in order to increase walking stability. The cost effectiveness of this procedure could be highly dependent on the rehab program. The parameters studied in this article are useful in assessing the rehabilitation protocol. PMID:25705305

Resilience in the Disabling Effect of Gait Speed Among Older Turkish and Moroccan Immigrants and Native Dutch.

PubMed

Klokgieters, Silvia S; van Tilburg, Theo G; Deeg, Dorly J H; Huisman, Martijn

2018-06-01

To investigate the factors that inhibit the disabling effect of impairments among citizens who have migrated from Turkey and Morocco and native Dutch according to a resilience perspective. Using data from the Longitudinal Aging Study Amsterdam with 928 native Dutch, 255 Turks, and 199 Moroccans aged 55 to 65, linear regression analysis assessed whether country of origin, mastery, income, and contact frequency modified the relationship between gait speed and activity limitations. Turks, but not Moroccans, demonstrated stronger associations between gait speed and activity limitations than the Dutch. Mastery modified the association among the Dutch and the Turks. Income modified the association only among the Dutch. Effect modification by contact frequency was not observed. Moroccans and Dutch appeared to be more resilient against impairments than Turks. As none of the resilience factors buffered in all three populations, we conclude that resilience mechanisms are not universal across populations.

Blood pressure, gait speed, and mortality in very old individuals: a population-based cohort study.

PubMed

Weidung, Bodil; Boström, Gustaf; Toots, Annika; Nordström, Peter; Carlberg, Bo; Gustafson, Yngve; Littbrand, Håkan

2015-03-01

Clinical trials and observational studies have produced contradictory results regarding the association of blood pressure (BP) and mortality in people aged 80 years or older. Gait speed at usual pace has been shown to moderate this association in a population of noninstitutionalized people aged 65 years or older. The aims of this study were to investigate the association of BP with all-cause mortality in a representative sample of people aged 85 years or older and to assess whether gait speed moderates this association. A total of 806 participants in the population-based prospective Umeå 85+/GERDA study aged 85, 90, and 95 years or older. Gait speed at usual pace was measured over 2.4 m. The main outcome was hazard ratios (HRs) for all-cause mortality according to systolic and diastolic BP categories in the total sample and in faster-walking (≥0.5 m/s, n = 312) and slower-walking (<0.5 m/s, n = 433) subcohorts; the latter also included habitually nonwalking participants. Comprehensive adjustments were made for sociodemographic and clinical characteristics associated with death. Mean age and baseline systolic and diastolic BP were 89.6 ± 4.6 years, 146.8 ± 23.9 mm Hg, and 74.8 ± 11.1 mm Hg, respectively. Most (n = 561 [69%]) participants were women, 315 (39%) were care facility residents, and 566 (70%) were prescribed BP-lowering drugs. Within 5 years, 490 (61%) participants died. In the total sample and slower-walking subcohort, systolic BP appeared to be inversely associated with mortality, although not independent of adjustments. Among faster-walking participants, mortality risk after adjustment was more than 2 times higher in those with systolic BP of 140 to 149 mm Hg (HR = 2.25, 95% confidence interval [CI] = 1.03-4.94) and 165 mm Hg or higher (HR = 2.13, 95% CI = 1.01-4.49), compared with systolic BP of 126 to 139 mm Hg. Mortality risk was also independently higher in faster-walking participants with diastolic BP higher than 80 mm Hg, compared with

An Automatic Gait Feature Extraction Method for Identifying Gait Asymmetry Using Wearable Sensors

PubMed Central

Vassallo, Michael

2018-01-01

This paper aims to assess the use of Inertial Measurement Unit (IMU) sensors to identify gait asymmetry by extracting automatic gait features. We design and develop an android app to collect real time synchronous IMU data from legs. The results from our method are validated using a Qualisys Motion Capture System. The data are collected from 10 young and 10 older subjects. Each performed a trial in a straight corridor comprising 15 strides of normal walking, a turn around and another 15 strides. We analyse the data for total distance, total time, total velocity, stride, step, cadence, step ratio, stance, and swing. The accuracy of detecting the stride number using the proposed method is 100% for young and 92.67% for older subjects. The accuracy of estimating travelled distance using the proposed method for young subjects is 97.73% and 98.82% for right and left legs; and for the older, is 88.71% and 89.88% for right and left legs. The average travelled distance is 37.77 (95% CI ± 3.57) meters for young subjects and is 22.50 (95% CI ± 2.34) meters for older subjects. The average travelled time for young subjects is 51.85 (95% CI ± 3.08) seconds and for older subjects is 84.02 (95% CI ± 9.98) seconds. The results show that wearable sensors can be used for identifying gait asymmetry without the requirement and expense of an elaborate laboratory setup. This can serve as a tool in diagnosing gait abnormalities in individuals and opens the possibilities for home based self-gait asymmetry assessment. PMID:29495299

Gait disorders in the elderly and dual task gait analysis: a new approach for identifying motor phenotypes.

PubMed

Auvinet, Bernard; Touzard, Claude; Montestruc, François; Delafond, Arnaud; Goeb, Vincent

2017-01-31

Gait disorders and gait analysis under single and dual-task conditions are topics of great interest, but very few studies have looked for the relevance of gait analysis under dual-task conditions in elderly people on the basis of a clinical approach. An observational study including 103 patients (mean age 76.3 ± 7.2, women 56%) suffering from gait disorders or memory impairment was conducted. Gait analysis under dual-task conditions was carried out for all patients. Brain MRI was performed in the absence of contra-indications. Three main gait variables were measured: walking speed, stride frequency, and stride regularity. For each gait variable, the dual task cost was computed and a quartile analysis was obtained. Nonparametric tests were used for all the comparisons (Wilcoxon, Kruskal-Wallis, Fisher or Chi 2 tests). Four clinical subgroups were identified: gait instability (45%), recurrent falls (29%), memory impairment (18%), and cautious gait (8%). The biomechanical severity of these subgroups was ordered according to walking speed and stride regularity under both conditions, from least to most serious as follows: memory impairment, gait instability, recurrent falls, cautious gait (p < 0.01 for walking speed, p = 0.05 for stride regularity). According to the established diagnoses of gait disorders, 5 main pathological subgroups were identified (musculoskeletal diseases (n = 11), vestibular diseases (n = 6), mild cognitive impairment (n = 24), central nervous system pathologies, (n = 51), and without diagnosis (n = 8)). The dual task cost for walking speed, stride frequency and stride regularity were different among these subgroups (p < 0.01). The subgroups mild cognitive impairment and central nervous system pathologies both showed together a higher dual task cost for each variable compared to the other subgroups combined (p = 0.01). The quartile analysis of dual task cost for stride frequency and stride regularity

Effects of Continuous and Interval Training on Running Economy, Maximal Aerobic Speed and Gait Kinematics in Recreational Runners.

PubMed

González-Mohíno, Fernando; González-Ravé, José M; Juárez, Daniel; Fernández, Francisco A; Barragán Castellanos, Rubén; Newton, Robert U

2016-04-01

The purpose of this study was to evaluate the effects on running economy (RE), V[Combining Dot Above]O2max, maximal aerobic speed (MAS), and gait kinematics (step length [SL] and frequency, flight and contact time [CT]) in recreational athletes, with 2 different training methods, Interval and Continuous (CON). Eleven participants were randomly distributed in an interval training group (INT; n = 6) or CON training group (CON; n = 5). Interval training and CON performed 2 different training programs (95-110% and 70-75% of MAS, respectively), which consisted of 3 sessions per week during 6 weeks with the same external workload (%MAS × duration). An incremental test to exhaustion was performed to obtain V[Combining Dot Above]O2max, MAS, RE, and gait variables (high speed camera) before and after the training intervention. There was a significant improvement (p ≤ 0.05) in RE at 60 and 90% of MAS by the CON group; without changes in gait. The INT group significantly increased MAS and higher stride length at 80, 90, and 100% of MAS and lower CT at 100% of MAS. As expected, training adaptations are highly specific to the overload applied with CON producing improvements in RE at lower percentage of MAS whereas INT produces improvements in MAS. The significantly increased stride length and decreased CT for the INT group are an important outcome of favorable changes in running gait.

Risk of falls in older people during fast-walking--the TASCOG study.

PubMed

Callisaya, M L; Blizzard, L; McGinley, J L; Srikanth, V K

2012-07-01

To investigate the relationship between fast-walking and falls in older people. Individuals aged 60-86 years were randomly selected from the electoral roll (n=176). Gait speed, step length, cadence and a walk ratio were recorded during preferred- and fast-walking using an instrumented walkway. Falls were recorded prospectively over 12 months. Log multinomial regression was used to estimate the relative risk of single and multiple falls associated with gait variables during fast-walking and change between preferred- and fast-walking. Covariates included age, sex, mood, physical activity, sensorimotor and cognitive measures. The risk of multiple falls was increased for those with a smaller walk ratio (shorter steps, faster cadence) during fast-walking (RR 0.92, CI 0.87, 0.97) and greater reduction in the walk ratio (smaller increase in step length, larger increase in cadence) when changing to fast-walking (RR 0.73, CI 0.63, 0.85). These gait patterns were associated with poorer physiological and cognitive function (p<0.05). A higher risk of multiple falls was also seen for those in the fastest quarter of gait speed (p=0.01) at fast-walking. A trend for better reaction time, balance, memory and physical activity for higher categories of gait speed was stronger for fallers than non-fallers (p<0.05). Tests of fast-walking may be useful in identifying older individuals at risk of multiple falls. There may be two distinct groups at risk--the frail person with short shuffling steps, and the healthy person exposed to greater risk. Copyright © 2012 Elsevier B.V. All rights reserved.

Pedometer accuracy in slow walking older adults

PubMed Central

Martin, Jessica B.; Krč, Katarina M.; Mitchell, Emily A.; Eng, Janice J.; Noble, Jeremy W.

2013-01-01

The purpose of this study was to determine pedometer accuracy during slow overground walking in older adults (Mean age = 63.6 years). A total of 18 participants (6 males, 12 females) wore 5 different brands of pedometers over 3 pre-set cadences that elicited walking speeds between 0.3 and 0.9 m/s and one self-selected cadence over 80 meters of indoor track. Pedometer accuracy decreased with slower walking speeds with mean percent errors across all devices combined of 56%, 40%, 19% and 9% at cadences of 50, 66, and 80 steps/min, and self selected cadence, respectively. Percent error ranged from 45.3% for Omron HJ105 to 66.9% for Yamax Digiwalker 200. Due to the high level of error across the slowest cadences of all 5 devices, the use of pedometers to monitor step counts in healthy older adults with slower gait speeds is problematic. Further research is required to develop pedometer mechanisms that accurately measure steps at slower walking speeds. PMID:24795762

Quantitative Gait Measurement With Pulse-Doppler Radar for Passive In-Home Gait Assessment

PubMed Central

Skubic, Marjorie; Rantz, Marilyn; Cuddihy, Paul E.

2014-01-01

In this paper, we propose a pulse-Doppler radar system for in-home gait assessment of older adults. A methodology has been developed to extract gait parameters including walking speed and step time using Doppler radar. The gait parameters have been validated with a Vicon motion capture system in the lab with 13 participants and 158 test runs. The study revealed that for an optimal step recognition and walking speed estimation, a dual radar set up with one radar placed at foot level and the other at torso level is necessary. An excellent absolute agreement with intraclass correlation coefficients of 0.97 was found for step time estimation with the foot level radar. For walking speed, although both radars show excellent consistency they all have a system offset compared to the ground truth due to walking direction with respect to the radar beam. The torso level radar has a better performance (9% offset on average) in the speed estimation compared to the foot level radar (13%–18% offset). Quantitative analysis has been performed to compute the angles causing the systematic error. These lab results demonstrate the capability of the system to be used as a daily gait assessment tool in home environments, useful for fall risk assessment and other health care applications. The system is currently being tested in an unstructured home environment. PMID:24771566

Quantitative gait measurement with pulse-Doppler radar for passive in-home gait assessment.

PubMed

Wang, Fang; Skubic, Marjorie; Rantz, Marilyn; Cuddihy, Paul E

2014-09-01

In this paper, we propose a pulse-Doppler radar system for in-home gait assessment of older adults. A methodology has been developed to extract gait parameters including walking speed and step time using Doppler radar. The gait parameters have been validated with a Vicon motion capture system in the lab with 13 participants and 158 test runs. The study revealed that for an optimal step recognition and walking speed estimation, a dual radar set up with one radar placed at foot level and the other at torso level is necessary. An excellent absolute agreement with intraclass correlation coefficients of 0.97 was found for step time estimation with the foot level radar. For walking speed, although both radars show excellent consistency they all have a system offset compared to the ground truth due to walking direction with respect to the radar beam. The torso level radar has a better performance (9% offset on average) in the speed estimation compared to the foot level radar (13%-18% offset). Quantitative analysis has been performed to compute the angles causing the systematic error. These lab results demonstrate the capability of the system to be used as a daily gait assessment tool in home environments, useful for fall risk assessment and other health care applications. The system is currently being tested in an unstructured home environment.

Changes in spatiotemporal gait parameters following intravenous immunoglobulin treatment for chronic inflammatory demyelinating polyneuropathy.

PubMed

Vo, Mary L; Chin, Russell L; Miranda, Caroline; Latov, Norman

2017-10-01

Gait impairment is a common presenting symptom in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). However, gait parameters have not previously been evaluated in detail as potential independent outcome measures. We prospectively measured changes in spatiotemporal gait parameters of 20 patients with CIDP at baseline and following treatment with intravenous immunoglobulin (IVIG), using GAITRite® a computerized walkway system with embedded sensors. Overall, study patients showed significant improvements in gait velocity, cadence, stride length, double support time, stance phase, and swing phase following IVIG treatment. Mean changes in velocity, stance phase, and swing phase, exhibited the greatest statistical significance among the subgroup that exhibited clinically meaningful improvement in Inflammatory Neuropathy Cause and Treatment disability score, Medical Research Council sum score, and grip strength. Assessment of gait parameters, in particular velocity, step phase and swing phase, is a potentially sensitive outcome measure for evaluating treatment response in CIDP. Muscle Nerve 56: 732-736, 2017. © 2017 Wiley Periodicals, Inc.

Influence of Body Mass Index on Sagittal Knee Range of Motion and Gait Speed Recovery 1-Year After Total Knee Arthroplasty.

PubMed

Bonnefoy-Mazure, Alice; Martz, Pierre; Armand, Stéphane; Sagawa, Yoshimasa; Suva, Domizio; Turcot, Katia; Miozzari, Hermes H; Lübbeke, Anne

2017-08-01

The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA). Seventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI <30 kg/m 2 ) and obese patients (BMI ≥30 kg/m 2 ) were compared. Healthy controls were also assessed. Univariate and multivariate linear regression analyses were used to assess the association between gait speed and ROM gains. Adjustment was performed for gender, age, and WOMAC pain improvement. At baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P < .001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011). These findings show that all patients improved biomechanically and clinically, regardless of their BMI. Copyright © 2017 Elsevier Inc. All rights reserved.

The Effects of Augmented Reality-based Otago Exercise on Balance, Gait, and Falls Efficacy of Elderly Women.

PubMed

Yoo, Ha-Na; Chung, Eunjung; Lee, Byoung-Hee

2013-07-01

[Purpose] The purpose of this study was to determine the effects of augmented reality-based Otago exercise on balance, gait, and falls efficacy of elderly women. [Subjects] The subjects were 21 elderly women, who were randomly divided into two groups: an augmented reality-based Otago exercise group of 10 subjects and an Otago exercise group of 11 subjects. [Methods] All subjects were evaluated for balance (Berg Balance Scale, BBS), gait parameters (velocity, cadence, step length, and stride length), and falls efficacy. Within 12 weeks, Otago exercise for muscle strengthening and balance training was conducted three times, for a period of 60 minutes each, and subjects in the experimental group performed augmented reality-based Otago exercise. [Results] Following intervention, the augmented reality-based Otago exercise group showed significant increases in BBS, velocity, cadence, step length (right side), stride length (right side and left side) and falls efficacy. [Conclusion] The results of this study suggest the feasibility and suitability of this augmented reality-based Otago exercise for elderly women.

Validity of an Exercise Test Based on Habitual Gait Speed in Mobility-Limited Older Adults

PubMed Central

Li, Xin; Forman, Daniel E.; Kiely, Dan K.; LaRose, Sharon; Hirschberg, Ronald; Frontera, Walter R.; Bean, Jonathan F.

2013-01-01

Objective To evaluate whether a customized exercise tolerance testing (ETT) protocol based on an individual’s habitual gait speed (HGS) on level ground would be a valid mode of exercise testing older adults. Although ETT provides a useful means to risk-stratify adults, age-related declines in gait speed paradoxically limit the utility of standard ETT protocols for evaluating older adults. A customized ETT protocol may be a useful alternative to these standard methods, and this study hypothesized that this alternative approach would be valid. Design We performed a cross-sectional analysis of baseline data from a randomized controlled trial of older adults with observed mobility problems. Screening was performed using a treadmill-based ETT protocol customized for each individual’s HGS. We determined the content validity by assessing the results of the ETTs, and we evaluated the construct validity of treadmill time in relation to the Physical Activity Scale for the Elderly (PASE) and the Late Life Function and Disability Instrument (LLFDI). Setting Outpatient rehabilitation center. Participants Community-dwelling, mobility-limited older adults (N = 141). Interventions Not applicable. Main Outcome Measures Cardiac instability, ETT duration, peak heart rate, peak systolic blood pressure, PASE, and LLFDI. Results Acute cardiac instability was identified in 4 of the participants who underwent ETT. The remaining participants (n = 137, 68% female; mean age, 75.3y) were included in the subsequent analyses. Mean exercise duration was 9.39 minutes, with no significant differences in durations being observed after evaluating among tertiles by HGS status. Mean peak heart rate and mean peak systolic blood pressure were 126.6 beats/ min and 175.0mmHg, respectively. Within separate multivariate models, ETT duration in each of the 3 gait speed groups was significantly associated (P<.05) with PASE and LLFDI. Conclusions Mobility-limited older adults can complete this customized

Cellular Telephone Dialing Influences Kinematic and Spatiotemporal Gait Parameters in Healthy Adults.

PubMed

Seymour, Kelly M; Higginson, Christopher I; DeGoede, Kurt M; Bifano, Morgan K; Orr, Rachel; Higginson, Jill S

2016-01-01

Gait speed is typically reduced when individuals simultaneously perform other tasks. However, the impact of dual tasking on kinetic and kinematic gait parameters is unclear because these vary with gait speed. The objective of this study was to identify whether dual tasking impacts gait in healthy adults when speed is constant. Twenty-two healthy adults dialed a cell phone during treadmill walking at a self-selected speed while kinetic, kinematic, and spatial parameters were recorded. Results indicated that dual tasking did not impact phone dialing speed, but increased stride width, peak knee flexion during stance, and peak plantarflexion, and decreased knee and ankle range of motion. Dual tasking appears to influence kinematic gait variables in a manner consistent with promotion of stability.

Early signs of gait deviation in Duchenne muscular dystrophy.

PubMed

Doglio, L; Pavan, E; Pernigotti, I; Petralia, P; Frigo, C; Minetti, C

2011-12-01

Most analytical studies found in literature only focus on specific aspects of Duchenne muscular dystrophy (DMD) gait and posture (joint range of motion, standing balance, variations of gait spatial-temporal parameters). Some of them analyze single cases and do not provide a comprehensive evaluation of locomotion. There are few studies about DMD gait patterns, most of them concerning small groups of patients, sometimes not homogeneous, in which the clinical manifestations of the next stages of DMD were present. The goal of our study was to analyze the characteristics of gait patterns in early stage patients, when clinical and functional evaluation do not allow to quantify initial walking worsening or to identify the changes adopted to compensate for muscle weakness. Gait Analysis Laboratory by using a six-camera motion capture system (Vicon, Oxford Metrics, UK), set at a sampling rate of 60 Hz. Subjects were asked to walk barefoot at their usual cadence, along a 10-m walkway, where one force platform (Kistler, Switzerland), embedded in the middle portion of the pathway, measured the foot-ground reaction forces. Retroreflective markers were placed on the subjects according to the protocol described in Davis et al. A group of 15 patients aging from 5 to 6.8 years was compared with a similar age control group composed of 9 healthy children. Spatial and temporal parameters showed significant differences between the two groups: cadence was increased and step length was decreased significantly in the DMD group. We found a significant increase in the range of anterior-posterior pelvic tilt and in pelvic rotation. In the frontal plane there was a tendency for an increased pelvic obliquity. Dynamic range of motion in sagittal plane showed a significant difference at the ankle, with an increased plantarflexion in swing in the dystrophic patients. Maximum dorsiflexion was reduced in the DMD group. Kinetic analysis showed significant differences in power generation and

Gait variability and basal ganglia disorders: stride-to-stride variations of gait cycle timing in Parkinson's disease and Huntington's disease

NASA Technical Reports Server (NTRS)

Hausdorff, J. M.; Cudkowicz, M. E.; Firtion, R.; Wei, J. Y.; Goldberger, A. L.

1998-01-01

The basal ganglia are thought to play an important role in regulating motor programs involved in gait and in the fluidity and sequencing of movement. We postulated that the ability to maintain a steady gait, with low stride-to-stride variability of gait cycle timing and its subphases, would be diminished with both Parkinson's disease (PD) and Huntington's disease (HD). To test this hypothesis, we obtained quantitative measures of stride-to-stride variability of gait cycle timing in subjects with PD (n = 15), HD (n = 20), and disease-free controls (n = 16). All measures of gait variability were significantly increased in PD and HD. In subjects with PD and HD, gait variability measures were two and three times that observed in control subjects, respectively. The degree of gait variability correlated with disease severity. In contrast, gait speed was significantly lower in PD, but not in HD, and average gait cycle duration and the time spent in many subphases of the gait cycle were similar in control subjects, HD subjects, and PD subjects. These findings are consistent with a differential control of gait variability, speed, and average gait cycle timing that may have implications for understanding the role of the basal ganglia in locomotor control and for quantitatively assessing gait in clinical settings.

Comparison of standing postural control and gait parameters in people with and without chronic low back pain: a cross-sectional case-control study.

PubMed

MacRae, Catharine Siân; Critchley, Duncan; Lewis, Jeremy S; Shortland, Adam

2018-01-01

Differences in postural control and gait have been identified between people with and without chronic low back pain (CLBP); however, many previous studies present data from small samples, or have used methodologies with questionable reliability. This study, employing robust methodology, hypothesised that there would be a difference in postural control, and spatiotemporal parameters of gait in people with CLBP compared with asymptomatic individuals. This cross-sectional case-control study age-matched and gender-matched 16 CLBP and 16 asymptomatic participants. Participants were assessed barefoot (1) standing, over three 40 s trials, under four posture challenging conditions (2) during gait. Primary outcome was postural stability (assessed by root mean squared error of centre of pressure (CoP) displacement (CoP RMSEAP ) and mean CoP velocity (CoP VELAP ), both in the anteroposterior direction); gait outcomes were hip range of movement and peak moments, walking speed, cadence and stride length, assessed using force plates and a motion analysis system. There were no differences between groups in CoP RMSEAP (P=0.26), or CoP VELAP (P=0.60) for any standing condition. During gait, no differences were observed between groups for spatiotemporal parameters, maximum, minimum and total ranges of hip movement, or peak hip flexor or extensor moments in the sagittal plane. In contrast to previous research, this study suggests that people with mild to moderate CLBP present with similar standing postural control, and parameters of gait to asymptomatic individuals. Treatments directed at influencing postural stability (eg, standing on a wobble board) or specific parameters of gait may be an unnecessary addition to a treatment programme.

Gray matter volume and dual-task gait performance in mild cognitive impairment

PubMed Central

Blumen, Helena M.; Verghese, Joe; Shimada, Hiroyuki; Makizako, Hyuma; Tsutsumimoto, Kota; Hotta, Ryo; Nakakubo, Sho; Suzuki, Takao

2017-01-01

Dual-task gait performance is impaired in older adults with mild cognitive impairment, but the brain substrates associated with dual-task gait performance are not well-established. The relationship between gray matter and gait speed under single-task and dual-task conditions (walking while counting backward) was examined in 560 seniors with mild cognitive impairment (non-amnestic mild cognitive impairment: n = 270; mean age = 72.4 yrs., 63.6 % women; amnestic mild cognitive impairment: n = 290; mean age = 73.4 yrs., 45.4 % women). Multivariate covariance-based analyses of magnetic resonance imaging data, adjusted for potential confounders including single-task gait speed, were performed to identify gray matter patterns associated with dual-task gait speed. There were no differences in gait speed or cognitive performance during dual-task gait between individuals with non-amnestic mild cognitive impairment and amnestic mild cognitive impairment. Overall, increased dual-task gait speed was associated with a gray matter pattern of increased volume in medial frontal gyrus, superior frontal gyrus, anterior cingulate, cingulate, precuneus, fusiform gyrus, middle occipital gyrus, inferior temporal gyrus and middle temporal gyrus. The relationship between dual-task gait speed and brain substrates also differed by mild cognitive impairment subtype. Our study revealed a pattern of gray matter regions associated with dual-task performance. Although dual-task gait performance was similar in amnestic and non-amnestic mild cognitive impairment, the gray matter patterns associated with dual-task gait performance differed by mild cognitive impairment subtype. These findings suggest that the brain substrates supporting dual-task gait performance in amnestic and non-amnestic subtypes are different, and consequently may respond differently to interventions, or require different interventions. PMID:27392792

Identification of mouse gaits using a novel force-sensing exercise wheel.

PubMed

Smith, Benjamin J H; Cullingford, Lottie; Usherwood, James R

2015-09-15

The gaits that animals use can provide information on neurological and musculoskeletal disorders, as well as the biomechanics of locomotion. Mice are a common research model in many fields; however, there is no consensus in the literature on how (and if) mouse gaits vary with speed. One of the challenges in studying mouse gaits is that mice tend to run intermittently on treadmills or overground; this paper attempts to overcome this issue with a novel exercise wheel that measures vertical ground reaction forces. Unlike previous instrumented wheels, this wheel is able to measure forces continuously and can therefore record data from consecutive strides. By concatenating the maximum limb force at each time point, a force trace can be constructed to quantify and identify gaits. The wheel was three dimensionally printed, allowing the design to be shared with other researchers. The kinematic parameters measured by the wheel were evaluated using high-speed video. Gaits were classified using a metric called "3S" (stride signal symmetry), which quantifies the half wave symmetry of the force trace peaks. Although mice are capable of using both symmetric and asymmetric gaits throughout their speed range, the continuum of gaits can be divided into regions based on the frequency of symmetric and asymmetric gaits; these divisions are further supported by the fact that mice run less frequently at speeds near the boundaries between regions. The boundary speeds correspond to gait transition speeds predicted by the hypothesis that mice move in a dynamically similar fashion to other legged animals. Copyright © 2015 the American Physiological Society.

Identification of mouse gaits using a novel force-sensing exercise wheel

PubMed Central

Cullingford, Lottie; Usherwood, James R.

2015-01-01

The gaits that animals use can provide information on neurological and musculoskeletal disorders, as well as the biomechanics of locomotion. Mice are a common research model in many fields; however, there is no consensus in the literature on how (and if) mouse gaits vary with speed. One of the challenges in studying mouse gaits is that mice tend to run intermittently on treadmills or overground; this paper attempts to overcome this issue with a novel exercise wheel that measures vertical ground reaction forces. Unlike previous instrumented wheels, this wheel is able to measure forces continuously and can therefore record data from consecutive strides. By concatenating the maximum limb force at each time point, a force trace can be constructed to quantify and identify gaits. The wheel was three dimensionally printed, allowing the design to be shared with other researchers. The kinematic parameters measured by the wheel were evaluated using high-speed video. Gaits were classified using a metric called “3S” (stride signal symmetry), which quantifies the half wave symmetry of the force trace peaks. Although mice are capable of using both symmetric and asymmetric gaits throughout their speed range, the continuum of gaits can be divided into regions based on the frequency of symmetric and asymmetric gaits; these divisions are further supported by the fact that mice run less frequently at speeds near the boundaries between regions. The boundary speeds correspond to gait transition speeds predicted by the hypothesis that mice move in a dynamically similar fashion to other legged animals. PMID:26139220

31P Magnetic Resonance Spectroscopy Assessment of Muscle Bioenergetics as a Predictor of Gait Speed in the Baltimore Longitudinal Study of Aging.

PubMed

Choi, Seongjin; Reiter, David A; Shardell, Michelle; Simonsick, Eleanor M; Studenski, Stephanie; Spencer, Richard G; Fishbein, Kenneth W; Ferrucci, Luigi

2016-12-01

Aerobic fitness and muscle bioenergetic capacity decline with age; whether such declines explain age-related slowing of walking speed is unclear. We hypothesized that muscle energetics and aerobic capacity are independent correlates of walking speed in simple and challenging performance tests and that they account for the observed age-related decline in walking speed in these same tests. Muscle bioenergetics was assessed as postexercise recovery rate of phosphocreatine (PCr), k PCr , using phosphorus magnetic resonance spectroscopy ( 31 P-MRS) in 126 participants (53 men) of the Baltimore Longitudinal Study of Aging aged 26-91 years (mean = 72 years). Four walking tasks were administered-usual pace over 6 m and 150 seconds and fast pace over 6 m and 400 m. Separately, aerobic fitness was assessed as peak oxygen consumption (peak VO 2 ) using a graded treadmill test. All gait speeds, k PCr , and peak VO 2 were lower with older age. Independent of age, sex, height, and weight, both k PCr and peak VO 2 were positively and significantly associated with fast pace and long distance walking but only peak VO 2 and not k PCr was significantly associated with usual gait speed over 6 m. Both k PCr and peak VO 2 substantially attenuated the association between age and gait speed for all but the least stressful walking task of 6 m at usual pace. Muscle bioenergetics assessed using 31 P-MRS is highly correlated with walking speed and partially explains age-related poorer performance in fast and long walking tasks. Published by Oxford University Press on behalf of The Gerontological Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Gray matter volume and dual-task gait performance in mild cognitive impairment.

PubMed

Doi, Takehiko; Blumen, Helena M; Verghese, Joe; Shimada, Hiroyuki; Makizako, Hyuma; Tsutsumimoto, Kota; Hotta, Ryo; Nakakubo, Sho; Suzuki, Takao

2017-06-01

Dual-task gait performance is impaired in older adults with mild cognitive impairment, but the brain substrates associated with dual-task gait performance are not well-established. The relationship between gray matter and gait speed under single-task and dual-task conditions (walking while counting backward) was examined in 560 seniors with mild cognitive impairment (non-amnestic mild cognitive impairment: n = 270; mean age = 72.4 yrs., 63.6 % women; amnestic mild cognitive impairment: n = 290; mean age = 73.4 yrs., 45.4 % women). Multivariate covariance-based analyses of magnetic resonance imaging data, adjusted for potential confounders including single-task gait speed, were performed to identify gray matter patterns associated with dual-task gait speed. There were no differences in gait speed or cognitive performance during dual-task gait between individuals with non-amnestic mild cognitive impairment and amnestic mild cognitive impairment. Overall, increased dual-task gait speed was associated with a gray matter pattern of increased volume in medial frontal gyrus, superior frontal gyrus, anterior cingulate, cingulate, precuneus, fusiform gyrus, middle occipital gyrus, inferior temporal gyrus and middle temporal gyrus. The relationship between dual-task gait speed and brain substrates also differed by mild cognitive impairment subtype. Our study revealed a pattern of gray matter regions associated with dual-task performance. Although dual-task gait performance was similar in amnestic and non-amnestic mild cognitive impairment, the gray matter patterns associated with dual-task gait performance differed by mild cognitive impairment subtype. These findings suggest that the brain substrates supporting dual-task gait performance in amnestic and non-amnestic subtypes are different, and consequently may respond differently to interventions, or require different interventions.

47 CFR 10.530 - Common vibration cadence.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Common vibration cadence. 10.530 Section 10.530 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM Equipment Requirements § 10.530 Common vibration cadence. A Participating CMS Provider and equipment manufacturers may only...

The correlates of slow gait and its relation with social network among older adults in Singapore.

PubMed

Shafie, Saleha; Shahwan, Shazana; Abdin, Edimansyah; Vaingankar, Janhavi; Picco, Louisa; Sambasivam, Rajeswari; Zhang, Yunjue; Ng, Li Ling; Chong, Siow Ann; Subramaniam, Mythily

2017-11-01

This study aimed to identify socio-demographic correlates of slow gait speed among Singapore older adult residents and to examine the relationship between slow gait speed and the older adult residents' social network, physical health status, disability and mental health status. Trained interviewers administered the adapted 10/66 research protocol through face-to-face interviews to 2565 respondents aged 60 and over. Information on gait test, socio-demographic characteristics, obesity, social network, physical status and activity, overall health, disability and mental health status were collected. The gait test was completed by 2192 participants. Slow gait was defined as walking speed of 1 standard deviation (SD) below age and gender specific mean gait of the sample. The prevalence of slow gait speed after adjusting for age and gender was 13.7%. Slow gait speed was more prevalent among Indians, respondents with low education, and those who were retired. Those with slow gait speed were significantly associated with lower probability of being unemployed and attending religious activities. They were significantly associated with not being physically active and reported a higher disability score. Older adult residents' socio-demographic factors were found to be associated with gait speed. Those with slow gait speed were not physically active and had less frequent contact with people through religious activities and this might place them at risk of being socially isolated, which can have consequences. Gait speed can be included as a routine assessment tool to identify at-risk groups for interventions which aim to keep the older adults socially engaged and healthy.

Test-retest reliability and minimal detectable change scores for the timed "up & go" test, the six-minute walk test, and gait speed in people with Alzheimer disease.

PubMed

Ries, Julie D; Echternach, John L; Nof, Leah; Gagnon Blodgett, Michelle

2009-06-01

With the increasing incidence of Alzheimer disease (AD), determining the validity and reliability of outcome measures for people with this disease is necessary. The goals of this study were to assess test-retest reliability of data for the Timed "Up & Go" Test (TUG), the Six-Minute Walk Test (6MWT), and gait speed and to calculate minimal detectable change (MDC) scores for each outcome measure. Performance differences between groups with mild to moderate AD and moderately severe to severe AD (as determined by the Functional Assessment Staging [FAST] scale) were studied. This was a prospective, nonexperimental, descriptive methodological study. Background data collected for 51 people with AD included: use of an assistive device, Mini-Mental Status Examination scores, and FAST scale scores. Each participant engaged in 2 test sessions, separated by a 30- to 60-minute rest period, which included 2 TUG trials, 1 6MWT trial, and 2 gait speed trials using a computerized gait assessment system. A specific cuing protocol was followed to achieve optimal performance during test sessions. Test-retest reliability values for the TUG, the 6MWT, and gait speed were high for all participants together and for the mild to moderate AD and moderately severe to severe AD groups separately (intraclass correlation coefficients > or = .973); however, individual variability of performance also was high. Calculated MDC scores at the 90% confidence interval were: TUG=4.09 seconds, 6MWT=33.5 m (110 ft), and gait speed=9.4 cm/s. The 2 groups were significantly different in performance of clinical tests, with the participants who were more cognitively impaired being more physically and functionally impaired. A single researcher for data collection limited sample numbers and prohibited blinding to dementia level. The TUG, the 6MWT, and gait speed are reliable outcome measures for use with people with AD, recognizing that individual variability of performance is high. Minimal detectable change

Quantitative assessment of the effects of 6 months of adapted physical activity on gait in people with multiple sclerosis: a randomized controlled trial.

PubMed

Pau, Massimiliano; Corona, Federica; Coghe, Giancarlo; Marongiu, Elisabetta; Loi, Andrea; Crisafulli, Antonio; Concu, Alberto; Galli, Manuela; Marrosu, Maria Giovanna; Cocco, Eleonora

2018-01-01

The purpose of this study is to quantitatively assess the effect of 6 months of supervised adapted physical activity (APA i.e. physical activity designed for people with special needs) on spatio-temporal and kinematic parameters of gait in persons with Multiple Sclerosis (pwMS). Twenty-two pwMS with Expanded Disability Status Scale scores ranging from 1.5 to 5.5 were randomly assigned either to the intervention group (APA, n = 11) or the control group (CG, n = 11). The former underwent 6 months of APA consisting of 3 weekly 60-min sessions of aerobic and strength training, while CG participants were engaged in no structured PA program. Gait patterns were analyzed before and after the training using three-dimensional gait analysis by calculating spatio-temporal parameters and concise indexes of gait kinematics (Gait Profile Score - GPS and Gait Variable Score - GVS) as well as dynamic Range of Motion (ROM) of hip, knee, and ankle joints. The training originated significant improvements in stride length, gait speed and cadence in the APA group, while GPS and GVS scores remained practically unchanged. A trend of improvement was also observed as regard the dynamic ROM of hip, knee, and ankle joints. No significant changes were observed in the CG for any of the parameters considered. The quantitative analysis of gait supplied mixed evidence about the actual impact of 6 months of APA on pwMS. Although some improvements have been observed, the substantial constancy of kinematic patterns of gait suggests that the full transferability of the administered training on the ambulation function may require more specific exercises. Implications for rehabilitation Adapted Physical Activity (APA) is effective in improving spatio-temporal parameters of gait, but not kinematics, in people with multiple sclerosis. Dynamic range of motion during gait is increased after APA. The full transferability of APA on the ambulation function may require specific exercises rather than

Effects of conventional overground gait training and a gait trainer with partial body weight support on spatiotemporal gait parameters of patients after stroke

PubMed Central

Park, Byoung-Sun; Kim, Mee-Young; Lee, Lim-Kyu; Yang, Seung-Min; Lee, Won-Deok; Noh, Ji-Woong; Shin, Yong-Sub; Kim, Ju-Hyun; Lee, Jeong-Uk; Kwak, Taek-Yong; Lee, Tae-Hyun; Kim, Ju-Young; Kim, Junghwan

2015-01-01

[Purpose] The purpose of this study was to confirm the effects of both conventional overground gait training (CGT) and a gait trainer with partial body weight support (GTBWS) on spatiotemporal gait parameters of patients with hemiparesis following chronic stroke. [Subjects and Methods] Thirty stroke patients were alternately assigned to one of two treatment groups, and both groups underwent CGT and GTBWS. [Results] The functional ambulation classification on the affected side improved significantly in the CGT and GTBWS groups. Walking speed also improved significantly in both groups. [Conclusion] These results suggest that the GTBWS in company with CGT may be, in part, an effective method of gait training for restoring gait ability in patients after a stroke. PMID:26157272

Effects of conventional overground gait training and a gait trainer with partial body weight support on spatiotemporal gait parameters of patients after stroke.

PubMed

Park, Byoung-Sun; Kim, Mee-Young; Lee, Lim-Kyu; Yang, Seung-Min; Lee, Won-Deok; Noh, Ji-Woong; Shin, Yong-Sub; Kim, Ju-Hyun; Lee, Jeong-Uk; Kwak, Taek-Yong; Lee, Tae-Hyun; Kim, Ju-Young; Kim, Junghwan

2015-05-01

[Purpose] The purpose of this study was to confirm the effects of both conventional overground gait training (CGT) and a gait trainer with partial body weight support (GTBWS) on spatiotemporal gait parameters of patients with hemiparesis following chronic stroke. [Subjects and Methods] Thirty stroke patients were alternately assigned to one of two treatment groups, and both groups underwent CGT and GTBWS. [Results] The functional ambulation classification on the affected side improved significantly in the CGT and GTBWS groups. Walking speed also improved significantly in both groups. [Conclusion] These results suggest that the GTBWS in company with CGT may be, in part, an effective method of gait training for restoring gait ability in patients after a stroke.

Gait pattern in myotonic dystrophy (Steinert disease): a kinematic, kinetic and EMG evaluation using 3D gait analysis.

PubMed

Galli, Manuela; Cimolin, Veronica; Crugnola, Veronica; Priano, Lorenzo; Menegoni, Francesco; Trotti, Claudio; Milano, Eva; Mauro, Alessandro

2012-03-15

We investigated the gait pattern of 10 patients with myotonic dystrophy (Steinert disease; 4 females, 6 males; age: 41.5+7.6 years), compared to 20 healthy controls, through manual muscle test and gait analysis, in terms of kinematic, kinetic and EMG data. In most of patients (80%) distal muscle groups were weaker than proximal ones. Weakness at lower limbs was in general moderate to severe and MRC values evidenced a significant correlation between tibialis anterior and gastrocnemius medialis (R=0.91). An overall observation of gait pattern in patients when compared to controls showed that most spatio-temporal parameters (velocity, step length and cadence) were significantly different. As concerns kinematics, patients' pelvic tilt was globally in a higher position than control group, with reduced hip extension ability in stance phase and limited range of motion; 60% of the limbs revealed knee hyperextension during midstance and ankle joints showed a quite physiological position at initial contact and higher dorsiflexion during stance phase if compared to healthy individuals. Kinetic plots evidenced higher hip power during loading response and lower ankle power generation in terminal stance. The main EMG abnormalities were seen in tibialis anterior and gastrocnemius medialis muscles. In this study gait analysis gives objective and quantitative information about the gait pattern and the deviations due to the muscular situation of these patients; these results are important from a clinical point of view and suggest that rehabilitation programs for them should take these findings into account. Copyright © 2011 Elsevier B.V. All rights reserved.

Hemiparetic stepping to the beat: asymmetric response to metronome phase shift during treadmill gait.

PubMed

Pelton, Trudy A; Johannsen, Leif; Huiya Chen; Wing, Alan M

2010-06-01

Walking in time with a metronome is associated with improved spatiotemporal parameters in hemiparetic gait; however, the mechanism linking auditory and motor systems is poorly understood. Hemiparetic cadence control with metronome synchronization was examined to determine specific influences of metronome timing on treadmill walking. A within-participant experiment examined correction processes used to maintain heel strike synchrony with the beat by applying perturbations to the timing of a metronome. Eight chronic hemiparetic participants (mean age = 70 years; standard deviation = 12) were required to synchronize heel strikes with metronome pulses set according to each individual's comfortable speed (mean 0.4 m/s). During five 100-pulse trials, a fixed-phase baseline was followed by 4 unpredictable metronome phase shifts (20% of the interpulse interval), which amounted to 10 phase shifts on each foot. Infrared cameras recorded the motion of bilateral heel markers at 120 Hz. Relative asynchrony between heel strike responses and metronome pulses was used to index compensation for metronome phase shifts. Participants demonstrated compensation for phase shifts with convergence back to pre-phase shift asynchrony. This was significantly slower when the error occurred on the nonparetic side (requiring initial correction with the paretic limb) compared with when the error occurred on the paretic side (requiring initial nonparetic correction). Although phase correction of gait is slowed when the phase shift is delivered to the nonparetic side compared with the paretic side, phase correction is still present. This may underlie the utility of rhythmic auditory cueing in hemiparetic gait rehabilitation.

Cadence (steps/min) and intensity during ambulation in 6-20 year olds: the CADENCE-kids study.

PubMed

Tudor-Locke, Catrine; Schuna, John M; Han, Ho; Aguiar, Elroy J; Larrivee, Sandra; Hsia, Daniel S; Ducharme, Scott W; Barreira, Tiago V; Johnson, William D

2018-02-26

Steps/day is widely utilized to estimate the total volume of ambulatory activity, but it does not directly reflect intensity, a central tenet of public health guidelines. Cadence (steps/min) represents an overlooked opportunity to describe the intensity of ambulatory activity. We sought to establish thresholds linking directly observed cadence with objectively measured intensity in 6-20 year olds. One hundred twenty participants completed multiple 5-min bouts on a treadmill, from 13.4 m/min (0.80 km/h) to 134.0 m/min (8.04 km/h). The protocol was terminated when participants naturally transitioned to running, or if they chose to not continue. Steps were visually counted and intensity was objectively measured using a portable metabolic system. Youth metabolic equivalents (METy) were calculated for 6-17 year olds, with moderate intensity defined as ≥4 and < 6 METy, and vigorous intensity as ≥6 METy. Traditional METs were calculated for 18-20 year olds, with moderate intensity defined as ≥3 and < 6 METs, and vigorous intensity defined as ≥6 METs. Optimal cadence thresholds for moderate and vigorous intensity were identified using segmented random coefficients models and receiver operating characteristic (ROC) curves. Participants were on average (± SD) aged 13.1 ± 4.3 years, weighed 55.8 ± 22.3 kg, and had a BMI z-score of 0.58 ± 1.21. Moderate intensity thresholds (from regression and ROC analyses) ranged from 128.4 steps/min among 6-8 year olds to 87.3 steps/min among 18-20 year olds. Comparable values for vigorous intensity ranged from 157.7 steps/min among 6-8 year olds to 119.3 steps/min among 18-20 year olds. Considering both regression and ROC approaches, heuristic cadence thresholds (i.e., evidence-based, practical, rounded) ranged from 125 to 90 steps/min for moderate intensity, and 155 to 125 steps/min for vigorous intensity, with higher cadences for younger age groups. Sensitivities and specificities for these

Music and metronome cues produce different effects on gait spatiotemporal measures but not gait variability in healthy older adults.

PubMed

Wittwer, Joanne E; Webster, Kate E; Hill, Keith

2013-02-01

Rhythmic auditory cues including music and metronome beats have been used, sometimes interchangeably, to improve disordered gait arising from a range of clinical conditions. There has been limited investigation into whether there are optimal cue types. Different cue types have produced inconsistent effects across groups which differed in both age and clinical condition. The possible effect of normal ageing on response to different cue types has not been reported for gait. The aim of this study was to determine the effects of both rhythmic music and metronome cues on gait spatiotemporal measures (including variability) in healthy older people. Twelve women and seven men (>65 years) walked on an instrumented walkway at comfortable pace and then in time to each of rhythmic music and metronome cues at comfortable pace stepping frequency. Music but not metronome cues produced a significant increase in group mean gait velocity of 4.6 cm/s, due mostly to a significant increase in group mean stride length of 3.1cm. Both cue types produced a significant but small increase in cadence of 1 step/min. Mean spatio-temporal variability was low at baseline and did not increase with either cue type suggesting cues did not disrupt gait timing. Study findings suggest music and metronome cues may not be used interchangeably and cue type as well as frequency should be considered when evaluating effects of rhythmic auditory cueing on gait. Further work is required to determine whether optimal cue types and frequencies to improve walking in different clinical groups can be identified. Copyright © 2012 Elsevier B.V. All rights reserved.

Kinematic, Cardiopulmonary, and Metabolic Responses of Overweight Runners While Running at Self-Selected and Standardized Speeds

PubMed Central

Zdziarski, Laura Ann; Chen, Cong; Horodyski, Marybeth; Vincent, Kevin R.; Vincent, Heather K.

2017-01-01

Objective To determine the differences in kinematic, cardiopulmonary, and metabolic responses between overweight and healthy weight runners at a self-selected and standard running speed. Design Comparative descriptive study. Setting Tertiary care institution, university-affiliated research laboratory. Participants Overweight runners (n = 21) were matched with runners of healthy weight (n = 42). Methods Participants ran at self-selected and standardized speeds (13.6 km/h). Sagittal plane joint kinematics were captured simultaneously with cardiopulmonary and metabolic measures using a motion capture system and portable gas analyzer, respectively. Main Outcome Measurements Spatiotemporal parameters (cadence, step width and length, center of gravity displacement, stance time) joint kinematics, oxygen cost, heart rate, ventilation and energy expenditure. Results At the self-selected speed, overweight individuals ran slower (8.5 ± 1.3 versus 10.0 ± 1.6 km/h) and had slower cadence (163 versus 169 steps/min; P < .05). The sagittal plane range of motion (ROM) for flexion-extension at the ankle, knee, hip, and anterior pelvic tilt were all less in overweight runners compared to healthy weight runners (all P < .05). At self-selected speed and 13.6 km/h, energy expenditure was higher in the overweight runners compared to their healthy weight counterparts (P < .05). At 13.6 km/h, only the frontal hip and pelvis ROM were higher in the overweight versus the healthy weight runners (P < .05), and energy expenditure, net energy cost, and minute ventilation were higher in the overweight runners compared to the healthy weight runners (P < .05). Conclusion At self-selected running speeds, the overweight runners demonstrated gait strategies (less joint ROM, less vertical displacement, and shorter step lengths) that resulted in cardiopulmonary and energetic responses similar to those of healthy weight individuals. PMID:26146194

Knock knee and the gait of six-year-old children.

PubMed

Pretkiewicz-Abacjew, E

2003-06-01

Knock knee (genu valgum) interferes with the locomotive and supporting function of the lower limb. In static conditions the load-bearing axis of the valgus limb is displaced laterally in relation to the middle of the joint, causing the knee joint, the ankle joint, and the foot as a whole to be weighted in the wrong way. The purpose of this work is to examine the influence of knock knee on gait kinematics. The gait of twenty-two 6-year-old children of both sexes in whom knock knee had been medically diagnosed was compared with the gait of 33 children of the same age whose knee joints conformed to the norm in formation and position. Gait was recorded separately for the sagittal and the frontal planes, using a video-computer system. The results of the examination indicated statistically significant differences in the gait of the two groups of children. These differences related mainly to the time features of gait and to data on the angles in the knee and ankle joints. Although the results obtained for other features of gait did not reveal statistical differences, these did indicate that the children with knock knee walked more slowly and with a lower cadence. The results indicate that knock knee in 6-year-old children has an adverse impact on the mechanics of the lower limb joints in gait and causes a deterioration in gait quality. Thus knock knee in children should not be treated merely as a superficial defect but should be subject to therapy and, more importantly, taken into account when introducing children to early sports training.

Variability of gait, bilateral coordination, and asymmetry in women with fibromyalgia.

PubMed

Heredia-Jimenez, J; Orantes-Gonzalez, E; Soto-Hermoso, V M

2016-03-01

To analyze how fibromyalgia affected the variability, asymmetry, and bilateral coordination of gait walking at comfortable and fast speeds. 65 fibromyalgia (FM) patients and 50 healthy women were analyzed. Gait analysis was performed using an instrumented walkway (GAITRite system). Average walking speed, coefficient of variation (CV) of stride length, swing time, and step width data were obtained and bilateral coordination and gait asymmetry were analyzed. FM patients presented significantly lower speeds than the healthy group. FM patients obtained significantly higher values of CV_StrideLength (p=0.04; p<0.001), CV_SwingTime (p<0.001; p<0.001), CV_StepWidth (p=0.004; p<0.001), phase coordination index (p=0.01; p=0.03), and p_CV (p<0.001; p=0.001) than the control group, walking at comfortable or fast speeds. Gait asymmetry only showed significant differences in the fast condition. FM patients walked more slowly and presented a greater variability of gait and worse bilateral coordination than healthy subjects. Gait asymmetry only showed differences in the fast condition. The variability and the bilateral coordination were particularly affected by FM in women. Therefore, variability and bilateral coordination of gait could be analyzed to complement the gait evaluation of FM patients. Copyright © 2016 Elsevier B.V. All rights reserved.

Lower Wingate Test Power Outcomes From "All-Out" Pretest Pedaling Cadence Compared With Moderate Cadence.

PubMed

Lunn, William R; Zenoni, Maria A; Crandall, Ian H; Dress, Ashley E; Berglund, Michelle L

2015-08-01

The aim of the present study was to determine the effect of different pretest pedaling cadences on power outcomes obtained during the Wingate Anaerobic Test (WAnT). Vigorously exercising adult men (n = 14, 24.9 ± 1.2 years) and women (n = 14, 20.4 ± 0.6 years) participated in a randomized crossover study during which they performed the 30-second WAnT on a mechanically braked cycle ergometer (0.075 kg·kg(-1) body weight) under 2 conditions. Participants pedaled maximally with an unloaded flywheel during 5 seconds before resistance was applied and the test began (FAST). In another trial, participants maintained a moderate cadence (80 revolutions per minute [rpm]) during 5 seconds before the test began (MOD). All other components of the WAnT were identical. Peak power (PP), mean power (MP), minimum power (MinP), fatigue index (%FAT), and maximum cadence during test were recorded. Comparisons were made using a 2 × 2 factorial repeated-measures analysis of variance. Regardless of gender, the FAST condition resulted in 22.2% lower PP (612.6 ± 33.0 W vs. 788.3 ± 43.5 W), 13.3% lower MP (448.4 ± 22.2 W vs. 517.2 ± 26.4 W), 11.7% lower MinP (280.9 ± 14.8 W vs. 318.3 ± 17.2 W), and 9.0% lower %FAT (53.5 ± 1.3% vs. 58.8 ± 1.5%) than MOD condition (p < 0.01; mean ± SD). Similar outcomes were observed within gender. The authors conclude that practitioners of the WAnT should instruct participants to maintain a moderate pedal cadence (∼80 rpm) during 5 seconds before the test commences to avoid bias from software sampling and peripheral fatigue. Standardizing the pretest pedal cadence will be important to exercise testing professionals who compare data with norms or generate norms for specific populations.

The effects of mirror therapy on the gait of subacute stroke patients: a randomized controlled trial.

PubMed

Ji, Sang Gu; Kim, Myoung Kwon

2015-04-01

To investigate the effect of mirror therapy on the gait of patients with subacute stroke. Randomized controlled experimental study. Outpatient rehabilitation hospital. Thirty-four patients with stroke were randomly assigned to two groups: a mirror therapy group (experimental) and a control group. The stroke patients in the experimental group underwent comprehensive rehabilitation therapy and mirror therapy for the lower limbs. The stroke patients in the control group underwent sham therapy and comprehensive rehabilitation therapy. Participants in both groups received therapy five days per week for four weeks. Temporospatial gait characteristics, such as single stance, stance phase, step length, stride, swing phase, velocity, and cadence, were assessed before and after the four weeks therapy period. A significant difference was observed in post-training gains for the single stance (10.32 SD 4.14 vs. 6.54 SD 3.23), step length (8.47 SD 4.12 vs. 4.83 SD 2.14), and stride length (17.03 SD 6.57 vs 10.54 SD 4.34) between the experimental group and the control group (p < 0.05). However, there were no significant differences between two groups on stance phase, swing phase, velocity, cadence, and step width (P > 0.05). We conclude that mirror therapy may be beneficial in improving the effects of stroke on gait ability. © The Author(s) 2014.

Gait and Functional Mobility Deficits in Fragile X-Associated Tremor/Ataxia Syndrome.

PubMed

O'Keefe, Joan A; Robertson-Dick, Erin E; Hall, Deborah A; Berry-Kravis, Elizabeth

2016-08-01

Fragile X-associated tremor/ataxia syndrome (FXTAS) results from a "premutation" (PM) size CGG repeat expansion in the fragile X mental retardation 1 (FMR1) gene. Cerebellar gait ataxia is the primary feature in some FXTAS patients causing progressive disability. However, no studies have quantitatively characterized gait and mobility deficits in FXTAS. We performed quantitative gait and mobility analysis in seven FMR1 PM carriers with FXTAS and ataxia, six PM carriers without FXTAS, and 18 age-matched controls. We studied four independent gait domains, trunk range of motion (ROM), and movement transitions using an instrumented Timed Up and Go (i-TUG). We correlated these outcome measures with FMR1 molecular variables and clinical severity scales. PM carriers with FXTAS were globally impaired in every gait performance domain except trunk ROM compared to controls. These included total i-TUG duration, stride velocity, gait cycle time, cadence, double-limb support and swing phase times, turn duration, step time before turn, and turn-to-sit duration, and increased gait variability on several measures. Carriers without FXTAS did not differ from controls on any parameters, but double-limb support time was close to significance. Balance and disability scales correlated with multiple gait and movement transition parameters, while the FXTAS Rating Scale did not. This is the first study to quantitatively examine gait and movement transitions in FXTAS patients. Gait characteristics were consistent with those from previous cohorts with cerebellar ataxia. Sensitive measures like the i-TUG may help determine efficacy of interventions, characterize disease progression, and provide early markers of disease in FXTAS.

The three-dimensional locomotor dynamics of African (Loxodonta africana) and Asian (Elephas maximus) elephants reveal a smooth gait transition at moderate speed

PubMed Central

Ren, Lei; Hutchinson, John R

2007-01-01

We examined whether elephants shift to using bouncing (i.e. running) mechanics at any speed. To do this, we measured the three-dimensional centre of mass (CM) motions and torso rotations of African and Asian elephants using a novel multisensor method. Hundreds of continuous stride cycles were recorded in the field. African and Asian elephants moved very similarly. Near the mechanically and metabolically optimal speed (a Froude number (Fr) of 0.09), an inverted pendulum mechanism predominated. With increasing speed, the locomotor dynamics quickly but continuously became less like vaulting and more like bouncing. Our mechanical energy analysis of the CM suggests that at a surprisingly slow speed (approx. 2.2 m s−1, Fr 0.25), the hindlimbs exhibited bouncing, not vaulting, mechanics during weight support. We infer that a gait transition happens at this relatively slow speed: elephants begin using their compliant hindlimbs like pogo sticks to some extent to drive the body, bouncing over their relatively stiff, vaulting forelimbs. Hence, they are not as rigid limbed as typically characterized for graviportal animals, and use regular walking as well as at least one form of running gait. PMID:17594960

Gait characteristics before hardware removal in patients operated upon for tibial plateau fractures.

PubMed

Deleanu, Bogdan; Prejbeanu, Radu; Crisan, Dan; Predescu, Vlad; Popa, Iulian; Poenaru, Dan V

2015-07-01

The reporting of gait analysis data on operated fractures of the tibial plateau, while extensive for studies of knee osteoarthritis of mostly undisclosed aetiology and ACL deficient knees, is rather limited in literature. In the present study we investigated 25 tibial plateau fractures classified as Schatzker II, IV, V and VI that underwent operative reduction and lateral plate osteosynthesis. Apart from routine radiographic exploration and patient completed (KOOS) scores at three (mean of 3.2 months), six (mean of 5.6 months) and 12 months (mean of 11.3 months) postoperatively, gait analysis was performed at these intervals as well. Cadence, step time and knee flexion were the gait parameters that were selected for the comparison at six and 12 months postoperatively. The analysed gait parameters were significantly improved between the six and the 12-month session and statistically significant differences were found between the two groups of values. Cadence had a mean value of 41 steps/minute at six months and 45 steps/minute at 12 months (p = 0.99). Step time was a mean of 0.74 seconds at six months while at 12 months the median value was 0.66 seconds (p = 0.94). Knee flexion angles evolved in a similar manner with mean values of 58° at six months and 69° at 12 months (p = 0.95). The mean KOOS scores were 42.4, 56.3 and 67.99 at three, six and 12 months postoperatively, respectively. Complex intra-articular fractures, classified as Schatzker IV, V and VI, had a higher impact on joint function than Schatzker II fractures treated with similar techniques and implants. There were statistically significant improvements in the recovery status at 12 months postoperatively compared to six months with extended chances for improvement.

Collaborative robotic biomechanical interactions and gait adjustments in young, non-impaired individuals.

PubMed

Dionisio, Valdeci C; Brown, David A

2016-06-16

Collaborative robots are used in rehabilitation and are designed to interact with the client so as to provide the ability to assist walking therapeutically. One such device is the KineAssist which was designed to interact, either in a self-driven mode (SDM) or in an assist mode (AM), with neurologically-impaired individuals while they are walking on a treadmill surface. To understand the level of transparency (i.e., interference with movement due to the mechanical interface) between human and robot, and to estimate and account for changes in the kinetics and kinematics of the gait pattern, we tested the KineAssist under conditions of self-drive and horizontal push assistance. The aims of this study were to compare the joint kinematics, forces and moments during walking at a fixed constant treadmill belt speed and constrained walking cadence, with and without the robotic device (OUT) and to compare the biomechanics of assistive and self-drive modes in the device. Twenty non-neurologically impaired adults participated in this study. We evaluated biomechanical parameters of walking at a fixed constant treadmill belt speed (1.0 m/s), with and without the robotic device in assistive mode. We also tested the self-drive condition, which enables the user to drive the speed and direction of a treadmill belt. Hip, knee and ankle angular displacements, ground reaction forces, hip, knee and ankle moments, and center of mass displacement were compared "in" vs "out" of the device. A repeated measures ANOVA test was applied with the three level factor of condition (OUT, AM, and SDM), and each participant was used as its own comparison. When comparing "in" and "out" of the device, we did not observe any interruptions and/or reversals of direction of the basic gait pattern trajectory, but there was increased ankle and hip angular excursions, vertical ground reaction force and hip moments and reduced center of mass displacement during the "in device" condition. Comparing assistive

Relation of pulse pressure to long-distance gait speed in community-dwelling older adults: Findings from the LIFE-P study

USDA-ARS?s Scientific Manuscript database

Reduced long-distance gait speed, a measure of physical function, is associated with falls, late-life disability, hospitalization/institutionalization and cardiovascular morbidity and mortality. Aging is also accompanied by a widening of pulse pressure (PP) that contributes to ventricular-vascular ...

Effect of 24-h continuous rotigotine treatment on stationary and non-stationary locomotion in de novo patients with Parkinson disease in an open-label uncontrolled study.

PubMed

Serrao, Mariano; Ranavolo, Alberto; Conte, Carmela; Davassi, Chiara; Mari, Silvia; Fasano, Alfonso; Chini, Giorgia; Coppola, Gianluca; Draicchio, Francesco; Pierelli, Francesco

2015-11-01

The aim of this study was to investigate the effect of a rotigotine transdermal patch on stationary and non-stationary locomotion in de novo Parkinson disease (PD) patients in an open-label uncontrolled study. A 3-D gait analysis system was used to investigate four different locomotor tasks: steady-state linear walking, gait initiation, gait termination and 180°-turning. A series of gait variables were measured for each locomotor task. PD patients who received rotigotine treatment (4-8 mg) displayed: (1) increased step length, gait speed, cadence and arm oscillations, and reduced double support duration and step asymmetry during steady-state linear gait; (2) increased initial step length during gait initiation; (3) increased final step length and gait speed, and decreased stability index during gait termination; (4) decreased duration of turning and head-pelvis delays during 180°-turning. The main finding that emerges from the present study is that the dopamine agonist rotigotine can improve various aspects of gait in de novo PD patients.

Motor Physical Therapy Affects Muscle Collagen Type I and Decreases Gait Speed in Dystrophin-Deficient Dogs

PubMed Central

Gaiad, Thaís P.; Araujo, Karla P. C.; Serrão, Júlio C.; Miglino, Maria A.; Ambrósio, Carlos Eduardo

2014-01-01

Golden Retriever Muscular Dystrophy (GRMD) is a dystrophin-deficient canine model genetically homologous to Duchenne Muscular Dystrophy (DMD) in humans. Muscular fibrosis secondary to cycles of degeneration/regeneration of dystrophic muscle tissue and muscular weakness leads to biomechanical adaptation that impairs the quality of gait. Physical therapy (PT) is one of the supportive therapies available for DMD, however, motor PT approaches have controversial recommendations and there is no consensus regarding the type and intensity of physical therapy. In this study we investigated the effect of physical therapy on gait biomechanics and muscular collagen deposition types I and III in dystrophin-deficient dogs. Two dystrophic dogs (treated dogs-TD) underwent a PT protocol of active walking exercise, 3×/week, 40 minutes/day, 12 weeks. Two dystrophic control dogs (CD) maintained their routine of activities of daily living. At t0 (pre) and t1 (post-physical therapy), collagen type I and III were assessed by immunohistochemistry and gait biomechanics were analyzed. Angular displacement of shoulder, elbow, carpal, hip, stifle and tarsal joint and vertical (Fy), mediolateral (Fz) and craniocaudal (Fx) ground reaction forces (GRF) were assessed. Wilcoxon test was used to verify the difference of biomechanical variables between t0 and t1, considering p<.05. Type I collagen of endomysium suffered the influence of PT, as well as gait speed that had decreased from t0 to t1 (p<.000). The PT protocol employed accelerates morphological alterations on dystrophic muscle and promotes a slower velocity of gait. Control dogs which maintained their routine of activities of daily living seem to have found a better balance between movement and preservation of motor function. PMID:24713872

[Correlation between gait speed and muscular strength with balance for reducing falls among elderly].

PubMed

García-Flores, Fabián Ituriel; Rivera-Cisneros, Antonio Eugenio; Sánchez-González, Jorge Manuel; Guardado-Mendoza, Rodolfo; Torres-Gutiérrez, Jorge Luis

2016-01-01

Evidence of the benefit on propioceptive neuromuscular facilitation for reducing falls in older people does not exist. The aim of this study is to evaluate the effects of propioceptive facilitation over falls and biomechanical variables, in comparison to standard treatment and control groups. Series cases comparative for the 24 participants were recruited and randomnly assigned to 3 groups. Group 1, propioceptive neuromuscular facilitation, group 2, standard treatment, and 3 control. Falls and biomechanic variables were measured before and after. Chi(2) was used for falls and multiple regression for biomechanical variables, Participants had similar falls in previous year. Women had higher falls in a relation 7:1 women-men. After intervention, there was no difference between 3 groups. A correlation exista between muscular strength and gait speed with one foot position time r(2) = 0.67, p = 0.02. Improving 1kilogram-force of muscular strength of pelvic limb and 0.1meter/second in gait speed, balance (unipodal position time) increases balance by 11.3%. After 3 months of intervention group 2 got 7.9kg-force and 0.26m/s of profit, while group 1 had 4.1kg-force and 0.15m/s and control group 2.4kg-force and 0.1m/s. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Gait variability in community dwelling adults with Alzheimer disease.

PubMed

Webster, Kate E; Merory, John R; Wittwer, Joanne E

2006-01-01

Studies have shown that measures of gait variability are associated with falling in older adults. However, few studies have measured gait variability in people with Alzheimer disease, despite the high incidence of falls in Alzheimer disease. The purpose of this study was to compare gait variability of community-dwelling older adults with Alzheimer disease and control subjects at various walking speeds. Ten subjects with mild-moderate Alzheimer disease and ten matched control subjects underwent gait analysis using an electronic walkway. Participants were required to walk at self-selected slow, preferred, and fast speeds. Stride length and step width variability were determined using the coefficient of variation. Results showed that stride length variability was significantly greater in the Alzheimer disease group compared with the control group at all speeds. In both groups, increases in walking speed were significantly correlated with decreases in stride length variability. Step width variability was significantly reduced in the Alzheimer disease group compared with the control group at slow speed only. In conclusion, there is an increase in stride length variability in Alzheimer disease at all walking speeds that may contribute to the increased incidence of falls in Alzheimer disease.

Effect of Horseback Riding Simulation Machine Training on Trunk Balance and Gait of Chronic Stroke Patients

PubMed Central

Kim, Hyungguen; Her, Jin Gang; Ko, Jooyeon

2014-01-01

[Purpose] The purpose of this study was to assess the effect of horseback riding simulation machine training on trunk balance and gait of patients with chronic stroke. [Subjects and Methods] The subjects were 20 patients hospitalized for treatment after being diagnosed with stroke. Horseback riding simulation training was provided for 30 minutes, 5 times a week, for 6 weeks. Trunk balance was assessed using the Trunk Impairment Scale (TIS) and a balance measuring device (Biorescue, RM ingenierie, France), and gait ability was measured using the Functional Gait Assessment (FGA) and a gait analyzer (GAITRite, CIR system Inc., USA). [Results] There were significant changes in movement area, distance and velocity of body sway as measured by the TIS and the balance measuring device, and in gait velocity, cadence, stride length and double limb support as measured by the FGA and gait analyzer. [Conclusion] Horseback riding simulation training improved the trunk balance and gait of chronic stroke patients. This present study provides preliminary objective data for future research, and useful clinical information for physical therapists using horseback riding simulation machines as a treatment modality for patients with chronic stroke. PMID:24567670

Inverse association between insulin resistance and gait speed in nondiabetic older men: results from the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2002

PubMed Central

2009-01-01

Background Recent studies have revealed the associations between insulin resistance (IR) and geriatric conditions such as frailty and cognitive impairment. However, little is known about the relation of IR to physical impairment and limitation in the aging process, eg. slow gait speed and poor muscle strength. The aim of this study is to determine the effect of IR in performance-based physical function, specifically gait speed and leg strength, among nondiabetic older adults. Methods Cross-sectional data were from the population-based National Health and Nutrition Examination Survey (1999-2002). A total of 1168 nondiabetic adults (≥ 50 years) with nonmissing values in fasting measures of insulin and glucose, habitual gait speed (HGS), and leg strength were analyzed. IR was assessed by homeostasis model assessment (HOMA-IR), whereas HGS and peak leg strength by the 20-foot timed walk test and an isokinetic dynamometer, respectively. We used multiple linear regression to examine the association between IR and performance-based physical function. Results IR was inversely associated with gait speed among the men. After adjusting demographics, body mass index, alcohol consumption, smoking status, chronic co-morbidities, and markers of nutrition and cardiovascular risk, each increment of 1 standard deviation in the HOMA-IR level was associated with a 0.04 m/sec decrease (p = 0.003) in the HGS in men. We did not find such association among the women. The IR-HGS association was not changed after further adjustment of leg strength. Last, HOMA-IR was not demonstrated in association with peak leg strength. Conclusion IR is inversely associated with HGS among older men without diabetes. The results suggest that IR, an important indicator of gait function among men, could be further investigated as an intervenable target to prevent walking limitation. PMID:19922671

Robot-assisted vs. sensory integration training in treating gait and balance dysfunctions in patients with multiple sclerosis: a randomized controlled trial

PubMed Central

Gandolfi, Marialuisa; Geroin, Christian; Picelli, Alessandro; Munari, Daniele; Waldner, Andreas; Tamburin, Stefano; Marchioretto, Fabio; Smania, Nicola

2014-01-01

Background: Extensive research on both healthy subjects and patients with central nervous damage has elucidated a crucial role of postural adjustment reactions and central sensory integration processes in generating and “shaping” locomotor function, respectively. Whether robotic-assisted gait devices might improve these functions in Multiple sclerosis (MS) patients is not fully investigated in literature. Purpose: The aim of this study was to compare the effectiveness of end-effector robot-assisted gait training (RAGT) and sensory integration balance training (SIBT) in improving walking and balance performance in patients with MS. Methods: Twenty-two patients with MS (EDSS: 1.5–6.5) were randomly assigned to two groups. The RAGT group (n = 12) underwent end-effector system training. The SIBT group (n = 10) underwent specific balance exercises. Each patient received twelve 50-min treatment sessions (2 days/week). A blinded rater evaluated patients before and after treatment as well as 1 month post treatment. Primary outcomes were walking speed and Berg Balance Scale. Secondary outcomes were the Activities-specific Balance Confidence Scale, Sensory Organization Balance Test, Stabilometric Assessment, Fatigue Severity Scale, cadence, step length, single and double support time, Multiple Sclerosis Quality of Life-54. Results: Between groups comparisons showed no significant differences on primary and secondary outcome measures over time. Within group comparisons showed significant improvements in both groups on the Berg Balance Scale (P = 0.001). Changes approaching significance were found on gait speed (P = 0.07) only in the RAGT group. Significant changes in balance task-related domains during standing and walking conditions were found in the SIBT group. Conclusion: Balance disorders in patients with MS may be ameliorated by RAGT and by SIBT. PMID:24904361

The use of body weight support on ground level: an alternative strategy for gait training of individuals with stroke.

PubMed

Sousa, Catarina O; Barela, José A; Prado-Medeiros, Christiane L; Salvini, Tania F; Barela, Ana M F

2009-12-01

Body weight support (BWS) systems on treadmill have been proposed as a strategy for gait training of subjects with stroke. Considering that ground level is the most common locomotion surface and that there is little information about individuals with stroke walking with BWS on ground level, it is important to investigate the use of BWS on ground level in these individuals as a possible alternative strategy for gait training. Thirteen individuals with chronic stroke (four women and nine men; mean age 54.46 years) were videotaped walking on ground level in three experimental conditions: with no harness, with harness bearing full body weight, and with harness bearing 30% of full body weight. Measurements were recorded for mean walking speed, cadence, stride length, stride speed, durations of initial and terminal double stance, single limb support, swing period, and range of motion of ankle, knee, and hip joints; and foot, shank, thigh, and trunk segments. The use of BWS system leads to changes in stride length and speed, but not in stance and swing period duration. Only the hip joint was influenced by the BWS system in the 30% BWS condition. Shank and thigh segments presented less range of motion in the 30% BWS condition than in the other conditions, and the trunk was held straighter in the 30% BWS condition than in the other conditions. Individuals with stroke using BWS system on ground level walked slower and with shorter stride length than with no harness. BWS also led to reduction of hip, shank, and thigh range of motion. However, this system did not change walking temporal organization and body side asymmetry of individuals with stroke. On the other hand, the BWS system enabled individuals with chronic stroke to walk safely and without physical assistance. In interventions, the physical therapist can watch and correct gait pattern in patients' performance without the need to provide physical assistance.

Usability of Three-dimensional Augmented Visual Cues Delivered by Smart Glasses on (Freezing of) Gait in Parkinson's Disease.

PubMed

Janssen, Sabine; Bolte, Benjamin; Nonnekes, Jorik; Bittner, Marian; Bloem, Bastiaan R; Heida, Tjitske; Zhao, Yan; van Wezel, Richard J A

2017-01-01

External cueing is a potentially effective strategy to reduce freezing of gait (FOG) in persons with Parkinson's disease (PD). Case reports suggest that three-dimensional (3D) cues might be more effective in reducing FOG than two-dimensional cues. We investigate the usability of 3D augmented reality visual cues delivered by smart glasses in comparison to conventional 3D transverse bars on the floor and auditory cueing via a metronome in reducing FOG and improving gait parameters. In laboratory experiments, 25 persons with PD and FOG performed walking tasks while wearing custom-made smart glasses under five conditions, at the end-of-dose. For two conditions, augmented visual cues (bars/staircase) were displayed via the smart glasses. The control conditions involved conventional 3D transverse bars on the floor, auditory cueing via a metronome, and no cueing. The number of FOG episodes and percentage of time spent on FOG were rated from video recordings. The stride length and its variability, cycle time and its variability, cadence, and speed were calculated from motion data collected with a motion capture suit equipped with 17 inertial measurement units. A total of 300 FOG episodes occurred in 19 out of 25 participants. There were no statistically significant differences in number of FOG episodes and percentage of time spent on FOG across the five conditions. The conventional bars increased stride length, cycle time, and stride length variability, while decreasing cadence and speed. No effects for the other conditions were found. Participants preferred the metronome most, and the augmented staircase least. They suggested to improve the comfort, esthetics, usability, field of view, and stability of the smart glasses on the head and to reduce their weight and size. In their current form, augmented visual cues delivered by smart glasses are not beneficial for persons with PD and FOG. This could be attributable to distraction, blockage of visual feedback, insufficient

Kinematic Mechanisms of How Power Training Improves Healthy Old Adults' Gait Velocity.

PubMed

Beijersbergen, Chantal M I; Granacher, Urs; Gäbler, Martijn; Devita, Paul; Hortobágyi, Tibor

2017-01-01

Slow gait predicts many adverse clinical outcomes in old adults, but the mechanisms of how power training can minimize the age-related loss of gait velocity is unclear. We examined the effects of 10 wk of lower extremity power training and detraining on healthy old adults' lower extremity muscle power and gait kinematics. As part of the Potsdam Gait Study, participants started with 10 wk of power training followed by 10 wk of detraining (n = 16), and participants started with a 10-wk control period followed by 10 wk of power training (n = 16). We measured gait kinematics (stride characteristic and joint kinematics) and isokinetic power of the ankle plantarflexor (20°·s, 40°·s, and 60°·s) and knee extensor and flexor (60°·s, 120°·s, and 180°·s) muscles at weeks 0, 10, and 20. Power training improved isokinetic muscle power by ~30% (P ≤ 0.001) and fast (5.9%, P < 0.05) but not habitual gait velocity. Ankle plantarflexor velocity measured during gait at fast pace decreased by 7.9% (P < 0.05). The changes isokinetic muscle power and joint kinematics did not correlate with increases in fast gait velocity. The mechanisms that increased fast gait velocity involved higher cadence (r = 0.86, P ≤ 0.001) rather than longer strides (r = 0.49, P = 0.066). Detraining did not reverse the training-induced increases in muscle power and fast gait velocity. Because increases in muscle power and modifications in joint kinematics did not correlate with increases in fast gait velocity, kinematic mechanisms seem to play a minor role in improving healthy old adults' fast gait velocity after power training.

Altered spatiotemporal characteristics of gait in older adults with chronic low back pain.

PubMed

Hicks, Gregory E; Sions, J Megan; Coyle, Peter C; Pohlig, Ryan T

2017-06-01

Previous studies in older adults have identified that chronic low back pain (CLBP) is associated with slower gait speed. Given that slower gait speed is a predictor of greater morbidity and mortality among older adults, it is important to understand the underlying spatiotemporal characteristics of gait among older adults with CLBP. The purposes of this study were to determine (1) if there are differences in spatiotemporal parameters of gait between older adults with and without CLBP during self-selected and fast walking and (2) whether any of these gait characteristics are correlated with performance of a challenging walking task, e.g. stair negotiation. Spatiotemporal characteristics of gait were evaluated using a computerized walkway in 54 community-dwelling older adults with CLBP and 54 age- and sex-matched healthy controls. Older adults with CLBP walked slower than their pain-free peers during self-selected and fast walking. After controlling for body mass index and gait speed, step width was significantly greater in the CLBP group during the fast walking condition. Within the CLBP group, step width and double limb support time are significantly correlated with stair ascent/descent times. From a clinical perspective, these gait characteristics, which may be indicative of balance performance, may need to be addressed to improve overall gait speed, as well as stair-climbing performance. Future longitudinal studies confirming our findings are needed, as well as investigations focused on developing interventions to improve gait speed and decrease subsequent risk of mobility decline. Copyright © 2017 Elsevier B.V. All rights reserved.

Altered vision destabilizes gait in older persons.

PubMed

Helbostad, Jorunn L; Vereijken, Beatrix; Hesseberg, Karin; Sletvold, Olav

2009-08-01

This study assessed the effects of dim light and four experimentally induced changes in vision on gait speed and footfall and trunk parameters in older persons walking on level ground. Using a quasi-experimental design, gait characteristics were assessed in full light, dim light, and in dim light combined with manipulations resulting in reduced depth vision, double vision, blurred vision, and tunnel vision, respectively. A convenience sample of 24 home-dwelling older women and men (mean age 78.5 years, SD 3.4) with normal vision for their age and able to walk at least 10 m without assistance participated. Outcome measures were gait speed and spatial and temporal parameters of footfall and trunk acceleration, derived from an electronic gait mat and accelerometers. Dim light alone had no effect. Vision manipulations combined with dim light had effect on most footfall parameters but few trunk parameters. The largest effects were found regarding double and tunnel vision. Men increased and women decreased gait speed following manipulations (p=0.017), with gender differences also in stride velocity variability (p=0.017) and inter-stride medio-lateral trunk acceleration variability (p=0.014). Gender effects were related to differences in body height and physical functioning. Results indicate that visual problems lead to a more cautious and unstable gait pattern even under relatively simple conditions. This points to the importance of assessing vision in older persons and correcting visual impairments where possible.

Gait characteristics of individuals with multiple sclerosis before and after a 6-month aerobic training program.

PubMed

Rodgers, M M; Mulcare, J A; King, D L; Mathews, T; Gupta, S C; Glaser, R M

1999-07-01

Individuals who have multiple sclerosis (MS) typically experience problems with physical activities such as walking, resulting from the combined effects of skeletal muscle weakness, sensory disturbances, spasticity, gait ataxia, and reduction in aerobic capacity. The aim of this study was to determine whether a 6-mo exercise program designed for aerobic conditioning might also affect gait abnormalities in individuals with MS. Subjects included 18 individuals with MS who presented a range of disability. Passive range of motion (PROM) in the lower limbs was measured and gait analyzed before and after exercise conditioning. Three-dimensional kinematics, ground reaction forces (GRF), and electromyographic information were acquired as subjects walked at self-selected velocities. Hip PROM increased following conditioning. Mean walking velocity, cadence, and posterior shear GRF (push-off force) decreased. During walking, maximum ankle dorsiflexion decreased and ankle plantarflexion increased. Total knee flexion/extension range during the walking cycle decreased slightly as did maximum hip extension. Results suggest this 6-mo training program had minimal effect on gait abnormalities.

Viability of gait speed test in hospitalized elderly patients.

PubMed

Martinez, Bruno Prata; Batista, Anne Karine Menezes Santos; Ramos, Isis Resende; Dantas, Júlio Cesar; Gomes, Isabela Barboza; Forgiarini, Luiz Alberto; Camelier, Fernanda Rosa Warken; Camelier, Aquiles Assunção

2016-01-01

The gait speed test (GST) is a physical test that can predict falls and aid in the diagnosis of sarcopenia in the elderly. However, to our knowledge, there have been no studies evaluating its reproducibility in hospitalized elderly patients. The objective of this study was to evaluate the safety and reproducibility of the six-meter GST (6GST) in hospitalized elderly patients. This repeated measures study involved hospitalized elderly patients (≥ 60 years of age) who underwent the 6GST by the fifth day of hospitalization, were able to walk without assistance, and presented no signs of dyspnea or pain that would prevent them from performing the test. The 6GST was performed three times in sequence, with a rest period between each test, in a level corridor. Gait speed was measured in meters/second. Reproducibility was assessed by comparing the means, intraclass correlation coefficients (ICCs) and Bland-Altman plots. We evaluated 110 elderly patients in a total of 330 tests. All participants completed all of the tests. The comparisons between the speeds obtained during the three tests showed high ICCs and a low mean bias (Bland-Altman plots). The correlation and accuracy were greatest when the mean maximum speed was compared with that obtained in the third test (1.26 ± 0.44 m/s vs. 1.22 ± 0.44 m/s; ICC = 0.99; p = 0.001; mean bias = 0.04; and limits of agreement = -0.27 to 0.15). The 6GST was proven to be safe and to have good reproducibility in this sample of hospitalized elderly patients. The third measurement seems to correspond to the maximum speed, since the first two measurements underestimated the actual performance. O teste de velocidade de marcha (TVM) é um teste físico que pode predizer quedas e auxiliar no diagnóstico de sarcopenia em idosos da comunidade. Entretanto, pelo que sabemos, não há estudos que avaliaram sua reprodutibilidade em idosos hospitalizados. O objetivo deste estudo foi avaliar a segurança e a reprodutibilidade do TVM de seis

A pilot clinical trial on a Variable Automated Speed and Sensing Treadmill (VASST) for hemiparetic gait rehabilitation in stroke patients.

PubMed

Chua, Karen S G; Chee, Johnny; Wong, Chin J; Lim, Pang H; Lim, Wei S; Hoo, Chuan M; Ong, Wai S; Shen, Mira L; Yu, Wei S

2015-01-01

Impairments in walking speed and capacity are common problems after stroke which may benefit from treadmill training. However, standard treadmills, are unable to adapt to the slower walking speeds of stroke survivors and are unable to automate training progression. This study tests a Variable Automated Speed and Sensing Treadmill (VASST) using a standard clinical protocol. VASST is a semi-automated treadmill with multiple sensors and micro controllers, including wireless control to reposition a fall-prevention harness, variable pre-programmed exercise parameters and laser beam foot sensors positioned on the belt to detect subject's foot positions. An open-label study with assessor blinding was conducted in 10 community-dwelling chronic hemiplegic patients who could ambulate at least 0.1 m/s. Interventions included physiotherapist-supervised training on VASST for 60 min three times per week for 4 weeks (total 12 h). Outcome measures of gait speed, quantity, balance, and adverse events were assessed at baseline, 2, 4, and 8 weeks. Ten subjects (8 males, mean age 55.5 years, 2.1 years post stroke) completed VASST training. Mean 10-m walk test speed was 0.69 m/s (SD = 0.29) and mean 6-min walk test distance was 178.3 m (84.0). After 4 weeks of training, 70% had significant positive gains in gait speed (0.06 m/s, SD = 0.08 m/s, P = 0.037); and 90% improved in walking distance. (54.3 m, SD = 30.9 m, P = 0.005). There were no adverse events. This preliminary study demonstrates the initial feasibility and short-term efficacy of VASST for walking speed and distance for people with chronic post-stroke hemiplegia.

Gait parameter control timing with dynamic manual contact or visual cues.

PubMed

Rabin, Ely; Shi, Peter; Werner, William

2016-06-01

We investigated the timing of gait parameter changes (stride length, peak toe velocity, and double-, single-support, and complete step duration) to control gait speed. Eleven healthy participants adjusted their gait speed on a treadmill to maintain a constant distance between them and a fore-aft oscillating cue (a place on a conveyor belt surface). The experimental design balanced conditions of cue modality (vision: eyes-open; manual contact: eyes-closed while touching the cue); treadmill speed (0.2, 0.4, 0.85, and 1.3 m/s); and cue motion (none, ±10 cm at 0.09, 0.11, and 0.18 Hz). Correlation analyses revealed a number of temporal relationships between gait parameters and cue speed. The results suggest that neural control ranged from feedforward to feedback. Specifically, step length preceded cue velocity during double-support duration suggesting anticipatory control. Peak toe velocity nearly coincided with its most-correlated cue velocity during single-support duration. The toe-off concluding step and double-support durations followed their most-correlated cue velocity, suggesting feedback control. Cue-tracking accuracy and cue velocity correlations with timing parameters were higher with the manual contact cue than visual cue. The cue/gait timing relationships generalized across cue modalities, albeit with greater delays of step-cycle events relative to manual contact cue velocity. We conclude that individual kinematic parameters of gait are controlled to achieve a desired velocity at different specific times during the gait cycle. The overall timing pattern of instantaneous cue velocities associated with different gait parameters is conserved across cues that afford different performance accuracies. This timing pattern may be temporally shifted to optimize control. Different cue/gait parameter latencies in our nonadaptation paradigm provide general-case evidence of the independent control of gait parameters previously demonstrated in gait adaptation paradigms

Gait parameter control timing with dynamic manual contact or visual cues

PubMed Central

Shi, Peter; Werner, William

2016-01-01

We investigated the timing of gait parameter changes (stride length, peak toe velocity, and double-, single-support, and complete step duration) to control gait speed. Eleven healthy participants adjusted their gait speed on a treadmill to maintain a constant distance between them and a fore-aft oscillating cue (a place on a conveyor belt surface). The experimental design balanced conditions of cue modality (vision: eyes-open; manual contact: eyes-closed while touching the cue); treadmill speed (0.2, 0.4, 0.85, and 1.3 m/s); and cue motion (none, ±10 cm at 0.09, 0.11, and 0.18 Hz). Correlation analyses revealed a number of temporal relationships between gait parameters and cue speed. The results suggest that neural control ranged from feedforward to feedback. Specifically, step length preceded cue velocity during double-support duration suggesting anticipatory control. Peak toe velocity nearly coincided with its most-correlated cue velocity during single-support duration. The toe-off concluding step and double-support durations followed their most-correlated cue velocity, suggesting feedback control. Cue-tracking accuracy and cue velocity correlations with timing parameters were higher with the manual contact cue than visual cue. The cue/gait timing relationships generalized across cue modalities, albeit with greater delays of step-cycle events relative to manual contact cue velocity. We conclude that individual kinematic parameters of gait are controlled to achieve a desired velocity at different specific times during the gait cycle. The overall timing pattern of instantaneous cue velocities associated with different gait parameters is conserved across cues that afford different performance accuracies. This timing pattern may be temporally shifted to optimize control. Different cue/gait parameter latencies in our nonadaptation paradigm provide general-case evidence of the independent control of gait parameters previously demonstrated in gait adaptation paradigms

Gait Phase Estimation Based on Noncontact Capacitive Sensing and Adaptive Oscillators.

PubMed

Zheng, Enhao; Manca, Silvia; Yan, Tingfang; Parri, Andrea; Vitiello, Nicola; Wang, Qining

2017-10-01

This paper presents a novel strategy aiming to acquire an accurate and walking-speed-adaptive estimation of the gait phase through noncontact capacitive sensing and adaptive oscillators (AOs). The capacitive sensing system is designed with two sensing cuffs that can measure the leg muscle shape changes during walking. The system can be dressed above the clothes and free human skin from contacting to electrodes. In order to track the capacitance signals, the gait phase estimator is designed based on the AO dynamic system due to its ability of synchronizing with quasi-periodic signals. After the implementation of the whole system, we first evaluated the offline estimation performance by experiments with 12 healthy subjects walking on a treadmill with changing speeds. The strategy achieved an accurate and consistent gait phase estimation with only one channel of capacitance signal. The average root-mean-square errors in one stride were 0.19 rad (3.0% of one gait cycle) for constant walking speeds and 0.31 rad (4.9% of one gait cycle) for speed transitions even after the subjects rewore the sensing cuffs. We then validated our strategy in a real-time gait phase estimation task with three subjects walking with changing speeds. Our study indicates that the strategy based on capacitive sensing and AOs is a promising alternative for the control of exoskeleton/orthosis.

Multilayer Joint Gait-Pose Manifolds for Human Gait Motion Modeling.

PubMed

Ding, Meng; Fan, Guolian

2015-11-01

We present new multilayer joint gait-pose manifolds (multilayer JGPMs) for complex human gait motion modeling, where three latent variables are defined jointly in a low-dimensional manifold to represent a variety of body configurations. Specifically, the pose variable (along the pose manifold) denotes a specific stage in a walking cycle; the gait variable (along the gait manifold) represents different walking styles; and the linear scale variable characterizes the maximum stride in a walking cycle. We discuss two kinds of topological priors for coupling the pose and gait manifolds, i.e., cylindrical and toroidal, to examine their effectiveness and suitability for motion modeling. We resort to a topologically-constrained Gaussian process (GP) latent variable model to learn the multilayer JGPMs where two new techniques are introduced to facilitate model learning under limited training data. First is training data diversification that creates a set of simulated motion data with different strides. Second is the topology-aware local learning to speed up model learning by taking advantage of the local topological structure. The experimental results on the Carnegie Mellon University motion capture data demonstrate the advantages of our proposed multilayer models over several existing GP-based motion models in terms of the overall performance of human gait motion modeling.

Preliminary evaluation of prototype footwear and insoles to optimise balance and gait in older people.

PubMed

Menz, Hylton B; Auhl, Maria; Munteanu, Shannon E

2017-09-11

Footwear has the potential to influence balance in either a detrimental or beneficial manner, and is therefore an important consideration in relation to falls prevention. The objective of this study was to evaluate balance ability and gait patterns in older women while wearing prototype footwear and insoles designed to improve balance. Older women (n = 30) aged 65 - 83 years (mean 74.4, SD 5.6) performed a series of laboratory tests of balance ability (postural sway on a foam rubber mat, limits of stability and tandem walking, measured with the Neurocom® Balance Master) and gait patterns (walking speed, cadence, step length and step width at preferred speed, measured with the GAITRite® walkway) while wearing (i) flexible footwear (Dunlop Volley™), (ii) their own footwear, and (iii) prototype footwear and insoles designed to improve dynamic balance. Perceptions of the footwear were also documented using a structured questionnaire. There was no difference in postural sway, limits of stability or gait patterns between the footwear conditions. However, when performing the tandem walking test, there was a significant reduction in step width and end sway when wearing the prototype footwear compared to both the flexible footwear and participants' own footwear. Participants perceived their own footwear to be more attractive, comfortable, well-fitted and easier to put on and off compared to the prototype footwear. Despite this, most participants (n = 18, 60%) reported that they would consider wearing the prototype footwear to reduce their risk of falling. The prototype footwear and insoles used in this study improve balance when performing a tandem walk test, as evidenced by a narrower step width and decreased sway at completion of the task. However, further development of the design is required to make the footwear acceptable to older women from the perspective of aesthetics and comfort. Australian New Zealand Clinical Trials Registry. ACTRN12617001128381 , 01

Gait analysis in patients with chronic obstructive pulmonary disease: a systematic review.

PubMed

Zago, Matteo; Sforza, Chiarella; Bonardi, Daniela Rita; Guffanti, Enrico Eugenio; Galli, Manuela

2018-03-01

Gait instability is a major fall-risk factor in patients with chronic obstructive pulmonary disease (COPD). Clinical gait analysis is a reliable tool to predict fall onsets. However, controversy still exists on gait impairments associated with COPD. Thus, the aims of this review were to evaluate the current understanding of spatiotemporal, kinematic and kinetic gait features in patients with COPD. In line with PRISMA guidelines, a systematic literature search was performed throughout Web of Science, PubMed Medline, Scopus, PEDro and Scielo databases. We considered observational cross-sectional studies evaluating gait features in patients with COPD as their primary outcome. Risk of bias and applicability of these papers were assessed according to the QUADAS-2 tool. Seven articles, cross-sectional studies published from 2011 to 2017, met the inclusion criteria. Sample size of patients with COPD ranged 14-196 (mean age range: 64-75 years). The main reported gait abnormalities were reduced step length and cadence, and altered variability of spatiotemporal parameters. Only subtle biomechanical changes were reported at the ankle level. A convincing mechanistic link between such gait impairments and falls in patients with COPD is still lacking. The paucity of studies, small sample sizes, gender and disease status pooling were the main risk of biases affecting the results uncertainty. Two research directions emerged: stricter cohorts characterization in terms of COPD phenotype and longitudinal studies. Quantitative assessment of gait would identify abnormalities and sensorimotor postural deficiencies that in turn may lead to better falling prevention strategies in COPD. Copyright © 2018 Elsevier B.V. All rights reserved.

Gait and Balance in Essential Tremor: Variable Effects of Bilateral Thalamic Stimulation

PubMed Central

Earhart, Gammon M.; Clark, B. Ruth; Tabbal, Samer D.; Perlmutter, Joel S.

2010-01-01

Essential tremor (ET) is a multi-faceted condition best known for postural and action tremor but also may include disordered gait and postural instability. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus provides substantial tremor reduction yet some patients with bilateral VIM DBS have gait and balance impairment. This study examines gait and balance performance in 13 participants with ET who have bilateral VIM DBS compared to a matched control group. Participants with ET were tested with their stimulators off (DBS OFF) and on (DBS ON). For both standard and tandem walking, participants with ET walked significantly more slowly than controls, with significantly lower cadence, spending a lower percentage of the gait cycle in single limb support and a higher percentage in double support compared to controls. Participants with ET also had significantly lower tandem and one leg stance times, Berg balance scores, balance confidence, and required significantly greater time to perform the Timed Up-and-Go relative to controls. There were no significant differences in any gait or balance measures in the DBS OFF versus DBS ON conditions, but the effects of DBS on gait and balance were highly variable among individuals. Future studies are needed to determine why some individuals experience gait and balance difficulties after bilateral thalamic DBS and others do not. A better understanding of the mechanisms underlying gait and balance impairments in those with bilateral DBS is critical in order to reduce falls and fractures in this group. PMID:19006189

Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early poststroke: a single-blind, randomized trial.

PubMed

Thaut, M H; Leins, A K; Rice, R R; Argstatter, H; Kenyon, G P; McIntosh, G C; Bolay, H V; Fetter, M

2007-01-01

The effectiveness of 2 different types of gait training in stroke rehabilitation, rhythmic auditory stimulation (RAS) versus neurodevelopmental therapy (NDT)/Bobath- based training, was compared in 2 groups of hemiparetic stroke patients over a 3-week period of daily training (RAS group, n = 43; NDT/Bobath group =35). Mean entry date into the study was 21.3 days poststroke for the RAS group and 22.3 days for the control group. Patients entered the study as soon as they were able to complete 5 stride cycles with handheld assistance. Patients were closely equated by age, gender, and lesion site. Motor function in both groups was pre-assessed by the Barthel Index and the Fugl-Meyer Scales. Pre- to posttest measures showed a significant improvement in the RAS group for velocity (P = .006), stride length (P = .0001), cadence (P = .0001) and symmetry (P = .0049) over the NDT/Bobath group. Effect sizes for RAS over NDT/Bobath training were 13.1 m/min for velocity, 0.18 m for stride length, and 19 steps/min for cadence. The data show that after 3 weeks of gait training, RAS is an effective therapeutic method to enhance gait training in hemiparetic stroke rehabilitation. Gains were significantly higher for RAS compared to NDT/Bobath training.

Validity of Using Tri-Axial Accelerometers to Measure Human Movement – Part II: Step Counts at a Wide Range of Gait Velocities

PubMed Central

Fortune, Emma; Lugade, Vipul; Morrow, Melissa; Kaufman, Kenton

2014-01-01

A subject-specific step counting method with a high accuracy level at all walking speeds is needed to assess the functional level of impaired patients. The study aim was to validate step counts and cadence calculations from acceleration data by comparison to video data during dynamic activity. Custom-built activity monitors, each containing one tri-axial accelerometer, were placed on the ankles, thigh, and waist of 11 healthy adults. ICC values were greater than 0.98 for video inter-rater reliability of all step counts. The activity monitoring system (AMS) algorithm demonstrated a median (interquartile range; IQR) agreement of 92% (8%) with visual observations during walking/jogging trials at gait velocities ranging from 0.1 m/s to 4.8 m/s, while FitBits (ankle and waist), and a Nike Fuelband (wrist) demonstrated agreements of 92% (36%), 93% (22%), and 33% (35%), respectively. The algorithm results demonstrated high median (IQR) step detection sensitivity (95% (2%)), positive predictive value (PPV) (99% (1%)), and agreement (97% (3%)) during a laboratory-based simulated free-living protocol. The algorithm also showed high median (IQR) sensitivity, PPV, and agreement identifying walking steps (91% (5%), 98% (4%), and 96% (5%)), jogging steps (97% (6%), 100% (1%), and 95% (6%)), and less than 3% mean error in cadence calculations. PMID:24656871

Why is walker-assisted gait metabolically expensive?

PubMed

Priebe, Jonathon R; Kram, Rodger

2011-06-01

Walker-assisted gait is reported to be ∼200% more metabolically expensive than normal bipedal walking. However, previous studies compared different walking speeds. Here, we compared the metabolic power consumption and basic stride temporal-spatial parameters for 10 young, healthy adults walking without assistance and using 2-wheeled (2W), 4-wheeled (4W) and 4-footed (4F) walker devices, all at the same speed, 0.30m/s. We also measured the metabolic power demand for walking without any assistive device using a step-to gait at 0.30m/s, walking normally at 1.25m/s, and for repeated lifting of the 4F walker mimicking the lifting pattern used during 4F walker-assisted gait. Similar to previous studies, we found that the cost per distance walked was 217% greater with a 4F walker at 0.30m/s compared to unassisted, bipedal walking at 1.25m/s. Compared at the same speed, 0.30m/s, using a 4F walker was still 82%, 74%, and 55% energetically more expensive than walking unassisted, with a 4W walker and a 2W walker respectively. The sum of the metabolic cost of step-to walking plus the cost of lifting itself was equivalent to the cost of walking with a 4F walker. Thus, we deduce that the high cost of 4F walker assisted gait is due to three factors: the slow walking speed, the step-to gait pattern and the repeated lifting of the walker. Copyright © 2011 Elsevier B.V. All rights reserved.

Usability of Three-dimensional Augmented Visual Cues Delivered by Smart Glasses on (Freezing of) Gait in Parkinson’s Disease

PubMed Central

Janssen, Sabine; Bolte, Benjamin; Nonnekes, Jorik; Bittner, Marian; Bloem, Bastiaan R.; Heida, Tjitske; Zhao, Yan; van Wezel, Richard J. A.

2017-01-01

External cueing is a potentially effective strategy to reduce freezing of gait (FOG) in persons with Parkinson’s disease (PD). Case reports suggest that three-dimensional (3D) cues might be more effective in reducing FOG than two-dimensional cues. We investigate the usability of 3D augmented reality visual cues delivered by smart glasses in comparison to conventional 3D transverse bars on the floor and auditory cueing via a metronome in reducing FOG and improving gait parameters. In laboratory experiments, 25 persons with PD and FOG performed walking tasks while wearing custom-made smart glasses under five conditions, at the end-of-dose. For two conditions, augmented visual cues (bars/staircase) were displayed via the smart glasses. The control conditions involved conventional 3D transverse bars on the floor, auditory cueing via a metronome, and no cueing. The number of FOG episodes and percentage of time spent on FOG were rated from video recordings. The stride length and its variability, cycle time and its variability, cadence, and speed were calculated from motion data collected with a motion capture suit equipped with 17 inertial measurement units. A total of 300 FOG episodes occurred in 19 out of 25 participants. There were no statistically significant differences in number of FOG episodes and percentage of time spent on FOG across the five conditions. The conventional bars increased stride length, cycle time, and stride length variability, while decreasing cadence and speed. No effects for the other conditions were found. Participants preferred the metronome most, and the augmented staircase least. They suggested to improve the comfort, esthetics, usability, field of view, and stability of the smart glasses on the head and to reduce their weight and size. In their current form, augmented visual cues delivered by smart glasses are not beneficial for persons with PD and FOG. This could be attributable to distraction, blockage of visual feedback, insufficient

Dynamics in the Chromosphere Imaged at Four Second Cadence

NASA Astrophysics Data System (ADS)

Schmit, D.; De Pontieu, B.

2017-12-01

In this work we present analysis of rapid intensity fluctuations that are observed in the chromosphere and transition region using the slit-jaw datasets of IRIS and CLASP. While chromospheric oscillations have been a topic of interest for 30 years, the instrumentation to image those dynamics at high-cadence has only recently been developed. We use filtergraph data from 1215A, 2800A, and 1400A to examine the occurrence rate and morphology of rapid intensity fluctuations in different magnetic environments. There are indications of rapidly propagating disturbances with phase speeds greater than 100 km/s in all passbands although the morphology of the features differs significantly between passbands. The relationship between intensity fluctuations, spicules, and waves is discussed.

Propulsion strategy in the gait of primary school children; the effect of age and speed.

PubMed

Lye, Jillian; Parkinson, Stephanie; Diamond, Nicola; Downs, Jenny; Morris, Susan

2016-12-01

The strategy used to generate power for forward propulsion in walking and running has recently been highlighted as a marker of gait maturation and elastic energy recycling. This study investigated ankle and hip power generation as a propulsion strategy (PS) during the late stance/early swing phases of walking and running in typically developing (TD) children (15: six to nine years; 17: nine to 13years) using three-dimensional gait analysis. Peak ankle power generation at push-off (peakA2), peak hip power generation in early swing (peakH3) and propulsion strategy (PS) [peakA2/(peakA2+peakH3)] were calculated to provide the relative contribution of ankle power to total propulsion. Mean PS values decreased as speed increased for comfortable walking (p<0.001), fast walking (p<0.001) and fast running (p<0.001), and less consistently during jogging (p=0.054). PS varied with age (p<0.001) only during fast walking. At any speed of fast walking, older children generated more peakA2 (p=0.001) and less peakH3 (p=0.001) than younger children. While the kinetics of running propulsion appear to be developed by age six years, the skills of fast walking appeared to require additional neuromuscular maturity. These findings support the concept that running is a skill that matures early for TD children. Copyright © 2016 Elsevier B.V. All rights reserved.

Walking speed and peak plantar pressure distribution during barefoot walking in persons with diabetes.

PubMed

Ko, Mansoo; Hughes, Lynne; Lewis, Harriet

2012-03-01

The impact of walking speed has not been evaluated as a feasible outcome measure associated with peak plantar pressure (PPP) distribution, which may result in tissue damage in persons with diabetic foot complications. The objective of this pilot study was to determine the walking speed and PPP distribution during barefoot walking in persons with diabetes.   Nine individuals with diabetes and nine age-gender matched individuals without diabetes participated in this study. Each individual was marked at 10 anatomical landmarks for vibration and tactile pressure sensation tests to determine the severity of sensory deficits on the plantar surface of the dominant limb foot. A steady state walking speed, PPP, the fore and rear foot (F/R) PPP ratio and gait variables were measured during barefoot walking.   Persons with diabetes had a significantly slower walking speed than the age-gender matched group resulting in a significant reduction of PPP at the F/R foot during barefoot walking (p < 0.05). There was no significant difference in F/R foot PPP ratio in the diabetic group compared with the age-gender matched group during barefoot walking (p > 0.05). There was a significant difference between the diabetic and non-diabetic groups for cadence, step time, toe out angle and the anterior-posterior excursion (APE) for centre of force (p < 0.05).   Walking speed may be a potential indicator for persons with diabetes to identify PPP distribution during barefoot walking in a diabetic foot. However, the diabetic group demonstrated a more cautious walking pattern than the age-gender matched group by decreasing cadence, step length and APE, and increasing step time and toe in/out angle. People with diabetes may reduce the risk of foot ulcerations as long as they are able to prevent severe foot deformities such as callus, hammer toe or charcot foot. Copyright © 2011 John Wiley & Sons, Ltd.

Pathways linking regional hyperintensities in the brain and slower gait.

PubMed

Bolandzadeh, Niousha; Liu-Ambrose, Teresa; Aizenstein, Howard; Harris, Tamara; Launer, Lenore; Yaffe, Kristine; Kritchevsky, Stephen B; Newman, Anne; Rosano, Caterina

2014-10-01

Cerebral white matter hyperintensities (WMHs) are involved in the evolution of impaired mobility and executive functions. Executive functions and mobility are also associated. Thus, WMHs may impair mobility directly, by disrupting mobility-related circuits, or indirectly, by disrupting circuits responsible for executive functions. Understanding the mechanisms underlying impaired mobility in late life will increase our capacity to develop effective interventions. To identify regional WMHs most related to slower gait and to examine whether these regional WMHs directly impact mobility, or indirectly by executive functions. Cross-sectional study. Twenty-one WMH variables (i.e., total WMH volume and WMHs in 20 tracts), gait speed, global cognition (Modified Mini-Mental State Examination; 3MS), and executive functions and processing speed (Digit-Symbol Substitution Test; DSST) were assessed. An L1-L2 regularized regression (i.e., Elastic Net model) identified the WMH variables most related to slower gait. Multivariable linear regression models quantified the association between these WMH variables and gait speed. Formal tests of mediation were also conducted. Community-based sample. Two hundred fifty-three adults (mean age: 83years, 58% women, 41% black). Gait speed. In older adults with an average gait speed of 0.91m/sec, total WMH volume, WMHs located in the right anterior thalamic radiation (ATRR) and frontal corpuscallosum (CCF) were most associated with slower gait. There was a >10% slower gait for each standard deviation of WMH in CCF, ATRR or total brain (standardized beta in m/sec [p value]: -0.11 [p=0.046], -0.15 [p=0.007] and -0.14 [p=0.010], respectively). These associations were substantially and significantly attenuated after adjustment for DSST. This effect was stronger for WMH in CCF than for ATRR or total WMH (standardized beta in m/sec [p value]: -0.07 [p=0.190], -0.12 [p=0.024] and -0.10 [p=0.049], respectively). Adjustment for 3MS did not change these

Combined robotic-aided gait training and physical therapy improve functional abilities and hip kinematics during gait in children and adolescents with acquired brain injury.

PubMed

Beretta, Elena; Romei, Marianna; Molteni, Erika; Avantaggiato, Paolo; Strazzer, Sandra

2015-01-01

To evaluate the combined effect of robotic-aided gait training (RAGT) and physical therapy (PT) on functional abilities and gait pattern in children and adolescents exiting acquired brain injury (ABI), through functional clinical scales and 3D-Gait Analysis (GA). A group of 23 patients with ABI underwent 20 sessions of RAGT in addition to traditional manual PT. All the patients were evaluated before and after the training by using the Gross Motor Function Measures (GMFM) and the Functional Assessment Questionnaire. Ambulant children were also evaluated through the 6 Minutes Walk Test (6MinWT) and GA. Finally, results were compared with those obtained from a control group of ABI children who underwent PT only. After the training, the GMFM showed significant improvement in both dimensions 'D' (standing) and 'E' (walking). In ambulant patients the 6MinWT showed significant improvement after training and GA highlighted a significant increase in cadence, velocity and stride length. Moreover, hip kinematics on the sagittal plane revealed a statistically significant increase in range of motion (ROM) during the whole gait cycle, increased hip extension during terminal stance and increased ROM during the swing phase. The data suggest that the combined programme RAGT + PT induces improvements in functional activities and gait pattern in children and adolescents with ABI and demonstrated it to be an elective tool for the maintenance of the patients' full compliance throughout the rehabilitative programme.

Walking while talking: Young adults flexibly allocate resources between speech and gait.

PubMed

Raffegeau, Tiphanie E; Haddad, Jeffrey M; Huber, Jessica E; Rietdyk, Shirley

2018-05-26

Walking while talking is an ideal multitask behavior to assess how young healthy adults manage concurrent tasks as it is well-practiced, cognitively demanding, and has real consequences for impaired performance in either task. Since the association between cognitive tasks and gait appears stronger when the gait task is more challenging, gait challenge was systematically manipulated in this study. To understand how young adults accomplish the multitask behavior of walking while talking as the gait challenge was systematically manipulated. Sixteen young adults (21 ± 1.6 years, 9 males) performed three gait tasks with and without speech: unobstructed gait (easy), obstacle crossing (moderate), obstacle crossing and tray carrying (difficult). Participants also provided a speech sample while seated for a baseline indicator of speech. The speech task was to speak extemporaneously about a topic (e.g. first car). Gait speed and the duration of silent pauses during speaking were determined. Silent pauses reflect cognitive processes involved in speech production and language planning. When speaking and walking without obstacles, gait speed decreased (relative to walking without speaking) but silent pause duration did not change (relative to seated speech). These changes are consistent with the idea that, in the easy gait task, participants placed greater value on speech pauses than on gait speed, likely due to the negative social consequences of impaired speech. In the moderate and difficult gait tasks both parameters changed: gait speed decreased and silent pauses increased. Walking while talking is a cognitively demanding task for healthy young adults, despite being a well-practiced habitual activity. These findings are consistent with the integrated model of task prioritization from Yogev-Seligmann et al., [1]. Copyright © 2018 Elsevier B.V. All rights reserved.

Quadriceps strength, quadriceps power, and gait speed in older U.S. adults with diabetes mellitus: results from the National Health and Nutrition Examination Survey, 1999-2002.

PubMed

Kalyani, Rita Rastogi; Tra, Yolande; Yeh, Hsin-Chieh; Egan, Josephine M; Ferrucci, Luigi; Brancati, Frederick L

2013-05-01

To examine the independent association between diabetes mellitus (and its duration and severity) and quadriceps strength, quadriceps power, and gait speed in a national population of older adults. Cross-sectional nationally representative survey. United States. Two thousand five hundred seventy-three adults aged 50 and older in the National Health and Nutrition Examination Survey 1999-2002 who had assessment of quadriceps strength. Diabetes mellitus was ascertained according to questionnaire. Measurement of isokinetic knee extensor (quadriceps) strength was performed at 60º/s. Gait speed was assessed using a 20-foot walk test. Multiple linear regression analyses were used to assess the association between diabetes mellitus status and outcomes, adjusting for potential confounders or mediators. Older U.S. adults with diabetes mellitus had significantly slower gait speed (0.96 ± 0.02 m/s) than those without (1.08 ± 0.01 m/s; P < .001). After adjusting for demographic characteristics, weight, and height, diabetes mellitus was also associated with significantly lower quadriceps strength (-4.6 ± 1.9 Nm; P = .02) and power (-4.9 ± 2.0 W; P = .02) and slower gait speed (-0.05 ± 0.02 m/s; P = .002). Associations remained significant after adjusting for physical activity and C-reactive protein. After accounting for comorbidities (cardiovascular disease, peripheral neuropathy, amputation, cancer, arthritis, fracture, chronic obstructive pulmonary disease), diabetes mellitus was independently associated only with gait speed (-0.04 ± 0.02 m/s; P = .02). Diabetes mellitus duration in men and women was negatively associated with age-adjusted quadriceps strength (-5.7 and -3.5 Nm/decade of diabetes mellitus, respectively) and power (-6.1 and -3.8 W/decade of diabetes mellitus, respectively) (all P ≤ .001, no significant interactions according to sex). Glycosylated hemoglobin was not associated with outcomes after accounting for body weight. Older U.S. adults with diabetes

Is body-weight-supported treadmill training or robotic-assisted gait training superior to overground gait training and other forms of physiotherapy in people with spinal cord injury? A systematic review.

PubMed

Mehrholz, J; Harvey, L A; Thomas, S; Elsner, B

2017-08-01

Systematic review about randomised trials comparing different training strategies to improve gait in people with spinal cord injuries (SCI). The aim of this systematic review was to compare the effectiveness of body-weight-supported treadmill training (BWSTT) and robotic-assisted gait training with overground gait training and other forms of physiotherapy in people with traumatic SCI. Systematic review conducted by researchers from Germany and Australia. An extensive search was conducted for randomised controlled trials involving people with traumatic SCI that compared either BWSTT or robotic-assisted gait training with overground gait training and other forms of physiotherapy. The two outcomes of interest were walking speed (m s -1 ) and walking distance (m). BWSTT and robotic-assisted gait training were analysed separately, and data were pooled across trials to derive mean between-group differences using a random-effects model. Thirteen randomised controlled trials involving 586 people were identified. Ten trials involving 462 participants compared BWSTT to overground gait training and other forms of physiotherapy, but only nine trials provided useable data. The pooled mean (95% confidence interval (CI)) between-group differences for walking speed and walking distance were -0.03 m s -1 (-0.10 to 0.04) and -7 m (-45 to 31), respectively, favouring overground gait training. Five trials involving 344 participants compared robotic-assisted gait training to overground gait training and other forms of physiotherapy but only three provided useable data. The pooled mean (95% CI) between-group differences for walking speed and walking distance were -0.04 m s -1 (95% CI -0.21 to 0.13) and -6 m (95% CI -86 to 74), respectively, favouring overground gait training. BWSTT and robotic-assisted gait training do not increase walking speed more than overground gait training and other forms of physiotherapy do, but their effects on walking distance are not clear.

Effect of arm swing strategy on local dynamic stability of human gait.

PubMed

Punt, Michiel; Bruijn, Sjoerd M; Wittink, Harriet; van Dieën, Jaap H

2015-02-01

Falling causes long term disability and can even lead to death. Most falls occur during gait. Therefore improving gait stability might be beneficial for people at risk of falling. Recently arm swing has been shown to influence gait stability. However at present it remains unknown which mode of arm swing creates the most stable gait. To examine how different modes of arm swing affect gait stability. Ten healthy young male subjects volunteered for this study. All subjects walked with four different arm swing instructions at seven different gait speeds. The Xsens motion capture suit was used to capture gait kinematics. Basic gait parameters, variability and stability measures were calculated. We found an increased stability in the medio-lateral direction with excessive arm swing in comparison to normal arm swing at all gait speeds. Moreover, excessive arm swing increased stability in the anterior-posterior and vertical direction at low gait speeds. Ipsilateral and inphase arm swing did not differ compared to a normal arm swing. Excessive arm swing is a promising gait manipulation to improve local dynamic stability. For excessive arm swing in the ML direction there appears to be converging evidence. The effect of excessive arm swing on more clinically relevant groups like the more fall prone elderly or stroke survivors is worth further investigating. Excessive arm swing significantly increases local dynamic stability of human gait. Copyright © 2014 Elsevier B.V. All rights reserved.

Intensive gait training with rhythmic auditory stimulation in individuals with chronic hemiparetic stroke: a pilot randomized controlled study.

PubMed

Cha, Yuri; Kim, Young; Hwang, Sujin; Chung, Yijung

2014-01-01

Motor relearning protocols should involve task-oriented movement, focused attention, and repetition of desired movements. To investigate the effect of intensive gait training with rhythmic auditory stimulation on postural control and gait performance in individuals with chronic hemiparetic stroke. Twenty patients with chronic hemiparetic stroke participated in this study. Subjects in the Rhythmic auditory stimulation training group (10 subjects) underwent intensive gait training with rhythmic auditory stimulation for a period of 6 weeks (30 min/day, five days/week), while those in the control group (10 subjects) underwent intensive gait training for the same duration. Two clinical measures, Berg balance scale and stroke specific quality of life scale, and a 2-demensional gait analysis system, were used as outcome measure. To provide rhythmic auditory stimulation during gait training, the MIDI Cuebase musical instrument digital interface program and a KM Player version 3.3 was utilized for this study. Intensive gait training with rhythmic auditory stimulation resulted in significant improvement in scores on the Berg balance scale, gait velocity, cadence, stride length and double support period in affected side, and stroke specific quality of life scale compared with the control group after training. Findings of this study suggest that intensive gait training with rhythmic auditory stimulation improves balance and gait performance as well as quality of life, in individuals with chronic hemiparetic stroke.

Gait speed is limited but improves over the course of acute care physical therapy.

PubMed

Braden, Heather J; Hilgenberg, Sean; Bohannon, Richard W; Ko, Man-Soo; Hasson, Scott

2012-01-01

Gait is a common focus of physical therapists' management of patients in acute care settings. Walking speed, the distance a patient covers per unit time, has been advocated as a "sixth vital sign." However, the feasibility of measuring walking speed and the degree to which walking speed is limited or improves over the course of therapy in the acute care setting are unclear. The purpose of this study of patients undergoing physical therapy during acute care hospitalization, therefore, was to determine whether walking speed can be measured in acute care and whether walking speed is limited and changes over the course of therapy. This was an observational cross-sectional study. Participants were 46 hospital inpatients, mean age 75.0 years (SD = 7.8), referred to physical therapy and able to walk at least 20 ft. Information regarding diagnosis, comorbidities, physical assistance, device use, body height, and weight was obtained. Speed was determined during initial and final physical therapy visits while patients walked at their self-selected speed over a marked course in a hospital corridor. Therapists reported that walking speed was clinically feasible, requiring inexpensive, available resources, 4 minutes' additional time, and simple calculations for documentation. Initial walking speed was a mean of 0.33 m/s (SD = 0.21; 95% confidence interval [CI]: 0.27-0.39), whereas final speed was 0.37 m/s (SD = 0.20; 95% CI: 0.31-0.43). The Wilcoxon test showed the increase in walking speed (0.04 m/s) to be significant (P = .005) over a mean therapy period of 2.0 days (SD = 1.4) and total hospitalization period of 5.5 days (SD = 3.6). The effect size and standardized response mean were 0.19 and 0.36, respectively. Minimal detectable change was 0.18 m/s. Walking speed is a feasible measure for patients admitted to an acute care hospital. It shows that patients walk slowly relative to community requirements but that their speed improves even over a short course of therapy.

The Influence of Audio-Visual Cueing (Traffic Light) on Dual Task Walking in Healthy Older Adults and Older Adults with Balance Impairments.

PubMed

Kaewkaen, Kitchana; Wongsamud, Phongphat; Ngaothanyaphat, Jiratchaya; Supawarapong, Papawarin; Uthama, Suraphong; Ruengsirarak, Worasak; Chanabun, Suthin; Kaewkaen, Pratchaya

2018-02-01

The walking gait of older adults with balance impairment is affected by dual tasking. Several studies have shown that external cues can stimulate improvement in older adults' performance. There is, however, no current evidence to support the usefulness of external cues, such as audio-visual cueing, in dual task walking in older adults. Thus, the aim of this study was to investigate the influence of an audio-visual cue (simulated traffic light) on dual task walking in healthy older adults and in older adults with balance impairments. A two-way repeated measures study was conducted on 14 healthy older adults and 14 older adults with balance impairment, who were recruited from the community in Chiang Rai, Thailand. Their walking performance was assessed using a four-metre walking test at their preferred gait speed and while walking under two further gait conditions, in randomised order: dual task walking and dual task walking with a simulated traffic light. Each participant was tested individually, with the testing taking between 15 and 20 minutes to perform, including two-minute rest periods between walking conditions. Two Kinect cameras recorded the spatio-temporal parameters using MFU gait analysis software. Each participant was tested for each condition twice. The mean parameters for each condition were analysed using a two-way repeated measures analysis of variance (ANOVA) with participant group and gait condition as factors. There was no significant between-group effect for walking speed, stride length and cadence. There were also no significant effects between gait condition and stride length or cadence. However, the effect between gait condition and walking speed was found to be significant [F(1.557, 40.485) = 4.568, P = 0.024, [Formula: see text

Concordance and discordance between measured and perceived balance and the effect on gait speed and falls following stroke

PubMed Central

Liphart, Jodi; Gallichio, Joann; Tilson, Julie K; Pei, Qinglin; Wu, Samuel S; Duncan, Pamela W

2016-01-01

Objective To ascertain the existence of discordance between perceived and measured balance in persons with stroke and to examine the impact on walking speed and falls. Design A secondary analysis of a phase three, multicentered randomized controlled trial examining walking recovery following stroke. Subjects A total of 352 participants from the Locomotor Experience Applied Post-Stroke (LEAPS) trial. Methods Participants were categorized into four groups: two concordant and two discordant groups in relation to measured and perceived balance. Number and percentage of individuals with concordance and discordance were evaluated at two and 12 months. Walking speed and fall incidence between groups were examined. Main measures Perceived balance was measured by the Activity-specific Balance Confidence scale, measured balance was determined by the Berg Balance Scale and gait speed was measured by the 10-meter walk test. Results Discordance was present for 35.8% of participants at two months post-stroke with no statistically significant change in proportion at 12 months. Discordant participants with high perceived balance and low measured balance walked 0.09 m/s faster at two months than participants with concordant low perceived and measured balance (p < 0.05). Discordant participants with low perceived balance and high measured balance walked 0.15 m/s slower than those that were concordant with high perceived and measured balance (p ⩽ 0.0001) at 12 months. Concordant participants with high perceived and measured balance walked fastest and had fewer falls. Conclusions Discordance existed between perceived and measured balance in one-third of individuals at two and 12 months post-stroke. Perceived balance impacted gait speed but not fall incidence. PMID:25810426

Quantifying stimulus-response rehabilitation protocols by auditory feedback in Parkinson's disease gait pattern

NASA Astrophysics Data System (ADS)

Pineda, Gustavo; Atehortúa, Angélica; Iregui, Marcela; García-Arteaga, Juan D.; Romero, Eduardo

2017-11-01

External auditory cues stimulate motor related areas of the brain, activating motor ways parallel to the basal ganglia circuits and providing a temporary pattern for gait. In effect, patients may re-learn motor skills mediated by compensatory neuroplasticity mechanisms. However, long term functional gains are dependent on the nature of the pathology, follow-up is usually limited and reinforcement by healthcare professionals is crucial. Aiming to cope with these challenges, several researches and device implementations provide auditory or visual stimulation to improve Parkinsonian gait pattern, inside and outside clinical scenarios. The current work presents a semiautomated strategy for spatio-temporal feature extraction to study the relations between auditory temporal stimulation and spatiotemporal gait response. A protocol for auditory stimulation was built to evaluate the integrability of the strategy in the clinic practice. The method was evaluated in transversal measurement with an exploratory group of people with Parkinson's (n = 12 in stage 1, 2 and 3) and control subjects (n =6). The result showed a strong linear relation between auditory stimulation and cadence response in control subjects (R=0.98 +/-0.008) and PD subject in stage 2 (R=0.95 +/-0.03) and stage 3 (R=0.89 +/-0.05). Normalized step length showed a variable response between low and high gait velocity (0.2> R >0.97). The correlation between normalized mean velocity and stimulus was strong in all PD stage 2 (R>0.96) PD stage 3 (R>0.84) and controls (R>0.91) for all experimental conditions. Among participants, the largest variation from baseline was found in PD subject in stage 3 (53.61 +/-39.2 step/min, 0.12 +/- 0.06 in step length and 0.33 +/- 0.16 in mean velocity). In this group these values were higher than the own baseline. These variations are related with direct effect of metronome frequency on cadence and velocity. The variation of step length involves different regulation strategies and

LSST: Cadence Design and Simulation

NASA Astrophysics Data System (ADS)

Cook, Kem H.; Pinto, P. A.; Delgado, F.; Miller, M.; Petry, C.; Saha, A.; Gee, P. A.; Tyson, J. A.; Ivezic, Z.; Jones, L.; LSST Collaboration

2009-01-01

The LSST Project has developed an operations simulator to investigate how best to observe the sky to achieve its multiple science goals. The simulator has a sophisticated model of the telescope and dome to properly constrain potential observing cadences. This model has also proven useful for investigating various engineering issues ranging from sizing of slew motors, to design of cryogen lines to the camera. The simulator is capable of balancing cadence goals from multiple science programs, and attempts to minimize time spent slewing as it carries out these goals. The operations simulator has been used to demonstrate a 'universal' cadence which delivers the science requirements for a deep cosmology survey, a Near Earth Object Survey and good sampling in the time domain. We will present the results of simulating 10 years of LSST operations using realistic seeing distributions, historical weather data, scheduled engineering downtime and current telescope and camera parameters. These simulations demonstrate the capability of the LSST to deliver a 25,000 square degree survey probing the time domain including 20,000 square degrees for a uniform deep, wide, fast survey, while effectively surveying for NEOs over the same area. We will also present our plans for future development of the simulator--better global minimization of slew time and eventual transition to a scheduler for the real LSST.

Gait characteristics under different walking conditions: Association with the presence of cognitive impairment in community-dwelling older people

PubMed Central

Fransen, Erik; Perkisas, Stany; Verhoeven, Veronique; Beauchet, Olivier; Remmen, Roy

2017-01-01

Background Gait characteristics measured at usual pace may allow profiling in patients with cognitive problems. The influence of age, gender, leg length, modified speed or dual tasking is unclear. Methods Cross-sectional analysis was performed on a data registry containing demographic, physical and spatial-temporal gait parameters recorded in five walking conditions with a GAITRite® electronic carpet in community-dwelling older persons with memory complaints. Four cognitive stages were studied: cognitively healthy individuals, mild cognitive impaired patients, mild dementia patients and advanced dementia patients. Results The association between spatial-temporal gait characteristics and cognitive stages was the most prominent: in the entire study population using gait speed, steps per meter (translation for mean step length), swing time variability, normalised gait speed (corrected for leg length) and normalised steps per meter at all five walking conditions; in the 50-to-70 years old participants applying step width at fast pace and steps per meter at usual pace; in the 70-to-80 years old persons using gait speed and normalised gait speed at usual pace, fast pace, animal walk and counting walk or steps per meter and normalised steps per meter at all five walking conditions; in over-80 years old participants using gait speed, normalised gait speed, steps per meter and normalised steps per meter at fast pace and animal dual-task walking. Multivariable logistic regression analysis adjusted for gender predicted in two compiled models the presence of dementia or cognitive impairment with acceptable accuracy in persons with memory complaints. Conclusion Gait parameters in multiple walking conditions adjusted for age, gender and leg length showed a significant association with cognitive impairment. This study suggested that multifactorial gait analysis could be more informative than using gait analysis with only one test or one variable. Using this type of gait analysis

Evaluation of the performance of accelerometer-based gait event detection algorithms in different real-world scenarios using the MAREA gait database.

PubMed

Khandelwal, Siddhartha; Wickström, Nicholas

2017-01-01

Numerous gait event detection (GED) algorithms have been developed using accelerometers as they allow the possibility of long-term gait analysis in everyday life. However, almost all such existing algorithms have been developed and assessed using data collected in controlled indoor experiments with pre-defined paths and walking speeds. On the contrary, human gait is quite dynamic in the real-world, often involving varying gait speeds, changing surfaces and varying surface inclinations. Though portable wearable systems can be used to conduct experiments directly in the real-world, there is a lack of publicly available gait datasets or studies evaluating the performance of existing GED algorithms in various real-world settings. This paper presents a new gait database called MAREA (n=20 healthy subjects) that consists of walking and running in indoor and outdoor environments with accelerometers positioned on waist, wrist and both ankles. The study also evaluates the performance of six state-of-the-art accelerometer-based GED algorithms in different real-world scenarios, using the MAREA gait database. The results reveal that the performance of these algorithms is inconsistent and varies with changing environments and gait speeds. All algorithms demonstrated good performance for the scenario of steady walking in a controlled indoor environment with a combined median F1score of 0.98 for Heel-Strikes and 0.94 for Toe-Offs. However, they exhibited significantly decreased performance when evaluated in other lesser controlled scenarios such as walking and running in an outdoor street, with a combined median F1score of 0.82 for Heel-Strikes and 0.53 for Toe-Offs. Moreover, all GED algorithms displayed better performance for detecting Heel-Strikes as compared to Toe-Offs, when evaluated in different scenarios. Copyright © 2016 Elsevier B.V. All rights reserved.

Correlations between gait speed, 6-minute walk distance, physical activity, and self-efficacy in patients with severe chronic lung disease.

PubMed

DePew, Zachary S; Karpman, Craig; Novotny, Paul J; Benzo, Roberto P

2013-12-01

Four-meter gait speed (4MGS) has been associated with functional capacity and overall mortality in elderly patients, and may easily be translated to daily practice. We evaluated the association of 4MGS with meaningful outcomes. In 70 subjects we conducted the 4MGS, 6-min walk test (6MWT), objectively measured physical activity, and assessed dyspnea, quality of life, and self-efficacy for walking and routine physical activity. 4MGS was measured in 3 separate time epochs during the 6MWT, to explore 4MGS variability. Diagnoses included COPD (51.4%), interstitial lung disease (38.6%), and other pulmonary conditions (10%). The mean ± SD values were: 4MGS 0.85 ± 0.21 m/s, 6-min walk distance (6MWD) 305 ± 115 m, and physical activity level 1.28 ± 0.17, which is consistent with severe physical inactivity. The gait speeds within the time epochs 1-2, 3-4, and 5-6 min during the 6MWT were not significantly different: 1.01 ± 0.29 m/s, 0.98 ± 0.31 m/s, and 1.00 ± 0.31 m/s, respectively. 4MGS had a significant correlation with 6MWD (r = 0.70, P < .001). 6MWD was the dominant variable for predicting 4MGS. Other significant predictors of 4MGS included dyspnea, self-efficacy, quality of life, and objectively measured physical activity. 4MGS is significantly and independently associated with 6MWD, and may serve as a reasonable simple surrogate for 6MWD in subjects with chronic lung disease. Gait speed was remarkably stable throughout the 6MWT, which supports the validity of an abbreviated walk test such as 4MGS.

Slow Gait Speed and Risk of Long-Term Nursing Home Residence in Older Women, Adjusting for Competing Risk of Mortality: Results from the Study of Osteoporotic Fractures.

PubMed

Lyons, Jennifer G; Ensrud, Kristine E; Schousboe, John T; McCulloch, Charles E; Taylor, Brent C; Heeren, Timothy C; Stuver, Sherri O; Fredman, Lisa

2016-12-01

To determine whether slow gait speed increases the risk of costly long-term nursing home residence when accounting for death as a competing risk remains unknown. Longitudinal cohort study using proportional hazards models to predict long-term nursing home residence and subdistribution models with death as a competing risk. Community-based prospective cohort study. Older women (mean age 76.3) participating in the Study of Osteoporotic Fractures who were also enrolled in Medicare fee-for-service plans (N = 3,755). Gait speed was measured on a straight 6-m course and averaged over two trials. Long-term nursing home residence was defined using a validated algorithm based on Medicare Part B claims for nursing home-related care. Participants were followed until long-term nursing home residence, disenrollment from Medicare plan, death, or December 31, 2010. Over the follow-up period (median 11 years), 881 participants (23%) experienced long-term nursing home residence, and 1,013 (27%) died before experiencing this outcome. Slow walkers (55% of participants with gait speed <1 m/s) were significantly more likely than fast walkers to reside in a nursing home long-term (adjusted hazards ratio (aHR) = 1.79, 95% confidence interval (CI) = 1.54-2.09). Associations were attenuated in subdistribution models (aHR = 1.52, 95% CI = 1.30-1.77) but remained statistically significant. Older community-dwelling women with slow gait speed are more likely to experience long-term nursing home residence, as well as mortality without long-term residence. Ignoring the competing mortality risk may overestimate long-term care needs and costs. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Oxygen consumption and gait variables of Arabian endurance horses measured during a field exercise test.

PubMed

Cottin, F; Metayer, N; Goachet, A G; Julliand, V; Slawinski, J; Billat, V; Barrey, E

2010-11-01

Arabian horses have morphological, muscular and metabolic features designed for endurance races. Their gas exchange and gait variables were therefore measured during a field exercise test. This study presents original respiratory and locomotor data recorded in endurance horses under field conditions. Respiratory gas exchange ratio (RER) of Arabian horses at the speed required to win endurance races (18 km/h for 120-160 km) are <1 and running economy (RE) is also low in order to maintain exercise intensity using aerobic metabolism for long intervals. The purpose of this study was to measure oxygen consumption and gait variables in Arabian endurance horses running in the field in order to estimate RER and RE. Five Arabian horses trained for endurance racing were test ridden at increasing speeds on the field. Their speed was recorded and controlled by the rider using a GPS logger. Each horse was equipped with a portable respiratory gas analyser, which measured breath-by-breath respiratory variables and heart rate. The gait variables were recorded using tri-axial accelerometer data loggers and software for gait analysis. Descriptive statistics and linear regressions were used to analyse the speed related changes in each variable with P < 0.05 taken as significant. At a canter speed corresponding to endurance race winning speed (18 km/h), horses presented a VO(2) = 42 ± 9 ml/min/kg bwt, RER = 0.96 ± 0.10 and RE (= VO(2) /speed) = 134 ± 27 l/km/kg bwt. Linear relationships were observed between speed and VO(2,) HR and gait variables. Significant correlations were observed between VO(2) and gait variables. The RER of 0.96 at winning endurance speed indicates that Arabian horses mainly use aerobic metabolism based on lipid oxidation and that RER may also be related to a good coordination between running speed, respiratory and gait parameters. © 2010 EVJ Ltd.

Gait Characteristics over the Course of a Race in Recreational Marathon Competitors

ERIC Educational Resources Information Center

Bertram, John E. A.; Prebeau-Menezes, Leif; Szarko, Matthew J.

2013-01-01

We analyzed gait and function of the supporting limb in participants of a marathon race at three stages: prerace, midrace (18 km), and near the end of the race (36 km). We confirmed that the most successful runners were able to maintain running speed for the duration of the race with little change in speed or gait. Speed slowed progressively…

Spatiotemporal and Kinematic Parameters Relating to Oriented Gait and Turn Performance in Patients with Chronic Stroke

PubMed Central

Bonnyaud, Céline; Pradon, Didier; Vuillerme, Nicolas; Bensmail, Djamel; Roche, Nicolas

2015-01-01

Background The timed up and go test (TUG) is a functional test which is increasingly used to evaluate patients with stroke. The outcome measured is usually global TUG performance-time. Assessment of spatiotemporal and kinematic parameters during the Oriented gait and Turn sub-tasks of the TUG would provide a better understanding of the mechanisms underlying patients’ performance and therefore may help to guide rehabilitation. The aim of this study was thus to determine the spatiotemporal and kinematic parameters which were most related to the walking and turning sub-tasks of TUG performance in stroke patients. Methods 29 stroke patients carried out the TUG test which was recorded using an optoelectronic system in two conditions: spontaneous and standardized condition (standardized foot position and instructed to turn towards the paretic side). They also underwent a clinical assessment. Stepwise regression was used to determine the parameters most related to Oriented gait and Turn sub-tasks. Relationships between explanatory parameters of Oriented gait and Turn performance and clinical scales were evaluated using Spearman correlations. Results Step length and cadence explained 82% to 95% of the variance for the walking sub-tasks in both conditions. Percentage single support phase and contralateral swing phase (depending on the condition) respectively explained 27% and 56% of the variance during the turning sub-task in the spontaneous and standardized conditions. Discussion and Conclusion Step length, cadence, percentage of paretic single support phase and non-paretic swing phase, as well as dynamic stability were the main parameters related to TUG performance and they should be targeted in rehabilitation. PMID:26091555

Crowd-Sourced Amputee Gait Data: A Feasibility Study Using YouTube Videos of Unilateral Trans-Femoral Gait.

PubMed

Gardiner, James; Gunarathne, Nuwan; Howard, David; Kenney, Laurence

2016-01-01

Collecting large datasets of amputee gait data is notoriously difficult. Additionally, collecting data on less prevalent amputations or on gait activities other than level walking and running on hard surfaces is rarely attempted. However, with the wealth of user-generated content on the Internet, the scope for collecting amputee gait data from alternative sources other than traditional gait labs is intriguing. Here we investigate the potential of YouTube videos to provide gait data on amputee walking. We use an example dataset of trans-femoral amputees level walking at self-selected speeds to collect temporal gait parameters and calculate gait asymmetry. We compare our YouTube data with typical literature values, and show that our methodology produces results that are highly comparable to data collected in a traditional manner. The similarity between the results of our novel methodology and literature values lends confidence to our technique. Nevertheless, clear challenges with the collection and interpretation of crowd-sourced gait data remain, including long term access to datasets, and a lack of validity and reliability studies in this area.

Crowd-Sourced Amputee Gait Data: A Feasibility Study Using YouTube Videos of Unilateral Trans-Femoral Gait

PubMed Central

Gardiner, James; Gunarathne, Nuwan; Howard, David; Kenney, Laurence

2016-01-01

Collecting large datasets of amputee gait data is notoriously difficult. Additionally, collecting data on less prevalent amputations or on gait activities other than level walking and running on hard surfaces is rarely attempted. However, with the wealth of user-generated content on the Internet, the scope for collecting amputee gait data from alternative sources other than traditional gait labs is intriguing. Here we investigate the potential of YouTube videos to provide gait data on amputee walking. We use an example dataset of trans-femoral amputees level walking at self-selected speeds to collect temporal gait parameters and calculate gait asymmetry. We compare our YouTube data with typical literature values, and show that our methodology produces results that are highly comparable to data collected in a traditional manner. The similarity between the results of our novel methodology and literature values lends confidence to our technique. Nevertheless, clear challenges with the collection and interpretation of crowd-sourced gait data remain, including long term access to datasets, and a lack of validity and reliability studies in this area. PMID:27764226

Slow Gait Speed and Risk of Mortality or Hospital Readmission After Myocardial Infarction in the Translational Research Investigating Underlying Disparities in Recovery from Acute Myocardial Infarction: Patients' Health Status Registry.

PubMed

Dodson, John A; Arnold, Suzanne V; Gosch, Kensey L; Gill, Thomas M; Spertus, John A; Krumholz, Harlan M; Rich, Michael W; Chaudhry, Sarwat I; Forman, Daniel E; Masoudi, Frederick A; Alexander, Karen P

2016-03-01

To determine the prognostic value of slow gait in predicting outcomes 1 year after acute myocardial infarction (AMI). Observational cohort with longitudinal follow-up. Twenty-four U.S. hospitals participating in the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status Registry. Older adults (≥65) with in-home gait assessment 1 month after AMI (N = 338). Baseline characteristics and 1-year mortality or hospital readmission adjusted using Cox proportional hazards regression in older adults with slow (<0.8 m/s) versus preserved (≥0.8 m/s) gait speed. Slow gait was present in 181 participants (53.6%). Those with slow gait were older, more likely to be female and nonwhite, and had a higher prevalence of heart failure and diabetes mellitus. They were also more likely to die or be readmitted to the hospital within 1 year than those with preserved gait (35.4% vs 18.5%, log-rank P = .006). This association remained significant after adjusting for age, sex, and race (slow vs preserved gait hazard ratio (HR) = 1.76, 95% confidence interval (CI)=1.08-2.87, P = .02) but was no longer significant after adding clinical factors (HR = 1.23, 95% CI=0.74-2.04, P = .43). Slow gait, a marker of frailty, is common 1 month after AMI in older adults and is associated with nearly twice the risk of dying or hospital readmission at 1 year. Understanding its prognostic importance independent of comorbidities and whether routine testing of gait speed can improve care requires further investigation. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Dual-tasks and walking fast: relationship to extra-pyramidal signs in advanced Alzheimer disease.

PubMed

Camicioli, Richard; Bouchard, Thomas; Licis, Lisa

2006-10-25

Extra-pyramidal signs (EPS) and cadence predicted falls risk in patients with advanced Alzheimer disease (AD). Dual task performance predicts falls with variable success. Dual-task performance and walking fast were examined in advanced AD patients with EPS (EPS+, >3 modified Unified Parkinson's Disease Rating Scale [UPDRS] signs) or without EPS (EPS-, three or less UPDRS signs). Demographics, mental and functional status, behavioral impairment, EPS, and quantitative gait measures (GaitRite) were determined. The effects of an automatic dual-task (simple counting) and of walking fast on spatial and temporal gait characteristics were compared between EPS+ and EPS- subjects using a repeated measures design. Cadence decreased, while stride time, swing time and variability in swing time increased with the dual task. Results were insignificant after adjusting for secondary task performance. With walking fast, speed, cadence and stride length increased while stride time, swing time and double support time decreased. Although EPS+ subjects were slower and had decreased stride length, dual task and walking fast effects did not differ from EPS- subjects. Patient characteristics, the type of secondary task and the specific gait measures examined vary in the literature. In this moderately to severely demented population, EPS did not affect "unconscious" (dual task) or "conscious" (walking fast) gait modulation. Given their high falls risk, and retained ability to modulate walking, EPS+ AD patients may be ideal candidates for interventions aimed at preventing falls.

Different cognitive functions discriminate gait performance in younger and older women: A pilot study.

PubMed

Gonzales, Joaquin U; James, C Roger; Yang, Hyung Suk; Jensen, Daniel; Atkins, Lee; Thompson, Brennan J; Al-Khalil, Kareem; O'Boyle, Michael

2016-10-01

Cognitive dysfunction is associated with slower gait speed in older women, but whether cognitive function affects gait performance earlier in life has yet to be investigated. Thus, the objective of this study was to test the hypothesis that cognitive function will discriminate gait performance in healthy younger women. Fast-pace and dual-task gait speed were measured in 30 young to middle-aged (30-45y) and 26 older (61-80y) women without mild cognitive impairment. Visuoperceptual ability, working memory, executive function, and learning ability were assessed using neuropsychological tests. Within each age group, women were divided by the median into lower and higher cognitive function groups to compare gait performance. Younger women with higher visuoperceptual ability had faster fast-pace (2.25±0.30 vs. 1.98±0.18m/s, p≤0.01) and dual-task gait speed (2.02±0.27 vs. 1.69±0.25m/s, p≤0.01) than women with lower visuoperceptual ability. The difference in dual-task gait speed remained significant (p=0.02) after adjusting for age, years of education, and other covariates. Dividing younger women based on other cognitive domains showed no difference in gait performance. In contrast, working memory and executive function discriminated dual-task gait speed (p<0.05) in older women after adjusting for age and education. To our knowledge, this is the first study to show that poorer cognitive function even at a relatively young age can negatively impact mobility. Different cognitive functions discriminated gait performance based on age, highlighting a possible influence of aging in the relationship between cognitive function and mobility in women. Copyright © 2016 Elsevier B.V. All rights reserved.

Validity of using tri-axial accelerometers to measure human movement - Part II: Step counts at a wide range of gait velocities.

PubMed

Fortune, Emma; Lugade, Vipul; Morrow, Melissa; Kaufman, Kenton

2014-06-01

A subject-specific step counting method with a high accuracy level at all walking speeds is needed to assess the functional level of impaired patients. The study aim was to validate step counts and cadence calculations from acceleration data by comparison to video data during dynamic activity. Custom-built activity monitors, each containing one tri-axial accelerometer, were placed on the ankles, thigh, and waist of 11 healthy adults. ICC values were greater than 0.98 for video inter-rater reliability of all step counts. The activity monitoring system (AMS) algorithm demonstrated a median (interquartile range; IQR) agreement of 92% (8%) with visual observations during walking/jogging trials at gait velocities ranging from 0.1 to 4.8m/s, while FitBits (ankle and waist), and a Nike Fuelband (wrist) demonstrated agreements of 92% (36%), 93% (22%), and 33% (35%), respectively. The algorithm results demonstrated high median (IQR) step detection sensitivity (95% (2%)), positive predictive value (PPV) (99% (1%)), and agreement (97% (3%)) during a laboratory-based simulated free-living protocol. The algorithm also showed high median (IQR) sensitivity, PPV, and agreement identifying walking steps (91% (5%), 98% (4%), and 96% (5%)), jogging steps (97% (6%), 100% (1%), and 95% (6%)), and less than 3% mean error in cadence calculations. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

Evidence of Big Five and Aggressive Personalities in Gait Biomechanics.

PubMed

Satchell, Liam; Morris, Paul; Mills, Chris; O'Reilly, Liam; Marshman, Paul; Akehurst, Lucy

2017-01-01

Behavioral observation techniques which relate action to personality have long been neglected (Furr and Funder in Handbook of research methods in personality psychology, The Guilford Press, New York, 2007) and, when employed, often use human judges to code behavior. In the current study we used an alternative to human coding (biomechanical research techniques) to investigate how personality traits are manifest in gait. We used motion capture technology to record 29 participants walking on a treadmill at their natural speed. We analyzed their thorax and pelvis movements, as well as speed of gait. Participants completed personality questionnaires, including a Big Five measure and a trait aggression questionnaire. We found that gait related to several of our personality measures. The magnitude of upper body movement, lower body movement, and walking speed, were related to Big Five personality traits and aggression. Here, we present evidence that some gait measures can relate to Big Five and aggressive personalities. We know of no other examples of research where gait has been shown to correlate with self-reported measures of personality and suggest that more research should be conducted between largely automatic movement and personality.

Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait.

PubMed

Kwakkel, Gert; Wagenaar, Robert C

2002-05-01

The effects of different durations of rehabilitation sessions for the upper extremities (UEs) and lower extremities (LEs) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated. Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with (1) an emphasis on the LEs, (2) an emphasis on the paretic UE, or (3) a condition in which the paretic arm (UE) and leg (LE) were immobilized with an inflatable pressure splint (control treatment). The 3 treatment regimens were applied for 30 minutes, 5 days a week, during the first 20 weeks after onset of stroke. All subjects also participated in a rehabilitation program 5 days a week that consisted of 15 minutes of UE exercises and 15 minutes of LE exercises in addition to a weekly 11/2-hour session of training in activities of daily living. A repeated-measures design was used. Differences among the 3 treatment regimens were evaluated in terms of comfortable and maximal walking speeds. In addition, mean continuous relative phase (CRP) between paretic arm and leg (PAL) movements and nonparetic arm and leg (NAL) movements and standard deviations of CRP of both limb pairs as a measurement of stability (variability) were evaluated. Comfortable walking speed improved in the group that received interventions involving the LEs compared with the group that received interventions involving the UEs and the group that received the control treatment. No differences among the 3 treatment conditions were found for the mean CRP of NAL and PAL as well as the standard deviation of CRP of both limb pairs. With the exception of an improved comfortable walking speed as a result of a longer duration of rehabilitation sessions, no differential effects of duration of rehabilitation sessions for the LEs and UEs on the variable we measured related to hemiplegic gait were found. Increasing walking speed, however, resulted in a larger

Use of high-speed cinematography and computer generated gait diagrams for the study of equine hindlimb kinematics.

PubMed

Kobluk, C N; Schnurr, D; Horney, F D; Sumner-Smith, G; Willoughby, R A; Dekleer, V; Hearn, T C

1989-01-01

High-speed cinematography with computer aided analysis was used to study equine hindlimb kinematics. Eight horses were filmed at the trot or the pace. Filming was done from the side (lateral) and the back (caudal). Parameters measured from the lateral filming included the heights of the tuber coxae and tailhead, protraction and retraction of the hoof and angular changes of the tarsus and stifle. Abduction and adduction of the limb and tarsal height changes were measured from the caudal filming. The maximum and minimum values plus the standard deviations and coefficients of variations are presented in tabular form. Three gait diagrams were constructed to represent stifle angle versus tarsal angle, metatarsophalangeal height versus protraction-retraction (fetlock height diagram) and tuber coxae and tailhead height versus stride (pelvic height diagram). Application of the technique to the group of horses revealed good repeatability of the gait diagrams within a limb and the diagrams appeared to be sensitive indicators of left/right asymmetries.

Alpha oscillations in the pedunculopontine nucleus correlate with gait performance in parkinsonism

PubMed Central

Thevathasan, Wesley; Pogosyan, Alek; Hyam, Jonathan A.; Jenkinson, Ned; Foltynie, Tom; Limousin, Patricia; Bogdanovic, Marko; Zrinzo, Ludvic; Green, Alexander L.; Aziz, Tipu Z.

2012-01-01

The pedunculopontine nucleus, a component of the reticular formation, is topographically organized in animal models and implicated in locomotor control. In Parkinson's disease, pedunculopontine nucleus stimulation is an emerging treatment for gait freezing. Local field potentials recorded from pedunculopontine nucleus electrodes in such patients have demonstrated oscillations in the alpha and beta frequency bands, reactive to self-paced movement. Whether these oscillations are topographically organized or relevant to locomotion is unknown. Here, we recorded local field potentials from the pedunculopontine nucleus in parkinsonian patients during rest and unconstrained walking. Relative gait speed was assessed with trunk accelerometry. Peaks of alpha power were present at rest and during gait, when they correlated with gait speed. Gait freezing was associated with attenuation of alpha activity. Beta peaks were less consistently observed across rest and gait, and did not correlate with gait speed. Alpha power was maximal in the caudal pedunculopontine nucleus region and beta power was maximal rostrally. These results indicate a topographic distribution of neuronal activity in the pedunculopontine nucleus region and concur with animal data suggesting that the caudal subregion has particular relevance to gait. Alpha synchronization, proposed to suppress ‘task irrelevant’ distraction, has previously been demonstrated to correlate with performance of cognitive tasks. Here, we demonstrate a correlation between alpha oscillations and improved gait performance. The results raise the possibility that stimulation of caudal and rostral pedunculopontine nucleus regions may differ in their clinical effects. PMID:22232591

Bipedal gait model for precise gait recognition and optimal triggering in foot drop stimulator: a proof of concept.

PubMed

Shaikh, Muhammad Faraz; Salcic, Zoran; Wang, Kevin I-Kai; Hu, Aiguo Patrick

2018-03-10

Electrical stimulators are often prescribed to correct foot drop walking. However, commercial foot drop stimulators trigger inappropriately under certain non-gait scenarios. Past researches addressed this limitation by defining stimulation control based on automaton of a gait cycle executed by foot drop of affected limb/foot only. Since gait is a collaborative activity of both feet, this research highlights the role of normal foot for robust gait detection and stimulation triggering. A novel bipedal gait model is proposed where gait cycle is realized as an automaton based on concurrent gait sub-phases (states) from each foot. The input for state transition is fused information from feet-worn pressure and inertial sensors. Thereafter, a bipedal gait model-based stimulation control algorithm is developed. As a feasibility study, bipedal gait model and stimulation control are evaluated in real-time simulation manner on normal and simulated foot drop gait measurements from 16 able-bodied participants with three speed variations, under inappropriate triggering scenarios and with foot drop rehabilitation exercises. Also, the stimulation control employed in commercial foot drop stimulators and single foot gait-based foot drop stimulators are compared alongside. Gait detection accuracy (98.9%) and precise triggering under all investigations prove bipedal gait model reliability. This infers that gait detection leveraging bipedal periodicity is a promising strategy to rectify prevalent stimulation triggering deficiencies in commercial foot drop stimulators. Graphical abstract Bipedal information-based gait recognition and stimulation triggering.

[Subjective Gait Stability in the Elderly].

PubMed

Hirsch, Theresa; Lampe, Jasmin; Michalk, Katrin; Röder, Lotte; Munsch, Karoline; Marquardt, Jonas

2017-07-10

It can be assumed that the feeling of gait stability or gait instability in the elderly may be independent of a possible fear of falling or a history of falling when walking. Up to now, there has been a lack of spatiotemporal gait parameters for older people who subjectively feel secure when walking. The aim of the study is to analyse the distribution of various gait parameters for older people who subjectively feel secure when walking. In a cross-sectional study, the gait parameters stride time, step time, stride length, step length, double support, single support, and walking speed were measured using a Vicon three-dimensional motion capture system (Plug-In Gait Lower-Body Marker Set) in 31 healthy people aged 65 years and older (mean age 72 ± 3.54 years) who subjectively feel secure when walking. There was a homogeneous distribution in the gait parameters examined, with no abnormalities. The mean values have a low variance with narrow confidence intervals. This study provides evidence that people who subjectively feel secure when walking demonstrate similarly objective gait parameters..

Gait characteristics of post-poliomyelitis patients: standardization of quantitative data reporting.

PubMed

Portnoy, S; Schwartz, I

2013-10-01

To evaluate the differences in gait characteristics and gait symmetry of post-polio syndrome (PPS) patients ambulating with or without shoes and between subgroups walking with different walking aids and orthoses, study the correlation of these data with personal data, illness condition, physical health, frequency of using aids and orthotics and frequency of falls, and derive recommendations for standardization of reporting these data. Twenty-six PPS subjects ambulated with their own walking devices. We calculated spatio-temporal parameters and symmetry indices (SI) of gait using a data acquired by a motion capture system. We compared inter-subject differences in gait pattern for PPS groups that differed by questionnaire-obtained data of demographics, physical activity, polio history, falls and walking aids. Additional inter-subject comparisons were performed between normal subjects (n=16), PPS patients walking with shoes with/without an ankle-foot-orthosis (n=11), PPS patients walking with knee-ankle-foot-orthosis (n=5), and PPS patients walking with a walker/crutches (n=10). We also compared intra-subject variability in PPS subjects who were able to repeat the trials barefoot. Our main results show that subjects who reported participating in physical activity twice a week or more had significantly better step time and double support symmetry. Subjects who use walking aids on a daily basis had significantly higher gait cadence and shorter stride time. Also, subjects that do not require knee-ankle-foot orthoses and/or walking aids walked with a smaller base width and better symmetry in stance and swing durations than PPS subjects who require these aids. The gait pattern of PPS patients is related to numerous intrinsic and extrinsic factors. Standardization of the reporting protocol of gait-related data of PPS patients is crucial for patient evaluation and treatment design. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Deviations in gait metrics in patients with chronic ankle instability: a case control study.

PubMed

Gigi, Roy; Haim, Amir; Luger, Elchanan; Segal, Ganit; Melamed, Eyal; Beer, Yiftah; Nof, Matityahu; Nyska, Meir; Elbaz, Avi

2015-01-01

Gait metric alterations have been previously reported in patients suffering from chronic ankle instability (CAI). Previous studies of gait in this population have been comprised of relatively small cohorts, and the findings of these studies are not uniform. The objective of the present study was to examine spatiotemporal gait metrics in patients with CAI and examine the relationship between self-reported disease severity and the magnitude of gait abnormalities. Forty-four patients with CAI were identified and compared to 53 healthy controls. Patients were evaluated with spatiotemporal gait analysis via a computerized mat and with the Short Form (SF) - 36 health survey. Patients with CAI were found to walk with approximately 16% slower walking velocity, 9% lower cadence and approximately 7% lower step length. Furthermore, the base of support, during walking, in the CAI group was approximately 43% wider, and the single limb support phase was 3.5% shorter compared to the control group. All of the SF-36 8-subscales, as well as the SF-36 physical component summary and SF-36 mental component summary, were significantly lower in patients with CAI compared to the control group. Finally, significant correlations were found between most of the objective gait measures and the SF-36 mental component summary and SF-36 physical component summary. The results outline a gait profile for patients suffering from CAI. Significant differences were found in most spatiotemporal gait metrics. An important finding was a significantly wider base of support. It may be speculated that these gait alterations may reflect a strategy to deal with imbalance and pain. These findings suggest the usefulness of gait metrics, alongside with the use of self-evaluation questionnaires, in assessing disease severity of patients with CAI.

Hip kinetics during gait are clinically meaningful outcomes in young boys with Duchenne muscular dystrophy.

PubMed

Heberer, Kent; Fowler, Eileen; Staudt, Loretta; Sienko, Susan; Buckon, Cathleen E; Bagley, Anita; Sison-Williamson, Mitell; McDonald, Craig M; Sussman, Michael D

2016-07-01

Duchenne muscular dystrophy (DMD) is an X-linked genetic neuromuscular disorder characterized by progressive proximal to distal muscle weakness. The success of randomized clinical trials for novel therapeutics depends on outcome measurements that are sensitive to change. As the development of motor skills may lead to functional improvements in young boys with DMD, their inclusion may potentially confound clinical trials. Three-dimensional gait analysis is an under-utilized approach that can quantify joint moments and powers, which reflect functional muscle strength. In this study, gait kinetics, kinematics, spatial-temporal parameters, and timed functional tests were quantified over a one-year period for 21 boys between 4 and 8 years old who were enrolled in a multisite natural history study. At baseline, hip moments and powers were inadequate. Between the two visits, 12 boys began a corticosteroid regimen (mean duration 10.8±2.4 months) while 9 boys remained steroid-naïve. Significant between-group differences favoring steroid use were found for primary kinetic outcomes (peak hip extensor moments (p=.007), duration of hip extensor moments (p=.007), peak hip power generation (p=.028)), and spatial-temporal parameters (walking speed (p=.016) and cadence (p=.021)). Significant between-group differences were not found for kinematics or timed functional tests with the exception of the 10m walk test (p=.03), which improves in typically developing children within this age range. These results indicate that hip joint kinetics can be used to identify weakness in young boys with DMD and are sensitive to corticosteroid intervention. Inclusion of gait analysis may enhance detection of a treatment effect in clinical trials particularly for young boys with more preserved muscle function. Copyright © 2016 Elsevier B.V. All rights reserved.

Gait characteristics after gait-oriented rehabilitation in chronic stroke.

PubMed

Peurala, Sinikka H; Titianova, Ekaterina B; Mateev, Plamen; Pitkänen, Kauko; Sivenius, Juhani; Tarkka, Ina M

2005-01-01

To assess the effects of rehabilitation in thirty-seven ambulatory patients with chronic stroke during three weeks in-patient rehabilitation period. In the intervention group, each patient received 75 min physiotherapy daily every workday including 20 minutes in the electromechanical gait trainer with body-weight support (BWS). In the control group, each patient participated in 45 min conventional physiotherapy daily. Motor ability was assessed with the first five items of the Modified Motor Assessment Scale (MMAS1-5) and ten meters walking speed. Spatio-temporal gait characteristics were recorded with an electrical walkway. The MMAS1-5 (p<0.0005 and p=0.005) and ten meters walking time (p<0.0005 and p=0.006) improved in both groups. The improvements in MMAS1-5 and ten meters walking time did not differ between the groups (p=0.217 and p=0.195). Specific gait characteristics improved only in the intervention group, as seen in increased Functional Ambulation Profile score (p=0.023), velocity (p=0.023), the step lengths (affected side, p=0.011, non-affected side p=0.040), the stride lengths (p=0.018, p=0.006) and decreased step-time differential (p=0.043). Furthermore, all gait characteristics and other motor abilities remained in the discharge level at the six months in the intervention group. It appears that BWS training gives a long-lasting benefit in gait qualities even in chronic stroke patients.

Stepping strategies for regulating gait adaptability and stability.

PubMed

Hak, Laura; Houdijk, Han; Steenbrink, Frans; Mert, Agali; van der Wurff, Peter; Beek, Peter J; van Dieën, Jaap H

2013-03-15

Besides a stable gait pattern, gait in daily life requires the capability to adapt this pattern in response to environmental conditions. The purpose of this study was to elucidate the anticipatory strategies used by able-bodied people to attain an adaptive gait pattern, and how these strategies interact with strategies used to maintain gait stability. Ten healthy subjects walked in a Computer Assisted Rehabilitation ENvironment (CAREN). To provoke an adaptive gait pattern, subjects had to hit virtual targets, with markers guided by their knees, while walking on a self-paced treadmill. The effects of walking with and without this task on walking speed, step length, step frequency, step width and the margins of stability (MoS) were assessed. Furthermore, these trials were performed with and without additional continuous ML platform translations. When an adaptive gait pattern was required, subjects decreased step length (p<0.01), tended to increase step width (p=0.074), and decreased walking speed while maintaining similar step frequency compared to unconstrained walking. These adaptations resulted in the preservation of equal MoS between trials, despite the disturbing influence of the gait adaptability task. When the gait adaptability task was combined with the balance perturbation subjects further decreased step length, as evidenced by a significant interaction between both manipulations (p=0.012). In conclusion, able-bodied people reduce step length and increase step width during walking conditions requiring a high level of both stability and adaptability. Although an increase in step frequency has previously been found to enhance stability, a faster movement, which would coincide with a higher step frequency, hampers accuracy and may consequently limit gait adaptability. Copyright © 2012 Elsevier Ltd. All rights reserved.

Postural insoles on gait in children with cerebral palsy: Randomized controlled double-blind clinical trial.

PubMed

Pasin Neto, Hugo; Grecco, Luanda André Collange; Ferreira, Luis Alfredo Braun; Duarte, Natália Almeida Carvalho; Galli, Manuela; Oliveira, Claudia Santos

2017-10-01

The aim of the present study was to assess the effect of postural insoles on gait performance in children with Cerebral Palsy (CP). Twenty four children between four and 12 years of age were randomly allocated either the control group (n = 12) or experimental group (n = 12). The control group used placebo insoles and the experimental group used postural insoles. Three-dimensional gait analysis was performed under three conditions: barefoot, in shoes and in shoes with insoles. Three evaluations were carried out: 1)immediately following placement of the insoles; 2)after three months of insole use; and 3)one month after suspending insole use. Regarding the immediate effects and after three months use of insole, significant improvements in gait velocity and cadence were found in the experimental group, along with an increase in foot dorsiflexion, a reduction in knee flexion and a reduction in internal rotation. Conversely, these changes were not maintained in the third assessment, one month after withdrawal of the insoles. The use of postural insoles led to improvements in gait performance in children with CP. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effect of cadence on locomotor-respiratory coupling during upper-body exercise.

PubMed

Tiller, Nicholas B; Price, Mike J; Campbell, Ian G; Romer, Lee M

2017-02-01

Asynchronous arm-cranking performed at high cadences elicits greater cardiorespiratory responses compared to low cadences. This has been attributed to increased postural demand and locomotor-respiratory coupling (LRC), and yet, this has not been empirically tested. This study aimed to assess the effects of cadence on cardiorespiratory responses and LRC during upper-body exercise. Eight recreationally-active men performed arm-cranking exercise at moderate and severe intensities that were separated by 10 min of rest. At each intensity, participants exercised for 4 min at each of three cadences (50, 70, and 90 rev min -1 ) in a random order, with 4 min rest-periods applied in-between cadences. Exercise measures included LRC via whole- and half-integer ratios, cardiorespiratory function, perceptions of effort (RPE and dyspnoea), and diaphragm EMG using an oesophageal catheter. The prevalence of LRC during moderate exercise was highest at 70 vs. 50 rev min -1 (27 ± 10 vs. 13 ± 9%, p = 0.000) and during severe exercise at 90 vs. 50 rev min -1 (24 ± 7 vs. 18 ± 5%, p = 0.034), with a shorter inspiratory time and higher mean inspiratory flow (p < 0.05) at higher cadences. During moderate exercise, [Formula: see text] and f C were higher at 90 rev min -1 (p < 0.05) relative to 70 and 50 rev min -1 ([Formula: see text] 1.19 ± 0.25 vs. 1.05 ± 0.21 vs. 0.97 ± 0.24 L min -1 ; f C 116 ± 11 vs. 101 ± 13 vs. 101 ± 12 b min -1 ), with concomitantly elevated dyspnoea. There were no discernible cadence-mediated effects on diaphragm EMG. Participants engage in LRC to a greater extent at moderate-high cadences which, in turn, increase respiratory airflow. Cadence rate should be carefully considered when designing aerobic training programmes involving the upper-limbs.

Turtle mimetic soft robot with two swimming gaits.

PubMed

Song, Sung-Hyuk; Kim, Min-Soo; Rodrigue, Hugo; Lee, Jang-Yeob; Shim, Jae-Eul; Kim, Min-Cheol; Chu, Won-Shik; Ahn, Sung-Hoon

2016-05-04

This paper presents a biomimetic turtle flipper actuator consisting of a shape memory alloy composite structure for implementation in a turtle-inspired autonomous underwater vehicle. Based on the analysis of the Chelonia mydas, the flipper actuator was divided into three segments containing a scaffold structure fabricated using a 3D printer. According to the filament stacking sequence of the scaffold structure in the actuator, different actuating motions can be realized and three different types of scaffold structures were proposed to replicate the motion of the different segments of the flipper of the Chelonia mydas. This flipper actuator can mimic the continuous deformation of the forelimb of Chelonia mydas which could not be realized in previous motor based robot. This actuator can also produce two distinct motions that correspond to the two different swimming gaits of the Chelonia mydas, which are the routine and vigorous swimming gaits, by changing the applied current sequence of the SMA wires embedded in the flipper actuator. The generated thrust and the swimming efficiency in each swimming gait of the flipper actuator were measured and the results show that the vigorous gait has a higher thrust but a relatively lower swimming efficiency than the routine gait. The flipper actuator was implemented in a biomimetic turtle robot, and its average swimming speed in the routine and vigorous gaits were measured with the vigorous gait being capable of reaching a maximum speed of 11.5 mm s(-1).

The contributions of balance to gait capacity and motor function in chronic stroke.

PubMed

Lee, Kyoung Bo; Lim, Seong Hoon; Kim, Young Dong; Yang, Byung Il; Kim, Kyung Hoon; Lee, Kang Sung; Kim, Eun Ja; Hwang, Byong Yong

2016-06-01

[Purpose] The aim of this study was to identify the contributions of balance to gait and motor function in chronic stroke. [Subjects and Methods] Twenty-three outpatients participated in a cross-sectional assessment. Gait ability was assessed using the functional ambulation category, self-paced 10-m walking speed, and fastest 10-m walking speed. Standing balance and trunk control measures included the Berg Balance Scale and the Trunk Impairment Scale. Univariate and multivariate regression analyses were performed. [Results] Balance was the best predictor of the FAC, self-paced walking speed, and fastest walking speed, accounting for 57% to 61% of the variances. Additionally, the total score of TIS was the only predictor of the motor function of the lower limbs and the dynamic balance of TIS was a predictor of the motor function of the upper limbs, accounting for 41% and 29% of the variance, respectively. [Conclusion] This study demonstrated the relative contribution of standing balance and trunk balance to gait ability and motor function. They show that balance has a high power of explanation of gait ability and that trunk balance is a determinant of motor function rather than gait ability.