Effects of narrow-base walking and dual tasking on gait spatiotemporal characteristics in anterior cruciate ligament-injured adults compared to healthy adults

Lower extremity joint kinematics in individuals with and without bilateral knee osteoarthritis during normal and narrow-base walking: A cross-sectional study

BACKGROUND

Knee osteoarthritis (KOA) is a prevalent musculoskeletal disease affecting joint mechanics. Considering the effect of step-width changes on the biomechanics of gait, especially the alteration of stability dynamics during narrow-base gait, this study investigated the kinematic parameters of the lower extremities during both normal and narrow-base walking in individuals with and without KOA.

METHODS

A cross-sectional study with 20 individuals with bilateral KOA and 20 controls was conducted. Participants walked on a treadmill at a preferred speed across normal and narrow paths. Joint angles and angular velocities in the sagittal and frontal planes were recorded, and mixed ANOVA was used to analyze group × condition effects.

RESULTS

Significant main effects of walking condition were observed for hip (p = 0.001) and ankle angles (p = 0.002) in the frontal plane, and knee (p = 0.004) and ankle angular velocities (p = 0.002) in the sagittal plane. Moreover, there were significant main effects of group on the hip (p = 0.01) and knee angles (p = 0.04) in the sagittal plane. KOA group showed higher peak hip adduction (p < 0.001) and ankle inversion (p = 0.02]) during narrow-base walking than on the normal path. People with KOA had also significantly higher peak angular velocity of knee flexion (p = 0.03), ankle dorsiflexion (p = 0.002), and ankle inversion (p = 0.03) during narrow-base walking.

CONCLUSIONS

The findings suggest that KOA and narrow-base gait challenges may trigger distinct kinematic adaptation strategies, potentially contributing to cartilage degeneration and altering balance mechanisms.

The effect of cognitive task and gait speed on gait spatiotemporal parameters in athletes with anterior cruciate ligament reconstruction: Cross-sectional study

BACKGROUND

Restoring pre-injury normal gait following Anterior Cruciate Ligament Reconstruction (ACLR) is a critical challenge. The purpose of this study was to compare spatiotemporal parameters in athletes following ACL reconstruction with healthy athletes when cognitive load and speed were manipulated.

METHODS

Twenty male soccer players with an ACLR history and 20 healthy matched individuals completed walking tasks under four conditions: with and without a cognitive load (auditory Stroop task), and at preferred speed as well as high speed (20% higher than the individual's preferred speed). Step Width (SW), Step Time (ST), Step Length (SL), as well as Symmetry Indexes (SIs) were measured using three-dimensional (3D) motion analysis. Gait symmetry was evaluated by SIs. The data was analyzed using Three-way analysis of variances with repeated measures (ANOVA 3 × 2).

RESULTS

ST was significantly different between groups (P = 0.04) when the cognitive load was applied at the preferred speed. However, other spatiotemporal parameters were not significantly different between groups in any conditions (p > 0.05). The SW was reduced during high-speed walking with cognitive load in both groups (p = 0.004). High-speed resulted in greater SL (p < 0.001) and lower ST (p < 0.001) in both groups. SI was not significantly different for any parameter between groups under any conditions, however, the interaction of cognitive task × speed was significant for SW (p = 0.03).

CONCLUSION

Athletes at a mean of 19 months following ACL Reconstruction appear to manage speed and cognitive challenges similar to age and activity matched individuals who have not had surgery.

Relationship Between Cognitive Abilities and Lower-Limb Movements: Can Analyzing Gait Parameters and Movements Help Detect Dementia? A Systematic Review

Identifying and diagnosing cognitive impairment remains challenging. Some diagnostic procedures are invasive, expensive, and not always accurate. Meanwhile, evidence suggests that cognitive impairment is associated with changes in gait parameters. Certain gait parameters manifesting differences between people with and without cognitive impairment are more pronounced when adding a secondary task (dual-task scenario). In this systematic review, the capability of gait analysis to identify cognitive impairment is investigated. Twenty-three studies published between 2014 and 2024 met the inclusion criteria. A significantly lower gait speed and cadence as well as higher gait variability were found in people with mild cognitive impairment (MCI) and/or dementia, compared with the group with no cognitive impairment. While dual tasks appeared to amplify the differences between the two populations, the type of secondary tasks (e.g., calculations and recalling phone numbers) had an effect on gait changes. The activity and volume of different brain regions were also different between the two populations during walking. In conclusion, while this systematic review supported the potential of using gait analysis to identify cognitive impairment, there are a number of parameters researchers need to consider such as gait variables to be studied, types of dual tasks, and analysis of brain changes while performing the movement tasks.

The Influence of Cognitive Dual Tasking on the Outcomes of the Triple Hop Test Following Anterior Cruciate Ligament Reconstruction

Introduction

Anterior cruciate ligament (ACL) reconstruction involves prolonged rehabilitation, with Return to Sport (RTS) as a key goal for athletes. Integrating Dual Task (DT) strategies, which combine cognitive and physical tasks, is critical, as multitasking mirrors real-world and sports-specific demands. Assessing how distractions affect performance is essential to optimize RTS outcomes for both the reconstructed and healthy limbs.

Purpose

To analyze the influence of DT on the performance of the Triple Hop Test for distance (THD) in individuals' status post ACL reconstruction.

Study type

Cross Sectional.

Materials and Methods

Seventeen patients post-ACL were recruited and performed THD under two conditions: single task (standard condition) and dual task (with an added neurocognitive task). Assessments were conducted on both the healthy and the previously injured limb over six meters, measured via a standard measuring tape. Paired t-tests and Mann-Whitney-Wilcoxon or Kruskal-Wallis tests were applied to investigate differences. Categorical variables were compared using chi-squared tests.

Results

There was a significant difference in average distance between single task performances in the healthy and previously operated limbs, with a difference of 20.71 cm (p=0.016). A significant difference was also observed in DT performance, with a distance variation of 10.41 cm (p=0.038). Comparing performances, both the healthy and the ACL-reconstructed limbs showed performance deterioration under DT conditions, with a greater percentage decline in the healthy limb.

Conclusions

Dual Task conditions appear to hinder performance in the THD in both the healthy and post-ACL reconstructed limbs.

Level Of Evidence

3b.

Gait Variability at Different Walking Speeds

Gait variability (GV) is a crucial measure of inconsistency of muscular activities or body segmental movements during repeated tasks. Hence, GV might serve as a relevant and sensitive measure to quantify adjustments of walking control. However, it has not been clarified whether GV is associated with walking speed, a clarification needed to exploit effective better bilateral coordination level. For this aim, fourteen male students (age 22.4 ± 2.7 years, body mass 74.9 ± 6.8 kg, and body height 1.78 ± 0.05 m) took part in this study. After three days of walking 1 km each day at a self-selected speed (SS) on asphalt with an Apple Watch S. 7 (AppleTM, Cupertino, CA, USA), the participants were randomly evaluated on a treadmill at three different walking speed intensities for 10 min at each one, SS - 20%/SS + 20%/ SS, with 5 min of passive recovery in-between. Heart rate (HR) was monitored and normalized as %HRmax, while the rate of perceived exertion (RPE) (CR-10 scale) was asked after each trial. Kinematic analysis was performed, assessing the Contact Time (CT), Swing Time (ST), Stride Length (SL), Stride Cycle (SC), and Gait Variability as Phase Coordination Index (PCI). RPE and HR increased as the walking speed increased (p = 0.005 and p = 0.035, respectively). CT and SC decreased as the speed increased (p = 0.0001 and p = 0.013, respectively), while ST remained unchanged (p = 0.277). SL increased with higher walking speed (p = 0.0001). Conversely, PCI was 3.81 ± 0.88% (high variability) at 3.96 ± 0.47 km·h-1, 2.64 ± 0.75% (low variability) at SS (4.94 ± 0.58 km·h-1), and 3.36 ± 1.09% (high variability) at 5.94 ± 0.70 km·h-1 (p = 0.001). These results indicate that while the metabolic demand and kinematics variables change linearly with increasing speed, the most effective GV was observed at SS. Therefore, SS could be a new methodological approach to choose the individual walking speed, normalize the speed intensity, and avoid a gait pattern alteration.

Effect of Time After Injury on Tibiofemoral Joint Kinematics in Anterior Cruciate Ligament-Deficient Knees During Gait

Background:

Anterior cruciate ligament (ACL) injury can lead to changes in tibiofemoral kinematics during gait, but the detailed short-term kinematic changes after ACL injury are still unknown.

Purpose:

To measure tibiofemoral kinematics during gait in ACL-deficient (ACLD) knees over time after ACL injury.

Study Design:

Controlled laboratory study.

Methods:

The authors categorized 76 patients with unilateral ACLD knees into 4 groups based on the time from injury: <3 months (group 1), 3 to 6 months (group 2), >6 to 12 months (group 3), and >12 months (group 4). The controls were 20 participants with ACL-intact knees. Changes in the knee kinematics and range of motion during gait were compared among ACLD groups and those with ACL-intact knees.

Results:

Compared with controls, the range of motion of flexion in group 1 was significantly lower (6°; P = .033), and the mean knee flexion was significantly increased (0.7°-3.4°) in groups 1 to 4 (all P ≤ .004). There was more internal tibial rotation (2.9°-4.3°) in group 1 and 2, and more anterior tibial translation (4.3 mm) in group 1 during the stance or swing phases than in controls (P ≤ .049 for all). The mean internal tibial rotation and anterior tibial translation significantly decreased from group 1 to group 4 (P < .001 for both). Compared with controls, the mean medial tibial translation was significantly greater (1.2-2.5 mm) in all groups, and more medial tibial translations (2.4-3.7 mm) were observed during the stance phase in groups 1, 3, and 4 (P ≤ .047 for all).

Conclusion:

ACLD knees displayed a motion impairment walking strategy within 3 months, and a higher-flexion walking strategy increased with time after injury. Excessive anterior translation and internal rotation of the tibia tended to return to normal, while excessive medial translation of the tibia increased in ACLD knees after 6 months postinjury. These results may provide new insight into the compensatory mechanisms and risk factors for premature osteoarthritis in ACLD knees.

Uncontrolled manifold analysis of gait kinematic synergy during normal and narrow path walking in individuals with knee osteoarthritis compared to asymptomatic individuals

Knee osteoarthritis (KOA) is a common musculoskeletal disorder resulting in altered gait patterns. Uncontrolled manifold (UCM) analysis has been demonstrated as a useful approach for quantitative analysis of motor variability and synergies. The present study aimed to investigate the changes in the kinematic synergy, controlling the center of mass (COM) position while walking on normal and narrow paths in people with KOA compared to asymptomatic participants. In this cross-sectional study, twenty people with mild to moderate KOA and twenty asymptomatic individuals walked at their comfortable preferred speed across normal and narrow paths on a treadmill. The UCM analysis was performed separately using the lower limb segmental angles as elemental variables and the COM displacement as a performance variable during the stance phase of gait for the frontal and sagittal planes. The results revealed that KOA and asymptomatic individuals could exploit kinematic synergy to control the COM displacement regardless of walking conditions (p < 0.05). Furthermore, the variance within the UCM and synergy index were significantly higher on the narrow path than the normal walking in the mediolateral direction in the KOA group (p < 0.05). The findings of this study suggest that individuals with KOA modify their gait kinematic variability to ensure a stronger kinematic synergy when walking on a challenging narrow path.

The effects of challenging walking conditions on kinematic synergy and stability of gait in people with knee osteoarthritis: A study protocol

Background:

Knee osteoarthritis (KOA) may considerably change the gait parameters, including the gait variability patterns. Uncontrolled manifold (UCM) analysis has been used to evaluate the relationship between motor control and gait variability as a useful index for assessing the multi-segmental movements’ coordination during walking. To our knowledge, no research has evaluated the alterations in the gait kinematic parameters during normal and narrow path walking in individuals with KOA as compared to asymptomatic people.

Materials and Methods:

In this cross-sectional study, individuals diagnosed with mild to moderate medial KOA and asymptomatic people will walk at their comfortable preferred speed on a treadmill. A motion capture system will be used to record at least 50 successful gait cycles. The kinematic variability of joints during gait will be analyzed using UCM, with the center of mass (COM) displacement considered as the performance variable. The primary outcome measure will be the lower limb synergy index. Variability of the COM displacement and changes in angles and angular velocities of lower extremity joints will be assessed as the secondary outcomes.

Results:

The results of this protocol study provide information on the lower limb kinematic synergy during gait on normal and narrow paths for individuals with KOA and asymptomatic controls.

Conclusion:

This information will help the researchers and clinicians understand KOA patients’ gait variability characteristics more deeply. Moreover, it may lead to an enhanced evidence-based approach for clinical decision-making concerning improving gait stability and decreasing the falling risk in these people.

Validation of the Circular Tandem Walk Test and Optimal Cutoff Score to Determine the Risk of Falls in Active Community-Dwelling Older Adults

This study was to develop and validate the circular tandem walk test (CTWT) by deriving an optimal cutoff score to indicate the fall risk in 89 active community-dwelling older individuals. The participants aged 65 years and older were assessed for their demographic data, fear of fall variables, and history of falls in the past 6 months. Subsequently, participants were randomized for the sequence of tests between the tandem walk test and the CTWT. The outcomes of CTWT showed the highest significant correlation with all the fall variables (ranging from .631 to .827, p < .001). Moreover, the time to perform the CTWT ≥ 14.6 s and ≥ two error scores had excellent and acceptable diagnostic accuracy to determine the risk of falls in the older individuals, respectively. The CTWT can be used as alternative screening tests for assessing the fall risk in active older adults in community settings.

DUAL-TASK ASSESSMENT IMPLICATIONS FOR ANTERIOR CRUCIATE LIGAMENT INJURY: A SYSTEMATIC REVIEW

Background

Several systematic reviews have evaluated the role of dual-task assessment in individuals with concussion. However, no systematic reviews to date have investigated dual-task protocols with implications for individuals with anterior cruciate ligament (ACL) injury or ACL reconstruction (ACLR).

Purpose

To systematically review the evidence on dual-task assessment practices applicable to those with ACL deficiency/ACLR, specifically with the aim to identify motor-cognitive performance costs.

Study Design

Systematic review.

Methods

A systematic literature review was undertaken on those with ACL-deficient or ACL-reconstructed knees performing dual-task activities. The following databases were searched from inception to June 8, 2018 including CINAHL, PsychInfo, PubMed, SPORTDiscus, Web of Science, and gray literature. Three primary search categories (knee, cognition, and motor task) were included. Only one reviewer independently performed the database search, data extraction, and scored each article for quality. All studies were assessed for quality and pertinent data were extracted, examined and synthesized.

Results

Ten studies were included for analysis, all of which were published within the prior ten years. Performance deficits were identified in those with either ACL deficiency or ACLR while dual-tasking, such as prioritization of postural control at the expense of cognitive performance, impaired postural control in single limb stance, greater number of cognitive errors, and increased step width coefficient of variation while walking. No studies examined those with prior ACL injury or ACLR during tasks that mimicked ACL injury mechanisms such as jump-landing or single-leg cutting.

Conclusion

The results of the current systematic review suggests that postural control, gait, and/or cognitive deficits exist when evaluated under a dual-task paradigm in those with ACL deficiency or ACLR. This systematic review highlights the need for future research on dual-task assessment for individuals who have sustained an ACL injury or undergone ACLR, specifically utilizing more difficult athletic movements.

Level of Evidence

Level 3a.

Dual-Task Effects on Performance of Gait and Balance in People with Knee Pain: A Systematic Scoping Review

Dual-task paradigms have been increasingly used to assess the interaction between cognitive demands and the control of balance and gait. The interaction between functional and cognitive demands can alter movement patterns and increase knee instability in individuals with knee conditions, such as knee anterior cruciate ligament (ACL) injury or osteoarthritis (OA). However, there is no consensus on the effects of dual-task on gait mechanics and balance in those individuals. This systematic scoping review aims to examine the impact of dual-task gait and standing balance on motor and cognitive performance in individuals with knee OA or ACL injury. A comprehensive search of MEDLINE, PubMed, Web of Science, and EMBASE electronic databases up until December 2019 was carried out. Inclusion criteria was limited to include dual-task studies that combined cognitive tasks performed simultaneously with gait or standing balance in individuals with knee OA or ACL injuries. In total, fifteen studies met the inclusion criteria, nine articles examined dual-task effects on balance, and six articles reported the effects of dual-task on gait. The total number of individuals included was 230 individuals with ACL injuries, and 168 individuals with knee OA. A decline in gait and balance performance during dual-task testing is present among individuals with ACL injury and/or ACL reconstruction and knee OA. Further research is required, but dual taking assessment could potentially be used to identify individuals at risk of falling or further injury and could be used to develop targeted rehabilitation protocols. A variety of outcome measures have been used across the studies included, making comparisons difficult. The authors, therefore, recommend developing a standardized set of biomechanical balance variables.

The Effects of Cognitive Loading on Motor Behavior in Injured Individuals: A Systematic Review

BACKGROUND

Research suggests that individuals with musculoskeletal injury may have difficulty negotiating physical tasks when they are combined with cognitive loads.

OBJECTIVE

Our objective was to conduct a systematic review to understand the effects of increased cognitive demand on movement patterns among individuals with musculoskeletal injuries.

METHODS

A comprehensive search of PubMed, MEDLINE, the Cumulative Index for Nursing and Allied Health Literature (CINAHL), and SPORTDiscus was conducted to find research reports that included a population that had previously experienced an ankle, knee, or low back injury, included an uninjured control group, and assessed a dual-task paradigm.

RESULTS

Forty-five full-text research reports were assessed, of which 28 studies (six ankle injury, nine knee injury, and 13 low back pain studies) were included in the review. Included studies were assessed for methodological quality and the study design extracted for analysis including the participants, cognitive and physical tasks performed, as well as outcome measures (e.g., three-dimensional kinematics, center of pressure, etc.). All studies included were cross-sectional or case-control with methodological quality scores of 17.8 ± 2.2 out of a possible 22. Twenty-five of the 28 studies found changes in motor performance with dual-task conditions compared with single tasks. Furthermore, 54% of studies reported a significant group by task interaction effect, reporting at least one alteration in injured groups' motor performance under dual-task conditions when compared with an uninjured group.

CONCLUSION

The results of this systematic review indicate that motor performance is further impaired by placing a cognitive load on individuals in populations with musculoskeletal injury. More demanding tasks such as gait appear to be more affected in injured individuals than simple balance tasks. Future investigators may want to consider the difficulty of the tasks included as well as the impact of dual-task paradigms on rehabilitation programs.

Gait speed is more challenging than cognitive load on the stride-to-stride variability in individuals with anterior cruciate ligament deficiency

BACKGROUND

Several investigations have studied gait variability of individuals with anterior cruciate ligament (ACL) deficiency; however, the effect of dual-tasking on the gait variability of these individuals remained unclear. The aim of the present study was to determine the effect of gait speed and dual-tasking on knee flexion-extension variability in subjects with and without ACL deficiency.

METHODS

The knee flexion-extension Lyapunov exponent (LyE) was measured in 22 ACL-deficient (Mean±SD) (25.95 ± 4.69 years) and 22 healthy subjects (24.18 ± 3.32 years). They walked at three levels of gait speed in isolation or concurrently with a cognitive task.

RESULTS

Repeated-measure analyses of variance (ANOVAs) demonstrated that the interaction of group by gait speed was statistically significant. As the gait speed increased from low to high, the knee flexion-extension LyE significantly decreased for the subjects with ACL deficiency (effect size: 0.57, P = 0.01). The interaction of group by cognitive load was not statistically significant (P = 0.07). In addition, the ACL-deficient subjects had statistically slower reaction times than healthy subjects during the dual-task compared with the single-task condition.

CONCLUSIONS

The ACL-deficient and healthy individuals had a tendency to maintain safe gait. It seems that the ACL-deficient subjects sacrificed the cognitive task more than the healthy individuals to pay more attention toward gait. Additionally, it seems that the gait speed was more challenging than cognitive load on the stride-to-stride variability in the individuals with ACL deficiency.