Normal gait characteristics under temporal and distance constraints

Influence of the Hawthorne effect on spatiotemporal parameters, kinematics, ground reaction force, and the symmetry of the dominant and nondominant lower limbs during gait

The Hawthorne effect is a change in behavior resulting from awareness of being observed or evaluated. This study aimed to determine whether awareness of being evaluated or presence of an observer influence gait. Twenty-one young women were asked to walk in three conditions. In the first condition (unawareness of evaluation; UE), participants were aware that it was a practice trial, and there was no observer. In the second condition (awareness of evaluation; AE), participants were aware that their gait was being evaluated. The third condition (AE + researcher observation; RO) was similar to the second condition except that an additional researcher observed the participant' gait. The spatiotemporal, kinematic, ground reaction forces, and ratio index (symmetry of both lower limbs) were compared among the three conditions. A higher ratio index indicated a relative increase in the value on left versus right. Gait speed (P = 0.012) and stride length (right and left; P = 0.006 and 0.007, respectively) were significantly increased in the AE + RO than in UE. Range of motion of the right hip and left ankle was significantly greater in AE than in UE (P = 0.039 and 0.012, respectively). The ratio index of ground reaction force during push-off was significantly higher in AE and AE + RO conditions than in UE (P < 0.001 and P = 0.004, respectively). The Hawthorne effect (awareness of being evaluated or presence of an observer) potentially influences gait. Thus, factors that influence gait analysis should be considered when evaluating normal gait.

Effects of Load Carriage on Postural Control and Spatiotemporal Gait Parameters during Level and Uphill Walking

Load carriage and uphill walking are conditions that either individually or in combination can compromise postural control and gait eliciting several musculoskeletal low back and lower limb injuries. The objectives of this study were to investigate postural control responses and spatiotemporal parameters of gait during level and uphill unloaded (UL), back-loaded (BL), and front-loaded (FL) walking. Postural control was assessed in 30 asymptomatic individuals by simultaneously recording (i) EMG activity of neck, thoracic and lumbar erector spinae, and rectus abdominis, (ii) projected 95% ellipse area as well as the anteroposterior and mediolateral trunk displacement, and (iii) spatiotemporal gait parameters (stride/step length and cadence). Measurements were performed during level (0%) and uphill (5, 10, and 15%) walking at a speed of 5 km h^-1 without and with a suspended front pack or a backpack weighing 15% of each participant's body weight. The results of our study showed that postural control, as indicated by increased erector spinae EMG activity and changes in spatiotemporal parameters of gait that manifested with decreased stride/step length and increased cadence, is compromised particularly during level and uphill FL walking as opposed to BL or UL walking, potentially increasing the risk of musculoskeletal and fall-related injuries.

Dynamic gait stability in patients with idiopathic normal pressure hydrocephalus with high and low fall-risk

BACKGROUND

This study aimed to investigate whether dynamic gait stability differs between idiopathic normal-pressure hydrocephalus with high- and low-fall-risk.

METHODS

Participants comprised 40 idiopathic normal-pressure hydrocephalus patients and 23 healthy-controls. Idiopathic normal-pressure hydrocephalus patients were divided into those with high-fall-risk (n = 20) and low-fall-risk (n = 20) groups using the cut-off score of ≤14/30 for fall-risk on the Functional Gait Assessment. Dynamic stability during gait was assessed by three-dimensional motion analysis. Dynamic stability was defined as the ability to maintain an extrapolated center of mass within the base of support at heel contact, with the distance between the two defined as the margin of stability. Conscious motor control was assessed by the Movement-Specific Reinvestment Scale.

FINDINGS

Anteroposterior and mediolateral margin of stabilities were significantly larger in both idiopathic normal-pressure hydrocephalus groups than in healthy-controls. The mediolateral margin of stability was significantly higher in the high-fall-risk group than in the low-fall-risk group; whereas, the anteroposterior margin of stability did not differ between idiopathic normal-pressure hydrocephalus groups. The Movement-Specific Reinvestment Scale was significantly higher in the high-fall-risk group than in the low-fall-risk group.

INTERPRETATION

Idiopathic normal-pressure hydrocephalus patients with have high forward and lateral dynamic stability during gait regardless of their fall-risk. In particular, idiopathic normal-pressure hydrocephalus patients with high-fall-risk may consciously maintain lateral dynamic stability to a greater extent than those with low-fall-risk. These findings highlight a conscious motor control component in the pathological gait of idiopathic normal-pressure hydrocephalus, and provide clues for rehabilitation and fall prevention strategies in idiopathic normal-pressure hydrocephalus patients.

Dynamic stability during gait in idiopathic normal pressure hydrocephalus and Parkinson's disease

OBJECTIVES

To clarify a characteristic of dynamic stability during gait in idiopathic normal pressure hydrocephalus (iNPH) and Parkinson's disease (PD), and to explore the association between dynamic stability and disease severity in each disease.

MATERIALS AND METHODS

The 5-m gait of 36 iNPH (precerebrospinal fluid drainage), 20 PD (medicated state), and 25 healthy controls (HC) were evaluated using three-dimensional motion analysis. Ambulatory dynamic stability was defined as the ability to maintain the extrapolated center of mass within the base of support at heel contact, with the distance between the two referred to as the margin of stability (MOS).

RESULTS

Anteroposterior direction (AP) MOS was significantly larger in the iNPH and PD groups than in the HC group; no significant difference was found between the iNPH and PD groups. Mediolateral direction (ML) MOS was significantly larger in the iNPH and PD groups than in the HC group and significantly larger in the iNPH group than in the PD group. In the iNPH group, the disease severity was positively correlated with only ML MOS. In the PD group, the disease severity was positively correlated with the AP MOS and ML MOS.

CONCLUSIONS

Dynamic stability in iNPH increases in AP and ML, and it may be associated with not only iNPH-associated gait disturbance but also with a voluntarily cautious gait strategy. Dynamic stability in PD only increased in AP, and this may be associated with PD symptoms. These findings will help physicians understand the difference in pathological gait including dynamic stability between patients with iNPH and PD.

Effect of osteopathic manipulation on gait asymmetry

CONTEXT

Movement and loading asymmetry are associated with an increased risk of musculoskeletal injury, disease progression, and suboptimal recovery. Osteopathic structural screening can be utilized to determine areas of somatic dysfunction that could contribute to movement and loading asymmetry. Osteopathic manipulation treatments (OMTs) targeting identified somatic dysfunctions can correct structural asymmetries and malalignment, restoring the ability for proper compensation of stresses throughout the body. Little is currently known about the ability for OMTs to reduce gait asymmetries, thereby reducing the risk of injury, accelerated disease progression, and suboptimal recovery.

OBJECTIVES

To demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking.

METHODS

Forty-two healthy adults (20 males, 22 females) between the ages of 18 and 35 were recruited for this prospective intervention. Standardized osteopathic screening exams were completed by a single physician for each participant, and osteopathic manipulation was performed targeting somatic dysfunctions identified in the screening exam. Three-dimensional (3-D) biomechanical assessments, including the collection of motion capture and force plate data, were performed prior to and following osteopathic manipulation to quantify gait mechanics. Motion capture and loading data were processed utilizing Qualisys Track Manager and Visual 3D software, respectively. Asymmetry in the following temporal, kinetic, and kinematic measures was quantified utilizing a limb symmetry index (LSI): peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. A 2-way repeated-measures analysis of variance model was utilized to evaluate the effects of time (pre/post manipulation) and sex (male/female) on each measure of gait asymmetry.

RESULTS

Gait asymmetry in the peak vertical ground reaction force (-0.6%, p=0.025) and the impulse of the vertical ground reaction force (-0.3%, p=0.026) was reduced in males following osteopathic manipulation. There was no difference in gait asymmetry between time points in females. Osteopathic manipulation did not impact asymmetry in peak knee flexion angle, step length, stride length, or stance time. Among the participants, 59.5% (25) followed the common compensatory pattern, whereas 40.5% (17) followed the uncommon compensatory pattern. One third (33.3%, 14) of the participants showed decompensation at the occipitoatlantal (OA) junction, whereas 26.2% (11), one third (33.3%, 14), and 26.2% (11) showed decompensation at the cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) junctions, respectively. Somatic dysfunction at the sacrum, L5, right innominate, and left innominate occurred in 88.1% (37), 69.0% (29), 97.6% (41), and 97.6% (41) of the participants, respectively.

CONCLUSIONS

Correcting somatic dysfunction can influence gait asymmetry in males; the sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait, prevent injury and the progression of disease, and aid in recovery after surgery.

Bilateral in vivo neuromechanical properties of the triceps surae and Achilles tendon in runners and triathletes

Inter-limb differences in Achilles tendon mechanical, material and morphological properties have previously been described in non-athletes and attributed to the preferential use of a given limb. Achilles tendon overuse tendon injury generally initiate unilaterally and alters triceps surae activation and Achilles tendon properties. The investigation of inter-limb differences in muscle activation and tendon properties may provide directions for injury prevention in habitual runners. In this study triceps surae and Achilles tendon properties were investigated bilaterally in habitual runners during unilateral maximal isometric contractions. Morphological, mechanical and material Achilles tendon properties were assessed using isokinetic dynamometry, motion capture and ultrasonography while triceps surae activation strategies were assessed using electromyography. Lower limb preference was assessed for inter-limb comparisons using the Waterloo questionnaire. Zero and one-dimensional statistical analysis and Cohen's d were employed to investigate possible inter-limb differences. Inter-limb associations in Achilles tendon properties and intra-limb associations between triceps surae activations were assessed using Pearson's correlation coefficients. No differences were observed between the preferred and non-preferred limb in terms of triceps surae muscle activation amplitude and Achilles tendon properties. However, intra-limb association among triceps surae activation ratios were not identical between limbs. Runners and triathletes present similar Achilles tendons properties between limbs, and thus initial observations of unilateral changes in the Achilles tendon properties might be used as a strategy to prevent the onset of overuse tendon injury. The non-similar associations within activation ratios between limbs should be further explored since triceps surae activation strategies may alter loading of the Achilles tendon.

Measuring Effects of Two-Handed Side and Anterior Load Carriage on Thoracic-Pelvic Coordination Using Wearable Gyroscopes

Manual carrying of heavy weight poses a major risk for work-related low back injury. Body-worn inertial sensors present opportunities to study the effects of ambulatory work tasks such as load carriage in more realistic conditions. An immediate effect of load carriage is reflected in altered gait kinematics. To determine the effects of load carriage mode and magnitude on gait parameters using body-worn angular rate gyroscopes, two laboratory experiments (n = 9 and n = 10, respectively) were conducted. Participants performed walk trials at self-selected speeds while carrying hand loads in two modes (two-handed side vs. anterior) at four load levels (empty-handed, 4.5 kg, 9.1 kg, and 13.6 kg). Six measures of postural sway and three measures of thoracic-pelvic coordination were calculated from data recorded by four body-worn gyroscopes for 1517 gait cycles. Results demonstrated that, after adjusting for relative walking speed, thoracic-pelvic sway, and movement coordination particularly in the coronal and transverse planes, characterized by gyroscope-based kinematic gait parameters, are systematically altered by the mode of load carriage and load magnitude. Similar trends were obtained for an anthropometrically homogenous (Expt-1) and diverse (Expt-2) sample after adjusting for individual differences in relative walking speed. Measures of thoracic-pelvic coordination and sway showed trends of significant practical relevance and may provide sufficient information to typify alterations in gait across two-handed side vs. anterior load carriage of different load magnitudes. This study contributes to understanding the effects of manual load carriage on thoracic-pelvic movement and the potential application of body-worn gyroscopes to measuring these gait adaptations in naturalistic work settings.

Variance of the Gait Parameters and Fraction of Double-Support Interval for Determining the Severity of Parkinson’s Disease

The aim of this study was to determine the gait features that are most suitable for the quantified assessment of the severity of Parkinson’s disease (PD). This study computed the mean and variance of the four phases of gait intervals, i.e., stride, swing, stance and double-support intervals, and lateral difference to determine the difference between three groups, i.e., control subjects and PD patients with two severity levels (early and advanced stage) of the disease, PD1 and PD2. Data from 31 subjects were used in the study. The data were obtained from the public database (16 control healthy subjects, 6 Parkinson’s disease patients with early stages, and 9 Parkinson’s disease patients with advanced stages based on the Hoehn and Yahr scale). The main outcome measure of the study was the group difference of the four gait interval parameters and the statistical significance of this difference. The results show that there was a significant increase in the variance of the four gait intervals with the severity of the disease. However, there was no significant difference in the mean values between the three groups. It was also observed that the fraction corresponding to the double-support interval was significantly higher for PD patients. This study has shown that the variance of the gait parameters and the fraction of double-support interval are associated with the severity of PD and may be suitable measures for a quantified evaluation of the disease.

Speed and temporal adaptations during nonmotorized treadmill walking in Parkinson disease and nondisabled individuals

Few studies have explored the potential of gait analysis and training in nonmotorized treadmill (NMT) in Parkinson's disease (PD) patients. We investigated (a) the walking strategy adopted by patients with PD on NMT and (b) how balance may influence spatiotemporal gait parameters. We enrolled 12 patients with PD of modified Hoehn and Yahr stage 2-3 and 13 nondisabled individuals as controls. All participants were evaluated using Tinetti's performance oriented mobility assessment scale, freezing of gait questionnaire, modified falls efficacy scale, and the timed up and go test. They were asked to ambulate with comfortable and maximal speeds on the NMT. The gait parameters acquired on the NMT included walking speed, cadence (CAD), step length, and vertical ground reaction force, which were calculated for intragroup and intergroup comparisons. The PD group took on with higher contribution of CAD and less contribution of step length to increase walking speed as compared with control group. The postural stability is correlated significantly positively to the CAD at the setting of maximal speed in the PD group. Moreover, a significantly lower ratio of vertical ground reaction force/body weight was noted in the PD group during both comfortable and maximal walking speeds compared with the nondisabled controls. Our study outcomes clearly support the perceived benefits of NMT to differentiate spatiotemporal gait parameters between PD and controls. NMT may potentially be useful to evaluate the recovery of physical activities in PD receiving medications and/or rehabilitation.

Models for temporal-spatial parameters in walking with cadence ratio as the independent variable

Accurate models that describe temporal-spatial parameters are desirable in gait estimation and rehabilitation. This study aimed to explore simple but relatively accurate models to describe stride length (SL), speed (SP) and walk ratio (WR) at various cadences. Twenty-four able-bodied participants (16 in a test group and 8 in a validation group) walked at seven cadence ratios (CRs). The individual and group mean SL, SP and WR were studied. Suitable temporal-spatial model structures were proposed and used to approximate the individual SL, SP and WR at various CRs. After the temporal-spatial model structures were found to be feasible, the general temporal-spatial models were analysed using the test group mean SL, SP and WR. Accuracy was assessed using the validation group mean values. Individual approximation accuracies showed that the proposed model structure deduced from the linear SL model was suitable for WR approximation. The linear, deduced quadratic and power functions approximated the individual SL, SP and WR, respectively, with high accuracy. Based on the test group mean SL, SP and WR, the general temporal-spatial models were obtained and produced comparable approximation accuracies in the validation group. The general temporal-spatial models predicted well the individual gait parameters with similar individual errors for both groups. These temporal-spatial models clearly describe SL, SP and especially WR at various cadences. They provide accurate reference data for gait estimation and have potential to guide speed modulation in robot-assisted gait rehabilitation.

Graphical abstract

A mixed linear modelling characterisation of gender and speed related changes in spatiotemporal and kinematic characteristics of gait across a wide speed range in healthy adults

In exploring the relationship between the kinematics of gait and speed of progression individual variation in patterns and gender differences have not always been adequately taken into account. In the current study mixed linear modelling was used to isolate changes with speed from those associated with individual variation and gender. Three-dimensional motion analysis of 20 participants (10M/10F, 25.7 ± 5.1 years) walking at a wide range of speeds (normalised speeds 0.10-0.55 ∼0.41-2.26 m/s) was recorded (775 walks). Spatiotemporal (speed, cadence, step length, percentage of single and double support) and kinematic characteristics (pelvis through ankle) were determined. Significant between participant differences were highlighted in both intercept and slope of relationships. In addition females exhibiting different peak pelvic tilt and obliquity, hip flexion and internal rotation and ankle dorsiflexion compared to males. Spatiotemporal parameters exhibited non-linear relationships with normalised speed (R²> 0.5). Kinematic features exhibited significant relationships with normalised speed, varying from linear to cubic, from very weak to strong in fit (0.010 > R²> 0.672). Mixed linear modelling highlighted gender dependent, speed related changes in addition to inter-individual variation. Gender and speed are both important determinants of gait patterns, however, individual variations remain.

Visual targeting one step before force plates has no effect on gait parameters in orthopaedic patients during level walking

In clinical gait analysis, it is challenging to acquire usable force plate data for a patient in a limited amount of time. The aim of this study was to compare three measurement protocols, to investigate if any one of them was more time-efficient than the others at collecting kinetic data. Three conditions were compared for 15 orthopaedic patients: 1) approaching the force plate with four steps, 2) approaching the force plate with six steps, and 3) approaching the force plate with four steps while stepping on a target one step before the first force plate. Then, the following characteristics were analysed: the rate of usable force plate steps, the spatio-temporal parameters, the full-body gait kinematics, and the lower body kinetics. For the condition with four steps and targeting, the rate of usable force plate steps was highest: 84% (6.8 usable trials out of 8.1 trials on average per patient). Left hip adduction and rotation, right shoulder flexion, and total left hip power were the gait parameters with statistically significant differences between the four and six step approach. Left cadence, right step time, left thorax lateroflexion, left shoulder abduction, total right knee power, hip rotation, thorax tilt, and head tilt on both sides were statistically different between the four step approach with targeting and without targeting. None of the differences in gait parameters (except for head tilt) were of clinical relevance. Therefore, approaching the force plate with four steps and stepping on a foot-sized target one step prior to stepping on the force plate increases the rate of usable kinetic data.

One-Legged Balance Test Times

Means and ranges of single-leg balance times for 8 studies of men and women from 50 to 90 years of age are generally consistent, except the 50- to 59-yr.-old men's mean from the Rudisill and Toole study.

Similarity of Center of Pressure Progression during Walking and Jogging of Anterior Cruciate Ligament Deficient Patients

OBJECTIVE

To evaluate the center of pressure (COP) progression similarity and its change during walking and jogging in Anterior Cruciate Ligament deficient (ACLD) patients.

METHODS

A study was performed in 64 unilateral ACLD subjects and 32 healthy volunteers who walked and jogged on footscan® system at a self-selected speed. COP trajectory during walking and jogging was calculated. The robustness and similarity scores of COP (SSCOP, similarity scores with respect to corresponding COP trajectories) were computed, and then the Analysis of Variance test was employed to compare among different conditions (left or right side, within a subject or between subjects, walking or jogging).

RESULTS

(1) During the same motion status (walking or jogging), SSCOP were higher than 0.885. However, SSCOP between walking and jogging were lower than 0.25 in both the healthy and ACLD group. SSCOP between the intrasubjects were statistically higher than those between the intersubjects (p<0.01). (2) SSCOP in the ACLD group were statistically significantly reduced to 0.885±0.074 compared to 0.912±0.057 in healthy volunteers during walking, and 0.903±0.066 in the ACLD group compared to 0.919±0.050 in the healthy group during jogging (p<0.01).

CONCLUSIONS

SSCOP can distinguish walking from jogging, and SSCOP of ACLD patients would be different from that of healthy controls. The study protocol was approved by the Institutional Research Board of Peking University Third Hospital (IRB00006761-2012010).

An investigation into the bilateral functional differences of the lower limb muscles in standing and walking

To date, most studies use surface electromyographic (sEMG) signals as the control source on active rehabilitation robots, and unilateral data are collected based on the gait symmetry hypothesis, which has caused much controversy. The purpose of this study is to quantitatively evaluate the sEMG activity asymmetry of bilateral muscles in lower extremities during functional tasks. Nine participants were instructed to perform static and dynamic steady state tests. sEMG signals from the tibialis anterior, soleus, medial gastrocnemius and lateral gastrocnemius muscles of bilateral lower extremities were recorded in the experiments. Muscle activities are quantified in terms of sEMG amplitude. We investigated whether characteristics of left limb and the one of the right limb have the same statistical characteristics during functional tasks using The Wilcoxon rank-sum test, and studied dynamic signal irregularity degree for sEMG activities via sample entropy. The total of muscle activities showed significant differences between left limb and right limb during the static steady state (p = 0.000). For dynamic steady states, there were significant differences for most muscle activities between left limb and right limb at different speeds (p = 0.000). Nevertheless, there was no difference between the lateral gastrocnemius for bilateral limb at 2.0 kilometers per hour (p = 0.060). For medial gastrocnemius, differences were not found between left limb and right limb at 1.0 and 3.0 kilometers per hours (p = 0.390 and p = 0.085, respectively). Similarly, there was no difference for soleus at 3.0 kilometers per hour (p = 0.115). The importance of the differences in muscle activities between left limb and right limb were found. These results can potentially be used for evaluating lower limb extremity function of special populations (elderly people or stroke patients) in an objective and simple method.

Bipedal Locomotion: Stopping and the Standing/Balance Gait

A bipedal locomotion system is synthesized to characterize some of the previously overlooked aspects of the locomotion process, specifically standing/balance and initiation and stopping. The locomotion system is described by a three-element three-dimensional model consisting of two lower limbs and an upper body. The system equations of motion are derived using variational methods, and are retained in their nonlinear form. The impulsive contact events of impact of the swing limb with the ground and transfer of support are incorporated into the model. Bipedal locomotion is synthesized through numerical simulations. Several control inputs are studied for establishing and sustaining the standing/balance gait. Subsequent motion is analyzed via phase-space portraits. It is shown that an impulsive torque is sufficient for establishing and controlling the standing/balance gait as well as steady locomotion.

The design of a functional assessment and gait analysis facility for rehabilitation studies

A general functional assessment and gait facility has been designed for use in all aspects of measurement of handicap. The functional assessment course contains various features to assess the ability of subjects with different handicaps to sit, take off and apply orthotic or prosthetic devices, climb ramps and steps, negotiate corners, and doors with different locking and opening mechanisms. Incorporated in the middle of the walking section of the course is a force plate to assess the mechanical function of orthoses or prostheses by a force vector visualization system. A visual analogue scoring system of the quality of performance of the various tasks encountered on the functional assessment course as well as the freely selected speed and fastest walking in a straight line has been adopted. This visual analogue score is marked after analysing the video record obtained from a mobile colour camera. The doors, ramps and walking area are wide enough to assess wheelchair use. We have adopted a 'gait graph' for the gait analyses using a 10m straight walkway and measuring the temporal parameters at free speed walking and the fastest walking speed. Energy cost is measured using heart rate monitoring by telemetry on the functional assessment course and during gait analysis.

It is proposed to use this facility for the assessment and management of lower limb bracing in children, patients undergoing corrective surgery on the lower limb and for wheelchair users.

Gait Characteristics When Walking on Different Slippery Walkways

OBJECTIVE

This study sought to determine the changes in muscle activity about the ankle, knee, and hip in able-bodied people walking at steady state on surfaces with different degrees of slipperiness.

METHODS

Muscle activity was measured through electromyographic signals from selected lower limb muscles and quantified to directly compare changes across surface conditions.

RESULTS

Our results showed distinct changes in the patterns of muscle activity controlling each joint. Muscles controlling the ankle showed a significant reduction in activity as the surface became more slippery, presumably resulting in a compliant distal joint to facilitate full contact with the surface. Select muscles about the knee and hip showed a significant increase in activity as the surface became more slippery. This resulted in increased knee and hip flexion likely contributing to a lowering of the body's center of mass and stabilization of the proximal leg and trunk.

CONCLUSION

These findings suggest a proximal-distal gradient in the control of muscle activity that could inform the future design of adaptable prosthetic controllers.

SIGNIFICANCE

Walking on a slippery surface is extremely difficult, especially for individuals with lower limb amputations because current prostheses do not allow the compensatory changes in lower limb dynamics that occur involuntarily in unimpaired subjects. With recent advances in prosthetic control, there is the potential to provide some of these compensatory changes; however, we first need to understand how able-bodied individuals modulate their gait under these challenging conditions.

Agreement of spatio-temporal gait parameters between a vertical ground reaction force decomposition algorithm and a motion capture system

INTRODUCTION

A ground reaction force decomposition algorithm based on large force platform measurements has recently been developed to analyze ground reaction forces under each foot during the double support phase of gait. However, its accuracy for the measurement of the spatiotemporal gait parameters remains to be established.

OBJECTIVE

The aim of the present study was to establish the agreement between the spatiotemporal gait parameters obtained using (1) a walkway (composed of six large force platforms) and the newly developed algorithm, and (2) an optoelectronic motion capture system.

METHODS

Twenty healthy children and adolescents (age range: 6-17 years) and 19 healthy adults (age range: 19-51 years) participated in this study. They were asked to walk at their preferred speed and at a speed that was faster than the preferred one. Each participant performed three blocks of three trials in each of the two walking speed conditions.

RESULTS

The spatiotemporal gait parameters measured with the algorithm did not differ by more than 2.5% from those obtained with the motion capture system. The limits of agreement represented between 3% and 8% of the average spatiotemporal gait parameters. Repeatability of the algorithm was slightly higher than that of the motion capture system as the coefficient of variations ranged from 2.5% to 6%, and from 1.5% to 3.5% for the algorithm and the motion capture system, respectively.

CONCLUSION

The proposed algorithm provides valid and repeatable spatiotemporal gait parameter measurements and offers a promising tool for clinical gait analysis. Further studies are warranted to test the algorithm in people with impaired gait.

General and Specific Strategies Used to Facilitate Locomotor Maneuvers

People make anticipatory changes in gait patterns prior to initiating a rapid change of direction. How they prepare will change based on their knowledge of the maneuver. To investigate specific and general strategies used to facilitate locomotor maneuvers, we manipulated subjects’ ability to anticipate the direction of an upcoming lateral “lane-change” maneuver. To examine specific anticipatory adjustments, we observed the four steps immediately preceding a maneuver that subjects were instructed to perform at a known time in a known direction. We hypothesized that to facilitate a specific change of direction, subjects would proactively decrease margin of stability in the future direction of travel. Our results support this hypothesis: subjects significantly decreased lateral margin of stability by 69% on the side ipsilateral to the maneuver during only the step immediately preceding the maneuver. This gait adaptation may have improved energetic efficiency and simplified the control of the maneuver. To examine general anticipatory adjustments, we observed the two steps immediately preceding the instant when subjects received information about the direction of the maneuver. When the maneuver direction was unknown, we hypothesized that subjects would make general anticipatory adjustments that would improve their ability to actively initiate a maneuver in multiple directions. This second hypothesis was partially supported as subjects increased step width and stance phase hip flexion during these anticipatory steps. These modifications may have improved subjects’ ability to generate forces in multiple directions and maintain equilibrium during the onset and execution of the rapid maneuver. However, adapting these general anticipatory strategies likely incurred an additional energetic cost.

Biomechanics of Lower Limbs during Walking among Candidates for Total Knee Arthroplasty with and without Low Back Pain

The effect of joint pathologies, such as unilateral knee osteoarthritis (UKOA) or low back pain (LBP), on bilateral gait symmetry has gained increased attention during the past decade. This study is the first to compare gait patterns between patients with UKOA and LBP in combination and with UKOA only. Temporal, kinematic, and kinetic variables were measured bilaterally during gait stance phase in 31 subjects with UKOA and LBP (Group I) and 11 subjects with only UKOA (Group II). Group I patients exhibited less hip rotation in the affected limb (A) than in the nonaffected (NA) limb during walking in contrast to Group II patients. Group I patients had minimal bilateral differences in hip abduction and flexion, but Group II patients displayed significantly larger values in the NA limb compared to the A limb for both parameters. Hip flexion patterns were significantly different between Groups I and II. Subjects in both groups adapted gait patterns that minimized vertical ground reaction force, knee flexion motion, and stance time on the UKOA affected limb. The distinct kinematic gait patterns that were revealed in this study may provide clinical value for assessment of patients with UKOA in conjunction with LBP.

Force plate targeting has no effect on spatiotemporal gait measures and their variability in young and healthy population

Force plate targeting has been referenced as a confounding factor in gait research, but the literature is sparse. Asking participants to target force plates is a convenient strategy to increase the number of acceptable trials, but may inadvertently alter the motor control of gait and limit external validity. This study aimed to investigate the effect of visual targeting on spatiotemporal, kinematic, and kinetic measures of gait and their variability. Young healthy participants were asked to traverse a walkway with three embedded hidden force plates. Starting from a participant-specific initial position and leading with the same foot each time, participants performed series of natural walking trials (no targeting and unaware of the hidden force plates), followed by targeting walking trials. For the targeting trials, participants were asked to step completely within the bounds of a tape outline (∼50cm×45cm), which coincided with the position of the last hidden force plate. The results demonstrated evidence of targeting during targeting trials; compared to natural walking trials, mean heel-target distance variability for targeting trials decreased progressively for the steps approaching the targeting step, reaching significance (p<0.05) for the target (41%), and post-target steps (39%). Despite visual targeting, no significant differences between targeting and natural trials were detected in spatiotemporal, kinematic, and kinetic gait measures, or the variability of the measures. When the experimental set-up was tailored to the individual participant's gait variables (step/stride length), visual targeting of the force plates appeared to have no effect on the magnitude or variability of any gait measures.

Normative values for the foot posture index between right and left foot: a descriptive study

BACKGROUND

The foot posture index (FPI) is a commonly used method to quantify standing foot posture. No normative data have, however, been presented to establish the range of a normal difference and asymmetrical differences between FPI score in the right foot and in the left foot.

PURPOSE

The purpose of the present study was to establish normative values for the difference between the FPI scores across the two feet.

METHODS

Among 930 healthy adults, FPI score was quantified in both feet. Difference between the two feet was calculated as FPI score on the right foot minus the FPI score on the left foot. Based on a normal distribution of the differences, asymmetry was defined as values below or above one standard deviation (SD) from the mean. Severe asymmetry was below and above ±2SD from the mean. Normal difference was defined as the range between ±1SD.

RESULTS

A reference range for normal difference in FPI score between left foot and right foot was -2 to +2. Asymmetry scores ranged from -2 to -4 and +2 to +4, while severe asymmetry was <-4 and >4.

CONCLUSION

Normative values for the difference between FPI scores in right foot and left foot have been presented from a large sample of healthy adults. These normative values can be used to identify a normal difference or an asymmetrical difference in foot posture across feet in one individual.

Functional foot symmetry and its relation to lower extremity physical performance in older adults: the Framingham Foot Study

BACKGROUND

While many studies use gait symmetry as a marker of healthy gait, the evidence that gait symmetry exists is limited. Because gait symmetry is thought to arise through laterality (i.e., limb preference) and affects gait retraining efforts, it is important to understand if symmetry exists during gait in older adults. Therefore, the purpose of this study was to evaluate foot and gait symmetry in the population-based Framingham Foot Study as well as to determine the effects of vertical force symmetry on physical performance measures.

METHODS

Members of the Framingham Foot Study were included in this analysis (N=1333). Foot function and force data were collected using the Tekscan Matscan during self-selected gait, with symmetry evaluated using the symmetry index. The short physical performance battery (SPPB) measures of balance, chair stands and gait speed assessed lower extremity physical function. Participants were evaluated using quartiles of gait speed and foot symmetry to determine the effects of symmetry on lower extremity physical function.

RESULTS

Individuals with faster gait speed displayed greater foot function asymmetry; individuals with -3.0% to -9.5% asymmetry in foot function performed better on the short physical performance battery (SPPB). Further, with aging, the degree of asymmetry was reduced.

CONCLUSIONS

While this research suggests that a moderate degree of foot asymmetry is associated with better lower extremity function, the causes of vertical force asymmetry are unknown. Future studies should evaluate the causes of foot asymmetry and should track the changes in symmetry that occur with aging.

Dynamic margins of stability during human walking in destabilizing environments

Understanding how humans maintain stability when walking, particularly when exposed to perturbations, is key to preventing falls. Here, we quantified how imposing continuous, pseudorandom anterior-posterior (AP) and mediolateral (ML) oscillations affected the control of dynamic walking stability. Twelve subjects completed five 3-minute walking trials in the Computer Assisted Rehabilitation ENvironment (CAREN) system under each of 5 conditions: no perturbation (NOP), AP platform (APP) or visual (APV) or ML platform (MLP) or visual (MLV) oscillations. We computed AP and ML margins of stability (MOS) for each trial. Mean MOS(ml) were consistently slightly larger during all perturbation conditions than during NOP (p≤0.038). Mean MOS(ap) for the APP, MLP and MLV oscillations were significantly smaller than during NOP (p<0.0005). Variability of both MOS(ap) and MOS(ml) was significantly greater during the MLP and MLV oscillations than during NOP (p<0.0005). We also directly quantified how the MOS on any given step affected the MOS on the following step using first-return plots. There were significant changes in step-to-step MOS(ml) dynamics between experimental conditions (p<0.0005). These changes suggested that subjects may have been trying to control foot placement, and consequently stability, during the perturbation conditions. Quantifying step-to-step changes in margins of dynamic stability may be more useful than mean MOS in assessing how individuals control walking stability.

Postural asymmetries in response to holding evenly and unevenly distributed loads during self-selected stance

The authors examined postural asymmetries during quiet stance and while holding evenly or unevenly distributed loads. Right-hand dominant subjects preferentially loaded their right lower limb when holding no load or a load evenly distributed in both hands, but no differences in center of pressure (CoP) were observed between the left and right limbs. However, longer CoP displacement was observed under the preferentially loaded limb, which may reflect a functional asymmetry that allows quick movement of one limb in response to a potential perturbation. When a load was held only in the nondominant hand, sample entropy decreased in the left (loaded) limb but increased in the right (unloaded) limb, suggesting the unloaded foot compensated for a loss of control flexibility in the loaded foot.

Gender comparison of psychophysical forces, cardiopulmonary, and muscle metabolic responses during a simulated cart pushing task

The purpose was to compare psychophysiological responses between healthy male and female workers during dynamic pushing. Using a psychophysical approach, 27 participants chose an acceptable force that they could push over a 7.6m distance at a frequency of 1 push per min on a treadmill. On a separate day, cardiopulmonary (e.g., whole-body oxygen uptake, heart rate, ventilation volume) and muscle metabolic measurements (change in muscle blood volume [ΔtHb] and Tissue Oxygenation Index [TOI]) from the right and left gastrocnemius muscles were collected simultaneously while participants pushed the previously chosen acceptable force on the treadmill at a similar frequency and distance for 2h. Results showed no significant difference between men and women for integrated force exerted on the instrumented treadmill handle and cardiopulmonary responses. In contrast, women demonstrated 45.7% lower ΔtHb but 3.6% higher TOI in the gastrocnemius region as compared to men, suggesting a lower hemoglobin concentration in women and high venous oxygen saturation during pushing. When ΔtHb and TOI were corrected for both body mass and pushing force, the disparity in gender was retained, implying an increased muscle oxygen saturation per force development in women than men during pushing. In the left gastrocnemius region, ΔtHb was 60% lower and TOI was 5.7% higher in women than men, suggesting an uneven muscle loading during pushing. Overall, the gender similarity in cardiopulmonary responses versus disparity in muscle metabolic responses suggest the importance of evaluating human performance during physical work at both whole-body and localized muscle levels.

Bilateral limb phase relationship and its potential to alter muscle activity phasing during locomotion

It is well established that the sensorimotor state of one limb can influence another limb and therefore bilateral somatosensory inputs make an important contribution to interlimb coordination patterns. However, the relative contribution of interlimb pathways for modifying muscle activation patterns in terms of phasing is less clear. Here we studied adaptation of muscle activity phasing to the relative angular positions of limbs using a split-crank ergometer, where the cranks could be decoupled to allow different spatial angular position relationships. Twenty neurologically healthy individuals performed the specified pedaling tasks at different relative angular positions while surface electromyographic (EMG) signals were recorded bilaterally from eight lower extremity muscles. During each experiment, the relative angular crank positions were altered by increasing or decreasing their difference by randomly ordered increments of 30 degrees over the complete cycle [0 degrees (in phase pedaling); 30, 60, 90, 120, 150, and 180 degrees (standard pedaling); and 210, 240, 270, 300, and 330 degrees out of phase pedaling]. We found that manipulating the relative angular positions of limbs in a pedaling task caused muscle activity phasing changes that were either delayed or advanced, dependent on the relative spatial position of the two cranks and this relationship is well-explained by a sine curve. Further, we observed that the magnitude of phasing changes in biarticular muscles (like rectus femoris) was significantly greater than those of uniarticular muscles (like vastus medialis). These results are important because they provide new evidence that muscle phasing can be systematically influenced by interlimb pathways.

Overground and walkway ambulation with unilateral hip osteoarthritis: comparison of step length asymmetries and reproducibility of treadmill mounted force plate readings

The purpose of this study was to analyze and compare the degree of step length asymmetry of patients with hip osteoarthritis during free walking and treadmill ambulation and to determine the reproducibility of treadmill based vertical ground reaction force parameters. Twelve subjects with monoarticular hip osteoarthritis undergoing total hip replacement surgery were assessed preoperatively. The assessed parameters were step length, maximal forces at heel strike and push off minimum force, force inclining and declining rate and relative stance time. The results indicated significant step length differences when comparing overground and treadmill ambulation. The extent of step length asymmetry did not have a consistent expression in different gait conditions. The study demonstrated sufficient intraday reliability for mean GRF measurements. While comparing data from treadmill and walkway locomotion of patients with osteoarthritis it should be taken into account that the amount of step length asymmetry is not identical. Patients with gait disabilities seem to have a somewhat lower level of repeatability and it appears that an increased number of practice or acclimatization trials are necessary.

Extracting kinematic parameters for monkey bipedal walking from cortical neuronal ensemble activity

The ability to walk may be critically impacted as the result of neurological injury or disease. While recent advances in brain–machine interfaces (BMIs) have demonstrated the feasibility of upper-limb neuroprostheses, BMIs have not been evaluated as a means to restore walking. Here, we demonstrate that chronic recordings from ensembles of cortical neurons can be used to predict the kinematics of bipedal walking in rhesus macaques – both offline and in real time. Linear decoders extracted 3D coordinates of leg joints and leg muscle electromyograms from the activity of hundreds of cortical neurons. As more complex patterns of walking were produced by varying the gait speed and direction, larger neuronal populations were needed to accurately extract walking patterns. Extraction was further improved using a switching decoder which designated a submodel for each walking paradigm. We propose that BMIs may one day allow severely paralyzed patients to walk again.

Propulsion and Braking in the Study of Asymmetry in Able-Bodied Men's Gaits

The present study was designed to test functional differences between both lower limbs in able-bodied gait according to fore-aft force impulse analyses and to assess the existence of a preferential lower limb for forward propulsion and braking. The leg that did more of the braking (Most Braking Limb) and the leg that did more of the propulsion (Most Propulsive Limb) were defined by the higher negative and positive impulses calculated from the anterior-posterior component of the ground reaction force. 24 adult men free of pain and injury to their lower extremities ( M age = 25.9 yr., SD = 4.5) performed 10 walking trials on a 10-m walkway with two force plates flush mounted in the middle. The anterior-posterior component of the velocity of the center of mass ( VAP) was calculated with the VICON system. Results highlighted two forms of asymmetry behaviour: although significant bilateral differences between the legs concerning the propulsive and braking impulses were found in all participants, 70.8% of the participants displayed a different Most Braking Limb than Most Propulsive Limb, whereas 25% used the same leg to produce both more propulsion and braking. High consistency was found in the behavioural strategy. Bilateral differences in VAP according to the gait cycle (Most Propulsive Limb vs Most Braking Limb) suggested a functional division of tasks between the two lower limbs for 70.8% of the participants. The study provides support for the relevancy of a functional categorization to highlight different asymmetry strategies in able-bodied gait.

A test of the functional asymmetry hypothesis in walking

The causes of bilateral asymmetries during able-bodied gait are unclear. These asymmetries may represent a form of functional asymmetry, which has been defined as a consistent task discrepancy between the two lower limbs. According to this theory, the non-dominant lower limb contributes more to support, while the dominant lower limb contributes more to forward propulsion. Impulses due to vertical and propulsive (anterior) ground reaction forces during gait are directly associated with center of mass support and forward propulsion, respectively, but have not yet been investigated in the context of functional asymmetry. The purpose of this study was to compare bilateral ground reaction force impulses to evaluate functional asymmetry as an explanation for gait asymmetries. We hypothesized that if gait asymmetries are functional in nature: (1) vertical impulse (support) would be greater for the non-dominant limb, (2) propulsive impulse would be greater for the dominant limb, and (3) increasing walking speed would cause disproportionate increases in dominant-limb propulsive impulse, relative to the non-dominant limb propulsive impulse. Asymmetry for vertical and propulsive impulses was quantified during slow, preferred, and fast walking in 20 healthy adults. No significant bilateral differences existed between sample means for vertical or propulsive impulses at the slow or preferred speeds, yet dominant-limb propulsive impulse was 7% greater than non-dominant limb propulsive impulse at the fast speed. In conclusion, impulses were generally symmetrical, offering little support for the functional asymmetry idea, except at the fast speed, where contributions to propulsion were greater for the dominant limb.

Effects of severity of degeneration on gait patterns in patients with medial knee osteoarthritis

This study tested the hypothesis that patients with mild and severe medial knee osteoarthritis (OA) adopt different compensatory gait patterns to unload the deseased knee, in not only the frontal plane but also the sagittal plane. Fifteen patients with mild and 15 with severe bilateral medial knee OA, and 15 normal controls walked while the kinematic and kinetic data were measured. Compared to the normal group, both OA groups had significantly greater pelvic anterior tilt, swing-pelvis list, smaller standing knee abduction, as well as smaller standing hip flexor and knee extensor moments during stance. The severe group also had greater hip abduction, knee extension and ankle plantarflexion. The mild group successfully reduced the extensor moment and maintained normal abductor moment at the diseased knee mainly through listing and anterior tilting the pelvis. With extra compensatory changes at other joints and increased hip abductor moment, the severe group successfully reduced the knee extensor moment but failed to reduce the abductor moment. These results suggest that, apart from training of the knee muscles, training of the hip muscles and pelvic control are essential in the rehabilitative intervention of patients with knee OA, especially for more severe patients.

Muscular lower leg asymmetry in middle-aged people

BACKGROUND

The purpose of this study was to determine whether muscular asymmetries were present in the lower legs of recreationally active middle-aged people grouped by leg dominance.

METHODS

Twelve healthy middle-aged subjects were analyzed bilaterally. The clinical variables included leg dominance, sports level, range of motion, lower leg alignment, calf circumference, and AOFAS (American Orthopaedic Foot and Ankle Society) ankle score. The biomechanical variables included maximal voluntary isometric ankle joint torque and surface electromyography (EMG) with determination of mean EMG frequency and intensity of four lower leg muscles: anterior tibial (AT), medial gastrocnemius (MG), soleus (SO), and peroneus longus (PL).

RESULTS

The mean EMG frequency was significantly lower in the dominant leg for the AT (dominant, 148.6 Hz; nondominant, 157.8 Hz) and MG muscles (dominant, 183.9 Hz; nondominant, 196.8 Hz). A significantly higher plantarflexion torque was found in the dominant leg (27.1 Nm) compared to the nondominant leg (22.9 Nm). Higher (not significant) dorsiflexion torque was found in the dominant leg (dominant, 27.3 Nm; nondominant, 24.8 Nm). The calf circumference was marginally significantly higher (p =0.039) in the dominant leg (34.2 cm; nondominant leg, 33.8 cm). The dominant leg had a higher but not significantly different mean EMG intensity for all four muscles.

CONCLUSIONS AND CLINICAL RELEVANCE

Differences in muscle EMG and torque were found between the dominant and nondominant lower leg. These results might be applicable to treatment, rehabilitation, and future research of lower leg and foot and ankle disorders.

Spatial parameters of walking gait and footedness

OBJECTIVE

The present study was undertaken to assess whether footedness has effects on selected spatial and angular parameters of able-bodied gait by evaluating footprints of young adults.

SUBJECTS AND METHODS

A total of 112 males and 93 females were selected from among students and staff members of the University of Malawi using a simple random sampling method. Footedness of subjects was assessed by the Waterloo Footedness Questionnaire Revised. Gait at natural speed was recorded using the footprint method. The following spatial parameters of gait were derived from the inked footprint sequences of subjects: step and stride lengths, gait angle and base of gait. The anthropometric measurements taken were weight, height, leg and foot length, foot breadth, shoulder width, and hip and waist circumferences.

RESULTS

The prevalence of right-, left- and mix-footedness in the whole sample of young Malawian adults was 81%, 8.3% and 10.7%, respectively. One-way analysis of variance did not reveal a statistically significant difference between footedness categories in the mean values of anthropometric measurements (p > 0.05 for all variables). Gender differences in step and stride length values were not statistically significant. Correction of these variables for stature did not change the trend. Males had significantly broader steps than females. Normalized values of base of gait had similar gender difference. The group means of step length and normalized step length of the right and left feet were similar, for males and females. There was a significant side difference in the gait angle in both gender groups of volunteers with higher mean values on the left side compared to the right one (t = 2.64, p < 0.05 for males, and t = 2.78, p < 0.05 for females). One-way analysis of variance did not demonstrate significant difference between footedness categories in the mean values of step length, gait angle, bilateral differences in step length and gait angle, stride length, gait base and normalized gait variables of male and female volunteers (p > 0.05 for all variables).

CONCLUSIONS

The present study demonstrated that footedness does not affect spatial and angular parameters of walking gait.

The effect of prosthesis alignment on the symmetry of gait in subjects with unilateral transtibial amputation

A high degree of gait symmetry is characteristic of healthy gait. The aim of this study is to examine the symmetry of various gait parameters in subjects with unilateral trans-tibial amputation over a range of acceptable anteroposterior translational and tilt alignments, and further to examine if a consistent alignment of highest symmetry can be found. Acceptable alignments were determined by bench, static and dynamic testing on level and non-level surfaces. A total of 15 kinetic and kinematic parameters were then measured in the seven subjects participating in this study. Results indicate that some parameters show consistently higher symmetries, particularly the vertical ground reaction force parameters and the stance duration, step length and time to full knee flexion during the swing phase. Symmetries in other parameters such as knee flexion at loading response, acceleration impulse, and peak anteroposterior propulsive force seem to have little relevance in determining whether the gait pattern for that prosthetic alignment is acceptable or not. While analysis of the symmetry of more relevant gait parameters may assist the prosthetist in consistently and objectively identifying a most symmetrical alignment within the acceptable range, further clinical study is required before any conclusions can be drawn regarding evaluation of symmetry as a tool in defining any optimum alignment.

Adaptations in interlimb and intralimb coordination to asymmetrical loading in human walking

The purpose of this study was to examine both the intralimb (within a limb) and interlimb (between the right and left limbs) adaptations that occur in response to a unilaterally applied leg load as subjects walked at their preferred walking speed. It was hypothesized that this adaptation would alter interlimb coordination while intralimb coordination remained invariant. Subjects (n = 12) were required to walk on a treadmill at preferred walking speed. Bilateral 3-D kinematic data were collected while a load placed on the leg was increased. Gait adaptations to leg-loading were assessed through changes in coordination patterns between specific limb couplings. Continuous relative phase (CRP) was used to evaluate changes in limb coordination under each experimental load condition compared to a no load baseline condition. Both changes in magnitude of CRP (root-mean-square (RMS) analysis) as well as temporal changes in CRP across the stride cycle (cross-correlation) were assessed. Cross-Correlation values changed with load for all interlimb couplings assessed suggesting alterations in interlimb coordination across the stride cycle. CRP cross-correlation values were close to 1.0 in all the intralimb couplings examined, showing a relative invariance in intralimb coordination. Coordination changes in RMS were also observed for the interlimb couplings. RMS changes were also observed in the intralimb couplings on the loaded side. It appears that gait adaptations to a unilaterally applied leg load appear both at the intralimb and interlimb level. However, the majority of changes did appear at the interlimb level, where CRP as assessed through both cross-correlation and RMS measures changed. This study supports previous results that suggested a tighter coupling exists at the intralimb level, leaving the majority of gait adaptations to occur at the interlimb level. The observed adaptation in differences between interlimb and intralimb coordination may provide insight into gait adaptations in pathological gait.

The effect of velocity on the strategies used during gait termination

The purpose of this study was to examine the changes that occur in gait termination (GT) as cadence increases. Five healthy volunteers walked at three cadences in time to a metronome under the following conditions: normal walking, planned stopping and unplanned stopping. Electromyography and force plate data were collected at 1000 Hz. Peak posterior ground reaction force (deceleration force) was greatest for the lead limb in unplanned stopping and, in general, deceleration force increased as cadence increased. Duration of muscle activity relative to the time to peak loading was unchanged by cadence and was always longest in the lead limb during planned stopping. As cadence increases, the signal to stop must occur earlier during stance phase if a person is to stop in the subsequent step.

Influence of speed variation and age on the asymmetry of ground reaction forces and stride parameters of normal gait in children

The purpose of this study was to assess the influence of age and speed on the asymmetry of ground reaction forces (GRFs) and spatiotemporal parameters (STPs) during normal gait in 4- to 10-year-old children. Forty-seven children walked at three speeds on a treadmill dynamometer (ADAL; Tecmachine, Andrézieux Bouthéon, France). Thirty steps were recorded at each speed for each foot for each child. The GRF and stride parameters were normalized to body weight and to body height, respectively. A left-right symmetry index (SI) was calculated for each parameter. The influence of both age and speed on the different SI was examined with a two-way analysis of variance. GRF and STP were asymmetric (SI ranged from +/- 1.92% to +/- 45.05%). The SI of forces Fz1 and Fy1 are negative in children aged 4-6 years, indicating that left Fz1 and Fy1 are higher than right Fz1 and Fy1. The cross effect of age and speed on the asymmetries of gait parameters was not significant There was no significant effect of age on the asymmetries of vertical GRF and STP. The asymmetry of vertical propulsive force (Fz3) alone increased with the speed (P < 0.05). This study showed that the different tasks performed by the lower limbs could be responsible for the asymmetry of GRF and STP in children aged 4-6 years. It also shows that upper and lower limits of normal asymmetry of gait parameters are different. Therefore no single criterion value can be used to assess the symmetry of several gait parameters. The small values of upper and lower limits of symmetry indices of vertical forces and stride duration show that the symmetry indices of these variables are reliable measurements and should thus be used in symmetry analysis of gait in normal and disabled children.

Gender differences in three dimensional gait analysis data from 98 healthy Korean adults

OBJECTIVES

The research hypothesis was that healthy adults would walk differently according to their gender when walked barefoot at their comfortable speed. The aim of this study was to prove the hypothesis in healthy Korean adults.

DESIGN

Between-gender statistical comparisons of the gait analysis data including spatiotemporal, three-dimensional joint kinematic and kinetic data.

BACKGROUND

There have been few attempts to identify the significant gender differences in gait pattern and to explore their possible causes.

METHODS

Healthy 98 Korean adults (47 females and 51 males) volunteered. Gait analysis data was obtained with opto-electric system and force plates. Normalization was used to avoid the body size effect. Gender difference was tested with independent t-test, ancova, and two-way repeated anova.

RESULTS

Females were shorter, both in height and leg length ( P < 0.05 ). The cadence and pelvic width were as great as in males. They walked slower than males due to shorter stride length ( P < 0.05 ). The females had still shorter stride length and narrower step width ( P < 0.05 ), and they walked as fast as the males. Females walked with their pelvis tilted more anteriorly and more up and down oblique motion, hip joints more flexed-adducted-internally rotated, knee joint in more valgus angles ( P = 0.05 ).

CONCLUSIONS

The gait analysis data had significant gender differences. We assume that the difference is due to gender features of the gait-related anatomy and habits. Comparison with other research shows some evidence for racial differences.

The influence of horizontal velocity on interlimb symmetry in normal walking

Changes in horizontal velocity (HV) are known to influence many biomechanical characteristics of human locomotion. The purpose of the present study was to investigate this phenomenon with respect to the interlimb symmetry of walking in a normal population. Peak and temporal ground reaction force data from both feet of 20 able-bodied males were collected at each of three relative velocity conditions (slow, normal and fast). These data were analyzed using of a series of 2 x 3 repeated measures ANOVAs, which revealed a high degree of interlimb (bilateral) symmetry across HV conditions despite significant intralimb (unilateral) changes. In contrast to this primary finding were two significant interaction effects for the stance time and peak vertical force at push-off measures respectively. These interactions indicated greater asymmetries at the slow HV condition with a trend toward improved symmetry at higher velocities. Although these results may provide some theoretical insight into the underlying nature of symmetry in gait, their overall magnitude does not seem to invalidate the current widespread use of symmetry assumptions in clinical and research settings today.

Local or global asymmetry in gait of people without impairments

Using two consecutive gait cycles, simultaneous and bilateral kinetic gait data, the main objectives of this study were (a) to identify the main functional roles of ankle, knee and hip extensors/flexors, and (b) to determine whether the action taken by these muscle groups appears to be symmetric or not. Gait of our able-bodied subjects appears to be asymmetric with significant differences noted between each two corresponding peak muscle moment values. Using principal component analysis (PCA) as a curve structure detection method, task discrepancies were recognized when comparisons were made between each two corresponding representative moment curves at each joint (local asymmetry). Muscle moment behaved symmetrically when the right limb representative curve was compared to its corresponding principal component (PC) at the contralateral limb. Gait of able-bodied subjects appears to be symmetric, while control and propulsion were recognized as two major roles of the extensors and flexors (global gait asymmetry). Symmetrical behavior of the lower limbs should be considered a consequence of local asymmetry which indicates different levels of within and between muscle activities developed at each joint during gait cycles.

Agreement between physiotherapists on quality of movement rated via videotape

BACKGROUND

Although achieving quality of movement after stroke is an important aim of physiotherapy it is rarely measured objectively or described explicitly.

OBJECTIVE

To test whether physiotherapists agree on a composite measure of quality of movement. SETTING; A movement analysis laboratory

SUBJECTS

Ten stroke patients and 10 healthy age-matched volunteers.

DESIGN

Prospective correlational.

PROCEDURE

All subjects were videofilmed performing three trials of six standardized functional tasks. Two videotapes were made, each with a different randomized order of appearance of the trials. Ten senior physiotherapists independently rated the videotapes twice using a 100-mm visual analogue scale.

ANALYSIS

Analysis of variance models were fitted to transformed data. Estimates of components of variance were calculated and presented as a percentage of the total variance for differences, within subjects (intra-subject), between raters (inter-rater) and within raters (intra-rater). An acceptable percentage was set at less than 10%.

RESULTS

The percentage of intra-subject variance ranged from 1% (pick up box and walking) to 9% (step on block). The percentage of inter-rater variance ranged from 18% (pick up pencil) to 38% (sit to stand). The percentage of intra-rater variance was less than 1% for all tasks.

CONCLUSIONS

Although physiotherapists disagreed with each other on quality of movement they were more consistent in their own scoring.

Predicting peak kinematic and kinetic parameters from gait speed

OBJECTIVE

The aim of this study is to assess the predictability of the relationships between gait speed and common peak sagittal plane parameters in order to provide a set of reference parameter values.

DESIGN

Lower extremity biomechanical data were collected in 64 healthy adults while walking barefoot at his/her comfortable walking speed, then at self-selected fast, slow and very slow speeds. Twenty seven peak joint parameter values were plotted and regressed as a function of gait speed.

DISCUSSION

While most parameters change with increasing gait speed, in general, the kinetic parameters had better predictability than the kinematic parameters. Most of the power parameters were found to have a quadratic relationship with gait speed. Of the moment parameters, four had a linear relationship with gait speed, while four had a quadratic one. These relationships shown in the tables and graphs here can be used as a reference for 'normal' gait parameter values.

Frequency-Domain Analysis Detects Previously Unidentified Changes in Ground Reaction Force with Visually Guided Foot Placement

Studies investigating the effect of targeting on gait have focused on the analysis of ground reaction force (GRF) within the time domain. Analysis within the frequency domain may be a more sensitive method for evaluating variations in GRF. The aim of the present study was to investigate the effect of visual targeting on GRF analyzed within the frequency domain. A within-subject repeated-measures design was used to measure the mediolateral, vertical, and antero-posterior components of the GRF of 11 healthy volunteers while walking at their own pace over a paper-covered walkway. A 30 × 24-cm target area was superimposed over a hidden Kistler force plate mounted at the midpoint of the walkway. GRF were recorded with and without the target and were analyzed within the frequency domain. Although visually guided foot placement has previously been undetected by traditional time-domain measures, targeting was found to significantly increase the frequency content of both the mediolateral (t10= -4.07,p <0.05) and antero-posterior (t10= -2.52,p <0.05) components of GRF. Consequently, it appears that frequency analysis is a more sensitive analytic technique for evaluating GRF. These findings have methodological implications for research in which GRF is used to characterize and assess anomalies in gait patterns.

Lower limb muscle power relationships in bilateral able-bodied gait

OBJECTIVE

The purpose of this study was to test the hypothesis that limb propulsion is mainly associated with the interaction of a number of muscle power bursts developed throughout the stance phase and that the control actions are mainly achieved by the contralateral limb through different power-burst interactions. We also hypothesized that the power activities of the propulsion limb would be related to those of the control limb.

DESIGN

Sixty gait trials of 20 subjects with dominant right hands and right legs were chosen for analysis. Each trial represents a performance of an able-bodied gait. Data were assessed using an eight-camera, high-speed, video-based system synchronized to two force plates. The muscle powers and their related mechanical energies were calculated at each joint and in each plane of the lower limbs by use of an inverse dynamic technique. The Pearson correlation method was used to determine the relationships within each limb by use of the data identified by principal component analysis, whereas a canonical correlation analysis was performed to illustrate the interaction between the limbs.

RESULTS

Gait propulsion was an activity initiated by the hip shortly after heel-strike and maintained throughout the stance phase. Control was the main task of the left limb as evidenced by the power absorption bursts at the hip and knee. The left limb power generations were generally secondary to control activities and were possibly involved in adjustments to correct the other limb's propulsion. Interlimb interaction further emphasized the functional relationship between forward progression and control tasks developed by each limb and highlighted the importance of the frontal and transverse plane actions during gait.

CONCLUSION

These results do not support the hypothesis that the ankle was a major contributor to forward progression.

Trans-tibial amputee gait: time-distance parameters and EMG activity

Gait analysis of trans-tibial (TT) amputees discloses asymmetries in gait parameters between the amputated and sound legs. The present study aimed at outlining differences between both legs with regard to kinematic parameters and activity of the muscles controlling the knees. The gait of 14 traumatic TT amputees, walking at a mean speed of 74.96 m/min, was analysed by means of an electronic walkway, video camera, and portable electromyography system. Results showed differences in kinematic parameters. Step length, step time and swing time were significantly longer, while stance time and single support time were significantly shorter on the amputated side. A significant difference was also found between knee angle in both legs at heel strike. The biceps femoris/vastus medialis ratio in the amputated leg, during the first half of stance phase, was significantly higher when compared to the same muscle ratio in the sound leg. This difference was due to the higher activity of the biceps femoris, almost four times higher than the vastus medialis in the amputated leg. The observed differences in time-distance parameters are due to stiffness of the prosthesis ankle (the SACH foot) that impedes the normal forward advance of the amputated leg during the first half of stance. The higher knee flexion at heel strike is due to the necessary socket alignment. Unlike in the sound leg, the biceps femoris in the amputated leg reaches maximal activity during the first half of stance, cocontracting with the vastus medialis, to support body weight on the amputated leg. The obtained data can serve as a future reference for evaluating the influence of new prosthetic components on the quality of TT amputee's gait.

The effect of visual targeting on ground reaction force and temporospatial parameters of gait

BACKGROUND

Visual targeting has been cited as a confounding factor for gait analysis in which measures of ground reaction force and plantar pressure are obtained.

OBJECTIVE

To investigate the effect of visual targeting on temporospatial and kinetic aspects of gait when small targets, such as pressure platforms, have to be used.

DESIGN

A within subjects repeated measure design was used to measure step parameters and ground reaction forces of 11 healthy volunteers.

METHODS

Subjects were required to walk over a 10 m walkway at a self-selected pace. A 30x24 cm(2) target area was superimposed over a hidden Kistler force plate (60x90 cm(2)) mounted at the midpoint of the walkway. Step parameters and ground reaction forces were measured with and without the presence of the target. Ground reaction forces were analysed within the time-domain.

RESULTS

Subjects used visual control strategies when approaching targets of similar dimensions to a pressure platform. These strategies were manifested by an increase in the variability of the step length onto the target (P<0.05). However, targeting was observed to have no affect on the magnitude, timing and variability of ground reaction forces when measured within the time-domain and averaged over five trials (P>0.05).

CONCLUSIONS

Visual control strategies employed while walking toward a target area have no affect on ground reaction force parameters when measured within the time-domain.

RELEVANCE

These findings demonstrate that targeting a 30x24 cm(2) target does not affect ground reaction force parameters, when a gait protocol that fine-tunes the start position is employed. The findings are relevant to gait research in which small force or pressure platforms are used to assess gait kinetics.