Influence of a rhythmic auditory stimulation on asymptomatic gait

Inducing asymmetric gait in healthy walkers: a review

Gait symmetry between both legs is a typical hallmark of healthy walking. In contrast, several pathologies induce asymmetry in the gait pattern, regarding both spatial and temporal features. This can be due to either an asymmetrical change of the body morphology-e.g., after an amputation or an injury-or a damage in the brain-such as stroke or cerebral palsy. This deficit in gait symmetry usually induces higher metabolic effort in locomotion and might further accelerate severe comorbidities such as osteoarthritis and low back pain. Consequently, several assistive devices-such as active exoskeletons or prostheses-are currently developed to mitigate gait asymmetry and restore a healthier gait pattern. Typically, the development of such devices requires extensive tests and validations, and it is practically and ethically not always desirable to recruit disabled patients to run these tests in the preliminary stages of development. In this review paper, we collect and analyse the different reversible interventions described in the literature that can induce asymmetry in the gait pattern of healthy walkers. We perform a systematic literature research by exploring five databases, i.e., Pubmed, Embase, Web of Science, Google Scholar, and Scopus. This narrative review identifies more than 150 articles reporting 16 different interventional methods used to induce asymmetric gait pattern in healthy walkers or with the potential to do so. These interventions are categorized according to their mode of action, and their effects on spatiotemporal parameters, joint kinematics and kinetics are summarized adopting a macroscopic viewpoint. Interventions are compared in terms of efficacy, maturity of the results, and applicability. Recommendations are provided for guiding researchers in the field in using each of the identified manipulations in its most relevant research contexts.

Full-body kinematics and head stabilisation strategies during walking in patients with chronic unilateral and bilateral vestibulopathy

Chronic imbalance is a frequent and limiting symptom of patients with chronic unilateral and bilateral vestibulopathy. A full-body kinematic analysis of the movement of patients with vestibulopathy would provide a better understanding of the impact of the pathology on dynamic tasks such as walking. Therefore, this study aimed to investigate the global body movement during walking, its variability (assessed with the GaitSD), and the strategies to stabilise the head (assessed with the head Anchoring Index). The full-body motion capture data of 10 patients with bilateral vestibulopathy (BV), 10 patients with unilateral vestibulopathy (UV), and 10 healthy subjects (HS) walking at several speeds (slow, comfortable, and fast) were analysed in this prospective cohort study. We observed only a few significant differences between groups in parts of the gait cycle (shoulder abduction-adduction, pelvis rotation, and hip flexion-extension) during the analysis of kinematic curves. Only BV patients had significantly higher gait variability (GaitSD) for all three walking speeds. Head stabilisation strategies depended on the plan of motion and walking speed condition, but BV and UV patients tended to stabilise their head in relation to the trunk and HS tended to stabilise their head in space. These results suggest that GaitSD could be a relevant biomarker of chronic instability in BV and that the head Anchoring Index tends to confirm clinical observations of abnormal head-trunk dynamics in patients with vestibulopathy while walking.

The Effect of Human Settlement Pedestrian Environment on Gait of Older People: An Umbrella Review

Older people are limited by the pedestrian environment in human settlements and are prone to travel difficulties, falls, and stumbles. Furthermore, we still lack systematic knowledge of the pedestrian environment affecting the gait of older people. The purpose of this review is to synthesize current evidence of effective human settlement pedestrian environments interfering with gait in older people. The systematic effects of the human settlement pedestrian environment on gait in older people are discussed. Databases such as Web of Science, Medline (via PubMed), Scopus, and Embase were searched for relevant studies up to June 2022. The literature was screened to extract relevant evidence from the included literature, assess the quality of the evidence, and analyze the systematic effects of the pedestrian environment on gait in older people. From the 4297 studies identified in the initial search, 11 systematic reviews or meta-analysis studies were screened, from which 18 environmental factors and 60 gait changes were extracted. After removing duplicate elements and merging synonymous features, a total of 53 relationships between environmental factors and gait change in older people were extracted: the main human settlement pedestrian environmental factors affecting gait change in older people in existing studies were indoor and outdoor stairs/steps, uneven and irregular ground, obstacles, walking path turns, vibration interventions, mechanical perturbation during gait, and auditory sound cues. Under the influence of these factors, older people may experience changes in the degree of cautiousness and conservatism of gait and stability, and their body posture performance and control, and muscle activation may also be affected. Factors such as ground texture or material, mechanical perturbations during gait, and vibration interventions stimulate older people's understanding and perception of their environment, but there is controversy over the results of specific gait parameters. The results support that human settlements' pedestrian environment affects the gait changes of older people in a positive or negative way. This review may likely contribute evidence-based information to aid communication among practitioners in public health, healthcare, and environmental construction. The above findings are expected to provide useful preference for associated interdisciplinary researchers to understand the interactions among pedestrian environments, human behavior, and physiological characteristics.

Synchronization performance affects gait variability measures during cued walking

BACKGROUND

Incorporating variability within gait rehabilitation offers a promising approach to restore functional capacity. However, it's success requires adequate synchronization, a parameter that lacks report in most of the literature regarding cued gait training.

RESEARCH QUESTION

How changes to synchronization performance during fractal-like and isochronous cueing impacts gait variability measures?

METHODS

We asked twelve young male participants to walk in synchronization to two different temporally structure cueing (isochronous [ISO] and fractal [FRC]). We have also manipulated the cueing's tempo by increasing and decreasing it by 5% to manipulate synchronization, resulting in six conditions (stimuli [ISO,FRC] x tempo [SLOW, NORMAL, FAST]). The normal condition was set from an uncued trial through the participant's self-paced stride time. Synchronization performance (ASYNC) and gait variability (fractal scaling and coefficient of variation) were calculated from stride time data ( -ISIs,CV-ISIs). Repeated measures analysis of variance or Aligned Rank Transform were conducted to determine significant differences between metronome tempo and stimuli for the dependent variables RESULTS: Our results showed a FAST tempo decreases synchronization performance (ASYNC) and leads to lower -ISIs, for both ISO and FRC stimuli. This indicates that when an individual exhibits poor synchronization during cued gait training, his/her gait variability patterns will not follow the temporal structure of the presented metronome. Specifically, if the individual poorly synchronizes to the cues, the gait patterns become more random, a condition typically observed in older adults and neurological patients, which runs contrary to the hypothesis when using fractal-like metronomes.

SIGNIFICANCE

This study provides supporting evidence that measuring synchronization performance in cued training is fundamental for a proper clinical interpretation of its effects. This is particularly relevant for the recent and ongoing clinical research using fractal-like metronomes since the expected gait patterns are dependent on the synchronization performance. Randomized control trials must incorporate synchronization performance related measures.

Superposition principle applies to human walking with two simultaneous interventions

Gait rehabilitation therapies provide adjusted sensory inputs to modify and retrain walking patterns in an impaired gait. Asymmetric walking is a common gait abnormality, especially among stroke survivors. Physical therapy interventions using adaptation techniques (such as treadmill training, auditory stimulation, visual biofeedback, etc.) train gait toward symmetry. However, a single rehabilitation therapy comes up short of affecting all aspects of gait performance. Multiple-rehabilitation therapy applies simultaneous stimuli to affect a wider range of gait parameters and create flexible training regiments. Understanding gait responses to individual and jointly applied stimuli is important for developing improved and efficient therapies. In this study, 16 healthy subjects participated in a four-session experiment to study gait kinetics and spatiotemporal outcomes under training. Each session consisted of two stimuli, treadmill training and auditory stimulation, with symmetric or asymmetric ratios between legs. The study hypothesizes a linear model for gait response patterns. We found that the superposition principle largely applies to the gait response under two simultaneous stimuli. The linear models developed in this study fit the actual data from experiments with the r-squared values of 0.95 or more.

Effect of Short-Term Metro-Rhythmic Stimulations on Gait Variability

The aim of the study was to define the effect of different short-term metro-rhythmic stimulations on the time and spatial parameters of gait. The secondary goal was to test whether prior instructions on how to respond to stimulations played a significant role in the stimulation by sound stimuli. Experimental tests of gait were conducted on a group of 36 healthy participants: group 1—subjects who were not informed how to react after hearing sound stimuli, group 2—subjects who received a clear instruction before the test to adjust the frequency of taking steps to the rhythm of the music. The gait research was carried out on a Zebris FDM-S (zebris Medical Gmbh, Isny, Germany) treadmill for various sound stimuli (arrhythmic stimulus, rhythmic stimuli at different rate). It was shown that a short-term influence of metro-rhythmic stimulations changes the time and spatial parameters of gait, i.e., gait frequency, length and duration of the gait cycle. The greatest impact on the modification of the time–space parameters of walking is exerted by rhythmic stimuli at a pace different from the frequency of gait at a preferred velocity. Providing information on how to respond to sounds heard may be important in gait therapy with RAS (rhythmic auditory stimulation).

Rhythmic Auditory Stimulation as an Adjuvant Therapy Improved Post-stroke Motor Functions of the Upper Extremity: A Randomized Controlled Pilot Study

OBJECTIVES

To explore whether rhythmic auditory stimulation (RAS) could improve motor functions of post-stroke hemiparetic upper extremity.

DESIGN

A prospective, randomized controlled, assessor-blinded pilot study.

METHODS

Thirty stroke patients were randomly distributed into the RAS group (n = 15) and the control group (n = 15). Both groups received regular therapies. The RAS group received additional 30 min of RAS training, while the control group received additional 30 min of regular therapies for 5 days per week for 4 weeks. The Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI) were used. The co-activation interval and co-contraction index were calculated from surface electromyography (sEMG) recordings on the affected biceps and triceps during elbow flexion and extension. Assessments were performed before and after the treatments.

RESULTS

Significant improvements in motor functions were observed within both groups (p < 0.05 in the FMA-UE, WMFT, and BI, respectively), as well as between groups after the treatments (higher scores in the RAS group, all p < 0.05 except for p = 0.052 in the FMA-UE; group × time interaction, all p < 0.05). Statistical significance was found in the co-activation interval between groups after the treatments (lower in the RAS group; p = 0.022 during elbow extension; p = 0.001 during elbow flexion; group × time interaction, p < 0.05 only during elbow extension). No statistical significance was found in the co-contraction index between groups; an inversed pattern of changes was observed between groups supported by relatively higher increments in the triceps recruitments to the biceps.

CONCLUSION

Using RAS in task-oriented exercises was effective in moderating co-contraction, facilitating task-oriented movements of the hemiparetic upper extremity, and improving ADLs among those who had emerging isolated joint movements. The effects were evident on sEMG possibly by adjusting the balance of recruitments between the agonist and the antagonist.

CLINICAL TRIAL REGISTRATION

The study was registered at the Chinese Clinical Trial Registry (No. 1900026665).

A multimodal dataset of human gait at different walking speeds established on injury-free adult participants

Human motion capture is used in various fields to analyse, understand and reproduce the diversity of movements that are required during daily-life activities. The proposed dataset of human gait has been established on 50 adults healthy and injury-free for lower and upper extremities in the most recent six months, with no lower and upper extremity surgery in the last two years. Participants were asked to walk on a straight level walkway at 5 speeds during one unique session: 0-0.4 m.s^-1, 0.4-0.8 m.s^-1, 0.8-1.2 m.s^-1, self-selected spontaneous and fast speeds. Three dimensional trajectories of 52 reflective markers spread over the whole body, 3D ground reaction forces and moment, and electromyographic signals were simultaneously recorded. For each participants, a minimum of 3 trials per condition have been made available in the dataset for a total of 1143 trials. This dataset could increase the sample size of similar datasets, lead to analyse the effect of walking speed on gait or conduct unusual analysis of gait thanks to the full body markerset used.

Lower limb sagittal gait kinematics can be predicted based on walking speed, gender, age and BMI

Clinical gait analysis attempts to provide, in a pathological context, an objective record that quantifies the magnitude of deviations from normal gait. However, the identification of deviations is highly dependent with the characteristics of the normative database used. In particular, a mismatch between patient characteristics and an asymptomatic population database in terms of walking speed, demographic and anthropometric parameters may lead to misinterpretation during the clinical process. Rather than developing a new normative data repository that may require considerable of resources and time, this study aims to assess a method for predicting lower limb sagittal kinematics using multiple regression models based on walking speed, gender, age and BMI as predictors. With this approach, we were able to predict kinematics with an error within 1 standard deviation of the mean of the original waveforms recorded on fifty-four participants. Furthermore, the proposed approach allowed us to estimate the relative contribution to angular variations of each predictor, independently from the others. It appeared that a mismatch in walking speed, but also age, sex and BMI may lead to errors higher than 5° on lower limb sagittal kinematics and should thus be taken into account before any clinical interpretation.

Music Therapy and Dance as Gait Rehabilitation in Patients With Parkinson Disease: A Review of Evidence

AIM

This review aims to demonstrate the efficiency of music and dance for gait improvement and symptom alleviation in Parkinson disease.

METHODOLOGY

Studies that analyzed sound stimuli and dance in gait improvement in Parkinson disease were searched through PubMed, Scopus, Doaj, MEDLINE, and ScienceDirect databases from November 2017 to April 2018 and repeated in September 2018.

RESULTS AND DISCUSSION

Forty-five studies met the inclusion criteria to synthesize the findings on dance and music performance as a treatment for classical symptoms of Parkinson disease. Five reviews and 40 experimental papers have shown that rhythmic stimulation and dance provide the motor, cognitive, and quality of life benefits for participants with Parkinson disease. Thus, sound stimuli and dance offer satisfactory effects for gait, improving cognitive abilities such as motor control and adjustment and spatial memory. In addition, these new treatment modalities stimulate the elderly population to practice physical exercise, generating well-being and helping self-esteem.

CONCLUSION

Dance and music therapy interventions are noninvasive, simple treatment options, which promote gait and cognition.

Effect of Rhythmic Auditory Cueing on Aging Gait: A Systematic Review and Meta-Analysis

Rhythmic auditory cueing has been widely used in gait rehabilitation over the past decade. The entrainment effect has been suggested to introduce neurophysiological changes, alleviate auditory-motor coupling and reduce cognitive-motor interferences. However, a consensus as to its influence over aging gait is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal gait parameters among healthy young and elderly participants. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until May 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 2789 records, 34 studies, involving 854 (499 young/355 elderly) participants met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e. gait velocity (Hedge's g: 0.85), stride length (0.61), and cadence (1.1), amongst both age groups. This review, for the first time, evaluates the effects of auditory entrainment on aging gait and discusses its implications under higher and lower information processing constraints. Clinical implications are discussed with respect to applications of auditory entrainment in rehabilitation settings.

Influence of normative data's walking speed on the computation of conventional gait indices

The pathology's impact on gait pattern may be overestimated by conventional gait indices (Gillette Gait Index - GGI, Gait Deviation Index - GDI, Gait Profile Score - GPS), since impairments' consequences on kinematics may be amplified by a change in walking speed. The objectives of this study were to evaluate the influence of walking speed on the computation of gait indices and to propose a corrective method to cancel the effects of walking speed. Spatiotemporal parameters and kinematics of fifty-four asymptomatic participants (30 M/24 W, 37.9 ± 13.7 years, 72.8 ± 13.3 kg, 1.74 ± 0.10 m) were collected at four speed conditions (C₁:[0,0.4] m s^-1, C₂:[0.4,0.8] m s^-1, C₃:[0.8,1.2] m s^-1, C₄:spontaneous). Four values of each index were computed for each trial using successively the four conditions as normative data repository. Mean values over all participants were statistically compared (paired t-tests, 95% confidence level). Indices values computed with normative at equivalent walking speed were not statistically different from reference values. Meanwhile, deviations appeared when the walking speed discrepancy between conditions and normative increased. These drifts related to walking speed mismatch have been quantified and fitting functions proposed. A correction was applied to indices. GGI was efficiently adjusted while GDI and GPS remain different from their reference values for C₁ and C₂. Gait indices must be interpreted cautiously in function of the normative data repository's walking speed used for computation. Furthermore, a coupled use of conventional and corrected gait indices could lead to a better comprehension of the contribution of impairments and walking speed on gait deviations and overall gait quality.