Assessing Reliability of Measurement of Gait Velocity

The effects of vibrating shoe insoles on standing balance, walking, and ankle-foot muscle activity in adults with diabetic peripheral neuropathy

BACKGROUND

Peripheral neuropathy is one of the most common complications of type 2 diabetes, which can lead to impaired balance and walking. Innovative footwear devices designed to stimulate foot sensory receptors, such as vibrating insoles, could offer a new route to improve motor impairments in people with diabetic peripheral neuropathy (DPN).

RESEARCH QUESTION

Does wearing vibrating insoles for the first time alter measures of balance, walking, and ankle-foot muscle activity, in people with DPN?

METHODS

A randomised cross-over study was conducted with 18 ambulant men and women with a diagnosis of DPN. Participants performed tests of standing balance (Bertec® force platform) under four conditions (foam/firm surface, eyes open/closed) and level-ground walking (GAITRite® instrumented walkway), whilst wearing vibrating and non-vibrating (control) insoles on two separate occasions (one insole/session). Electromyography (EMG) was used to assess soleus, medial gastrocnemius, tibialis anterior, peroneus longus activity during balance tests. Outcomes included centre of pressure (CoP) sway, EMG amplitude, spatiotemporal gait patterns, and Timed Up and Go test. One sample t-tests were used to explore %differences in outcomes between insole conditions.

RESULTS

Wearing vibrating insoles led to a reduction (improvement) in CoP elliptical area, when standing on a foam surface with eyes closed, relative to non-vibrating insoles (P=0.03). Applying perceptible vibrations to the soles of the feet also reduced the EMG amplitude in soleus (P=0.01 and P=0.04) and medial gastrocnemius (P=0.03 and P=0.09) when standing with eyes closed on firm and foam surfaces.

SIGNIFICANCE

Our findings of signs of improved balance and altered muscle activity with suprasensory vibrating insoles provides new insights into how these devices can be used to inform innovative rehabilitation approaches in individuals with DPN. This will be strengthened by further research into possible clinical benefits of these devices - given that the effects we detected were small with uncertain clinical meaning.

Immediate effects of wearing textured versus smooth insoles on standing balance and spatiotemporal gait patterns when walking over even and uneven surfaces in people with multiple sclerosis

PURPOSE

To investigate the immediate effects of wearing novel sensory-stimulating textured insoles on balance and gait in 41 people with multiple sclerosis (pwMS).

MATERIALS AND METHODS

Assessments of balance (firm/foam surface; eyes open/closed) and walking (when negotiating even/uneven surfaces) were performed wearing textured insoles, smooth insoles, shoes only, and barefoot. Outcome measures were centre of pressure (CoP) movement during standing (elliptical area, sway path velocity) and spatiotemporal gait patterns (stride/step width, stride time, double-limb support time, stride length, velocity).

RESULTS

Wearing textured insoles led to reductions in CoP velocity measures when standing on foam with eyes open and closed when compared to barefoot (p values ≤0.02). Textured insoles did not appear to be consistently superior to smooth insoles or shoes only for improving gait. Relative to the insole/shoe conditions, walking barefoot led to poorer gait performance for the even and uneven surface tasks (p values ≤0.03).

CONCLUSIONS

For pwMS, stimulating the foot with "texture" appears to provide enhanced sensory input with the capacity to improve CoP movement control during standing; offering a potential new treatment option for balance rehabilitation. Further research is needed to identify which individuals may benefit most from textured insoles.Implications for rehabilitationTextured shoe insoles, designed to stimulate plantar mechanoreceptors, are a novel approach to improve standing balance and walking patterns in people with multiple sclerosis (pwMS).Wearing textured insoles for the first time can lead to improvements in centre of pressure movement control when standing on an unstable compliant supporting surface.Textured insoles offer a potential new treatment technique for balance rehabilitation in pwMS who show early signs of diminished foot sensation.

Effects of wearing textured versus smooth shoe insoles for 12 weeks on gait, foot sensation and patient-reported outcomes, in people with multiple sclerosis: a randomised controlled trial

BACKGROUND

Innovative shoe insoles, designed to enhance sensory information on the plantar surface of the feet, could help to improve walking in people with Multiple Sclerosis.

OBJECTIVE

To compare the effects of wearing textured versus smooth insoles, on measures of gait, foot sensation and patient-reported outcomes, in people with Multiple Sclerosis.

METHODS

A prospective, randomised controlled trial was conducted with concealed allocation, assessor blinding and intention-to-treat analysis. Thirty ambulant men and women with multiple sclerosis (MS) (Disease Steps rating 1-4) were randomly allocated to wear textured or smooth insoles for 12 weeks. Self-reported insole wear and falls diaries were completed over the intervention period. Laboratory assessments of spatiotemporal gait patterns, foot sensation and proprioception, and patient-reported outcomes, were performed at Weeks 0 (Baseline 1), 4 (Baseline 2) and 16 (Post-Intervention). The primary outcome was the size of the mediolateral base of support (stride/step width) when walking over even and uneven surfaces. Independent t-tests were performed on change from baseline (average of baseline measures) to post-intervention.

RESULTS

There were no differences in stride width between groups, when walking over the even or uneven surfaces (P ≥ 0.20) at post-intervention. There were no between-group differences for any secondary outcomes including gait (all P values > 0.23), foot sensory function (all P values ≥ 0.08) and patient-reported outcomes (all P values ≥ 0.23).

CONCLUSIONS

In our small trial, prolonged wear of textured insoles did not appear to alter walking or foot sensation in people with MS who have limited foot sensory loss. Further investigation is needed to explore optimal insole design.

CLINICAL TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry (ACTRN12615000421538).

Age-related gait standards for healthy children and young people: the GOS-ICH paediatric gait centiles

OBJECTIVE

To develop paediatric gait standards in healthy children and young people.

METHODS

This observational study aims to address the lack of population standards for gait measurements in children. Analysing gait in children affected by neurological or musculoskeletal conditions is an important component of paediatric assessment but is often confounded by developmental changes. The standards presented here do not require clinician expertise to interpret and offer an alternative to developmental tables of normalised gait data. Healthy children aged 1-19 years were recruited from community settings in London and Hertfordshire, UK. The GAITRite walkway was used to record measurements for each child for velocity, cadence, step length, base of support and stance, single and double support (as percentage of gait cycle). We fitted generalised linear additive models for location, scale and shape (gamlss).

RESULTS

We constructed percentile charts for seven gait variables measured on 624 (321 males) contemporary healthy children using a gamlss package in R. A clinical application of gait standards was explored.

CONCLUSION

Age-related, gender-specific standards for seven gait variables were developed and are presented here. They have a familiar format and can be used clinically to aid diagnoses and to monitor change over time for both medical therapy and natural history of the condition. The clinical example demonstrates the potential of the Great Ormond Street Institute of Child Health Paediatric Gait Centiles to enable meaningful interpretation of change in an individual's performance and describes characteristic features of gait from a specific population throughout childhood.

Textured shoe insoles to improve balance performance in adults with diabetic peripheral neuropathy: study protocol for a randomised controlled trial

INTRODUCTION

Peripheral neuropathy is a major risk factor for falls in adults with diabetes. Innovative footwear devices which artificially manipulate the sensory environment at the feet, such as textured shoe insoles, are emerging as an attractive option to mitigate balance and walking problems in neuropathic populations. This study aims to explore whether wearing textured insoles for 4 weeks alters balance performance in adults with diabetic peripheral neuropathy.

METHODS AND ANALYSIS

A prospective, single-blinded randomised controlled trial with parallel groups will be conducted on 70 adults with diabetic peripheral neuropathy. Adults with a diagnosis of peripheral neuropathy (secondary to type 2 diabetes), aged ≥18 years, ambulant over 20 m (with/without an assistive device), will be recruited. Participants will be randomised to receive a textured insole (n=35) or smooth insole (n=35), to be worn for 4 weeks. During baseline and post intervention assessments, standing balance (foam/firm surface; eyes open/closed) and walking tasks will be completed barefoot, wearing standard shoes only, and two different insoles (smooth, textured). The primary outcome measure will be centre of pressure (CoP) velocity, with higher values indicating poorer balance. Secondary outcome measures include walking quality (gait velocity, base of support, stride length and double-limb support time), physical activity levels, foot sensation (light-touch pressure, vibration) and proprioception (ankle joint position sense), and other balance parameters (CoP path length, anteroposterior and mediolateral excursion). Patient-reported outcomes will be completed evaluating foot health, frequency of falls and fear of falling. Data will be analysed using a repeated measures mixed models approach (including covariates) to establish any differences between-groups, for all outcome measures, over the intervention period.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the institutional Human Research Ethics Committee (#2017000098). Findings will be disseminated at national and international conferences, through peer-reviewed journals, workshops and social media.

TRIAL REGISTRATION NUMBER

ACTRN12617000543381; Pre-results.

The effects of prolonged wear of textured shoe insoles on gait, foot sensation and proprioception in people with multiple sclerosis: study protocol for a randomised controlled trial

BACKGROUND

Many people with multiple sclerosis experience problems with walking, which can make daily activities difficult and often leads to falls. Foot sensation plays an important role in keeping the body balanced whilst walking; however, people with multiple sclerosis often have poor sensation on the soles of their feet. Wearing a specially designed shoe insole, which enhances plantar sensory information, could help people with multiple sclerosis to walk better. This study will explore whether long-term wear of a textured insole can improve walking in people with multiple sclerosis.

METHODS

A prospective randomised controlled trial with two parallel groups will be conducted aiming to recruit 176 people with multiple sclerosis living in the community (Brisbane, Australia). Adults with a clinical diagnosis of multiple sclerosis, Disease Steps score 1-4, who are ambulant over 100 m and who meet specific inclusion criteria will be recruited. Participants will be randomised to a smooth control insole (n = 88) or textured insole (n = 88) group. The allocated insole will be worn for 12-weeks within participants' own footwear, with self-report wear diaries and falls calendars being completed over this period. Blinded assessors will conduct two baseline assessments and one post-intervention assessment. Gait tasks will be completed barefoot, wearing standardised footwear only, and wearing standardised footwear with smooth and textured insoles. The primary outcome measure will be mediolateral base of support when walking over even and uneven surfaces. Secondary measures include spatiotemporal gait parameters (stride length, stride time variability, double-limb support time, velocity), gait kinematics (hip, knee, and ankle joint angles, toe clearance, trunk inclination, arm swing, mediolateral pelvis/head displacement), foot sensation (light touch-pressure, vibration, two-point discrimination) and proprioception (ankle joint position sense). Group allocation will be concealed and all analyses will be based on an intention-to-treat principle.

DISCUSSION

This study will explore the effects of wearing textured insoles over 12-weeks on gait, foot sensation and proprioception in people with multiple sclerosis. The study has the potential to identify a new, evidence-based footwear intervention which has the capacity to enhance mobility and independent living in people with multiple sclerosis.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12615000421538 . Registered 4 May 2015.

A study of the immediate effects of glycerine-filled insoles, contoured prefabricated orthoses and flat insoles on single-leg balance, gait patterns and perceived comfort in healthy adults

Background

Footwear interventions are often prescribed to assist with the management of lower limb pain, injury and disease. Commercially available shoe insoles and orthoses are increasingly incorporating novel design features to alleviate foot and lower limb symptoms, but this may be at a cost to optimal functional performance. This study compared the immediate effects of wearing glycerine-filled insoles, contoured prefabricated orthoses, and flat insoles, on balance and gait measures.

Methods

Thirty healthy adults (17 men, 13 women; mean [SD] age: 24.3 [2.5] years) performed tests of single-leg standing with eyes open (Kistler force platform), star excursion balance test, and level-ground walking (GAITRite® walkway system), under three randomised conditions: wearing glycerine-filled insoles, prefabricated orthoses, and flat (control) insoles, within their own footwear. Centre of pressure movement (anterior-posterior and mediolateral range and standard deviation, total path velocity), star excursion balance test reach distance, and temporospatial gait variables were collected. Perceived comfort of the inserts was scored immediately after use on a 100 mm visual analogue rating scale. After trialling all inserts each participant ranked their level of comfort from least to most.

Results

Centre of pressure measures, star excursion balance test reach distance, or temporospatial gait variables did not differ between the three inserts (all P values >0.088). Significant between-condition differences were reported for comfort ranking (P = 0.031), but not rating scores (P = 0.638). Weak to moderate negative correlations (r values ranged between −0.368 and −0.406) were observed between visual analogue scale comfort rating for the flat insoles and prefabricated orthoses, star excursion balance test and gait measures.

Conclusions

Single-leg standing balance, star excursion balance test performance, and level-ground walking patterns in asymptomatic adults do not appear to differ when wearing glycerine-filled insoles, contoured prefabricated orthoses, or flat insoles. Perceived comfort may be related to the biomechanical or clinical effectiveness of novel footwear interventions, and requires further investigation. Importantly, these findings are specific to a healthy population and further research is needed to determine the long-term effects of glycerine-filled insoles in patients with known balance impairments.

Effect of textured insoles on balance and gait in people with multiple sclerosis: an exploratory trial

OBJECTIVES

To investigate the immediate effects of textured insoles on balance and gait in people with multiple sclerosis (MS), and to explore any effects after 2 weeks of wear.

STUDY DESIGN

Within-session repeated-measures design with an exploratory follow-up period.

SETTING

Hospital gait laboratory.

PARTICIPANTS

Forty-six individuals with MS (34 females, 12 males), with a mean (SD) age of 49 (7) years, who could walk 100m unassisted or using one stick/crutch.

INTERVENTION

Participants were tested wearing three types of insoles in a random order: control (smooth), Texture 1 (Algeos) or Texture 2 (Crocs™). Participants were allocated at random to wear one type of textured insoles for 2 weeks, after which they were retested.

MAIN OUTCOME MEASURES

Standing balance (centre of pressure excursions and velocity) was measured with eyes open and eyes closed on a Kistler force platform. Spatio-temporal parameters of gait were measured using a GAITRite system.

RESULTS

The textured insoles had no significant immediate effects on balance or gait, apart from an increase in anteroposterior sway range with eyes open for Texture 2 insoles [mean difference 4.5 (95% confidence interval 0.6 to 8.4)mm]. After 2 weeks, balance was not significantly different, but both types of textured insoles showed significant effects on spatio-temporal parameters of gait, with mean stride length increases of 3.5cm (Texture 1) and 5.3cm (Texture 2) when wearing the insoles.

CONCLUSIONS

After 2 weeks of wear, there were improvements in spatio-temporal parameters of gait. However, it is unclear whether this was a placebo effect or a learning effect.

Responsiveness of 2 procedures for measurement of temporal and spatial gait parameters in older adults

OBJECTIVE

To determine the responsiveness of the GAITRite system and a stopwatch-footfall count technique for measurement of walking speed, cadence, and stride length during comfortable and fast-paced walking.

DESIGN

Criterion standard.

SETTING

Research laboratory in a physical therapy education program.

PARTICIPANTS

Twenty-four healthy volunteers (13 men, 11 women; mean age 74.5 years) without lower extremity injury or history of falls.

INTERVENTIONS

Participants walked across a GAITRite mat with embedded pressure sensors at their self-selected comfortable and fast walking speeds. Simultaneously, an examiner, using a stopwatch, recorded the elapsed time necessary to cross the mat and counted the number of complete footfalls.

MAIN OUTCOME MEASURE(S)

Walking speed, cadence, and stride length were compared between the GAITRite system and the stopwatch-footfall count technique for both comfortable and fast walking speeds. Responsiveness values for each procedure were described by the 95% minimal detectable change (MDC).

RESULTS

During comfortable self-paced walking, MDC values for the stopwatch-footfall count technique ranged from 10% to 65% greater than those obtained for the GAITRite system. During fast self-paced walking MDC values for the stopwatch-footfall count technique ranged from 26% to 65% larger than those measured by the GAITRite system for the temporal and spatial gait performance parameters.

CONCLUSIONS

When measured by the GAITRite system, the 95% MDC values for temporal and spatial gait parameters of older community-dwelling adults were more responsive to change than those obtained by the stopwatch-footfall technique. Clinicians should recognize that self-selected walking speed, cadence, and stride length when obtained by an instrumented walkway must be equal to or exceed 12.6 cm/s, 8.4 steps/min, or 7 cm, respectively, for the change to be considered real change and not from measurement error.

Within- and between-day repeatability and variability in children's physiological responses during submaximal treadmill exercise

The purpose of this study was to verify within- and between-day repeatability and variability in children's oxygen uptake (VO2), gross economy (GE; VO2 divided by speed) and heart rate (HR) during treadmill walking based on self-selected speed (SS). Fourteen children (10.1 +/- 1.4 years) undertook three testing sessions over 2 days in which four walking speeds, including SS were tested. Within- and between-day repeatability were assessed using the Bland and Altman method, and coefficients of variability (CV) were determined for each child across exercise bouts and averaged to obtain a mean group CV value for VO2, GE, and HR per speed. Repeated measures analysis of variance showed no statistically significant differences in within- or between-day CV for VO2, GE, or HR at any speed. Repeatability within- and between-day for VO2, GE, and HR for all speeds was verified. These results suggest that submaximal VO2 during treadmill walking is stable and reproducible at a range of speeds based on children's SS.

Immediate effect of treadmill walking practice versus overground walking practice on overground walking pattern in ambulatory stroke patients: an experimental study

Objective: To determine whether 10 minutes of treadmill walking had a different effect on overground walking pattern compared with 10 minutes of overground walking in newly ambulatory stroke patients. Are any changes influenced by walking ability?

Design: A within-participant, repeated measures experimental study was conducted. Each participant carried out 10 minutes of overground walking practice followed by 10 minutes of treadmill walking practice at matched heart rate on separate days. Setting: An inpatient rehabilitation facility.

Subjects: Twenty-one participants receiving inpatient rehabilitation following stroke.

Measures: Overground walking pattern was measured as linear and angular kinematics using GAITRite and a two-dimensional webcam application respectively.

Results: Following treadmill walking practice, there was 6 degrees (95% confidence interval (CI) 2 to 10) more knee extension at heel strike during overground walking than following overground walking practice. Poorer walkers increased non-paretic limb step length following treadmill walking practice more than those with better walking ability (mean difference 2.2 cm, 95% CI 0 to 5).

Conclusions: Ten minutes of treadmill walking practice resulted in a similar overground walking pattern compared with overground walking practice in newly ambulatory stroke patients undergoing rehabilitation, regardless of walking ability.

Agreement between the GAITRite walkway system and a stopwatch-footfall count method for measurement of temporal and spatial gait parameters

OBJECTIVE

To determine the agreement for measurements of stride length, cadence, and walking speed obtained from the GAITRite system and the stopwatch-footfall count technique.

DESIGN

Criterion standard.

SETTING

Research laboratory in a physical therapy education program.

PARTICIPANTS

Forty healthy volunteers (13 men, 27 women) without lower-extremity injury.

INTERVENTIONS

Participants walked across a GAITRite mat with embedded pressure sensors at their self-selected walking speed. Simultaneously, an examiner used a stopwatch to record the elapsed time necessary to cross the mat and counted the number of complete footfalls.

MAIN OUTCOME MEASURES

Walking speed, cadence, and stride-length measures were compared between the GAITRite system and the stopwatch-footfall count technique.

RESULTS

Correlation coefficients comparing both systems were .97 for walking speed, .75 for cadence, and .85 for stride length. Ninety-five percent of the time we would expect the between-methods differences to range between .09 and -.05m/s for walking speed, between -1.5 and -24.3 steps/min for cadence, and between .01 and .37m for stride length.

CONCLUSIONS

This study shows that the GAITRite and stopwatch-footfall count methods lack clinically acceptable agreement for the measurements of cadence and stride length in a group of healthy volunteers walking at their self-selected speeds. Clinicians who require precise measurement of cadence and stride length should consider using the GAITRite system instead of the stopwatch-footfall count technique.

Within-day reliability of temporal-spatial gait parameters associated with rheumatoid arthritic feet

OBJECTIVE

To determine whether the GAITRite system can reliably measure temporal and spatial gait parameters in patients with rheumatoid arthritic feet.

METHODS

Fifty patients diagnosed with rheumatoid arthritis were each measured on two separate occasions on the same outpatient visit. Temporal and spatial gait parameter readings were recorded for each of three walks across the GAITRite mat. Intraclass correlations (2,1) in combination with within-subject standard deviation were used to quantify within-day reliability.

RESULTS

The intraclass correlation, ranging from 0.75 to 0.87, demonstrated excellent within-day repeatability for walking speed, cadence, step length and stride length. Good reliability was reported with cycle time (0.74) and base of support (0.62). Within-subject standard deviation allows these to be used in a clinical setting.

CONCLUSION

The within-day reliability of temporal and spatial gait parameters in rheumatoid arthritic patients has been demonstrated in the current study. However, further investigation of between-day reliability is necessary and would provide clinicians with reliable data in the objective assessment and any form of intervention in rheumatoid arthritis patients.