Validity and reliability of a kinematic protocol for determining foot contact events

Assessment of Sensorized Insoles in Balance and Gait in Individuals With Parkinson's Disease

Individuals with Parkinson's disease (PD) are characterized by gait and balance disorders limiting their independence and quality of life. Home-based rehabilitation programs, combined with drug therapy, demonstrated to be beneficial in the daily-life activities of PD subjects. Sensorized shoes can extract balance- and gait-related data in home-based scenarios and allow clinicians to monitor subjects' activities. In this study, we verified the capability of a pair of sensorized shoes (including pressure-sensitive insoles and one inertial measurement unit) in assessing ground-level walking and body weight shift exercises. The shoes can potentially be combined with a sensory biofeedback module that provides vibrotactile cues to individuals. Sensorized shoes have been assessed in terms of the capability of detecting relevant gait events (heel strike, flat foot, toe off), estimating spatiotemporal parameters of gait (stance, swing, and double support duration, stride length), estimating gait variables (vertical ground-reaction force, vGRF; coordinate of the center of pressure along the longitudinal axes of the feet, yCoP; and the dorsiflexion angle of the feet, Pitch angle). The assessment compared the outcomes with those extracted from the gold standard equipment, namely force platforms and a motion capture system. Results of this comparison with 9 PD subjects showed an overall median absolute error lower than 0.03 s in detecting the foot-contact, foot-off, and heel-off gait events while performing ground-level walking and lower than 0.15 s in body weight shift exercises. The computation of spatiotemporal parameters of gait showed median errors of 1.62 % of the stance phase duration and 0.002 m of the step length. Regarding the estimation of vGRF, yCoP, and Pitch angle, the median across-subjects Pearson correlation coefficient was 0.90, 0.94, and 0.91, respectively. These results confirm the suitability of the sensorized shoes for quantifying biomechanical features during body weight shift and gait exercises of PD and pave the way to exploit the biofeedback modules of the bidirectional interface in future studies.

Motor flexibility to stabilize the toe position during obstacle crossing in older adults: an investigation using an uncontrolled manifold analysis

Introduction

An age-related decrease in the ability to exploit the abundant degrees of freedom of the body, referred to as motor flexibility, leads to a heightened fall risk. The present study investigated motor flexibility to stabilize the toe position during obstacle crossing in older adults and its correlation with the magnitude of foot elevation.

Methods

Twenty-six older adults (70.9 ± 7.4 years old) and 21 younger adults (25.4 ± 5.0 years old) walked and crossed an obstacle, during which the dominant limb was always the leading limb. An uncontrolled manifold (UCM) analysis was used to quantify the flexibility during obstacle crossing as the synergy index, with the vertical toe position being regarded as the performance variable and the segment angles of the lower limbs as the elemental variables.

Results and discussion

The results showed that older participants had a significantly lower synergy index for the trailing limb before the moment of obstacle crossing than younger participants, suggesting reduced flexibility in part. The results also showed that, regardless of age, foot elevation was negatively correlated with the synergy index, suggesting that a so-called "conservative strategy" (i.e., a tendency to show extraordinarily high foot elevation to ensure collision avoidance) may be related to their reduced motor flexibility.

Characterizing Bodyweight-Supported Treadmill Walking on Land and Underwater Using Foot-Worn Inertial Measurement Units and Machine Learning for Gait Event Detection

Gait rehabilitation commonly relies on bodyweight unloading mechanisms, such as overhead mechanical support and underwater buoyancy. Lightweight and wireless inertial measurement unit (IMU) sensors provide a cost-effective tool for quantifying body segment motions without the need for video recordings or ground reaction force measures. Identifying the instant when the foot contacts and leaves the ground from IMU data can be challenging, often requiring scrupulous parameter selection and researcher supervision. We aimed to assess the use of machine learning methods for gait event detection based on features from foot segment rotational velocity using foot-worn IMU sensors during bodyweight-supported treadmill walking on land and underwater. Twelve healthy subjects completed on-land treadmill walking with overhead mechanical bodyweight support, and three subjects completed underwater treadmill walking. We placed IMU sensors on the foot and recorded motion capture and ground reaction force data on land and recorded IMU sensor data from wireless foot pressure insoles underwater. To detect gait events based on IMU data features, we used random forest machine learning classification. We achieved high gait event detection accuracy (95-96%) during on-land bodyweight-supported treadmill walking across a range of gait speeds and bodyweight support levels. Due to biomechanical changes during underwater treadmill walking compared to on land, accurate underwater gait event detection required specific underwater training data. Using single-axis IMU data and machine learning classification, we were able to effectively identify gait events during bodyweight-supported treadmill walking on land and underwater. Robust and automated gait event detection methods can enable advances in gait rehabilitation.

Comparison of Three Motion Capture-Based Algorithms for Spatiotemporal Gait Characteristics: How Do Algorithms Affect Accuracy and Precision of Clinical Outcomes?

Gait assessment is of interest to clinicians and researchers because it provides information about patients' functional mobility. Optoelectronic camera-based systems with gait event detection algorithms are considered the gold standard for gait assessment. Yet, the choice of the algorithm used to process data and extract the desired parameters from those detected gait events has an impact on the validity and reliability of the gait parameters computed. There are multiple techniques documented in the literature for computing gait events, including the analysis of the minimal position of the heel and toe markers, the computation of the relative distance between sacrum and foot markers, and the assessment of the smallest distance between the heel and toe markers. Validation studies conducted on these algorithms report variations in accuracy. Yet, these studies were conducted in different conditions, at varying gait velocities, and on different populations. The purpose of this study is to compare accuracy, precision, and robustness of three algorithms using motion capture data obtained from 25 healthy persons and 21 psoriatic arthritic patients walking at three distinct speeds on an instrumented treadmill. Errors in gait events recognition (heel strike-HS and toe-off-TO) and their impact on gait metrics (stance phase and stride length) are reported and compared to ground reaction force events measured with force plates. Over the 9114 collected steps across all walking speeds, more than 99% of gait events were recognized by all algorithms. On average, HS events were detected within 1.2 ms of the reference for two algorithms, while the third one detected HS late, with an average detection error of 40.7 ms. Yet, significant variations in accuracy were noted with gait speed; the performance decreased for all algorithms at slow speed. TO events were identified early by all algorithms, with an average error ranging from 16.0 to 100.0 ms. These gait events errors lead to 2-15% inaccuracies in stance phase assessment, while the impact on stride length remains below 0.3 cm. Overall, the algorithm based on the relative distance between the sacral and foot markers stood out for its accuracy, precision, and robustness at all walking speeds.

Validity and Reliability of Inertial Measurement Unit (IMU)-Derived 3D Joint Kinematics in Persons Wearing Transtibial Prosthesis

BACKGROUND

A validity and reliability assessment of inertial measurement unit (IMU)-derived joint angular kinematics during walking is a necessary step for motion analysis in the lower extremity prosthesis user population. This study aimed to assess the accuracy and reliability of an inertial measurement unit (IMU) system compared to an optical motion capture (OMC) system in transtibial prosthesis (TTP) users.

METHODS

Thirty TTP users were recruited and underwent simultaneous motion capture from IMU and OMC systems during walking. Reliability and validity were assessed using intra- and inter-subject variability with standard deviation (S.D.), average S.D., and intraclass correlation coefficient (ICC).

RESULTS

The intra-subject S.D. for all rotations of the lower limb joints were less than 1° for both systems. The IMU system had a lower mean S.D. (^o), as seen in inter-subject variability. The ICC revealed good to excellent agreement between the two systems for all sagittal kinematic parameters.

CONCLUSION

All joint angular kinematic comparisons supported the IMU system's results as comparable to OMC. The IMU was capable of precise sagittal plane motion data and demonstrated validity and reliability to OMC. These findings evidence that when compared to OMC, an IMU system may serve well in evaluating the gait of lower limb prosthesis users.

Effects of experimentally induced cervical spine mobility alteration on the postural organisation of gait initiation

Gait initiation (GI), the transient period between quiet standing and locomotion, is a functional task classically used in the literature to investigate postural control. This study aimed to investigate the influence of an experimentally-induced alteration of cervical spine mobility (CSM) on GI postural organisation. Fifteen healthy young adults initiated gait on a force-plate in (1) two test conditions, where participants wore a neck orthosis that passively simulated low and high levels of CSM alteration; (2) one control condition, where participants wore no orthosis; and (3) one placebo condition, where participants wore a cervical bandage that did not limit CSM. Centre-of-pressure and centre-of-mass kinematics were computed based on force-plate recordings according to Newton’s second law. Main results showed that anticipatory postural adjustments amplitude (peak backward centre-of-pressure shift and forward centre-of-mass velocity at toe-off) and motor performance (step length and forward centre-of-mass velocity at foot-contact) were altered under the condition of high CSM restriction. These effects of CSM restriction may reflect the implementation of a more cautious strategy directed to attenuate head-in-space destabilisation and ease postural control. It follows that clinicians should be aware that the prescription of a rigid neck orthosis to posturo-deficient patients could exacerbate pre-existing GI deficits.

The Effects of the EquiAmiTM Training Aid on the Kinematics of the Horse at the Walk and Trot In-Hand

The EquiAmi Training Aid (ETA) is a popular training and rehabilitation tool, however knowledge about its effect on the equine gait is lacking. Understanding of its effects on equine kinematics, and the clinical relevance of these effects is vital to promote optimal use of training aids within training and rehabilitation programmes. Therefore, this study aimed to determine how the ETA influences horses' gait kinematics at walk and trot. Eight horses walked and trotted in-hand with and without the ETA. Optical motion capture was used to measure forelimb and hindlimb pro- and retraction angles, withers-croup angle, and stride length. Separate repeated-measures ANOVAs in each gait were used to assess the differences between gait kinematics and stride length variability with and without the ETA. The ETA did not significantly influence the horses' kinematics in walk or trot, however, individual differences in the effect of the ETA on the horses' angular and linear kinematics were found, with variation between gaits within the same horse observed. The ETA does not have the same effect on every horse, and its effect can vary within the same horse between gaits. Therefore, the individual characteristics and needs of the horse must be considered when applying training aids.

Real-time kinematic-based detection of foot-strike during walking

Detection of foot-strike events is an integral part of gait analysis, as it allows the temporal registration of gait cycles. At the same time, it is necessary to register gait phases in real-time for applications such as wearable assistive devices and gait biofeedback that work synchronously with the human gait. Although many algorithms have been proposed for detecting foot-strikes with either wearable (e.g. Inertial Measurement Units (IMUs)) or non-wearable (e.g. force plates) sensors, there is a great need for real-time algorithms that rely only on recording the kinematics of the leg motion. This work proposes a novel and efficient kinematic algorithm, called the Foot VErtical & Sagittal Position Algorithm (F-VESPA), which has several advantages over existing methods. First, it accurately estimates foot-strike events using kinematic data without requiring access to future data points, hence achieving reduced latency during real-time implementation. Moreover, it does not require tuning of the utilized parameters, rendering it robust to different subjects and treadmill speeds. The algorithm is tested in a large set of subjects across various treadmill speeds, and it is shown to outperform even offline implementations of existing prominent kinematic algorithms. Using a 150 Hz data collection system, the F-VESPA achieved a median of 33 ms for the total true errors in detecting foot-strike. The F-VESPA is a highly responsive kinematic algorithm that can detect foot-strike events in real-time, with high accuracy, robustness and reduced latency, enabling real-time temporal registration of gait cycles.

Revisiting the lumbosacral orthosis from the perspective of dynamical systems theory: a preliminary randomized clinical trial on patients with chronic low back pain

BACKGROUND

The prevalent method for investigating the effect of therapeutic interventions on walking in the individuals with chronic low back pain (CLBP) is component-level approach in which all measurements focus on the spine component alone. However, this approach cannot disclose information about the overall function of the movement system such as complex walking patterns, which, in turn, reveal the underlying movement control.

OBJECTIVES

To compare the effect of 3-week wearing of lumbosacral orthosis (LSO) along with routine physical therapy with routine physical therapy alone on walking complexity in the individuals with nonspecific CLBP on the basis of the systems approach.

STUDY DESIGN

Preliminary randomized clinical trial.

METHODS

Twenty-four subjects were randomly allocated to two groups. The control group received the routine physical therapy for 3 weeks. The intervention group received the same program plus an LSO. Nonlinear analysis was used to quantify walking complexity, as behavior of the entire movement system, before and after the intervention and at 1-month follow-up.

RESULTS

An average of 496 strides during ten minutes of walking was used for analysis. There was no significant difference (p > 0.05) in degree of walking complexity between two groups during all evaluation periods.

CONCLUSIONS

The administered orthotic intervention did not alter walking complexity. This suggests that therapeutic goal of current LSOs, which is not based on the systems approach, cannot recover the emergent behavior of the movement system. This may be a potential source of controversies.

CLINICAL RELEVANCE

To achieve an effective treatment, orthotists should focus on the individuals themselves, not only on their CLBP symptoms. Although the component-level approach aims to decrease the symptoms, the systems approach focuses on the whole context that fosters LBP symptoms.

Plantar Pressure Variability and Asymmetry in Elderly Performing 60-Minute Treadmill Brisk-Walking: Paving the Way towards Fatigue-Induced Instability Assessment Using Wearable In-Shoe Pressure Sensors

Evaluation of potential fatigue for the elderly could minimize their risk of injury and thus encourage them to do more physical exercises. Fatigue-related gait instability was often assessed by the changes of joint kinematics, whilst planar pressure variability and asymmetry parameters may complement and provide better estimation. We hypothesized that fatigue condition (induced by the treadmill brisk-walking task) would lead to instability and could be reflected by the variability and asymmetry of plantar pressure. Fifteen elderly adults participated in the 60-min brisk walking trial on a treadmill without a pause, which could ensure that the fatigue-inducing effect is continuous and participants will not recover halfway. The plantar pressure data were extracted at baseline, the 30th minute, and the 60th minute. The median of contact time, peak pressure, and pressure-time integrals in each plantar region was calculated, in addition to their asymmetry and variability. After 60 min of brisk walking, there were significant increases in peak pressure at the medial and lateral arch regions, and central metatarsal regions, in addition to their impulses (p < 0.05). In addition, the variability of plantar pressure at the medial arch was significantly increased (p < 0.05), but their asymmetry was decreased. On the other hand, the contact time was significantly increased at all plantar regions (p < 0.05). The weakened muscle control and shock absorption upon fatigue could be the reason for the increased peak pressure, impulse, and variability, while the improved symmetry and prolonged plantar contact time could be a compensatory mechanism to restore stability. The outcome of this study can facilitate the development of gait instability or fatigue assessment using wearable in-shoe pressure sensors.

Towards validation and standardization of automatic gait event identification algorithms for use in paediatric pathological populations

BACKGROUND

To analyse and interpret gait patterns in pathological paediatric populations, accurate determination of the timing of specific gait events (e.g. initial contract - IC, or toe-off - TO) is essential. As currently used clinical identification methods are generally subjective, time-consuming, or limited to steps with force platform data, several techniques have been proposed based on processing of marker kinematics. However, until now, validation and standardization of these methods for use in diverse gait patterns remains lacking.

RESEARCH QUESTIONS

1) What is the accuracy of available kinematics-based identification algorithms in determining the timing of IC and TO for diverse gait signatures? 2) Does automatic identification affect interpretation of spatio-temporal parameters?.

METHODS

3D kinematic and kinetic data of 90 children were retrospectively analysed from a clinical gait database. Participants were classified into 3 gait categories: group A (toe-walkers), B (flat IC) and C (heel IC). Five kinematic algorithms (one modified) were implemented for two different foot marker configurations for both IC and TO and compared with clinical (visual and force-plate) identification using Bland-Altman analysis. The best-performing algorithm-marker configuration was used to compute spatio-temporal parameters (STP) of all gait trials. To establish whether the error associated with this configuration would affect clinical interpretation, the bias and limits of agreement were determined and compared against inter-trial variability established using visual identification.

RESULTS

Sagittal velocity of the heel (Group C) or toe marker configurations (Group A and B) was the most reliable indicator of IC, while the sagittal velocity of the hallux marker configuration performed best for TO. Biases for walking speed, stride time and stride length were within the respective inter-trial variability values.

SIGNIFICANCE

Automatic identification of gait events was dependent on algorithm-marker configuration, and best results were obtained when optimized towards specific gait patterns. Our data suggest that correct selection of automatic gait event detection approach will ensure that misinterpretation of STPs is avoided.

'Recoupling' the attentional and motor control of preparatory postural adjustments to overcome freezing of gait in Parkinson's

Objectives

This study examined if people with Parkinson’s and freezing of gait pathology (FoG) could be trained to increase preparatory weight-shift amplitude, and facilitate step initiation during FoG.

Methods

Thirty-five people with Parkinson’s and FoG attempted to initiate forward walking from a stationary position caused by a freeze (n = 17, FoG-F) or voluntarily stop (n = 18, FoG-NF) in a Baseline condition and two conditions where an increased weight-shift amplitude was trained via: (i) explicit verbal instruction, and (ii) implicit movement analogies.

Results

At Baseline, weight-shift amplitudes were smaller during: (i) unsuccessful, compared to successful step initiations (FoG-F group), and (ii) successful step initiations in the FoG-F group compared to FoG-NF. Both Verbal and Analogy training resulted in significant increases in weight-shift amplitude in both groups, and a corresponding pronounced reduction in unsuccessful attempts to initiate stepping (FoG-F group).

Conclusions

Hypometric preparatory weight-shifting is associated with failure to initiate forward stepping in people with Parkinson’s and FoG. However, impaired weight-shift characteristics are modifiable through conscious strategies. This current study provides a novel and critical evaluation of preparatory weight-shift amplitudes during FoG events. The intervention described represents an attractive ‘rescue’ strategy and should be further scrutinised regarding limitations posed by physical and cognitive deficits.

Automated gait event detection for a variety of locomotion tasks using a novel gyroscope-based algorithm

BACKGROUND

The robust identification of initial contact (IC) and toe-off (TO) events is a vital task in mobile sensor-based gait analysis. Shank attached gyroscopes in combination with suitable algorithms for data processing can robustly and accurately complete this task for gait event detection. However, little research has considered gait detection algorithms that are applicable to different locomotion tasks.

RESEARCH QUESTION

Does a gait event detection algorithm for various locomotion tasks provide comparable estimation accuracies as existing task-specific algorithms?

METHODS

Thirteen males, equipped with a gyroscope attached to the right shank, volunteered to perform nine different locomotion tasks consisting of linear movements and movements with a change of direction. A rule-based algorithm for IC and TO events was developed based on the shank sagittal plane angular velocity. The algorithm was evaluated against events determined by vertical ground reaction force. Absolute mean error (AME), relative absolute mean error (RAME) and Bland-Altman analysis was used to assess its accuracy.

RESULTS

The average AME and RAME were 11 ± 3 ms and 3.07 ± 1.33 %, respectively, for IC and 29 ± 11 ms and 7.27 ± 2.92 %, respectively, for TO. Alterations of the walking movement, such as turns and types of running, slightly reduced the accuracy of IC and TO detection. In comparison to previous methods, increased or comparable accuracies for both IC and TO detection are shown.

SIGNIFICANCE

The study shows that the proposed algorithm is capable of detecting gait events for a variety of locomotion tasks by means of a single gyroscope located on the shank. In consequence, the algorithm can be applied to activities, which consist of various movements (e.g., soccer). Ultimately, this extends the use of mobile sensor-based gait analysis.

Improved Gait of Persons With Multiple Sclerosis After Rehabilitation: Effects on Lower Limb Muscle Synergies, Push-Off, and Toe-Clearance

Introduction: Persons with MS (PwMS) have markedly reduced push-off and toe-clearance during gait compared to healthy subjects (HS). These deficits may result from alterations in neuromotor control at the ankle. To optimize rehabilitation interventions for PwMS, a crucial step is to evaluate if and how altered neuromotor control, as represented by muscle synergies, improves with rehabilitation. In this study we investigated changes in ankle motor control and associated biomechanical parameters during gait in PwMS, occurring with increase in speed after gait rehabilitation. Methods: 3D motion and EMG data were collected while 11 PwMS (age 50.3 + 11.1; EDSS 5.2 + 1.2) walked overground at self-selected speed before (T0) and after 20 sessions (T1) of intensive treadmill training. Muscle synergies were extracted using non-negative matrix factorization. Gait parameters were computed according to the LAMB protocol. Pearson's correlation coefficient was used to evaluate the similarity of motor modules between PwMS and HS. To assess differences in distal module activations representing neuromotor control at the ankle [Forward Propulsion (FPM) and Ground Clearance modules (GCM)], each module's activation timing was integrated over 100% of the gait cycle and the activation percentage index (API) was computed in six phases. Ten age matched HS provided two separate speed-matched normative datasets for T0 and T1. For speed independent comparison for the PwMs Z scores were calculated for all their gait variables. Results: In PwMS velocity increased significantly from T0 to T1 (0.74-0.90 m/s, p < 0.05). The activation profiles (API) of FPM and GCM of PwMS improved in pre-swing (p < 0.05): FPM (Mean [95% CI] [%]: T0: 12.5 [5.7-19.3] vs. T1: 9.0 [2.7-15.3]); GCM (T0: 26.7 [18.2-35.3] vs. T1: 24.5 [18.2-30.7]). This was associated with an increase in toe clearance (80.3 to 103.6 mm, p < 0.05) and a higher ankle power peak in pre-swing (1.53-1.93 W/kg, p < 0.05). Conclusion: Increased gait speed of PwMS after intensive gait training was consistent with improvements in spatio-temporal gait parameters. The most important finding of this study was the re-organization of distal leg modules related to neurophysiological changes induced by rehabilitation. This was associated with an improved ankle performance.

Influence of Swing-Foot Strike Pattern on Balance Control Mechanisms during Gait Initiation over an Obstacle to Be Cleared

Gait initiation (GI) over an obstacle to be cleared is a functional task that is highly challenging for the balance control system. Two swing-foot strike patterns were identified during this task—the rearfoot strike (RFS), where the heel strikes the ground first, and the forefoot strike (FFS), where the toe strikes the ground first. This study investigated the effect of the swing-foot strike pattern on the postural organisation of GI over an obstacle to be cleared. Participants performed a series of obstacle clearance tasks with the instruction to strike the ground with either an FFS or RFS pattern. Results showed that anticipatory postural adjustments in the frontal plane were smaller in FFS than in RFS, while stability was increased in FFS. The vertical braking of the centre of mass (COM) during GI swing phase was attenuated in FFS compared to RFS, leading to greater downward centre of mass velocity at foot contact in FFS. In addition, the collision forces acting on the foot were smaller in FFS than in RFS, as were the slope of these forces and the slope of the C7 vertebra acceleration at foot contact. Overall, these results suggest an interdependent relationship between balance control mechanisms and foot strike pattern for optimal stability control.

A Determination Method for Gait Event Based on Acceleration Sensors

A gait event is a crucial step towards the effective assessment and rehabilitation of motor dysfunctions. However, for the data acquisition of a three-dimensional motion capture (3D Mo-Cap) system, the high cost of setups, such as the high standard laboratory environment, limits widespread clinical application. Inertial sensors are increasingly being used to recognize and classify physical activities in a variety of applications. Inertial sensors are now sufficiently small in size and light in weight to be part of a body sensor network for the collection of human gait data. The acceleration signal has found important applications in human gait recognition. In this paper, using the experimental data from the heel and toe, first the wavelet method was used to remove noise from the acceleration signal, then, based on the threshold of comprehensive change rate of the acceleration signal, the signal was primarily segmented. Subsequently, the vertical acceleration signals, from heel and toe, were integrated twice, to compute their respective vertical displacement. Four gait events were determined in the segmented signal, based on the characteristics of the vertical displacement of heel and toe. The results indicated that the gait events were consistent with the synchronous record of the motion capture system. The method has achieved gait event subdivision, while it has also ensured the accuracy of the defined gait events. The work acts as a valuable reference, to further study gait recognition.

Pose estimates from online videos show that side-by-side walkers synchronize movement under naturalistic conditions

Marker-less video-based pose estimation promises to allow us to do movement science on existing video databases. We revisited the old question of how people synchronize their walking using real world data. We thus applied pose estimation to 348 video segments extracted from YouTube videos of people walking in cities. As in previous, more constrained, research, we find a tendency for pairs of people to walk in phase or in anti-phase with each other. Large video databases, along with pose-estimation algorithms, promise answers to many movement questions without experimentally acquiring new data.

Gait initiation and partial body weight unloading for functional improvement in post-stroke individuals

BACKGROUND

To better understand gait initiation in individuals with stroke and suggest possible training strategies, we compared the gait initiation of individuals with stroke and age-matched controls, and we examined the influence of different amounts of body weight support (BWS) during the execution of gait initiation in individuals with stroke.

MATERIALS AND METHODS

Twelve individuals with stroke and 12 age-matched controls initiated gait after a verbal command at a self-selected and comfortable speed, and individuals with stroke also initiated gait wearing a harness with 0%, 15%, and 30% of BWS. Length and velocity of the first step, distance between heels, and weight bearing in both lower limbs in the initial position were calculated. We also assessed the displacement and average velocity of the center of pressure (CoP) in the medial-lateral (ML) and anterior-posterior (AP) directions in 3 distinct sections during gait initiation, which correspond to the CoP position toward the swing limb, stance limb and progression line, respectively.

RESULTS

Individuals with stroke presented shorter and slower step, shorter and slower CoP-ML and CoP-AP toward swing limb and Cop-ML towards stance limb, and longer and faster CoP-AP toward stance limb compared to their peers. The BWS lead individuals with stroke to decrease step length and to increase CoP-ML displacement and average velocity toward stance limb.

CONCLUSION

Individuals with stroke present impairments in executing gait initiation mainly during the preparation period and the employment of an overground BWS system promotes a better performance. These results suggest that BWS is a functional strategy that enables individuals with stroke to modulate gait initiation and it could be adopted for gait intervention.

System for automatic gait analysis based on a single RGB-D camera

Human gait analysis provides valuable information regarding the way of walking of a given subject. Low-cost RGB-D cameras, such as the Microsoft Kinect, are able to estimate the 3-D position of several body joints without requiring the use of markers. This 3-D information can be used to perform objective gait analysis in an affordable, portable, and non-intrusive way. In this contribution, we present a system for fully automatic gait analysis using a single RGB-D camera, namely the second version of the Kinect. Our system does not require any manual intervention (except for starting/stopping the data acquisition), since it firstly recognizes whether the subject is walking or not, and identifies the different gait cycles only when walking is detected. For each gait cycle, it then computes several gait parameters, which can provide useful information in various contexts, such as sports, healthcare, and biometric identification. The activity recognition is performed by a predictive model that distinguishes between three activities (walking, standing and marching), and between two postures of the subject (facing the sensor, and facing away from it). The model was built using a multilayer perceptron algorithm and several measures extracted from 3-D joint data, achieving an overall accuracy and F1 score of 98%. For gait cycle detection, we implemented an algorithm that estimates the instants corresponding to left and right heel strikes, relying on the distance between ankles, and the velocity of left and right ankles. The algorithm achieved errors for heel strike instant and stride duration estimation of 15 ± 25 ms and 1 ± 29 ms (walking towards the sensor), and 12 ± 23 ms and 2 ± 24 ms (walking away from the sensor). Our gait cycle detection solution can be used with any other RGB-D camera that provides the 3-D position of the main body joints.

Transition versus Continuous Slope Walking: Adaptation to Change Center of Mass Velocity in Young Men

During continuous uphill walking (UW) or downhill walking, human locomotion is modified to counteract the gravitational force, aiding or impeding the body's forward momentum, respectively. This study aimed at investigating the center of mass (COM) and center of pressure (COP) velocities and their relative distance during the transition from uphill to downhill walking (UDW) to determine whether locomotor adjustments differ between UDW and UW. Fourteen participants walked on a triangular slope and a continuous upslope of 15°. The kinematics and COPs were obtained using a force plate and a motion capture system. The vertical velocity of the COM in the propulsion phase, the horizontal distance between the COM and COP at initial contact, and the duration of the subphases significantly differed between UDW and UW (all p < 0.05). Compared with the results of UW, longer durations and the deeper downward moving COM in the propulsion phase were observed during UDW (all p < 0.05). Additionally, a shorter horizontal distance between the COM and COP at initial contact was associated with a slower vertical COM velocity in the propulsion phase during UDW. The reduced velocity is likely a gait alteration to decrease the forward momentum of the body during UDW.

Postural adaptations to unilateral knee joint hypomobility induced by orthosis wear during gait initiation

Balance control and whole-body progression during gait initiation (GI) involve knee-joint mobility. Single knee-joint hypomobility often occurs with aging, orthopedics or neurological conditions. The goal of the present study was to investigate the capacity of the CNS to adapt GI organization to single knee-joint hypomobility induced by the wear of an orthosis. Twenty-seven healthy adults performed a GI series on a force-plate in the following conditions: without orthosis ("control"), with knee orthosis over the swing leg ("orth-swing") and with the orthosis over the contralateral stance leg ("orth-stance"). In orth-swing, amplitude of mediolateral anticipatory postural adjustments (APAs) and step width were larger, execution phase duration longer, and anteroposterior APAs smaller than in control. In orth-stance, mediolateral APAs duration was longer, step width larger, and amplitude of anteroposterior APAs smaller than in control. Consequently, step length and progression velocity (which relate to the "motor performance") were reduced whereas stability was enhanced compared to control. Vertical force impact at foot-contact did not change across conditions, despite a smaller step length in orthosis conditions compared to control. These results show that the application of a local mechanical constraint induced profound changes in the global GI organization, altering motor performance but ensuring greater stability.

Mechanisms of head stability during gait initiation in young and older women: A neuro-mechanical analysis

Decreased head stability has been reported in older women during locomotor transitions such as the initiation of gait. The aim of the study was to investigate the neuro-mechanical mechanisms underpinning head stabilisation in young and older women during gait initiation. Eleven young (23.1 ± 1.1 yrs) and 12 older (73.9 ± 2.4 yrs) women initiated walking at comfortable speed while focussing on a fixed visual target at eye level. A stereophotogrammetric system was used to assess variability of angular displacement and RMS acceleration of the pelvis, trunk and head, and dynamic stability in the anteroposterior and mediolateral directions. Latency of muscle activation in the sternocleidomastoid, and upper and lower trunk muscles were determined by surface electromyography. Older displayed higher variability of head angular displacement, and a decreased ability to attenuate accelerations from trunk to head, compared to young in the anteroposterior but not mediolateral direction. Moreover, older displayed a delayed onset of sternocleidomastoid activation than young. In conclusion, the age-related decrease in head stability could be attributed to an impaired ability to attenuate accelerations from trunk to head along with delayed onset of neck muscles activation.

Effects of constraint-induced movement therapy for lower limbs on measurements of functional mobility and postural balance in subjects with stroke: a randomized controlled trial

Abstrato Background: Constraint-induced movement therapy (CIMT) is suggested to reduce functional asymmetry between the upper limbs after stroke. However, there are few studies about CIMT for lower limbs.

OBJECTIVE

To examine the effects of CIMT for lower limbs on functional mobility and postural balance in subjects with stroke.

METHODS

A 40-day follow-up, single-blind randomized controlled trial was performed with 38 subacute stroke patients (mean of 4.5 months post-stroke). Participants were randomized into: treadmill training with load to restraint the non-paretic ankle (experimental group) or treadmill training without load (control group). Both groups performing daily training for two consecutive weeks (nine sessions) and performed home-based exercises during this period. As outcome measures, postural balance (Berg Balance Scale - BBS) and functional mobility (Timed Up and Go test - TUG and kinematic parameters of turning - Qualisys System of movement analysis) were obtained at baseline, mid-training, post-training and follow-up.

RESULTS

Repeated-measures ANOVA showed improvements after training in postural balance (BBS: F = 39.39, P < .001) and functional mobility, showed by TUG (F = 18.33, P < .001) and by kinematic turning parameters (turn speed: F = 35.13, P < .001; stride length: F = 29.71, P < .001; stride time: F = 13.42, P < .001). All these improvements were observed in both groups and maintained in follow-up.

CONCLUSIONS

These results suggest that two weeks of treadmill gait training associated to home-based exercises can be effective to improve postural balance and functional mobility in subacute stroke patients. However, the load addition was not a differential factor in intervention.

Effects of treadmill training with load addition on non-paretic lower limb on gait parameters after stroke: A randomized controlled clinical trial

The addition of load on the non-paretic lower limb for the purpose of restraining this limb and stimulating the use of the paretic limb has been suggested to improve hemiparetic gait. However, the results are conflicting and only short-term effects have been observed. This study aims to investigate the effects of adding load on non-paretic lower limb during treadmill gait training as a multisession intervention on kinematic gait parameters after stroke. With this aim, 38 subacute stroke patients (mean time since stroke: 4.5 months) were randomly divided into two groups: treadmill training with load (equivalent to 5% of body weight) on the non-paretic ankle (experimental group) and treadmill training without load (control group). Both groups performed treadmill training during 30min per day, for two consecutive weeks (nine sessions). Spatiotemporal and angular gait parameters were assessed by a motion system analysis at baseline, post-training (at the end of 9days of interventions) and follow-up (40days after the end of interventions). Several post-training effects were demonstrated: patients walked faster and with longer paretic and non-paretic steps compared to baseline, and maintained these gains at follow-up. In addition, patients exhibited greater hip and knee joint excursion in both limbs at post-training, while maintaining most of these benefits at follow-up. All these improvements were observed in both groups. Although the proposal gait training program has provided better gait parameters for these subacute stroke patients, our data indicate that load addition used as a restraint may not provide additional benefits to gait training.

Quantitative method for gait pattern detection based on fiber Bragg grating sensors

This paper presents a method that uses fiber Bragg grating (FBG) sensors to distinguish the temporal gait patterns in gait cycles. Unlike most conventional methods that focus on electronic sensors to collect those physical quantities (i.e., strains, forces, pressure, displacements, velocity, and accelerations), the proposed method utilizes the backreflected peak wavelength from FBG sensors to describe the motion characteristics in human walking. Specifically, the FBG sensors are sensitive to external strain with the result that their backreflected peak wavelength will be shifted according to the extent of the influence of external strain. Therefore, when subjects walk in different gait patterns, the strains on FBG sensors will be different such that the magnitude of the backreflected peak wavelength varies. To test the reliability of the FBG sensor platform for gait pattern detection, the gold standard method using force-sensitive resistors (FSRs) for defining gait patterns is introduced as a reference platform. The reliability of the FBG sensor platform is determined by comparing the detection results between the FBG sensors and FSRs platforms. The experimental results show that the FBG sensor platform is reliable in gait pattern detection and gains high reliability when compared with the reference platform.

Tactile stimuli affect long-range correlations of stride interval and stride length differently during walking

Sensory feedback below the sole of the foot using sub-threshold mechanical noise significantly reduced postural sway in patients with diabetes and stroke. However, the effects of tactile parameters on walking are still elusive. Specifically, the effects of such parameters on human gait variability need to be studied because of possible rehabilitation outcomes in terms of bringing improvement in temporal and spatial gait parameters. The purpose of this study was to investigate whether different frequency and amplitude combinations of vibro-tactile stimulation of feet would affect stride-to-stride variability in healthy young adults. Ten healthy subjects walked on a treadmill at self-selected pace while wearing customized insoles fitted with tactors that vibrated at selected frequencies and amplitudes. The results show that the frequency manipulations of tactile stimulation altered the long-range correlations (LRCs) in stride length while amplitude manipulations affected the LRCs in stride interval without having any effect on the amount of gait variability. Our findings suggest that independent neural mechanisms may be responsible for coordinating LRCs of gait parameters in the spatial and temporal domains.

MULTI-SEGMENTED TRUNK MOTION OF HEALTHY NON-ELDERLY ADULTS IN DIFFERENT DECADES OF LIFE

Traditionally, gait analysis models the trunk as one rigid body segment. This approach has limitations; it does not capture all the movements of this area of the body throughout locomotion. Lower-extremity-gait kinematics do not routinely change in healthy non-elderly adults in different decades of life; however, it is unknown if trunk kinematics will be altered during different activities of daily living as a function of age. The purpose of this study was to determine if a previously validated multi-segmented trunk model would detect trunk movement variations in non-elderly healthy adults in different decades of life. Thirty-four non-elderly healthy adults in various decades of life (20-29 years, 30-39 years, 40-49 years, and 50-59 years) completed two tasks of ambulatory daily living (level walking and stair descent). Trunk maximum angle during the gait cycle, timing of the trunk maximum angle during the gait cycle and trunk range of motion were examined using analysis of variance procedures. Findings are that age group did not affect the trunk kinematics of individuals in different decades of life, but that may not represent the experiences of elderly individuals.

THREE-DIMENSIONAL MULTI-SEGMENTED SPINE JOINT REACTION FORCES DURING COMMON WORKPLACE PHYSICAL DEMANDS/ACTIVITIES OF DAILY LIVING

Objective

The quantification of inter-segmental spine joint reaction forces during common workplace physical demands.

Background

Many spine reaction force models have focused on the L5/S1 or L4/L5 joints to quantify the vertebral joint reaction forces. However, the L5/S1 or L4/L5 approach neglects most of the intervertebral joints.

Methods

The current study presents a clinically applicable and noninvasive model which calculates the spinal joint reaction forces at six different regions of the spine. Subjects completed four ambulatory activities of daily living: level walking, obstacle crossing, stair ascent, and stair descent.

Results

Peak joint spinal reaction forces were compared between tasks and spine regions. Differences existed in the bodyweight normalized vertical joint reaction forces where the walking (8.05±3.19N/kg) task had significantly smaller peak reaction forces than the stair descent (12.12±1.32N/kg) agreeing with lower extremity data comparing walking and stair descent tasks.

Conclusion

This method appears to be effective in estimating the joint reaction forces using a segmental spine model. The results suggesting the main effect of peak reactions forces in the segmental spine can be influenced by task.

Gait event detection in laboratory and real life settings: Accuracy of ankle and waist sensor based methods

Wearable sensors technology based on inertial measurement units (IMUs) is leading the transition from laboratory-based gait analysis, to daily life gait monitoring. However, the validity of IMU-based methods for the detection of gait events has only been tested in laboratory settings, which may not reproduce real life walking patterns. The aim of this study was to evaluate the accuracy of two algorithms for the detection of gait events and temporal parameters during free-living walking, one based on two shank-worn inertial sensors, and the other based on one waist-worn sensor. The algorithms were applied to gait data of ten healthy subjects walking both indoor and outdoor, and completing protocols that entailed both straight supervised and free walking in an urban environment. The values obtained from the inertial sensors were compared to pressure insoles data. The shank-based method showed very accurate initial contact, stride time and step time estimation (<14ms error). Accuracy of final contact timings and stance time was lower (28-51ms error range). The error of temporal parameter variability estimates was in the range 0.09-0.89%. The waist method failed to detect about 1% of the total steps and performed worse than the shank method, but the temporal parameter estimation was still satisfactory. Both methods showed negligible differences in their accuracy when the different experimental conditions were compared, which suggests their applicability in the analysis of free-living gait.

Anticipatory Postural Control of Stability during Gait Initiation Over Obstacles of Different Height and Distance Made Under Reaction-Time and Self-Initiated Instructions

Despite the abundant literature on obstacle crossing in humans, the question of how the central nervous system (CNS) controls postural stability during gait initiation with the goal to clear an obstacle remains unclear. Stabilizing features of gait initiation include anticipatory postural adjustments (APAs) and lateral swing foot placement. To answer the above question, 14 participants initiated gait as fast as possible in three conditions of obstacle height, three conditions of obstacle distance and one obstacle-free (control) condition. Each of these conditions was performed with two levels of temporal pressure: reaction-time (high-pressure) and self-initiated (low-pressure) movements. A mechanical model of the body falling laterally under the influence of gravity and submitted to an elastic restoring force is proposed to assess the effect of initial (foot-off) center-of-mass position and velocity (or “initial center-of-mass set”) on the stability at foot-contact. Results showed that the anticipatory peak of mediolateral (ML) center-of-pressure shift, the initial ML center-of-mass velocity and the duration of the swing phase, of gait initiation increased with obstacle height, but not with obstacle distance. These results suggest that ML APAs are scaled with swing duration in order to maintain an equivalent stability across experimental conditions. This statement is strengthened by the results obtained with the mechanical model, which showed how stability would be degraded if there was no adaptation of the initial center-of-mass set to swing duration. The anteroposterior (AP) component of APAs varied also according to obstacle height and distance, but in an opposite way to the ML component. Indeed, results showed that the anticipatory peak of backward center-of-pressure shift and the initial forward center-of-mass set decreased with obstacle height, probably in order to limit the risk to trip over the obstacle, while the forward center-of-mass velocity at foot-off increased with obstacle distance, allowing a further step to be taken. These effects of obstacle height and distance were globally similar under low and high-temporal pressure. Collectively, these findings imply that the CNS is able to predict the potential instability elicited by the obstacle clearance and that it scales the spatiotemporal parameters of APAs accordingly.

Concurrent validity and reliability of using ground reaction force and center of pressure parameters in the determination of leg movement initiation during single leg lift

Postural adjustment evaluations during single leg lift requires the initiation of heel lift (T1) identification. T1 measured by means of motion analyses system is the most reliable approach. However, this method involves considerable workspace, expensive cameras, and time processing data and setting up laboratory. The use of ground reaction forces (GRF) and centre of pressure (COP) data is an alternative method as its data processing and setting up is less time consuming. Further, kinetic data is normally collected using frequency samples higher than 1000Hz whereas kinematic data are commonly captured using 50-200Hz. This study describes the concurrent-validity and reliability of GRF and COP measurements in determining T1, using a motion analysis system as reference standard. Kinematic and kinetic data during single leg lift were collected from ten participants. GRF and COP data were collected using one and two force plates. Displacement of a single heel marker was captured by means of ten Vicon(©) cameras. Kinetic and kinematic data were collected using a sample frequency of 1000Hz. Data were analysed in two stages: identification of key events in the kinetic data, and assessing concurrent validity of T1 based on the chosen key events with T1 provided by the kinematic data. The key event presenting the least systematic bias, along with a narrow 95% CI and limits of agreement against the reference standard T1, was the Baseline COPy event. Baseline COPy event was obtained using one force plate and presented excellent between-tester reliability.

Executive Function and Measures of Fall Risk Among People With Obesity

This study investigated the relationship between obesity and executive function, and between executive function and fall risk (as estimated from select gait parameters). Of the 39 young adults (age = 21.3 ± 2.6 years) recruited from the local university population via email announcement, 19 were in the obese group (based upon BMI and body fat percentage) and 20 were in the nonobese comparison group. Executive function was assessed using standardized tests including the Stroop test for selective attention; Trail Making test for divided attention, visuomotor tracking, and cognitive flexibility; the Verbal Fluency test for semantic memory; and the Digit-span test for working memory. Participants performed single- and dual-task walking (walking while talking) to evaluate fall risk during gait as measured by minimum toe clearance, required coefficient of friction, stance time, and stance-time variability. The obese group had lower scores for selective attention, semantic memory, and working memory. All participants had gait changes suggestive of a higher fall risk, for example, lower minimum toe clearance, longer stance time, and increased stance variability, during dual-task walking compared with single-task walking, and executive function scores (selective attention) were associated with gait (stance-time variability) during dual-task walking. Results indicate obesity was negatively associated with executive function among young adults and could increase fall risk.

Predicting ground contact events for a continuum of gait types: An application of targeted machine learning using principal component analysis

An ongoing challenge in the application of gait analysis to clinical settings is the standardized detection of temporal events, with unobtrusive and cost-effective equipment, for a wide range of gait types. The purpose of the current study was to investigate a targeted machine learning approach for the prediction of timing for foot strike (or initial contact) and toe-off, using only kinematics for walking, forefoot running, and heel-toe running. Data were categorized by gait type and split into a training set (∼30%) and a validation set (∼70%). A principal component analysis was performed, and separate linear models were trained and validated for foot strike and toe-off, using ground reaction force data as a gold-standard for event timing. Results indicate the model predicted both foot strike and toe-off timing to within 20ms of the gold-standard for more than 95% of cases in walking and running gaits. The machine learning approach continues to provide robust timing predictions for clinical use, and may offer a flexible methodology to handle new events and gait types.

INFLUENCE OF VARIOUS DAILY TASKS ON SEGMENTED TRUNK KINEMATICS

Back pain can affect up to 65% of the American population and cost the health care system approximately fifty billion dollars each year. Due to the difficulty with recording spine/trunk movement, several methods and models exist. The myriad of methods and the need for understanding of spine/trunk motion has led to a lack in a ‘gold-standard’ of treatment for individuals with back pain. Therefore, the purpose of this study was to examine the effect of different activities of daily living on the kinematics of individual trunk segments in young adults to determine how common ambulatory tasks will alter trunk motion compared to level walking.

Young healthy adults completed, in a random order, four activities of daily living: level walking, obstacle crossing, stair ascent and descent using a previously validated model. Subjects were outfitted with a full body marker set which included a segmented trunk. Multi-segmented trunk angles between the three inferior segments, sacrum to lower lumbar [SLL], lower lumbar to upper lumbar [LLUL] and upper lumbar to lower thorax [ULLT], were calculated and compared between tasks. Peak flexion angles, instance of peak angle and range of motion were analyzed.

The overall hypothesis that different spine levels will have altered kinematics during various activities of daily living was supported. Stair descent had smaller peak flexion angles than obstacle crossing and stair ascent. The instance of peak angle were different depending on trunk angle and daily task. The most inferior trunk angle — Sacrum-to-Lower Lumbar — had the largest range of motion during all four tasks in all three (sagittal, frontal and transverse) planes of motion.

This study was able to show how various activities of daily living produce different motions in the three inferior segments of a multi-segmented trunk method. The results of this study are the first steps in understanding how the trunk responds on a daily basis and how those responses could lead to back pain.

Optic flow improves adaptability of spatiotemporal characteristics during split-belt locomotor adaptation with tactile stimulation

Human locomotor adaptation requires feedback and feed-forward control processes to maintain an appropriate walking pattern. Adaptation may require the use of visual and proprioceptive input to decode altered movement dynamics and generate an appropriate response. After a person transfers from an extreme sensory environment and back, as astronauts do when they return from spaceflight, the prolonged period required for re-adaptation can pose a significant burden. In our previous paper, we showed that plantar tactile vibration during a split-belt adaptation task did not interfere with the treadmill adaptation however, larger overground transfer effects with a slower decay resulted. Such effects, in the absence of visual feedback (of motion) and perturbation of tactile feedback, are believed to be due to a higher proprioceptive gain because, in the absence of relevant external dynamic cues such as optic flow, reliance on body-based cues is enhanced during gait tasks through multisensory integration. In this study, we therefore investigated the effect of optic flow on tactile-stimulated split-belt adaptation as a paradigm to facilitate the sensorimotor adaptation process. Twenty healthy young adults, separated into two matched groups, participated in the study. All participants performed an overground walking trial followed by a split-belt treadmill adaptation protocol. The tactile group (TC) received vibratory plantar tactile stimulation only, whereas the virtual reality and tactile group (VRT) received an additional concurrent visual stimulation: a moving virtual corridor, inducing perceived self-motion. A post-treadmill overground trial was performed to determine adaptation transfer. Interlimb coordination of spatiotemporal and kinetic variables was quantified using symmetry indices and analyzed using repeated-measures ANOVA. Marked changes of step length characteristics were observed in both groups during split-belt adaptation. Stance and swing time symmetries were similar in the two groups, suggesting that temporal parameters are not modified by optic flow. However, whereas the TC group displayed significant stance time asymmetries during the post-treadmill session, such aftereffects were absent in the VRT group. The results indicated that the enhanced transfer resulting from exposure to plantar cutaneous vibration during adaptation was alleviated by optic flow information. The presence of visual self-motion information may have reduced proprioceptive gain during learning. Thus, during overground walking, the learned proprioceptive split-belt pattern is more rapidly overridden by visual input due to its increased relative gain. The results suggest that when visual stimulation is provided during adaptive training, the system acquires the novel movement dynamics while maintaining the ability to flexibly adapt to different environments.

Using horizontal heel displacement to identify heel strike instants in normal gait

Heel strike instants are an important component of gait analyses, yet accurate detection can be difficult without a force plate. This paper presents two novel techniques for kinematic heel strike instant (kHSI) detection which examined maximal resultant horizontal heel displacement (HHD). Each of these HHD techniques calculates HHD from a selected reference location of either the stance ankle or stance heel to the swing heel. The proposed techniques, along with other previously established techniques, were validated against a 10N force plate threshold. Fifty-four healthy adults walked overground at both normal and fast speeds while wearing athletic shoes. The reported true and absolute errors were as low as 3.2 (4.4) and 5.7 (3.4)ms, respectively, across 8678kHSI when using the stance ankle as a reference, which significantly outperformed (p<0.0001) the established techniques. Gait speed was shown to have a significant effect (p<0.0001) on HHD-determined kHSI, as well as the three other techniques evaluated, highlighting the need for condition-specific identification of kHSI.

Influence of temporal pressure constraint on the biomechanical organization of gait initiation made with or without an obstacle to clear

Many daily motor tasks have to be performed under a temporal pressure constraint. This study aimed to explore the influence of such constraint on motor performance and postural stability during gait initiation. Young healthy participants initiated gait at maximal velocity under two conditions of temporal pressure: in the low-pressure condition, gait was self-initiated (self-initiated condition, SI); in the high-pressure condition, it was initiated as soon as possible after an acoustic signal (reaction-time condition, RT). Gait was initiated with and without an environmental constraint in the form of an obstacle to be cleared placed in front of participants. Results showed that the duration of postural adjustments preceding swing heel-off ("anticipatory postural adjustments", APAs) was shorter, while their amplitude was larger in RT compared to SI. These larger APAs allowed the participants to reach equivalent postural stability and motor performance in both RT and SI. In addition, the duration of the execution phase of gait initiation increased greatly in the condition with an obstacle to be cleared (OBST) compared to the condition without an obstacle (NO OBST), thereby increasing lateral instability and thus involving larger mediolateral APA. Similar effects of temporal pressure were obtained in NO OBST and OBST. This study shows the adaptability of the postural system to temporal pressure in healthy young adults initiating gait. The outcome of this study may provide a basis for better understanding the aetiology of balance impairments with the risk of falling in frail populations while performing daily complex tasks involving a whole-body progression.

A universal approach to determine footfall timings from kinematics of a single foot marker in hoofed animals

The study of animal movement commonly requires the segmentation of continuous data streams into individual strides. The use of forceplates and foot-mounted accelerometers readily allows the detection of the foot-on and foot-off events that define a stride. However, when relying on optical methods such as motion capture, there is lack of validated robust, universally applicable stride event detection methods. To date, no method has been validated for movement on a circle, while algorithms are commonly specific to front/hind limbs or gait. In this study, we aimed to develop and validate kinematic stride segmentation methods applicable to movement on straight line and circle at walk and trot, which exclusively rely on a single, dorsal hoof marker. The advantage of such marker placement is the robustness to marker loss and occlusion. Eight horses walked and trotted on a straight line and in a circle over an array of multiple forceplates. Kinetic events were detected based on the vertical force profile and used as the reference values. Kinematic events were detected based on displacement, velocity or acceleration signals of the dorsal hoof marker depending on the algorithm using (i) defined thresholds associated with derived movement signals and (ii) specific events in the derived movement signals. Method comparison was performed by calculating limits of agreement, accuracy, between-horse precision and within-horse precision based on differences between kinetic and kinematic event. In addition, we examined the effect of force thresholds ranging from 50 to 150 N on the timings of kinetic events. The two approaches resulted in very good and comparable performance: of the 3,074 processed footfall events, 95% of individual foot on and foot off events differed by no more than 26 ms from the kinetic event, with average accuracy between −11 and 10 ms and average within- and between horse precision ≤8 ms. While the event-based method may be less likely to suffer from scaling effects, on soft ground the threshold-based method may prove more valuable. While we found that use of velocity thresholds for foot on detection results in biased event estimates for the foot on the inside of the circle at trot, adjusting thresholds for this condition negated the effect. For the final four algorithms, we found no noteworthy bias between conditions or between front- and hind-foot timings. Different force thresholds in the range of 50 to 150 N had the greatest systematic effect on foot-off estimates in the hind limbs (up to on average 16 ms per condition), being greater than the effect on foot-on estimates or foot-off estimates in the forelimbs (up to on average ±7 ms per condition).

Automated gait temporal-spatial assessment from non-motorized treadmill belt speed data

Non-motorized treadmills (NMT) provide belt speed data that can be used to estimate work output, and potentially, gait temporal-spatial parameters that provide an improved understanding of gait performance. The purpose of this study was to determine the validity of an automated technique that uses belt speed data from an NMT to estimate temporal-spatial gait parameters. Seventeen injury-free adult participants performed a series of 20-s, metronome-guided walking and running trials for each of eight predetermined cadence conditions (72-200 steps/min). Two NMT-based cadence algorithms [PSD estimated cadence (PEC) and threshold estimated cadence (TEC)], and one NMT-based step length algorithm (NMT_SL) were evaluated for their ability to predict traditional motion analysis-based measures of cadence and step length (MAC and MA_SL, respectively). The results of this study demonstrate that both the PEC and TEC algorithms were capable of predicting MAC with a standard error of the estimate (SEE) less than four steps/min (R(2) = 0.997 and R(2) = 0.993, respectively). Predictions of MA_SL from NMT_SL were separated by gait type (walking vs. running) to account for an obvious separation in the step length data with a qualitative gait change. When applied to walking data, NMT_SL was capable of predicting MA_SL with an SEE of 23 mm (R(2) = 0.96). When applied to running data, NMT_SL was capable of predicting MA_SL with an SEE of 44 mm (R(2) = 0.80). The assessment of the novel technique suggests that it is feasible to use non-motorized treadmill belt speed data to predict gait events and analyze simple gait metrics. Future research should evaluate the applicability of these algorithms for use with participants/patients presenting with pathological gait.

Locomotor sensory organization test: a novel paradigm for the assessment of sensory contributions in gait

Feedback based balance control requires the integration of visual, proprioceptive and vestibular input to detect the body's movement within the environment. When the accuracy of sensory signals is compromised, the system reorganizes the relative contributions through a process of sensory recalibration, for upright postural stability to be maintained. Whereas this process has been studied extensively in standing using the Sensory Organization Test (SOT), less is known about these processes in more dynamic tasks such as locomotion. In the present study, ten healthy young adults performed the six conditions of the traditional SOT to quantify standing postural control when exposed to sensory conflict. The same subjects performed these six conditions using a novel experimental paradigm, the Locomotor SOT (LSOT), to study dynamic postural control during walking under similar types of sensory conflict. To quantify postural control during walking, the net Center of Pressure sway variability was used. This corresponds to the Performance Index of the center of pressure trajectory, which is used to quantify postural control during standing. Our results indicate that dynamic balance control during locomotion in healthy individuals is affected by the systematic manipulation of multisensory inputs. The sway variability patterns observed during locomotion reflect similar balance performance with standing posture, indicating that similar feedback processes may be involved. However, the contribution of visual input is significantly increased during locomotion, compared to standing in similar sensory conflict conditions. The increased visual gain in the LSOT conditions reflects the importance of visual input for the control of locomotion. Since balance perturbations tend to occur in dynamic tasks and in response to environmental constraints not present during the SOT, the LSOT may provide additional information for clinical evaluation on healthy and deficient sensory processing.

Accuracy, sensitivity and robustness of five different methods for the estimation of gait temporal parameters using a single inertial sensor mounted on the lower trunk

In the last decade, various methods for the estimation of gait events and temporal parameters from the acceleration signals of a single inertial measurement unit (IMU) mounted at waist level have been proposed. Despite the growing interest for such methodologies, a thorough comparative analysis of methods with regards to number of extra and missed events, accuracy and robustness to IMU location is still missing in the literature. The aim of this work was to fill this gap. Five methods have been tested on single IMU data acquired from fourteen healthy subjects walking while being recorded by a stereo-photogrammetric system and two force platforms. The sensitivity in detecting initial and final contacts varied between 81% and 100% across methods, whereas the positive predictive values ranged between 94% and 100%. For all tested methods, stride and step time estimates were obtained; three of the selected methods also allowed estimation of stance, swing and double support time. Results showed that the accuracy in estimating step and stride durations was acceptable for all methods. Conversely, a statistical difference was found in the error in estimating stance, swing and double support time, due to the larger errors in the final contact determination. Except for one method, the IMU positioning on the lower trunk did not represent a critical factor for the estimation of gait temporal parameters. Results obtained in this study may not be applicable to pathologic gait.

Temporal and spatial gait parameters in patients dependent on walking assistance after stroke: reliability and agreement between simple and advanced methods of assessment

The aim of this study was to investigate the reliability of temporal and spatial gait parameters in patients dependent on walking assistance after severe stroke, and to examine agreement between simple and advanced methods. Twenty-one patients, admitted for in-patient multidisciplinary rehabilitation, were assessed repeatedly for walking function, both in a test corridor and a gait laboratory (3D camera system) before and after 11 weeks of rehabilitation. The test-retest reliability was examined using intraclass correlation (ICC1.1), and measurement error was reported by within-subject standard deviation (Sw). The agreement between different methods for assessing walking speed, cadence and step length was explored by Bland-Altman plots. High to excellent test-retest reliability was found between trials, both when assessed in the corridor (ICC: 0.93-0.99) and in the laboratory (ICC: 0.88-0.99). Agreement between methods was satisfactory at baseline and was higher after the rehabilitation period. Agreement was found to be slightly better at lower walking speeds and for shorter step lengths. The results implicate that temporal-spatial gait parameters may be measured reliably by both simple and advanced methods in dependent walkers after stroke. A high level of agreement was found between the two methods for walking speed, cadence and average step length at both test points.

Influence of gait speed on the control of mediolateral dynamic stability during gait initiation

This study investigated the influence of gait speed on the control of mediolateral dynamic stability during gait initiation. Thirteen healthy young adults initiated gait at three self-selected speeds: Slow, Normal and Fast. The results indicated that the duration of anticipatory postural adjustments (APA) decreased from Slow to Fast, i.e. the time allocated to propel the centre of mass (COM) towards the stance-leg side was shortened. Likely as an attempt at compensation, the peak of the anticipatory centre of pressure (COP) shift increased. However, COP compensation was not fully efficient since the results indicated that the mediolateral COM shift towards the stance-leg side at swing foot-off decreased with gait speed. Consequently, the COM shift towards the swing-leg side at swing heel-contact increased from Slow to Fast, indicating that the mediolateral COM fall during step execution increased as gait speed rose. However, this increased COM fall was compensated by greater step width so that the margin of stability (the distance between the base-of-support boundary and the mediolateral component of the "extrapolated centre of mass") at heel-contact remained unchanged across the speed conditions. Furthermore, a positive correlation between the mediolateral extrapolated COM position at heel-contact and step width was found, indicating that the greater the mediolateral COM fall, the greater the step width. Globally, these results suggest that mediolateral APA and step width are modulated with gait speed so as to maintain equivalent mediolateral dynamical stability at the time of swing heel-contact.