Reduced hip extension during walking: healthy elderly and fallers versus young adults

Pelvic joint stiffness and fear of falling in patients over 75 years of age: a prospective cohort study of 100 patients

CONTEXT

A third of the population aged 65 and over experiences a fall during a given year, often with severe traumatic consequences, dependence, and consequently, a decline in quality of life. The fear of falling itself leads to avoidance behavior from daily activities leading to a downward spiral of dependence, loss of confidence, and therefore an increased risk of falling. Joint stiffness is often observed during clinical examination of elderly people. However, the association between lumbopelvic stiffness and fear of falling has not been studied.

OBJECTIVES

Osteopathic manipulative treatment/medicine (OMT/OMM), targeted to improve the stiffness of the pelvic girdle, may improve the prognosis of patients afraid of falling and slow down their loss of autonomy.

METHODS

We performed a prospective cohort study enrolling hospitalized patients and nursing home residents over 75 years of age. Patients able to walk and without significant cognitive impairment completed the International Fall Efficacy Scale (FES-I) questionnaire to assess their intensity of fear of falling. The modified Schober test and hip goniometry (flexion and extension) were measured and compared to the FES-I score.

RESULTS

A total of 100 patients were included. A high fear of falling (FES-I≥28) was associated with female sex (31 [79.5 %] vs. 29 [47.5 %]; p=0.002) and with a reduction in the amplitudes tested by the Schober test (2 [1.5-3] vs. 3 [2-4]; p=0.002), the hip extension goniometry (7 [4-10] vs. 10 [7-15]; p<0.001) and the hip flexion goniometry (70 [60-77] vs. 82 [71-90]; p<0.001). The association between FES-I score and each anthropometric variable was strongly linear (p<0.001 for all), especially with hip flexion goniometry (R2=30 %).

CONCLUSIONS

Lumbopelvic stiffness, especially in hip flexion, is strongly associated with a high fear of falling in patients over 75 years of age. When combined with other movement-based therapies, OMM targeted to improve the stiffness of the pelvic girdle may improve the prognosis of patients afraid of falling and slow down their loss of autonomy.

Anterior and posterior hip osteoarthritis: prevalence and potential value of CT compared to radiographs

PURPOSE

To determine the added value of computed tomography (CT) to identify severe hip osteoarthritis (OA).

MATERIALS AND METHODS

A retrospective query of all cases of hip or knee arthroplasty planning CTs between January 2018 and March 2022 was performed. Age, sex, and symptoms were collected from the medical record. CTs were evaluated for the degree of osteoarthritis and classified using an adapted Kellgren-Lawrence (KL) grading system in the anterior, posterior, superior, and superomedial hip. Frontal hip or pelvis radiographs within 1 year of the CT were also graded.

RESULTS

There were 265 eligible hips in 178 subjects, age 66 ± 11 (range 31-93) years, with 85/178 (48%) males and 93/178 (52%) females, and 127/265 (48%) right and 138/265 (52%) left hips. The posterior hip joint was the most common location for grade 2/3 OA (20%), followed by superior hip joint (14%). Anterior or posterior grade 2/3 OA occurred concurrently with superior or superomedial grade 2/3 OA in 32/68 (47%) of hips. Grade 2/3 OA was detected on CT more commonly than on XR both in the superior (14 vs 8.6%, P = 0.0016) and superomedial (8.7 vs 4.8%, P = 0.016) hip joint. Of the 71 symptomatic hips, 22 (31%) hips demonstrated either anterior and/or posterior grade 2/3 OA on CT, and 9 (9/22, 41%) of these hips had superior or superomedial grade 0/1 OA.

CONCLUSION

CT may be warranted when the patient has pain suggestive of osteoarthritis not detected on radiographs.

A multifactorial fall risk assessment system for older people utilizing a low-cost, markerless Microsoft Kinect

Falls among older people are a major health concern. This study aims to develop a multifactorial fall risk assessment system for older people using a low-cost, markerless Microsoft Kinect. A Kinect-based test battery was designed to comprehensively assess major fall risk factors. A follow-up experiment was conducted with 102 older participants to assess their fall risks. Participants were divided into high and low fall risk groups based on their prospective falls over a 6-month period. Results showed that the high fall risk group performed significantly worse on the Kinect-based test battery. The developed random forest classification model achieved an average classification accuracy of 84.7%. In addition, the individual's performance was computed as the percentile value of a normative database to visualise deficiencies and targets for intervention. These findings indicate that the developed system can not only screen out 'at risk' older individuals with good accuracy, but also identify potential fall risk factors for effective fall intervention.Practitioner summary: Falls are the leading cause of injuries in older people. We newly developed a multifactorial fall risk assessment system for older people utilising a low-cost, markerless Kinect. Results showed that the developed system can screen out 'at risk' individuals and identify potential risk factors for effective fall intervention.

Exploring Successful Cognitive Aging: Insights Regarding Brain Structure, Function, and Demographics

In the realm of cognitive science, the phenomenon of "successful cognitive aging" stands as a hallmark of individuals who exhibit cognitive abilities surpassing those of their age-matched counterparts. However, it is paramount to underscore a significant gap in the current research, which is marked by a paucity of comprehensive inquiries that deploy substantial sample sizes to methodically investigate the cerebral biomarkers and contributory elements underpinning this cognitive success. It is within this context that our present study emerges, harnessing data derived from the UK Biobank. In this study, a highly selective cohort of 1060 individuals aged 65 and above was meticulously curated from a larger pool of 17,072 subjects. The selection process was guided by their striking cognitive resilience, ascertained via rigorous evaluation encompassing both generic and specific cognitive assessments, compared to their peers within the same age stratum. Notably, the cognitive abilities of the chosen participants closely aligned with the cognitive acumen commonly observed in middle-aged individuals. Our study leveraged a comprehensive array of neuroimaging-derived metrics, obtained from three Tesla MRI scans (T1-weighted images, dMRI, and resting-state fMRI). The metrics included image-derived phenotypes (IDPs) that addressed grey matter morphology, the strength of brain network connectivity, and the microstructural attributes of white matter. Statistical analyses were performed employing ANOVA, Mann-Whitney U tests, and chi-square tests to evaluate the distinctive aspects of IDPs pertinent to the domain of successful cognitive aging. Furthermore, these analyses aimed to elucidate lifestyle practices that potentially underpin the maintenance of cognitive acumen throughout the aging process. Our findings unveiled a robust and compelling association between heightened cognitive aptitude and the integrity of white matter structures within the brain. Furthermore, individuals who exhibited successful cognitive aging demonstrated markedly enhanced activity in the cerebral regions responsible for auditory perception, voluntary motor control, memory retention, and emotional regulation. These advantageous cognitive attributes were mirrored in the health-related lifestyle choices of the surveyed cohort, characterized by elevated educational attainment, a lower incidence of smoking, and a penchant for moderate alcohol consumption. Moreover, they displayed superior grip strength and enhanced walking speeds. Collectively, these findings furnish valuable insights into the multifaceted determinants of successful cognitive aging, encompassing both neurobiological constituents and lifestyle practices. Such comprehensive comprehension significantly contributes to the broader discourse on aging, thereby establishing a solid foundation for the formulation of targeted interventions aimed at fostering cognitive well-being among aging populations.

Daily walking kinematic characteristics of the elderly in different residential settings: experimental study on Chinese community-living elderly and long-term nursing home residents

BACKGROUND

Long-term nursing home (NH) care helps NH residents with their daily activities and improves their quality of life, but negatively affects their independent physical activities and increases the risk of dangerous events. Dangerous events in the elderly usually occur in the conversion of walking periods when forward striding has already happened, but the body has not yet entered a completely steady walking.

OBJECTIVES

Compare the gait characteristics in Chinese long-term NH residents and community-living elderly during the walking Transitional Period (TP) and Stabilization Period (SP).

METHODS

32 long-term NH residents and 33 age- and sex-matched community-living elderly were recruited. The 30-Second Chair Stand Test (30-s CST), Timed Up and Go Test (TUGT), and Modified Falls Efficacy Scale (MFES) were used to assess their body function. The Xsens MVN BIOMECH system was used to collect and analyze the gait parameters of participants.

RESULTS

Compared to community-living elderly, NH residents had fewer numbers of 30-s CST, took more time to complete TUGT, and lower MEFS scores. NH residents showed slower gait speed (P < 0.001), less peak hip flexion (P = 0.022) and extension (P = 0.003), knee internal rotation (P = 0.023), and ankle plantarflexion (P = 0.001) and internal rotation (P = 0.007) angles during walking. When walking progressed from TP to SP, NH residents showed increased ankle dorsiflexion (P < 0.001), decreased hip internal rotation (P < 0.001), and community-living elderly had increased hip extension (P = 0.005) angles.

CONCLUSIONS

Chinese long-term NH residents had reduced lower extremities strength and postural balance, and higher fear of falling compared to community-living elderly. Their walking performance also showed high fall risk. Besides, long-term NH residents adopted a distal strategy to propel the body forward, which may be a compensatory measure to compensate for inadequate proximal joint control from forward walking to stable walking, and long-term NH residents have reduced postural stability during this process.

Effects of Functional Electrical Stimulation on Gait Characteristics in Healthy Individuals: A Systematic Review

BACKGROUND

This systematic review aimed to provide a comprehensive overview of the effects of functional electrical stimulation (FES) on gait characteristics in healthy individuals.

METHODS

Six electronic databases (PubMed, Embase, Epistemonikos, PEDro, COCHRANE Library, and Scopus) were searched for studies evaluating the effects of FES on spatiotemporal, kinematic, and kinetic gait parameters in healthy individuals. Two examiners evaluated the eligibility and quality of the included studies using the PEDro scale.

RESULTS

A total of 15 studies met the inclusion criteria. The findings from the literature reveal that FES can be used to modify lower-limb joint kinematics, i.e., to increase or reduce the range of motion of the hip, knee, and ankle joints. In addition, FES can be used to alter kinetics parameters, including ground reaction forces, center of pressure trajectory, or knee joint reaction force. As a consequence of these kinetics and kinematics changes, FES can lead to changes in spatiotemporal gait parameters, such as gait speed, step cadence, and stance duration.

CONCLUSIONS

The findings of this review improve our understanding of the effects of FES on gait biomechanics in healthy individuals and highlight the potential of this technology as a training or assistive solution for improving gait performance in this population.

Surface, but Not Age, Impacts Lower Limb Joint Work during Walking and Stair Ascent

Older adults often suffer an accidental fall when navigating challenging surfaces during common locomotor tasks, such as walking and ascending stairs. This study examined the effect of slick and uneven surfaces on lower limb joint work in older and younger adults while walking and ascending stairs. Fifteen young (18-25 years) and 12 older (>65 years) adults had stance phase positive limb and joint work quantified during walking and stair ascent tasks on a normal, slick, and uneven surface, which was then submitted to a two-way mixed model ANOVA for analysis. The stair ascent required greater limb, and hip, knee, and ankle work than walking (all p < 0.001), with participants producing greater hip and knee work during both the walk and stair ascent (both p < 0.001). Surface, but not age, impacted positive limb work. Participants increased limb (p < 0.001), hip (p = 0.010), and knee (p < 0.001) positive work when walking over the challenging surfaces, and increased hip (p = 0.015), knee (p < 0.001), and ankle (p = 0.010) work when ascending stairs with challenging surfaces. Traversing a challenging surface during both walking and stair ascent tasks required greater work production from the large proximal hip and knee musculature, which may increase the likelihood of an accidental fall in older adults.

Overhead squat assessment reflects treadmill running kinematics

PURPOSE

Overhead squat assessment (OHSA) is a pre-activity dynamic movement analysis tool used to define deviations from an ideal motion pattern which known as compensation. Compensatory movements may result from abnormality in myofascial activity, length-tension relationships, neuro-motor control strategies, osteokinematics and arthrokinematics. The aim of this study is to identify the association between selected biomechanical variables of the ankle, knee, hip, pelvis, torso during OHSA and 16 km/h treadmill running tasks.

METHODS

Thirteen national long distance male runners (17.3 ± 0.5 age (years); 5.89 ± 1.95 experience (years), 57.9 ± 3.7 body mass (kg); 175.4 ± 5.7 height (cm)) participated in this 2controlled laboratory study. Three-dimensional kinematics were collected at 250 Hz using a 9-camera Qualisys motion analysis system (Qualisys AB, Goteborg, Sweden) while participants performed 16 km/h treadmill running and OHSA tasks.

RESULTS

Correlation coefficients demonstrated that OHSA pelvic anterior tilt angle was in a positive association with foot strike (FS), mid-stance (MS), and toe-off (TO) pelvic anterior tilt angles and MS tibial internal rotation on talus, MS ankle pronation, MS hip internal rotation. OHSA pelvic anterior tilt angle was in a negative association with TO hip extension. OHSA maximal hip adduction was positively correlated with MS and stance maximal knee adduction. FS, MS, stance maximal angular dorsiflexion values were positively correlated with OHSA dorsiflexion. Increased OHSA dorsiflexion angle was negatively associated with TO plantar flexion. OHSA pronation was positively associated with MS and stance pronation. MS hip internal rotation, MS hip adduction angles were increased, and MS ankle dorsiflexion was significantly decreased with the increase of trunk forward lean relative to tibia during OHSA.

CONCLUSIONS

OHSA was associated with some important and dysfunction-related hip, knee and ankle kinematics. Running coaches, may use OHSA as an assessment tool before the corrective training plan to detect injury-related compensation patterns to reduce the risk of injury and improve running technique.

Estimation of Reference Values of Gait Spatiotemporal and Kinematic Parameters in the Lower Extremities and Trunk Using a Markerless Motion Capture System for Healthy Older Japanese Adults

OBJECTIVE

This preliminary study aimed to explore the reference values of spatiotemporal and kinematic parameters in the lower extremities and trunk during gait for the healthy older adults.

METHODS

Walking speed, stride length and time, cadence, walk ratio, and step width were calculated as spatiotemporal parameters of gait. Forward tilting of the trunk (FTT), hip flexion and extension, knee flexion and extension, and their laterality were measured as peak angles during one-gait cycle. The bootstrap method was conducted to estimate the 95% confidence interval (CI).

RESULTS

This study included 334 healthy older adults (255 women). The following gait parameters were estimated with 95%CI: walking speed (95%CI 1.21-1.30), cadence (95%CI 116.35-121.20), walk ratio (95%CI 0.0055-0.0060), step width (95%CI 0.15-0.17), FTT (95%CI 1.91-4.19), hip flexion (95%CI 28.54-31.01), hip extension (95%CI 19.30-22.27), knee extension (95%CI 0.09-0.14), laterality of hip flexion (95%CI 1.31-2.02), laterality of hip extension (95%CI 1.32-1.97), laterality of knee flexion (95%CI 3.41-4.77), and laterality of knee extension (95%CI 0.07-0.13) in men, and walking speed (95%CI 1.28-1.34), walk ratio (95%CI 0.0050-0.0054), FTT (95%CI 2.54-3.73), hip flexion (95%CI 32.80-34.28), laterality of hip flexion (95%CI 1.65-2.05), laterality of hip extension (95%CI 2.06-2.57), and laterality of knee flexion (95%CI 3.04-3.89) in women.

CONCLUSION

This study suggested provisional reference values of spatiotemporal and kinematic parameters in the lower extremities and trunk during gait for the healthy older adults.

Hamstrings fascicle length and physical performance changes after a single bout of dynamic stretching or neurodynamic gliding in healthy young and older adults

INTRODUCTION

The physiological and structural alterations have been less reported in response to dynamic stretching (DS) or neurodynamic nerve gliding (NG). Accordingly, this study investigated the changes in fascicle lengths (FL), popliteal artery velocity, and physical fitness in response to a single bout of DS or NG.

METHODS

The study included 15 healthy young adults (20.9 ± 0.7 yrs) and 15 older adults (66.6 ± 4.2 yrs) who randomly performed three different interventions (DS, NG, and rest control) for 10 min and 3 days apart. The biceps femoris and semitendinosus FL, popliteal artery velocity, sit and reach (S&R), straight leg raise (SLR), and fast walking speed were measured before and immediately after the intervention.

RESULTS

After NG intervention, S&R was largely greater by 2 cm (1.2, 2.8 cm) and 3.4 cm (2.1, 4.7 cm) with largely increased SLR angles of 4.9° (3.7°, 6.1°) and 4.6° (3.0°, 6.2°) with all p < 0.001 for the older adults and young groups, respectively. A similar magnitude improvement in the S&R and SLR testing was also seen for both groups after DS (p < 0.05). Moreover, no changes were seen in FL, popliteal artery velocity, fast gait speed, and age effect following all three intervention occasions.

CONCLUSION

Stretching with DS or NG immediately increased flexibility, which appeared to be largely due to changes in stretch tolerance rather than an increase in fascicle length. Furthermore, age dependency in response to stretching exercise was not seen in the present study.

Validity of temporo-spatial characteristics of gait as an index for fall risk screening in community-dwelling older people

[Purpose] This study aimed to identify kinematic gait indicators for a fall risk screening test through quantitative comparisons of gait characteristics measured using mobile inertial sensors between faller and non-faller groups in a population of community-dwelling older people. [Participants and Methods] We enrolled 50 people aged ≥65 years who used long-term care prevention services, interviewed them to determine their fall history during the past year, and divided them into faller and non-faller groups. Gait parameters (velocity, cadence, stride length, foot height, heel strike angle, ankle joint angle, knee joint angle, and hip joint angle) were assessed using the mobile inertial sensors. [Results] Gait velocity and left and right heel strike angles were significantly lower and smaller, respectively, in the faller versus non-faller group. Receiver operating characteristic curve analysis revealed areas under the curve of 0.686, 0.722, and 0.691 for gait velocity, left heel strike angle, and right heel strike angle, respectively. [Conclusion] Gait velocity and heel strike angle during gait assessed using mobile inertial sensors may be important kinematic indicators in a fall risk screening test to estimate the likelihood of falls among community-dwelling older people.

Evaluating the contribution of fat infiltration in anterior gluteus minimus muscle to walking ability in female with unilateral hip osteoarthritis and candidates for total hip arthroplasty

BACKGROUND

The purpose of this study is to investigate the relationship between gait and fat infiltration in anterior and posterior gluteus minimus in the patients with hip osteoarthritis.

METHODS

Ninety-one female patients who were diagnosed as the unilateral hip osteoarthritis, classified into Kellgren-Lawrence global scoring system grades 3 or 4, and candidate for total hip arthroplasty were retrospectively reviewed. The horizontally cross-sectional regions of interest for the gluteus medius and anterior and posterior gluteus minimus were manually circumscribed in a single transaxial computed tomography image and muscle density of those regions were obtained. The gait was assessed as the step and speed with the 10-Meter Walk Test. The multiple regression analysis was used to compare the step and speed with age, height, range of motion in flexion, the muscle density of anterior gluteus minimus in the affected side, and that of gluteus medius muscle in both affected and unaffected sides.

FINDINGS

Multiple regression analysis for step revealed that the muscle density of anterior gluteus minimus in the affected side and height were the independent predictors for step (R² = 0.389, p < 0.001). That for speed identified the muscle density of anterior gluteus minimus in the affected side as the only factor determining speed (R² = 0.287, p < 0.001).

INTERPRETATION

The fatty infiltration of anterior gluteus minimus muscle in affected side can be a predictor for the gait in in female with unilateral hip osteoarthritis and candidates for total hip arthroplasty.

Type 2 diabetes mellitus and obesity: The synergistic effects on human locomotor function

BACKGROUND

Diabetes Mellitus and obesity represent two chronic multifactorial conditions which may induce modifications in human motion strategy. Our study focused on gaining insight into biomechanical aspects of gait occurring in patients affected by both aforementioned pathologies.

METHODS

One hundred subjects were recruited and divided into four groups: 25 obese-diabetic patients with peripheral neuropathy; 25 obese non-diabetic patients; 25 non-obese diabetic patients with peripheral neuropathy; 25 healthy volunteers participated as a control group. Subjects performed 3-D Gait Analysis while walking barefoot at self-selected speed, performing three consecutive trials. A multivariate analysis of variance test was used to assess spatio-temporal and kinematic data difference in the four groups. Tukey's post-hoc adjustment was applied on multiple groups' comparison.

FINDINGS

Diabetic-obese subjects showed increased step width compared to controls, while step and stride length, and walking velocity were reduced. Interestingly, step width presented increased values even compared to diabetic patients. Kinematics data showed a significant reduction in ankle plantarflexion during the push-off phase of the gait cycle compared to controls, and to obese subjects. Furthermore, knee kinematics revealed a reduced peak flexion during the swing time of the gait cycle, compared to controls and diabetic subjects, which resulted in reduced knee dynamic excursion during normal walking compared to healthy subjects.

INTERPRETATION

Our data demonstrated that diabetic-obese subjects present gait features typical of both such pathologies. The specific impairment of ankle and knee joint kinematics provides evidence of a synergistic effect of Diabetes Mellitus type 2 and obesity on human ambulatory function.

Effect of Increasing Obstacle Distances Task on Postural Stability Variables During Gait Initiation in Older Nonfallers and Fallers

OBJECTIVE

To compare the scaling of the postural stability variables between older nonfallers and fallers during gait initiation (GI) while stepping over increasing obstacle distances.

DESIGN

Cross-sectional study.

SETTING

University research laboratory.

PARTICIPANTS

A sample of participants (N=24) divided into 2 groups: older nonfallers (n=12) and older fallers (n=12). Participants had no known neurologic, musculoskeletal, or cardiovascular conditions that could have affected their walking, and all were independent walkers. All the participants had an adequate cognitive function to participate as indicated by a score of more than 24 on the Mini-Mental State Examination.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The primary dependent variables were peak anterior-posterior (AP) center of mass (CoM)-center of pressure (CoP) separation during anticipatory postural adjustments (APAs), AP CoM-CoP separation at the toe-off, and peak AP CoM-CoP separation during the swing. Secondary dependent variables were AP trunk angle during GI. Within- and between-repeated measures analysis of variance was used to compare means between groups across different task conditions for all the dependent variables.

RESULTS

There was a main effect of group for peak AP CoM-CoP separation during APA (P=.018), an interaction effect between group and condition for AP CoM-CoP separation at toe-off (P=.009), and a main effect of condition for peak AP CoM-CoP separation during the swing (P<.001). We also found a main effect of group for peak AP trunk angle during the swing (P=.028).

CONCLUSIONS

For GI while stepping over increasing obstacle distances, older fallers adopt a more conservative strategy of AP CoM-CoP separation than nonfallers prior to toe-off and demonstrate increased peak AP trunk lean during the swing. AP CoM-CoP separation prior to toe-off during the GI task may be a critical marker to identify fallers and warrants additional investigation.

The effect of exercise modality on age-related changes observed during running

INTRODUCTION

With the increase in participation by older adults in endurance events, research is needed to evaluate how exercising throughout the lifespan can affect the aging process regarding gait and mobility. The purpose of this study was to determine how the type of exercise modality one participates in will affect age-related declines observed during running.

METHODS

Fifty-six individuals between the ages of 18-65 who considered running, resistance training or cycling/swimming as their primary form of activity participated in this study. Kinematics were captured using a 10-camera motion capture system while participants ran at a controlled pace of 3.5 m/s (± 5%) over a 10-m runway with force platforms collecting kinetic data. Eight successful trials were chosen for analysis. A one-way ANOVA assessed differences in mean kinematic and kinetic variables of interest between physical activity groups (α = 0.05).

RESULTS

Older resistance trainers exhibited greater maximal knee power compared to older runners. No other group differences were observed.

CONCLUSION

Despite type of exercise modality, regularly participating in exercise has positive effects. This is evident through the preservation of the function of the lower extremity with age, specifically function of the ankle, and its contribution to healthy movement patterns.

Non-age-related gait kinematics and kinetics in the elderly

BACKGROUND

The change of gait kinematics and kinetics along aging were reported to indicate age-related gait patterns. However, few studies focus on non-age-related gait analysis. This study aims to explore the non-age-related gait kinematics and kinetics by comparing gait analysis outcomes among the healthy elderly and young subjects.

METHODS

Gait analysis at self-paced was conducted on 12 healthy young subjects and 8 healthy elderly subjects. Kinematic and kinetic features of ankle, knee and hip joints were analyzed and compared in two groups. The degree of variation between the young and elderly in each kinematic or kinetic feature was calculated from pattern distance and percentage of significant difference. The k-means clustering and Elbow Method were applied to select and validate non-age-related features. The average waveforms with standard deviation were plotted for the comparison of the results.

RESULTS

A total of five kinematic and five kinetic features were analyzed on ankle, knee and hip joints in healthy young and elderly groups. The degrees of variation in ankle moment, knee angle, hip flexion angle, and hip adduction moment were 0.1074, 0.1593, 0.1407, and 0.1593, respectively. The turning point was where the k value equals two. The clustering centers were 0.1417 and 0.3691, and the two critical values closest to the cutoff were 0.1593 and 0.3037. The average waveforms of the kinematic or kinetic features mentioned above were highly overlapped with a minor standard deviation between the healthy young and elderly but showed larger variations between the healthy and abnormal.

CONCLUSIONS

The cluster with a minor degree of variation in kinematic and kinetic features between the young and elderly were identified as non-age-related, including ankle moment, knee angle, hip flexion angle, and hip adduction moment. Non-age-related gait kinematics and kinetics are essential indicators for gait with normal function, which is essential in the evaluation of mobility and functional ability of the elderly, and data fusion of the assistant device.

Kinematic analysis of speed transitions within walking in younger and older adults

The ability to adapt to environmental and task demands while walking is critical to independent mobility outside the home and this ability wanes with age. Such adaptability requires individuals to acutely change their walking speed. Regardless of age, changes between walking speeds are common in daily life, and are a frequent type of walking adaptability. Here, we report on older and younger adults when transitioning from preferred walking speed overground to either slower or faster walking. Specifically, we evaluated biomechanical parameters prior to, during, and post transition. Individuals approached the walking speed transition similarly, independent of whether the transition was to slower or faster walking. Regardless of age or walking speed, the step during which a walking speed transition occurred was distinct from those prior- and post- transition, with on average 0.15 m shorter step lengths, 3.6° more hip flexion, and 3.3° more dorsiflexion during stance. We also found that peak hip flexion occurred 22% later, and peak hip extension (39%), knee flexion (26%), and dorsiflexion (44%) occurred earlier in stance for both typical to slower and typical to faster walking. Older adults had altered timing of peak joint angles compared with younger adults across both acceleration and deceleration conditions, indicating age-dependent responses to changing walking speed. Our findings are an important first step in establishing values for kinematics during walking speed transitions in younger and typical older adults.

Lower-limb muscle function in healthy young and older adults across a range of walking speeds

BACKGROUND

Previous studies have compared the functional roles of the individual lower-limb muscles when healthy young and older adults walk at their self-selected speeds. No age-group differences were observed in ankle muscle forces and ankle muscle contributions to support and progression. However, older adults displayed higher gluteus maximus (hip extensor) muscle forces and greater contributions to support during early stance. There are no data that describe the functions of the individual lower-limb muscles in healthy older adults for walking at speeds other than the self-selected speed.

RESEARCH QUESTION

How does walking speed affect the functional roles of the individual lower-limb muscles in healthy older adults?

METHODS

Three-dimensional gait data were recorded for 10 healthy young and 10 healthy older adults walking at slow, normal, and fast speeds (0.7 m/s, 1.4 m/s, and 1.7 m/s, respectively). Both groups walked at the same speed at each condition. The experimental data were combined with a full-body musculoskeletal model to calculate and compare muscle forces and muscle contributions to the vertical, fore-aft, and mediolateral ground reaction forces (support, progression, and balance, respectively) in both groups.

RESULTS

Lower-limb muscle function was similar in young and older adults when both groups walked at the same speed at each condition. The same five muscles - gluteus maximus, gluteus medius, vasti, gastrocnemius, and soleus - contributed most significantly to support, progression, and balance in both groups at all speeds. However, gluteus maximus generated greater support and braking forces during early stance and gastrocnemius contributed less to forward propulsion during late stance at all speeds in the older group.

SIGNIFICANCE

These results provide further insight into the functional roles of the individual lower-limb muscles of older adults during walking and could inform the design of exercise programs aimed at improving support and balance in those at risk of falling.

Effects of abdominal drawing-in maneuver with or without prior iliopsoas stretching on gluteus maximus activity during prone hip extension

BACKGROUND

Prone hip extension (PHE) has been investigated to strengthen the hip joint and back extensor muscles. However, it has not been compared with various PHE exercises in individuals with iliopsoas shortness.

OBJECTIVE

This study compared pelvic compensation and hip and back extensor muscle activities in individuals with iliopsoas shortness during prone hip extension (PHE) using the abdominal drawing-in maneuver alone (PHEA) and after iliopsoas stretching (PHEAS).

METHODS

Twenty-five individuals with iliopsoas shortness were included in the study. Electromyography was used to investigate bilateral erector spinae (ES) and ipsilateral gluteus maximus (GM), biceps femoris (BF), and semitendinosus (ST) muscles during PHE, PHEA, and PHEAS. Pelvic anterior tilting and rotation angles were measured during each PHE exercise via electromagnetic motion tracking. A modified Thomas test was used to examine the hip extension angle before and after iliopsoas stretching. One-way repeated-measures analysis of variance was used to investigate differences in pelvic anterior tilting and rotation angle and in hip and back extensor muscle activities among PHE, PHEA, and PHEAS. The level of statistical significance was set at α= 0.01.

RESULTS

GM muscle activity was significantly greater with PHEAS, compared to PHE and PHEA (p< 0.01). Bilateral ES and ipsilateral BF and ST muscle activities were significantly reduced with PHEAS, compared to PHE and PHEA (p< 0.01). Anterior pelvic tilting and rotation angles were significantly reduced with PHEAS, compared to PHE and PHEA (p< 0.01).

CONCLUSIONS

PHEAS is recommended to selectively strengthen GM muscles with minimal BF and ST muscle activities and pelvic compensation in individuals with iliopsoas shortness. The abdominal drawing-in maneuver (ADIM) after iliopsoas stretching is more efficient than ADIM alone during PHE, especially in individuals with iliopsoas shortness.

Step length and fall risk in adults with chronic kidney disease: a pilot study

Background

Patients with chronic kidney disease commonly experience gait abnormalities, which predispose to falls and fall-related injuries. An unmet need is the development of improved methods for detecting patients at high risk of these complications, using tools that are feasible to implement in nephrology practice. Our prior work suggested step length could be such a marker. Here we explored the use of step length as a marker of gait impairment and fall risk in adults with chronic kidney disease.

Methods

We performed gait assessments in 2 prospective studies of 82 patients with stage 4 and 5 chronic kidney disease (n = 33) or end-stage renal disease (ESRD) (n = 49). Gait speed and step length were evaluated during the 4-m walk component of the Short Physical Performance Battery (SPPB). Falls within 6 months prior to or following enrollment were identified by questionnaire. Associations of low step length (≤47.2 cm) and slow gait speed (≤0.8 m/s) with falls were examined using logistic regression models adjusted for demographics and diabetes and peripheral vascular disease status.

Results

Assessments of step length were highly reproducible (r = 0.88, p < 0.001 for duplicate measurements at the same visit; r = 0.78, p < 0.001 between baseline and 3-month evaluations). Patients with low step length had poorer physical function, including lower SPPB scores, slower gait speed, and lower handgrip strength. Although step length and gait speed were highly correlated (r = 0.73, p < 0.001), one-third (n = 14/43) of patients with low step length did not have slow gait speed. Low step length and slow gait speed were each independently associated with the likelihood of falls (odds ratio (OR) 3.90 (95% confidence interval (CI) 1.05–14.60) and OR 4.25 (95% CI 1.24–14.58), respectively). Compared with patients who exhibited neither deficit, those with both had a 6.55 (95% CI 1.40–30.71) times higher likelihood of falls, and the number of deficits was associated with a graded association with falls (p trend = 0.02). Effect estimates were similar after further adjustment for ESRD status.

Conclusions

Step length and gait speed may contribute additively to the assessment of fall risk in a general adult nephrology population.

Unilateral non-electric assistive walking device helps neurological and orthopedic patients to improve gait patterns

BACKGROUND

Pathological gait patterns are common in neurological and orthopedic patients. These put them at risk of falling and restrict their autonomy and social participation. Novel assistive walking devices are designed to actively support physiological gait patterns by means of motor guidance and mechanical support of the lower limbs.

RESEARCH QUESTION

Does a non-electric assistive walking device powered by a cam-spring mechanism (aLQ, Imasen) improve or otherwise affect pathological gait patterns in neurological and orthopedic patients?

METHODS

A three-dimensional instrumented gait analysis was conducted on a treadmill (quasar, hp cosmos) using spatiotemporal, kinetic, and kinematic data obtained from synchronized motion capturing (Miqus M3, Qualisys), surface EMG (sEMG; Ultium, Noraxon), and pressure distribution measurements (FMD-T, Zebris). Participants with impaired walking were tested in a randomized repeated measures design (assisted/unassisted; at preferred/fast speed) and analyzed with regard to their medical condition (orthopedic or neurological group, n = 20 each).

RESULTS

In both groups, participants showed a significant increase of step length and decrease of cadence during assisted walking compared to baseline. Immediate kinematic effects included enhanced sagittal hip flexion but reduced extension. On the contrary, knee joint angles and muscle activity of M. gastrocnemius and M. rectus femoris seemed to be unaffected by the aLQ device.

SIGNIFICANCE

Participants appear to benefit from the assistive walking device regarding gait and movement patterns, which suggests that the tested device may help to improve patients' functional health status and quality of life. Activities of daily living (ADLs) that involve extensive hip flexion like stairs or curb climbing are promising applications. We propose the implementation of an invertible cam-spring that provides an additional resistance training option.

The roles of lower-limb joint proprioception in postural control during gait

The objective of the present study was to investigate the roles of lower-limb joint proprioception in postural control during gait. Seventy-two healthy adults including 36 younger and 36 older adults participated in two experimental sessions, i.e., lower-limb joint proprioception assessment session and gait assessment session. Lower-limb joint proprioception was assessed by joint position sense errors measured at the ankle, knee and hip of the dominant side. Postural control during gait was characterized by step length, step width and local dynamic stability. Results showed that hip proprioception contributed the most to postural control during gait among the lower-limb joint proprioception components, and that mechanisms for the hip proprioception effects were different between age groups. These findings highlighted the importance of incorporating hip proprioception enhancement exercises in postural control training programs, and the necessity of considering age-related differences in the effects of hip proprioception when designing these exercises.

Kinematic characteristics during gait in frail older women identified by principal component analysis

Frailty is associated with gait variability in several quantitative parameters, including high stride time variability. However, the associations between joint kinematics during walking and increased gait variability with frailty remain unclear. In the current study, principal component analysis was used to identify the key joint kinematics characteristics of gait related to frailty. We analyzed whole kinematic waveforms during the entire gait cycle obtained from the pelvis and lower limb joint angle in 30 older women (frail/prefrail: 15 participants; non-frail: 15 participants). Principal component analysis was conducted using a 60 × 1224 input matrix constructed from participants’ time-normalized pelvic and lower-limb-joint angles along three axes (each leg of 30 participants, 51 time points, four angles, three axes, and two variables). Statistical analyses revealed that only principal component vectors 6 and 9 were related to frailty. Recombining the joint kinematics corresponding to these principal component vectors revealed that frail older women tended to exhibit greater variability of knee- and ankle-joint angles in the sagittal plane while walking compared with non-frail older women. We concluded that greater variability of knee- and ankle-joint angles in the sagittal plane are joint kinematic characteristics of gait related to frailty.

Persons with Parkinson's disease show impaired interlimb coordination during backward walking

INTRODUCTION

Although there is growing literature supporting the implementation of backward walking as a potential rehabilitation tool, moving backwards may precipitate falls for persons with Parkinson's disease. We sought to better understand interlimb coordination during backward walking in comparison to forward walking in persons with Parkinson's disease and healthy controls.

METHODS

We assessed coordination using point estimate of relative phase at each participant's preferred walking speed.

RESULTS

Persons with Parkinson's disease demonstrated impaired interlimb coordination between the more affected arm and each leg compared to controls, which worsened during backward walking.

CONCLUSION

For those with Parkinson's disease, inability to output smooth coordinated movement of the more affected shoulder may impair coordination during forward and, especially, backward walking. Our findings provide new information about backward walking that can allow clinicians to make safer, more effective therapeutic recommendations for persons with Parkinson's disease.

Influence of 8-Week Horseback Riding Activity on Balance and Pelvic Movements in an Older Adult Population

The biomechanical relationship between horse and rider in equine-assisted activities and therapies has been largely unexplored. The three-dimensional stimulation of the horse’s gait has potential to improve rider musculature and coordination, especially in an older adult population. This study utilized dual-axis goniometers and video motion capture tracking to simultaneously track horse and rider hip flexion and extension. Ten older adult riders participated in 8 weeks of horseback riding lessons, where pelvis kinematics and balance assessments were compared between Weeks 1 and 8. Pelvic roll of the rider and horses’ hip flexion and extension were successfully tracked and summed improvements in balance assessments were also evident after 8 weeks of horseback riding lessons. Future research will assess deeper kinematic relationships between a horse’s gait and rider biomechanical responses.

The Relationship between Leg Extension Angle at Late Stance and Knee Flexion Angle at Swing Phase during Gait in Community-Dwelling Older Adults

This study aimed to clarify the relationship between leg extension angle and knee flexion angle during gait in older adults. The subjects of this cross-sectional study were 588 community-dwelling older adults (74.6 ± 6.1 y). Segment angles and acceleration were measured using five inertial measurement units during comfortable gait, and bilateral knee and hip joint angles, and leg extension angle, reflecting whole lower limb extension at late stance, were calculated. Propulsion force was estimated using the increase in velocity calculated from anterior acceleration of the sacrum during late stance. Correlation analysis showed that leg extension angle was associated with knee flexion angle at swing phase and hip extension angle and increase in velocity at late stance (r = 0.444–508, p < 0.001). Multiple regression analysis showed that knee flexion angle at mid-swing was more affected by leg extension angle (β = 0.296, p < 0.001) than by gait speed (β = 0.219, p < 0.001) and maximum hip extension angle (β = −0.150, p < 0.001). These findings indicate that leg extension angle may be a meaningful parameter for improving gait function in older adults due to the association with knee kinematics during swing as well as propulsion force at late stance.

Investigating the Microchannel Architectures Inside the Subchondral Bone in Relation to Estimated Hip Reaction Forces on the Human Femoral Head

The interplay between articular cartilage (AC) and subchondral bone (SB) plays a pivotal role in cartilage homeostasis and functionality. As direct connective pathways between the two are poorly understood, we examined the location-dependent characteristics of the 3D microchannel network within the SB that connects the basal cartilage layer to the bone marrow (i.e. cartilage-bone marrow microchannel connectors; CMMC). 43 measuring points were defined on five human cadaveric femoral heads with no signs of osteoarthritis (OA) (age ≤ 60), and cartilage-bone cylinders with diameters of 2.00 mm were extracted for high-resolution scanning (n = 215). The micro-CT data were categorized into three groups (load-bearing region: LBR, n = 60; non-load-bearing region: NLBR, n = 60; and the peripheral rim: PR, n = 95) based on a gait analysis estimation of the joint reaction force (young, healthy cohort with no signs of OA). At the AC-SB interface, the number of CMMC in the LBR was 1.8 times and 2.2 times higher compared to the NLBR, and the PR, respectively. On the other hand, the median Feret size of the CMMC were smallest in the LBR (55.2 µm) and increased in the NLBR (73.5 µm; p = 0.043) and the PR (89.1 µm; p = 0.043). AC thickness was positively associated with SB thickness (Pearson's r = 0.48; p < 1e-13), CMMC number. (r = 0.46; p < 1e-11), and circularity index (r = 0.61; p < 1e-38). In conclusion, our data suggest that regional differences in the microchannel architecture of SB might reflect regional differences in loading.

Association of mobility capacity with the masses and amounts of intramuscular non-contractile tissue of the trunk and lower extremity muscles in community-dwelling older adults

We examined the association of mobility capacity with muscle thicknesses and echo intensities of the trunk and lower extremity muscles measured using an ultrasound imaging device in community-dwelling older adults. The participants were 57 community-dwelling older adults. Mobility capacity was assessed based on the measurement of usual and maximal walking speeds and timed up-and-go (TUG) time. Muscle thickness and echo intensity of the trunk and lower extremity muscles were measured using an ultrasound imaging device. Finally, sagittal spinal alignment was assessed based on the measurement of thoracic kyphosis, lumbar lordosis, and sacral anterior inclination angles in the standing position using a Spinal Mouse. Stepwise regression analysis showed that the tibialis anterior muscle thickness, tibialis posterior muscle echo intensity, and body weight were significant and independent factors of usual walking speed, with a coefficient of determination (R²) of 0.25. The thicknesses of the thoracic erector spinae and obliquus externus abdominis muscles were significant and independent factors of maximal walking speed (R² = 0.26). Moreover, only age was a significant and independent factor for TUG time (R² = 0.10). The results of this study suggested associations 1) between slow usual walking speed and low tibialis anterior muscle thicknesses and high echo intensity of the tibialis posterior muscle and 2) between slow maximal walking speed and low thoracic erector spinae and obliquus externus abdominis thicknesses in community-dwelling older adults.

Segmental contribution to whole-body angular momentum during stepping in healthy young and old adults

Recent evidence suggests that during volitional stepping older adults control whole-body angular momentum (H) less effectively than younger adults, which may impose a greater challenge for balance control during this task in the elderly. This study investigated the influence of aging on the segment angular momenta and their contributions to H during stepping. Eighteen old and 15 young healthy adults were instructed to perform a series of stepping at two speed conditions: preferred and as fast as possible. Full-body kinematics were recorded to compute angular momenta of the trunk, arms and legs and their contributions to total absolute H on the entire stepping movement. Results indicated that older adults exhibited larger angular momenta of the trunk and legs in the sagittal plane, which contributed to a higher sagittal plane H range during stepping compared to young adults. Results also revealed that older adults had a greater trunk contribution and lower leg contribution to total absolute H in the sagittal plane compared to young adults, even though there was no difference in the other two planes. These results stress that age-related changes in H control during stepping arise as a result of changes in trunk and leg rotational dynamics.

Mobility Deviations in Adults With Human Immunodeficiency Virus: A Cross-Sectional Assessment Using Gait Analysis, Functional Performance, and Self-Report

Background

Little is known about how human immunodeficiency virus (HIV) affects walking biomechanics, or about associations between HIV-related gait deviations, functional performance, and self-reported outcomes. This paper reports on (1) gait biomechanics and variability in people with HIV (PWH) and (2) associations with clinical tests, self-reported function, and falls.

Methods

A cross-sectional study tested consecutively sampled PWH (n = 50) and HIV-seronegative participants ([SNP] n = 50). Participants underwent 3-dimensional gait analysis, performed clinical tests (short walk and single leg stance tests with and without dual tasking, chair-rise tests, and a physical performance battery), and completed questionnaires about function and falls. Between-group comparisons were done using analysis of covariance. Linear correlations between gait variability, clinical tests, and patient-reported outcomes were established.

Results

People with HIV and SNP had comparable median ages (PWH = 36.6, interquartile range [IQR] = 32.0–45.6]; SNP = 31.1, IQR = 23.2–45.1). Compared with SNP, PWH walked slower (adjusted mean difference [MD] = −0.2 meters per second [m/s], 95% confidence interval [CI] = −0.3 to −0.1) with greater variability (adjusted MD = 14.7 variability score points, 95% CI = 9.9–19.5). Moreover, PWH were slower in five-times sit-to-stand (5STS) performance (adjusted MD = 1.9 seconds, 95% CI = 1.00–2.9). Significant deviations in hip kinematics (increased flexion; adjusted MDs = 2.4°–2.8°, P = .012–.016) and knee kinematics (reduced flexion; adjusted MDs = 2.3°–3.7°, P = .007–.027) were found in PWH during dual-task (DT) walking. The PWH’s 5STS moderately correlated with larger gait variability (usual pace r = −0.5; dual task r = −0.6), poorer self-reported mobility (r = 0.4) and self-care function (r = 0.5), and fear of falling (P = .003).

Conclusions

People with HIV presented with biomechanical deviations suggestive of a slowed and variable gait, especially under cognitive challenges. Five-times STS may be useful to screen for gait deviations in PWH.

Age and sex differences in normative gait patterns

BACKGROUND

A comprehensive understanding of healthy gait patterns is a critical first step towards understanding age-related pathologies and disorders that are commonly associated with mobility limitations throughout aging. Further, consideration of sex-specific gait patterns throughout the lifespan is important, considering biological differences between males and females that can manifest biomechanically, and epidemiological evidence of female sex being a risk factor for some age-related pathologies such as osteoarthritis.

RESEARCH QUESTION

The aim of this study was to characterize the differences in lower extremity joint kinematics and kinetics during gait between asymptomatic adult women and men in different age groups (20-40 years, 41-50 years, 51-59 years, 60+ years).

METHODS

This was a secondary analysis conducted on instrumented gait data from 154 asymptomatic adult participants (94 females, 60 males). Three-dimensional hip, knee and ankle joint angles and net external moments were calculated and waveform principal component analysis (PCA) was applied to extract major patterns of variability from each. PC scores were examined for significant sex, age and interaction effects using a two-factor ANOVA analysis (p = 0.001).

RESULTS

13 PC features differed between asymptomatic male and female gait patterns, and were independent of age category. No PC features significantly differed between the age groups, and there were no significant sex by age interactions.

SIGNIFICANCE

There are significant magnitude and pattern differences in hip, knee and ankle kinematics and kinetics between asymptomatic women and men. As study participants were asymptomatic, these differences do not necessarily correlate with any injury or disease mechanisms. However, these results do suggest the importance of considering sex-specific analyses in gait study design, and the use of sex-specific normative data in clinical gait studies. These results further suggest that consideration of strict age-matching for gait analysis studies using adult controls is not as critical as sex considerations.

Relationship of the sacral slope with early gait derangements in robust older women

BACKGROUND

Trunk pelvic dissociation is fundamental to the compensatory mechanism for muscle weakness during body bending. We carried out an early investigation of gait changes in a sample of community-dwelling women ≥60 years without gait complaints. The primary objective was to correlate spine and pelvic angles with performance tests and accelerometry parameters. The secondary objective was to correlate performance tests with accelerometry.

METHODS

In this cross-sectional study, 54 community-dwelling women ≥60 years were subjected to Falls Efficacy Scale-International (FES-I), performance tests (Berg Balance Scale, Timed Up and Go, and Gait analysis), and radiographic analysis of sagittal alignment (Thoracic and Lumbar Cobb, Pelvic Incidence, Sacral Slope, and Pelvic Tilt angles). Gait speed was assessed in a 10-m comfortable walk, and accelerometry parameters were obtained in a 30-m walk distance.

RESULTS

The sample, aged 72 ± 6 years, exhibited moderate correlation between Sacral Slope and Step Length (+ 0.615). Sacral Slope weakly correlated with FES-I (- 0.339), Berg Balance Scale (+ 0.367), and with further accelerometry data in the AP plane: RMS, (+ 0.439) and Stride Regularity (+ 0.475), p < 0.05, all. Lumbar Cobb weakly correlated with the following accelerometry data in the AP plane: Step Length (+ 0.405), RMS, (+ 0.392), and Stride Regularity (+ 0.345), p < 0.05, all. Additionally, Stride Regularity in AP moderately correlated with FES-I (0,561, p < 0.05), among other weak correlations between performance tests and accelerometry data in AP.

CONCLUSIONS

Early alterations in Sacral Slope and gait abnormalities in the AP plane may provide understanding of the early gait changes in robust older women.

Effect of foot-floor friction on the external moment about the body center of mass during shuffling gait: a pilot study

Herein, we investigated the effect of friction between foot sole and floor on the external forward moment about the body center of mass (COM) in normal and shuffling gaits. Five young male adults walked with normal and shuffling gaits, under low- and high-friction surface conditions. The maximum external forward moment about the COM (MEFM-COM) in a normal gait appeared approximately at initial foot contact and was unaffected by floor condition. However, MEFM-COM in a shuffling gait under high-friction conditions exceeded that under low-friction conditions (p < 0.001). Therein, MEFM-COM increased with an increasing utilized coefficient of friction at initial foot contact; this effect was weaker during a normal gait. These findings indicate that increased friction between foot sole and floor might increase tripping risk during a shuffling gait, even in the absence of discrete physical obstacles.

Age-based comparison of gait asymmetry using unilateral ankle weights

BACKGROUND

The locomotor system is proposed to be able to adapt to asymmetric conditions, which reflects the interaction between interlimb control and task constraints. However, this adaptability may be confounded by intrinsic differences between age groups.

RESEARCH QUESTION

What are the effects of mechanical asymmetry on kinematic symmetry in healthy younger and older adults?

METHODS

Two groups of 10 participants (age 18-25 and 58-65 years) walked (3 km h -1) and ran (9 km h -1) on a treadmill normally, and with unilateral ankle weights (UW). Lower-body kinematic data was collected. Symmetry Index (SI) and bilateral cyclograms were used to evaluate spatiotemporal step-cycle characteristics and joint angles.

RESULTS

Step-cycle characteristics were not significantly different between all comparisons. In running gait, asymmetry in range of motion (SI_RoM) of the knee and bilateral cyclogram minimum bounding box length (L) of the ankle was greater with UW compared to the normal condition. Ankle angle characteristics (SI_RoM ankle and minimum ankle angle) were more asymmetrical for older compared to younger adults, regardless of the UW condition. Interaction effects between age and UW were observed. In running gait, L knee and SI_RoM hip were greater with UW for younger adults, and smaller with UW for older adults. In walking gait, ankle angle at touchdown was greater with UW for younger adults, but smaller with UW for older adults.

SIGNIFICANCE

For both age groups walking and running with UW, symmetry appears to be preserved in step-cycle characteristics, but not in joint angle measures. While adapting to unilateral perturbation, older adults show greater asymmetry in some ankle kinematic measures compared to younger adults while running, suggesting that some kinematic solutions are altered with age, while the majority of symmetry values about the lower limbs were not.

Gait Pattern in People with Multiple Sclerosis: A Systematic Review

The aim of the present systematic review was to describe the gait pattern in people with multiple sclerosis (MS) by compiling the main findings obtained from studies using three-dimensional capture systems of human movement. The search was carried out in PubMed, Web of Science, Physiotherapy Evidence Database (PEDro), and the Cumulative Index to Nursing and Allied Health (CINAHL) databases. Studies that used three-dimensional gait analysis systems and that analyzed spatiotemporal, kinematic, kinetic, or electromyographic parameters, were included. The quality of the studies was assessed using the Critical Review Form-Quantitative Studies scale. 12 articles were included with 523 (342 women and 181 men) people with a diagnosis of MS. The present work suggests that people with MS have a decrease in speed and stride length, as well as an increase in double-stance intervals during gait. Likewise, it is common to observe a decrease in hip extension during the stance period, a decrease in knee flexion in the swing period, a decrease in ankle dorsiflexion in the initial contact and a decrease in ankle plantar flexion during the pre-swing phase. The subjects with MS decrease the hip extensor moment and the ankle power during the stance period of walking.

2-D forward dynamics simulation of gait adaptation to muscle weakness in elderly gait

BACKGROUND

Age-related changes of human gait characteristics associated with muscle weakness have been reported in previous studies. Human gait is considered as a cyclic motion adapted to individual body-characteristics and the surrounding-environment based on motion criteria. Based on this hypothesis, elderly gait characteristics may be caused by an adaptation to muscle weakness.

RESEARCH QUESTION

What role does gait adaptation to muscle weakness play in the development of elderly gait, and what criteria are used in elderly gait adaptation?

METHODS

We examined the effects of gait adaptation to muscle weakness on steady gait characteristics using computational forward dynamics simulation with a two-dimensional neuro-musculo-skeletal model. For gait adaptation, we tested two motion criteria: (i) energy cost minimization, which is a widely used criterion for healthy adults; and (ii) energy rate minimization, based on existing measurements of elderly gait characteristics.

RESULTS

Progression of muscle weakness enhanced the reduction of joint angle motion and minimum toe clearance, and finally resulted in falling. Gait adaptation to muscle weakness successfully formed stable walking patterns regardless of motion criteria, even at muscle weakness of 30 %, which represents a moderate degree of elderly muscle weakness. When criterion (i) was used, the time courses of joint motion were similar to those of healthy adults and a relatively high level of muscle activation was found in the whole gait cycle to compensate for muscle weakness. When criterion (ii) was used, the muscle activity level was lower than that of criterion (i) to minimize the energy rate, and the constructed gait successfully captured the characteristics of elderly gait reported in previous studies.

SIGNIFICANCE

These findings suggest that gait adaptation to muscle weakness plays an essential role in the development of stable gait characteristics, whereas elderly people might use a different motion criterion compared with healthy adults in gait adaptation.

Effects of Horizontal Impeding Force Gait Training on Older Adult Push-Off Intensity

INTRODUCTION

Aging and many gait pathologies are often characterized by deficits in push-off intensity (i.e., propulsive ground reaction forces and peak ankle moment and power output) during walking. Unfortunately, conventional interventions such as progressive resistance training, designed to enhance calf muscle mechanical output, generally fail to translate strength gains to functional improvements in habitual push-off intensity.

METHODS

Horizontal impeding forces applied to the body's center of mass systematically augment the mechanical output required from muscle-tendon units spanning the ankle during the push-off phase of walking, which could convey long-term benefits via training. Therefore, the purpose of this study was to investigate the preliminary efficacy of a 6-wk horizontal impeding force training paradigm on improving habitual push-off intensity in 11 healthy but not physically active older adults (age = 76 ± 4 yr, 6 females and 5 males).

RESULTS

We found that older adults significantly (P < 0.05) increased measures of isometric strength by 18%, maximum walking speed by 10%, and 6-min walk test distance by 9% as a result of horizontal impeding force training. As a more clinically significant contribution of this work, we found that those subjects also increased habitual peak ankle moment and peak ankle power during push off after training by a significant 10% and 15%, respectively (P ≤ 0.036).

CONCLUSIONS

We conclude that the use of horizontal impeding forces in older adults improves their maximum muscular and walking capacities while encouraging access to newfound strength gains, thereby improving habitual push-off intensity during walking.

Validity and reliability of smartphone applications for measurement of hip rotation, compared with three-dimensional motion analysis

BACKGROUND

Measurement of hip rotation is a crucial clinical parameter for the identification of hip problems and the monitoring of symptoms. The objective of this study was to determine whether the use of two smartphone applications is valid and reliable for the measurement of hip rotation.

METHODS

An experimental, cross-sectional study was undertaken to assess passive hip internal and external rotation in three positions by two examiners. The hip rotational angles were measured by a smartphone clinometer application in the sitting and prone positions, and by a smartphone compass application in the supine position; their results were compared with those of the standard, three-dimensional, motion analysis system. The validities and inter-rater and intra-rater reliabilities of the smartphone applications were evaluated.

RESULTS

The study involved 24 participants. The validities were good to excellent for the internal rotation angles in all positions (ICC 0.81-0.94), good for the external rotation angles in the prone position (ICC 0.79), and fair for the sitting and supine positions (ICC 0.70-0.73). The measurement of the hip internal rotation in the supine position had the highest ICC value of 0.94 (0.91, 0.96). The two smartphone applications showed good-to-excellent intra-rater reliability, but good-to-excellent inter-rater reliability for only three of the six positions (two other positions had fair reliability, while one position demonstrated poor reliability).

CONCLUSIONS

The two smartphone applications have good-to-excellent validity and intra-rater reliability, but only fair-to-good inter-rater reliability for the measurement of the hip rotational angle. The most valid hip rotational position in this study was the supine IR angle measurement, while the lowest validity was the ER angle measurement in the sitting position. The smartphone application is one of the practical measurements in hip rotational angles.

TRIAL REGISTRATION

Number 20181022003 at the Thai Clinical Trials Registry ( http://www.clinicaltrials.in.th ) which was retrospectively registered at 2018-10-18 15:30:29.

Gluteal atrophy and fatty infiltration in end-stage osteoarthritis of the hip: a case-control study

Aims

The gluteus minimus (GMin) and gluteus medius (GMed) have unique structural and functional segments that may be affected to varying degrees, by end-stage osteoarthritis (OA) and normal ageing. We used data from patients with end-stage OA and matched healthy controls to 1) quantify the atrophy of the GMin and GMed in the two groups and 2) describe the distinct patterns of the fatty infiltration in the different segments of the GMin and GMed in the two groups.

Methods

A total of 39 patients with end-stage OA and 12 age- and sex frequency-matched healthy controls were prospectively enrolled in the study. Fatty infiltration within the different segments of the GMin and the GMed was assessed on MRI according to the semiquantitative classification system of Goutallier and normalized cross-sectional areas were measured.

Results

The GMin was smaller in the OA-group (p < 0.001) compared to the control group, but there was no group difference in the size of the GMed (p = 0.101). Higher levels of fatty infiltration were identified in the anterior segment of the GMin (p = 0.006) and the anterior (p = 0.006) and middle (p = 0.047) segments of the GMed in the OA group. All subjects in the control group had fatty infiltration of the anterior segment of the GMin, but all except one had no fatty infiltration in the entire GMed.

Conclusion

End-stage OA was associated with significant atrophy of the GMin and higher levels of fatty infiltration, particularly in the anterior segments of the GMin and GMed. Minor fatty infiltration of the anterior segment of GMin appears to be a normal part of ageing. Our study has demonstrated different patterns of atrophy and fatty infiltration between patients with end-stage OA and healthy matched peers.

Cite this article: Bone Jt Open 2021;2(1):40–47.

Effects of stretching exercises on human gait: a systematic review and meta-analysis

Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.

Effects of stretching exercises on human gait: a systematic review and meta-analysis

Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.

Which Are the Key Kinematic and Kinetic Components to Distinguish Recovery Strategies for Overground Slips Among Community-Dwelling Older Adults?

Slip outcomes are categorized as either a backward loss of balance (LOB) or a no loss of balance (no-LOB) in which an individual does not take a backward step to regain their stability. LOB includes falls and nonfalls, while no-LOB includes skate overs and walkovers. Researchers are uncertain about which factors determine slip outcomes and at which critical instants they do so. The purpose of the study was to investigate factors affecting slip outcomes in proactive and early reactive phases by analyzing 136 slip trials from 68 participants (age: 72.2 [5.3] y, female: 22). Segment angles and average joint moments in the sagittal plane of the slipping limb were compared for different slip outcomes. The results showed that knee flexor, hip extensor, and plantar flexor moments were significantly larger for no-LOB than for LOB in the midproactive phase, leading to smaller shank-ground and foot-ground angles at the slip onset, based on forward dynamics. In the early reactive phase, the hip extensor and plantar flexor moments were larger for no-LOB than for LOB, and all segment angles were smaller for no-LOB. Our findings indicate that the shank angle and knee moment were the major determinants of slip outcomes in both proactive and reactive phases.

Parkinson's gait kinematics deteriorates across multiple cognitive domains under dual-task paradigms

OBJECTIVE

The symptoms of Parkinson's disease (PD) in many circumstances lead to gait dysfunction which contribute to decreased mobility, reduced quality of life, and increased risk of falling. Dual-task conditions have been shown to amplify gait dysfunction from a spatiotemporal parameter standpoint; however, less is known regarding gait joint kinematics under dual-task conditions in PD, specifically across multiple cognitive domains. The purpose of this project was to systematically characterize lower extremity joint kinematics in individuals with mild-moderate PD under dual-task paradigms across multiple cognitive domains.

PATIENTS AND METHODS

Twenty-three individuals with idiopathic Parkinson's disease participated in this observational study evaluating hip, knee, and ankle joint kinematics while walking on a self-paced treadmill under dual-task conditions that taxed memory, attention, verbal fluency, and information processing.

RESULTS

Gait velocity and range of motion at the ankle, knee, and hip decreased (p < 0.05) under all of the dual-task conditions. Hip kinematics were affected to a greater extent than the ankle and knee, with reduction in flexion and extension during all timestamps of the gait cycle (p < 0.05) under all dual-task conditions.

CONCLUSION

The worsening of gait kinematics under dual-task conditions regardless of the aspect of cognition being challenged suggest that information processing and motor output are unable to withstand dual-task loads without consequence. These study results provide insight for target areas to focus on during therapeutic interventions in order to help minimize gait kinematic decrements observed under dual-task conditions.

Is Handgrip Strength a Useful Measure to Evaluate Lower Limb Strength and Functional Performance in Older Women?

Aim

This study aimed to determine the association of handgrip strength with isometric and isokinetic strength (hip, knee and ankle extensor/flexor muscles), and functional capacity in older women.

Methods

The handgrip strength and lower limb strength of 199 older women (60–86 years) were measured using JAMAR and BIODEX dynamometers, respectively. Time Up and Go, Five-times-sit-to-stand and 6m-walk functional tests were evaluated. Pearson correlations were used to determine the relationship between variables. Regression analysis was applied to identify if HS was able to predict TUG performance. The effect of age was analyzed by splitting the participants in a group of older women (OLD; from 60 to 70 years old) and very old women (from 71 to 86 years old).

Results

The HS and isometric/isokinetic strength correlations were negligible/low and, in most cases, were non-significant. The correlation between handgrip strength and functional tests also ranged predominantly from negligible (r=0.0 to 0.3) to low (r=0.3 to 0.5), irrespective of the group age. The handgrip strength was not able to explain the variance of the TUG performance.

Conclusion

Generalizing handgrip strength as a practical and straightforward measure to determine lower limbs and overall strength, and functional capacity in older women must be viewed with caution. Handgrip strength and standard strength measures of the lower limbs and functional tests present a negligible/low correlation.

Interrelated Neuromuscular and Clinical Risk Factors That Contribute to Falls

BACKGROUND

Neuromuscular and clinical factors contribute to falls among older adults, yet the interrelated nature of these factors is not well understood. We investigated the relationships between these factors and how they contribute to falls, which may help optimize fall risk assessment and prevention.

METHODS

A total of 365 primary care patients (age = 77 ± 7, 67% female) were included from the Boston Rehabilitative Impairment Study of the Elderly. Neuromuscular measures included leg strength and leg velocity, trunk extensor endurance, and knee range of motion. Clinical measures included memory, executive function, depressive symptoms, pain, sensory loss, vision, comorbidity, physical activity, mobility self-efficacy, and psychiatric medication. Factor analysis was used to evaluate clustering of factors. Negative binomial regression assessed the relationship of factors with three-year fall rate. Interactions were tested to examine whether clinical factors modified the relationship between neuromuscular factors and falls.

RESULTS

Three factors emerged: (i) neuromuscular factors, pain, and self-efficacy; (ii) memory; and (iii) executive function. Having three neuromuscular impairments predicted higher fall rate (incidence rate ratio [95% confidence interval]: 3.39 [1.82-6.32]) but was attenuated by memory (1.69 [1.10-2.61]), mobility self-efficacy (0.99 [0.98-0.99]), psychiatric medication use (1.54 [1.10-2.14]), and pain (1.13 [1.04-1.23]). Pain modified the relationship between neuromuscular impairment burden (number of neuromuscular impairments) and falls. Having three neuromuscular impairments was associated with a higher fall rate in patients with high levels of pain (5.73 [2.46-13.34]) but not among those with low pain.

CONCLUSIONS

Neuromuscular impairment burden was strongly associated with fall rate in older adults with pain. These factors should be considered together during fall risk assessment, post fall assessment, and prevention.

Effects of A "Modified" Otago Exercise Program on the Functional Abilities and Social Participation of Older Adults Living in the Community-The AGA@4life Model

Strength and balance exercises form part of multifactorial programs to reduce the risk of falling and promote active ageing. The aim of this study was to evaluate the effect of a strength and balance exercise program, adapted from the traditional Otago Exercise Program (OTAGO) into a technological system. A non-randomized experimental study enrolled 34 participants (83.24 ± 6.89 years) from a daycare center in Portugal, who were distributed into an intervention group (IG; 18 participants) and a control group (CG; 16 participants). The IG underwent a "modified" OTAGO incorporated in a technological system using pressure and inertial sensors, feedback, and Exergames for 8 weeks, 3 times a week. The CG continued their regular activities. Outcome measures were evaluated at baseline and after 8 weeks of intervention. After the program, differences were observed between the groups in handgrip strength (p = 0.03), step test (p = 0.03), 4stage balance test "modified" (p < 0.001) and activities and participation profile related to mobility (PAPM) (p < 0.001). The IG showed positive results in the self-efficacy for exercise (p = 0.03), PAPM (p = 0.00) and all functional tests, except for timed up and go (p = 0.35). No significant changes were observed in the CG. The results support this intervention program as a good exercise solution to improve functional abilities, social participation, and self-efficacy, reducing the risk of falling.