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Kim YK, Gwerder M, Taylor WR, Baur H, Singh NB. Adaptive gait responses to varying weight-bearing conditions: Inferences from gait dynamics and H-reflex magnitude. Exp Physiol 2024; 109:754-765. [PMID: 38488681 PMCID: PMC11061628 DOI: 10.1113/ep091492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024]
Abstract
This study investigates the effects of varying loading conditions on excitability in neural pathways and gait dynamics. We focussed on evaluating the magnitude of the Hoffman reflex (H-reflex), a neurophysiological measure representing the capability to activate motor neurons and the timing and placement of the foot during walking. We hypothesized that weight manipulation would alter H-reflex magnitude, footfall and lower body kinematics. Twenty healthy participants were recruited and subjected to various weight-loading conditions. The H-reflex, evoked by stimulating the tibial nerve, was assessed from the dominant leg during walking. Gait was evaluated under five conditions: body weight, 20% and 40% additional body weight, and 20% and 40% reduced body weight (via a harness). Participants walked barefoot on a treadmill under each condition, and the timing of electrical stimulation was set during the stance phase shortly after the heel strike. Results show that different weight-loading conditions significantly impact the timing and placement of the foot and gait stability. Weight reduction led to a 25% decrease in double limb support time and an 11% narrowing of step width, while weight addition resulted in an increase of 9% in step width compared to body weight condition. Furthermore, swing time variability was higher for both the extreme weight conditions, while the H-reflex reduced to about 45% between the extreme conditions. Finally, the H-reflex showed significant main effects on variability of both stance and swing phases, indicating that muscle-motor excitability might serve as feedback for enhanced regulation of gait dynamics under challenging conditions.
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Affiliation(s)
- Yong Kuk Kim
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
| | - Michelle Gwerder
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - William R. Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
| | - Heiner Baur
- School of Health Professions, PhysiotherapyUniversity of Applied SciencesBernSwitzerland
| | - Navrag B. Singh
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Singapore‐ETH Centre, Future Health Technologies ProgramSingaporeSingapore
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Cofré Lizama LE, Wheat J, Slattery P, Middleton K. Can handling a weapon make soldiers more unstable? ERGONOMICS 2023; 66:1246-1254. [PMID: 36326486 DOI: 10.1080/00140139.2022.2143906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
Gait stability in soldiers can be affected by task constraints that may lead to injuries. This study determined the effects of weapon handling and speed on gait stability in seventeen soldiers walking on a treadmill with and without a replica weapon at self-selected (SS), 3.5 km·h-1, 5.5 km·h-1, and 6.5 km·h-1 while carrying a 23-kg load. Local dynamic stability was measured using accelerometry at the sacrum (LDESAC) and sternum (LDESTR). No significant weapon and speed interaction were found. A significant effect of speed for the LDESAC, and a significant effect of speed and weapon for the LDESTR were found. Per plane analyses showed that the weapon effect was consistent across all directions for the LDESTR but not for LDESAC. Weapon handling increased trunk but did not affect pelvis stability. Speed decreased stability when walking slower than SS and increased when faster. These findings can inform injury prevention strategies in the military. Practitioner summary: We determined the effects of two constraints in soldier's walking stability, weapon handling and speed, measured at the trunk and sacrum. No constraints interactions were found, however, lower stability when walking slow and greater stability with the weapon at the trunk can inform preventive strategies in military training.
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Affiliation(s)
- L Eduardo Cofré Lizama
- Applied Biomechanics Laboratory, Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Jonathan Wheat
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, United Kingdom
| | - Patrick Slattery
- Applied Biomechanics Laboratory, Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Kane Middleton
- Applied Biomechanics Laboratory, Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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Ren X, Kebbach M, Bruhn S, Yang Q, Lin H, Bader R, Tischer T, Lutter C. Barefoot walking is more stable in the gait of balance recovery in older adults. BMC Geriatr 2022; 22:904. [PMID: 36434546 PMCID: PMC9700923 DOI: 10.1186/s12877-022-03628-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Perturbation-based balance training on a treadmill is an emerging method of gait stability training with a characteristic task nature that has had positive and sustained effects on balance recovery strategies and fall reduction. Little is known about the effects produced by shod and barefoot walking. We aimed to investigate which is more appropriate, shod or barefoot walking, for perturbation-based balance training in older adults. METHODS Fourteen healthy older adults (age: 68.29 ± 3.41 years; body height: 1.76 ± 0.10 m; body mass: 81.14 ± 14.52 kg) performed normal and trip-like perturbed walking trials, shod and barefoot, on a treadmill of the Gait Real-time Analysis Interactive Lab. The marker trajectories data were processed by Human Body Model software embedded in the Gait Offline Analysis Tool. The outcomes of stride length variability, stride time variability, step width variability, and swing time variability were computed and statistically analyzed by a two-way repeated-measures analysis of variance (ANOVA) based on gait pattern (normal gait versus perturbed recovery gait) and footwear condition (shod versus barefoot). RESULTS Footwear condition effect (p = 0.0310) and gait pattern by footwear condition interaction effect (p = 0.0055) were only observed in swing time variability. Gait pattern effects were detected in all four outcomes of gait variability. CONCLUSIONS Swing time variability, independent of gait speed, could be a valid indicator to differentiate between footwear conditions. The lower swing time variability in perturbed recovery gait suggests that barefoot walking may be superior to shod walking for perturbation-based balance training in older adults.
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Affiliation(s)
- Xiping Ren
- College of Physical Education and Health Sciences, Zhejiang Normal University, 688 Yingbin Road, Jinhua, 321000, China.
- Department of Orthopedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany.
| | - Maeruan Kebbach
- Department of Orthopedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Sven Bruhn
- Institute of Sport Science, University of Rostock, 18051, Rostock, Germany
| | - Qining Yang
- Department of Joint Surgery, The Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321099, China
| | - Huijie Lin
- School of Physical Education, Taizhou University, Linhai, 318000, China
| | - Rainer Bader
- Department of Orthopedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Thomas Tischer
- Department of Orthopedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
| | - Christoph Lutter
- Department of Orthopedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Doberaner Strasse 142, 18057, Rostock, Germany
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Identifying the Effects of Age and Speed on Whole-Body Gait Symmetry by Using a Single Wearable Sensor. SENSORS 2022; 22:s22135001. [PMID: 35808494 PMCID: PMC9269851 DOI: 10.3390/s22135001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
Studies on gait symmetry in healthy population have mainly been focused on small range of age categories, neglecting Teenagers (13–18 years old) and Middle-Aged persons (51–60 years old). Moreover, age-related effects on gait symmetry were found only when the symmetry evaluation was based on whole-body acceleration than on spatiotemporal parameters of the gait cycle. Here, we provide a more comprehensive analysis of this issue, using a Symmetry Index (SI) based on whole-body acceleration recorded on individuals aged 6 to 84 years old. Participants wore a single inertial sensor placed on the lower back and walked for 10 m at comfortable, slow and fast speeds. The SI was computed using the coefficient of correlation of whole-body acceleration measured at right and left gait cycles. Young Adults (19–35 years old) and Adults (36–50 years old) showed stable SI over the three speed conditions, while Children (6–12 years old), Teenagers (13–18 years old), Middle-Aged persons and Elderly (61–70 and 71–84 years old) exhibited lower SI values when walking at fast speed. Overall, this study confirms that whole-body gait symmetry is lower in Children and in Elderly persons over 60 years of age, showing, for the first time, that asymmetries appear also during teenage period and in Middle-Aged persons (51–60 years old).
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Ravi DK, Heimhofer CC, Taylor WR, Singh NB. Adapting Footfall Rhythmicity to Auditory Perturbations Affects Resilience of Locomotor Behavior: A Proof-of-Concept Study. Front Neurosci 2021; 15:678965. [PMID: 34393705 PMCID: PMC8358836 DOI: 10.3389/fnins.2021.678965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
For humans, the ability to effectively adapt footfall rhythm to perturbations is critical for stable locomotion. However, only limited information exists regarding how dynamic stability changes when individuals modify their footfall rhythm. In this study, we recorded 3D kinematic activity from 20 participants (13 males, 18–30 years old) during walking on a treadmill while synchronizing with an auditory metronome sequence individualized to their baseline walking characteristics. The sequence then included unexpected temporal perturbations in the beat intervals with the subjects required to adapt their footfall rhythm accordingly. Building on a novel approach to quantify resilience of locomotor behavior, this study found that, in response to auditory perturbation, the mean center of mass (COM) recovery time across all participants who showed deviation from steady state (N = 15) was 7.4 (8.9) s. Importantly, recovery of footfall synchronization with the metronome beats after perturbation was achieved prior (+3.4 [95.0% CI +0.1, +9.5] s) to the recovery of COM kinematics. These results highlight the scale of temporal adaptation to perturbations and provide implications for understanding regulation of rhythm and balance. Thus, our study extends the sensorimotor synchronization paradigm to include analysis of COM recovery time toward improving our understanding of an individual’s resilience to perturbations and potentially also their fall risk.
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Affiliation(s)
- Deepak K Ravi
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Switzerland
| | - Caroline C Heimhofer
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Switzerland
| | - William R Taylor
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Switzerland
| | - Navrag B Singh
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Switzerland
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Walsh GS, Harrison I. Gait and neuromuscular dynamics during level and uphill walking carrying military loads. Eur J Sport Sci 2021; 22:1364-1373. [PMID: 34231431 DOI: 10.1080/17461391.2021.1953154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The neuromuscular system responds to perturbation and increasing locomotor task difficulty by altering the stability of neuromuscular output signals. The purpose of this study was to determine the effects of two different military load carriage systems on the dynamic stability of gait and muscle activation signals. 14 army office cadets (20 ± 1 years) performed 4-minute treadmill walking trials on level (0%) and uphill (10%) gradients while unloaded, and with 11 kg backpack and 11 kg webbing loads while the activity of 6 leg and trunk muscles and the motion of the centre of mass (COM) were recorded. Loaded and uphill walking decreased stability and increased magnitude of muscle activations compared to loaded and level gradient walking. Backpack loads increased the medio-lateral stability of COM and uphill walking decreased stability of vertical COM motion and increased stride time variability. However, there was no difference between the two load carriage systems for any variable. The reduced stability of muscle activations in loaded and uphill conditions indicates an impaired ability of the neuromuscular control systems to accommodate perturbations in these conditions which may have implications on the operational performance of military personnel. However, improved medio-lateral stability in backpack conditions may indicate that participants were able to compensate for the loads used in this study, despite the decreased vertical stability and increased stride time variability evident in uphill walking. This study did not find differences between load carriage systems however, specific load carriage system effects may be elicited by greater load carriage masses.Highlights Loaded and uphill walking decreased dynamic stability of muscle activationsLower activation stability indicates impaired neuromotor resistance to perturbationBackpack and webbing loads produced similar effects on muscle activations.
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Affiliation(s)
- Gregory S Walsh
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Isabel Harrison
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
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Fallahtafti F, Gonabadi AM, Samson K, Yentes JM. Margin of Stability May Be Larger and Less Variable during Treadmill Walking Versus Overground. BIOMECHANICS 2021; 1:118-130. [PMID: 34414390 PMCID: PMC8372237 DOI: 10.3390/biomechanics1010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Margin of stability (MOS) is considered a measure of mechanical gait stability. Due to broad application of treadmills in gait assessment experiments, we aimed to determine if walking on a treadmill vs. overground would affect MOS during three speed-matched conditions. Eight healthy young participants walked on a treadmill and overground at Slow, Preferred, and Fast speed-matched conditions. The mean and variability (standard deviation) of the MOS in anterior-posterior and mediolateral directions at heel contact were calculated. Anterior-posterior and mediolateral mean MOS values decreased with increased speed for both overground and treadmill; although mediolateral mean MOS was always wider on the treadmill compared to overground. Due to lack of optic flow and different proprioceptive inputs during treadmill walking, subjects may employ strategies to increase their lateral stability on treadmill compared to overground. Anterior-posterior MOS variability increased with speed overground, while it did not change on treadmill, which might be due to the fixed speed of treadmill. Whereas, lateral variability on both treadmill and overground was U-shaped. Walking at preferred speed was less variable (may be interpreted as more stable) laterally, compared to fast and slow speeds. Caution should be given when interpreting MOS between modes and speeds of walking. As sagittal plane walking is functionally unstable, this raises the consideration as to the meaningfulness of using MOS as a global measure of gait stability in this direction.
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Affiliation(s)
- Farahnaz Fallahtafti
- Department of Biomechanics, University of Nebraska at Omaha; Omaha, NE 68182-0860, United States
- Correspondence: (F.F.); (J.M.Y.)
| | - Arash Mohammadzadeh Gonabadi
- Department of Biomechanics, University of Nebraska at Omaha; Omaha, NE 68182-0860, United States
- Rehabilitation Engineering Center, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals; Lincoln, NE 68506, United States
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center; Omaha, NE 68198-4375, United States
| | - Jennifer M. Yentes
- Department of Biomechanics, University of Nebraska at Omaha; Omaha, NE 68182-0860, United States
- VA Nebraska-Western Iowa Health Care System, Department of Veterans’ Affiars; Omaha, NE 68105, United States
- Department of Health & Kinesiology, Texas A&M University; College Station, TX 77843, United States
- Correspondence: (F.F.); (J.M.Y.)
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Ravi DK, Bartholet M, Skiadopoulos A, Kent JA, Wickstrom J, Taylor WR, Singh NB, Stergiou N. Rhythmic auditory stimuli modulate movement recovery in response to perturbation during locomotion. J Exp Biol 2021; 224:jeb.237073. [PMID: 33536309 PMCID: PMC7938806 DOI: 10.1242/jeb.237073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022]
Abstract
The capacity to recover after a perturbation is a well-known intrinsic property of physiological systems, including the locomotor system, and can be termed ‘resilience’. Despite an abundance of metrics proposed to measure the complex dynamics of bipedal locomotion, analytical tools for quantifying resilience are lacking. Here, we introduce a novel method to directly quantify resilience to perturbations during locomotion. We examined the extent to which synchronizing stepping with two different temporal structured auditory stimuli (periodic and 1/f structure) during walking modulates resilience to a large unexpected perturbation. Recovery time after perturbation was calculated from the horizontal velocity of the body's center of mass. Our results indicate that synchronizing stepping with a 1/f stimulus elicited greater resilience to mechanical perturbations during walking compared with the periodic stimulus (3.3 s faster). Our proposed method may help to gain a comprehensive understanding of movement recovery behavior of humans and other animals in their ecological contexts. Summary: A new method for the evaluation of intrinsic resilience during unsteady locomotion in humans and animals, analysing the relationship between the structure of movement variability and resilience.
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Affiliation(s)
- Deepak K Ravi
- Institute for Biomechanics, ETH Zürich, 8093 Zürich, Switzerland
| | - Marc Bartholet
- Institute for Biomechanics, ETH Zürich, 8093 Zürich, Switzerland
| | - Andreas Skiadopoulos
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Jenny A Kent
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Jordan Wickstrom
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - William R Taylor
- Institute for Biomechanics, ETH Zürich, 8093 Zürich, Switzerland
| | - Navrag B Singh
- Institute for Biomechanics, ETH Zürich, 8093 Zürich, Switzerland
| | - Nick Stergiou
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE 68182, USA .,Department of Environmental Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE 68198-4388, USA
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Bannwart M, Bayer SL, König Ignasiak N, Bolliger M, Rauter G, Easthope CA. Mediolateral damping of an overhead body weight support system assists stability during treadmill walking. J Neuroeng Rehabil 2020; 17:108. [PMID: 32778127 PMCID: PMC7418206 DOI: 10.1186/s12984-020-00735-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Body weight support systems with three or more degrees of freedom (3-DoF) are permissive and safe environments that provide unloading and allow unrestricted movement in any direction. This enables training of walking and balance control at an early stage in rehabilitation. Transparent systems generate a support force vector that is near vertical at all positions in the workspace to only minimally interfere with natural movement patterns. Patients with impaired balance, however, may benefit from additional mediolateral support that can be adjusted according to their capacity. An elegant solution for providing balance support might be by rendering viscous damping along the mediolateral axis via the software controller. Before use with patients, we evaluated if control-rendered mediolateral damping evokes the desired stability enhancement in able-bodied individuals. METHODS A transparent, cable-driven robotic body weight support system (FLOAT) was used to provide transparent body weight support with and without mediolateral damping to 21 able-bodied volunteers while walking at preferred gait velocity on a treadmill. Stability metrics reflecting resistance to small and large perturbations were derived from walking kinematics and compared between conditions and to free walking. RESULTS Compared to free walking, the application of body weight support per-se resulted in gait alterations typically associated with body weight support, namely increased step length and swing phase. Frontal plane dynamic stability, measured by kinematic variability and nonlinear dynamics of the center of mass, was increased under body weight support, indicating reduced balance requirements in both damped and undamped support conditions. Adding damping to the body weight support resulted in a greater increase of frontal plane stability. CONCLUSION Adding mediolateral damping to 3-DoF body weight support systems is an effective method of increasing frontal plane stability during walking in able-bodied participants. Building on these results, adjustable mediolateral damping could enable therapists to select combinations of unloading and stability specifically for each patient and to adapt this in a task specific manner. This could extend the impact of transparent 3-DoF body weight support systems, enabling training of gait and active balance from an early time point onwards in the rehabilitation process for a wide range of mobility activities of daily life.
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Affiliation(s)
- M. Bannwart
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - S. L. Bayer
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - M. Bolliger
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - G. Rauter
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Sensory Motor Systems Laboratory, Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- BIROMED-Laboratory, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - C. A. Easthope
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- cereneo Center for Interdisciplinary Research, Vitznau, Switzerland
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Ravi DK, Gwerder M, König Ignasiak N, Baumann CR, Uhl M, van Dieën JH, Taylor WR, Singh NB. Revealing the optimal thresholds for movement performance: A systematic review and meta-analysis to benchmark pathological walking behaviour. Neurosci Biobehav Rev 2019; 108:24-33. [PMID: 31639377 DOI: 10.1016/j.neubiorev.2019.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 01/29/2023]
Abstract
In order to address whether increased levels of movement output variability indicate pathological performance, we systematically reviewed and synthesized meta-analysis data on healthy and pathological motor behavior. After screening up to 24'000 reports from four databases, 85 studies were included containing 2409 patients and 2523 healthy asymptomatic controls. The optimal thresholds of variability with uncertainty boundaries (in % Coefficient of Variation ± Standard Error) were estimated in 7 parameters: stride time (2.34 ± 0.21), stride length (2.99 ± 0.37), step length (3.34 ± 0.84), swing time (2.94 ± 0.60), step time (3.35 ± 0.23), step width (15.87 ± 1.86), and dual-limb support time (6.08 ± 2.83). All spatio-temporal parameters exhibited a positive effect size (pathology led to increased variability) except step width variability (Effect Size = -0.21). By objectively benchmarking thresholds for pathological motor variability also presented through a case-study, this review provides access to movement signatures to understand neurological changes in an individual that are apparent in movement variability. The comprehensive evidence presented now qualifies stride time variability as a movement biomarker, endorsing its applicability as a viable outcome measure in clinical trials.
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Affiliation(s)
- Deepak K Ravi
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Michelle Gwerder
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Niklas König Ignasiak
- Department of Physical Therapy, Chapman University, Rinker Health Science Campus, 9401 Jeronimo Rd, Irvine, CA, 92618, USA
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, 8091, Zürich, Switzerland
| | - Mechtild Uhl
- Department of Neurology, University Hospital Zurich, 8091, Zürich, Switzerland
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van der Boechorststraat 9, 1081 BT, Amsterdam, the Netherlands
| | - William R Taylor
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
| | - Navrag B Singh
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
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