Local Dynamic Stability of the Locomotion of Lower Extremity Joints and Trunk During Backward Upslope Walking

Backward slope walking was considered as a practical rehabilitation and training skill. However, its gait stability has been hardly studied, resulting in its limited application as a rehabilitation tool. In this study, the effect of walking direction and slope grade were investigated on the local dynamic stability of the motion of lower extremity joints and trunk segment during backward and forward upslope walking (BUW/FUW). The local divergence exponents (λ_S) of 16 adults were calculated during their BUW and FUW at grades of 0%, 5%, 10%, and 15%. Mean standard deviation over strides (MeanSD) was analyzed as their gait variability. Backward walking showed larger λ_S for the abduction-adduction and rotational angles of knee and ankle on inclined surface than forward walking, while λ_S for hip flexion-extension angle at steeper grades was opposite. No grade effect for any joint existed during BUW, while λ_S increased with the increasing grade during FUW. As to the trunk, walking direction did little impact on λ_S. Still, significant larger λ_S for its medial-lateral and vertical motion were found at the steeper grades during both FUW and BUW. Results indicate that during BUW, the backward direction may influence the stability of joint motions, while the trunk stability was challenged by the increasing grades. Therefore, BUW may be a training tool for the stability of both upper and lower body motion during gait.     

The relation between preparatory stance and trunk rotation movements

The influence of preparatory stance on rotation movement reaction time of the trunk by bending of the knee and hip joint(s) was examined in 12 subjects. Four preparatory stances were examined: straight knee and hip extension (STAND), slight flexion of knee joints and hip joint (LIGHT), deep flexion (DEEP), and free initial position, i.e. that felt to be the most comfortable and effective (FREE). There was no significant influence of the preparatory stance on hip latency, but there were significant differences between the preparatory stances on response time (RT) and movement time (MT). Furthermore, using a quadratic curve fitting technique, knee joint angles of 24.8 degrees and a hip joint angle of 23.3 degrees were shown to be the optimum flexion angles in the preparatory stance for the initiation of quick trunk rotation movements. It is proposed that mechanical factors have considerably more effects on trunk rotation movements than does the nervous system.     

Influence of Restricted Vision and Knee Joint Range of Motion on Gait Properties During Level Walking and Stair Ascent and Descent

Because elderly individuals experience marked declines in various physical functions (e.g., vision, joint function) simultaneously, it is difficult to clarify the individual effects of these functional declines on walking. However, by imposing vision and joint function restrictions on young men, the effects of these functional declines on walking can be clarified. The authors aimed to determine the effect of restricted vision and range of motion (ROM) of the knee joint on gait properties while walking and ascending or descending stairs. Fifteen healthy young adults performed level walking and stair ascent and descent during control, vision restriction, and knee joint ROM restriction conditions. During level walking, walking speed and step width decreased, and double support time increased significantly with vision and knee joint ROM restrictions. Stance time, step width, and walking angle increased only with knee joint ROM restriction. Stance time, swing time, and double support time were significantly longer in level walking, stair descent, and stair ascent, in that order. The effects of vision and knee joint ROM restrictions were significantly larger than the control conditions. In conclusion, vision and knee joint ROM restrictions affect gait during level walking and stair ascent and descent. This effect is marked in stair ascent with knee joint ROM restriction.     

Influences of elbow,shoulder, trunk motion and temporospatial parameters on arm swing asymmetry of Parkinson's disease during walking

Arm swing asymmetry is commonly observed in early Parkinson's disease (PD) and has been found to be useful for early diagnosis. However, there are uncertainties about the nature of its relationships with gait parameters, especially shoulder and elbow motions. Therefore, this study explored how these relationships are different between PD and controls. Forty one early PD and 23 controls were included. Participants walked at self-selected speed for 3D motion analysis. Arm swing at the wrist (AS), temporospatial parameters and kinematics in elbow, shoulder and trunk were obtained. Amplitudes and asymmetries of these variables were compared between PD and control groups. PD group showed increased AS asymmetry, compared to controls. Multiple hierarchical regression analysis on AS asymmetry was conducted in order to investigate how PD influences on the relationship between AS asymmetry and other variables. In pooled data (PD and control group), asymmetries in elbow and shoulder range of motion (RoM) were significant predictors for AS asymmetry but walking speed and asymmetries in temporospatial parameters were not significant. Group effect (PD effect) was significantly mediated by only elbow RoM asymmetry. Interaction between group and elbow RoM asymmetry was statistically significant, indicating that group was an effect modifier for elbow RoM asymmetry effect on AS asymmetry. Conclusively, arm swing asymmetry measured at the wrist represents the involvement of PD effect on the unilateral and distal upper limb in early stage. These findings are helpful for future researches related to clinical applications and mechanisms of arm swing asymmetry in PD.     

The Effectiveness of Driving Game on Trunk Control and Gait Ability in Stroke

Abstract

Patients who require neurological rehabilitation often do not comply with conventional programs because they find the therapy uninteresting. As a result, specialized interactive video games have been designed to be more enjoyable than conventional therapy (CT) tasks. This study aimed to assess the trunk control and gait ability of patients with chronic stroke after participation in driving-based interactive video games (DBIVG). Participants included 24 chronic stroke patients allocated to an experimental group (n?=?13, CT?+?DBIVG) or a control group (n?=?11, CT?+?treadmill walking training). Both groups received CT five days/week; the experimental and control groups participated in DBIVG and treadmill walking training, respectively, three days/week for four weeks. The primary outcome of trunk control was measured by the trunk impairment scale (TISall) and TIS subscales, including static sitting balance (TISssb), dynamic sitting balance (TISdsb), and trunk co-ordination (TISco). Gait ability was measured by the dynamic gait index (DGI), timed walking test (TWT), and time up and go test (TUGT). Both groups demonstrated significant improvements in TISall, TISdsb, and TUGT results. The experimental group showed significantly greater improvement in TISssb, TISco, and DGI than the control group. Our findings indicate that DBIVG can improve trunk control and gait ability in patients with chronic stroke.     

Contralateral pelvic drop during gait increases knee adduction moments of asymptomatic individuals

PurposeThe current study purpose was to investigate the effects of contralateral pelvic drop gait on the magnitude of the knee adduction moment (KAM) within asymptomatic individuals.Methods15 participants walked on a dual belt instrumented treadmill while segment motions and ground reaction forces were recorded. Participants completed typical gait trials and pelvic drop gait trials. The net external KAM was calculated using inverse dynamics. Peak and impulse were identified. Frontal plane hip abduction/adduction and pelvic drop were determined. Correlations and paired t-tests were used for statistical hypothesis testing (alpha = 0.05).ResultsPeak hip adduction angle reached 4° (±6°) during pelvic drop trials compared to 0° (±6°) in the typical gait trials (p < 0.05) equating to 4° of pelvic drop. KAM impulse was higher in the pelvic drop trial (0.16 Nm s/kg ± 0.04) compared to the typical gait trial (0.13 Nm s/kg ± 0.05) (p < 0.001). Peak KAM was higher in the pelvic drop trial (0.55 Nm/kg ± 0.15) compared to the typical gait trial (0.40 Nm/kg ± 0.109) (p < 0.001). Correlations between change in KAM and change in hip adduction moment and pelvic drop were r > 0.80 (p < 0.001).ConclusionPelvic drop gait increased KAM peak and impulse. Results have implications for understanding relationships between frontal plane hip movement and the knee adduction moment during gait.     

Age-Related Changes in Smoothness of Gait of Healthy Children and Early Adolescents

Abstract

In this study, we acquired and processed trunk accelerations during level walking in 85 children aged 8-13?years to calculate spatio-temporal parameters and Harmonic Ratio (HR), which is a metrics representative of gait smoothness and step-to-step symmetry. The results show that while spatio-temporal parameters remain unchanged once normalized considering individuals’ anthropometry, significantly higher values of HR for both the antero-posterior and vertical directions were found in participants aged 12–13 with respect to those of 8–9. This indicates an improvement of gait symmetry, which suggests that the gait maturation process is still ongoing for the age ranges tested here.     

Age-Related Differences in Locomotor Strategies During Adaptive Walking

Simultaneous control of lower limb stepping movements and trunk motion is important for skilled walking; adapting gait to environmental constraints requires frequent alternations in stepping and trunk motion. These alterations provide a window into the locomotor strategies adopted by the walker. The authors examined gait strategies in young and healthy older adults when manipulating step width. Anteroposterior (AP) and mediolateral (ML) smoothness (quantified by harmonic ratios) and stepping consistency (quantified by gait variability) were analyzed during narrow and wide walking while controlling cadence to preferred pace. Results indicated older adults preserved ML smoothness at the expense of AP smoothness, shortened their steps, and exhibited reduced stepping consistency. The authors conclude that older adults prioritized ML control over forward progression during adaptive walking challenges.     

Sit-to-stand: Functional relationship between upper body and lower limb segments

The behaviour of linked body segments during sit-to-stand was the subject of this study which investigated the relationship between the trunk and lower limb segments by varying the initial position of the trunk. Six subjects were videotaped as they stood up with feet on a forceplate from three initial positions: erect sitting, trunk flexed forward 30 deg, and 60 deg. When subjects actively flexed the trunk in the pre-extension phase, the order in which lower limb joints extended was knee, hip, ankle. However, when there was no active flexion, the order of onsets changed, the hip extending first followed by the knee and ankle. An extensor support moment (SM), a summation of extensor moments at hip, knee and ankle, occurred throughout the extension phase. The mean peak value of SM remained invariant in all three conditions despite variability in individual hip, knee and ankle moments. When active trunk flexion was absent, the duration of the extension phase was longer and a high value of SM was sustained for a longer proportion of the phase, indicating that more muscle force was required. The findings support the view that biomechanical characteristics emerge naturally from a functional coupling between segments, according to the demands of the action.     

How does normal variability in trunk flexion affect lower limb muscle activity during walking?

A large proportion of the mass of the body is contained within the trunk segment. Therefore, small changes in the inclination of this segment have the potential to influence the direction of the ground reaction force and alter lower limb joint moments and muscle activation patterns during walking. The aim of this study was to investigate if variability in sagittal trunk inclination in healthy participants is associated with differences in lower limb biomechanics. Gait analysis data was collected on 41 healthy participants during walking. Two groups were defined based on habitual trunk flexion angle during normal walking, a forward lean group (n = 18) and a backward lean group (n = 17). Lower limb moments, muscle activation patterns and co-contraction levels were compared between the two groups using independent t-tests. The forward lean group walked with 5° more trunk flexion than the backward lean group. This difference was associated with a larger peak hip moment (effect size = 0.7) and higher activation of the lateral gastrocnemius (effect size =0.6) and the biceps femoris (effect size =0.7) muscles. The forward lean group also exhibited greater co-contraction in late stance (effect size =0.7). This is the first study to demonstrate that small differences in trunk flexion are associated with pronounced alterations in the activation of the lateral knee flexor muscles. This is important because people with knee osteoarthritis have been observed to walk with increased trunk flexion. It is possible that increased sagittal trunk inclination may be associated with elevated joint loads in people with knee osteoarthritis.     

Development of Postural Adjustment During Gait Initiation: Kinematic and EMG Analysis

The authors studied the development of postural adjustments associated with the initiation of gait in children by using kinematic and electromyographic (EMG) analysis. Participants (N = 28) included infants with 1-4 and 9-17 months of walking experience, children 4-5 years of age, and adults. Anticipatory postural adjustments (APA) were present in the youngest age groups, including a clear anticipatory lateral tilt of the pelvis and the stance leg, which enabled the child to unload the opposite leg shortly before its swing phase. An anticipatory activation of the hip abductor of the leg in stance phase prior to heel-off was found, suggesting pelvis stabilization. APA did not appear consistently until 4-5 years of age. A decrease in segmental oscillations occurred across the ages, indicating better control of intersegmental coordination in the frontal and sagittal planes during the postural phase of gait initiation. Young walkers presented APA involving movements of both the upper and the lower parts of the body, whereas, like adults, 4- to 5-year-olds were able to laterally shift only the pelvis and the stance leg. The oldest children and the adults also showed lower activation levels of hip and knee muscles but higher activation at the ankle level. Those kinematic and EMG results taken together suggest a clear developmental sequence from an en bloc operation of the body through an articulated operation with maturation, walking experience, or both.     

Monaural Auditory Cue Affects the Process of Choosing the Initial Swing Leg in Gait Initiation

The authors investigated the effect of an auditory cue on the choice of the initial swing leg in gait initiation. Healthy humans initiated a gait in response to a monaural or binaural auditory cue. When the auditory cue was given in the ear ipsilateral to the preferred leg side, the participants consistently initiated their gait with the preferred leg. In the session in which the side of the monaural auditory cue was altered trial by trial randomly, the probability of initiating the gait with the nonpreferred leg increased when the auditory cue was given in the ear contralateral to the preferred leg side. The probability of choosing the nonpreferred leg did not increase significantly when the auditory cue was given in the ear contralateral to the preferred leg side in the session in which the auditory cue was constantly given in the ear contralateral to the preferred leg side. The reaction time of anticipatory postural adjustment was shortened, but the probability of choosing the nonpreferred leg was not significantly increased when the gait was initiated in response to a binaural auditory cue. An auditory cue in the ear contralateral to the preferred leg side weakens the preference for choosing the preferred leg as the initial swing leg in gait initiation when the side of the auditory cue is unpredictable.     

Musical pleasure beneficially alters stride and arm swing amplitude during rhythmically-cued walking in people with Parkinson's disease

Entrainment of walking to rhythmic auditory cues (e.g., metronome and/or music) improves gait in people with Parkinson's disease (PD). Studies on healthy individuals indicate that entrainment to pleasant musical rhythm can be more beneficial for gait facilitation than entrainment to isochronous rhythm, potentially as a function of emotional/motivational responses to music and their associated influence on motor function. Here, we sought to investigate how emotional attributes of music and isochronous cues influence stride and arm swing amplitude in people with PD. A within-subjects experimental trial was completed with persons with PD serving as their own controls. Twenty-three individuals with PD walked to the cue of self-chosen pleasant music cue, pitch-distorted unpleasant music, and an emotionally neutral isochronous drumbeat. All music cues were tempo-matched to individual walking pace at baseline. Greater gait velocity, stride length, arm swing peak velocity and arm swing range of motion (RoM) were found when patients walked to pleasant music cues compared to baseline, walking to unpleasant music, and walking to isochronous cues. Cued walking in general marginally increased variability of stride-to-stride time and length compared with uncued walking. Enhanced stride and arm swing amplitude were most strongly associated with increases in perceived enjoyment and pleasant musical emotions such as power, tenderness, and joyful activation. Musical pleasure contributes to improvement of stride and arm swing amplitude in people with PD, independent of perceived familiarity with music, cognitive demands of music listening, and beat salience. Our findings aid in understanding the role of musical pleasure in invigorating gait in PD, and inform novel approaches for restoring or compensating impaired motor circuits.     

Head and Trunk Control While Walking in Older Adults with Diabetes: Effects of Balance Confidence

Investigations of gait in older adults with diabetes mellitus (DM) have been primarily focused on lower limb biomechanical parameters. Yet, the upper body accounts for two thirds of the body's mass, and head and trunk control are critical for balance. The authors examined head and trunk control during self-selected comfortable, fast, and dual-task walking and the relationship between balance confidence and potential head-trunk stiffening strategies in older adults with DM without diagnosed diabetic peripheral neuropathy (DPN). Twelve older adults with DM without diagnosed DPN (DM group) and 12 without DM (no-DM group) were recruited. Walking speed, peak-to-peak head and trunk roll displacement, head and trunk roll velocity, and head-trunk correlation were measured while walking at a self-selected comfortable or fastest possible speed with or without a secondary cognitive task. The Activities-specific Balance Confidence scale measured balance confidence. Subtle group differences in axial segmental control (lower trunk roll velocity; higher head-trunk correlation) were apparent in older adults with DM even in the absence of DPN. Balance confidence was 19% lower in the DM group than in the no-DM group, and partially explained (34%) the group difference in head-trunk stiffening. These results emphasize the need for proactive monitoring of postural control and balance confidence before the onset of DPN.     

Obstacle Avoidance Increases Asymmetry of Crossing Step in Individuals With Parkinson's Disease and Neurologically Healthy Individuals

The authors' aim was to investigate gait asymmetry of crossing step during obstacle avoidance while walking in people with Parkinson's disease (PD) under and without the effects of dopaminergic medication. Thirteen individuals with PD and 13 neurologically healthy individuals performed 5 trials of unobstructed gait and 10 trials of obstacle crossing during gait (5 trials with each leg) and spatiotemporal parameters were analyzed. Obstacle crossing increased step duration of the crossing step for the most-affected or nondominant limb compared to the crossing step with the least-affected or dominant limb. Individuals with PD without the effects of medication increased step duration for the step with the least-affected limb compared to the step with the most-affected limb during obstacle crossing.     

减少医师自卫医学行为的对策研究

根据自卫医学行为产生的原因,减少自卫医学行为有两个思路,一个是减轻医师的法律责任,另一个是化解医师在法律责任下所面临的风险.根据第二个思路,应该采取下面的措施:建立医师责任保险制度;建立医疗责任保险制度;实施医疗风险管理;提高医师个人的执业素养.     

Enhanced arm swing alters interlimb coordination during overground walking in individuals with traumatic brain injury

The current study investigated interlimb coordination in individuals with traumatic brain injury (TBI) during overground walking. The study involved 10 participants with coordination, balance, and gait abnormalities post-TBI, as well as 10 sex- and age-matched healthy control individuals. Participants walked 12 m under two experimental conditions: 1) at self-selected comfortable walking speeds; and 2) with instructions to increase the amplitude and out-of-phase coordination of arm swinging. The gait was assessed with a set of spatiotemporal and kinematic parameters including the gait velocity, step length and width, double support time, lateral displacement of the center of mass, the amplitude of horizontal trunk rotation, and angular motions at shoulder and hip joints in sagittal plane. Interlimb coordination (coupling) was analyzed as the relative phase angles between the left and right shoulders, hips, and contralateral shoulders and hips, with an ideal out-of-phase coupling of 180° and ideal in-phase coupling of 0°. The TBI group showed much less interlimb coupling of the above pairs of joint motions than the control group. When participants were required to increase and synchronize arm swinging, coupling between shoulder and hip motions was significantly improved in both groups. Enhanced arm swinging was associated with greater hip and shoulder motion amplitudes, and greater step length. No other significant changes in spatiotemporal or kinematic gait characteristics were found in either group. The results suggest that arm swinging may be a gait parameter that, if controlled properly, can improve interlimb coordination during overground walking in patients with TBI.     

Effects of back loading on the biomechanics of sit-to-stand motion in healthy children

The goal of the present study was to determine the thus far unstudied effects of back loading on the kinematics and kinetics of sit-to-stand (STS) motion in healthy children. Fifteen children (8 boys, 7 girls, mean age 9.6 years, SD 1.2 years) were tested with no back load and with a back load of 10% and 20% of body weight, respectively. A motion analysis system was used with six infrared cameras and two force plates. Total STS duration did not change; however, differential effects were shown for the durations of its phases. Back loading increased ankle dorsiflexion yielding a greater maximal dorsiflexion angle. Effects on the knee angle were limited except for a significant decrease in final knee flexion. Initial and maximal hip flexion increased but final hip angle did not change. Initial backward pelvic tilt decreased and a shift to forward pelvic tilt occurred at an earlier stage of STS motion. Back loading affected trunk motion: maximal and final forward shoulder tilt increased. Maximal ankle and knee moments and powers increased; however, hip joint kinetics was not affected significantly. Therefore, while maintaining the general pattern of STS motion, participants showed selectively significant adjustments to back loading during its different phases. The main kinematic adjustments were increased trunk flexion and greater ankle dorsiflexion, while the major kinetic adjustment was increased knee extension moment. Increased back loading yielded more pronounced effects, primarily in the ankle. In sum, back loading substantially affected the biomechanics of STS motion even for the lower load level studied. This finding may be of clinical relevance for musculoskeletal disorders, but this needs to be examined.     

Modulation of Gait During Visual Adaptation to Dark

The authors investigated the modulation of gait during dark adaptation. Twenty-five women (mean age = 72 years, SD = 5 years) walked back and forth on an arbitrarily uneven walkway during normal lighting at speeds ranging from slow to fast. Participants then performed 20 trials at preferred speed after sudden reduction of lighting; the authors compared those trials with point estimates at equivalent speeds representing normal lighting. The authors estimated speed, cadence, mediolateral trunk acceleration, and mediolateral interstep trunk-acceleration variability for each trial. Participants compensated for sudden reduction of lighting by reducing their walking speed. Compared with performance at equivalent speeds during normal lighting, cadence, trunk acceleration, and interstep trunk-acceleration variability initially increased. All variables showed an asymptotic approximation toward normal values during 60-90 s of walking in subdued lighting. The authors suggest that the sudden transition from normal to marginal lighting, rather than marginal lighting itself, may challenge locomotor control.     

Gender differences in the variability of lower extremity kinematics during treadmill locomotion

The authors examined whether there were gender differences in the variability of basic gait parameters (stride length, stride time) and 3-dimensional (3D) rotations of the hip, knee, and ankle joints during treadmill locomotion of 18 men and 15 women at 4 different gait speeds (walking at 5 km/hr, running at 8, 10, and 12 km/hr). The authors used 2-way analyses of variance to assess the data. No gender differences in the mean values or variability of basic gait parameters were detected. However, the women exhibited lower variability than did the men for 6 individual joint rotations: (a) transverse plane rotations of the ankle joint at 8, 10, and 12 km/hr, (b) transverse plane rotations of the hip and knee joints at 12 km/hr, and (c) sagittal plane rotations of the ankle joint at 12 km/hr. When collapsed across all 3D lower extremity rotations, the data showed that the women had lower variability than did the men at 12 km/hr. Reduced variability may result in more localized mechanical stress on anatomical structures and could therefore be a risk factor for injury in women at high gait speeds. The results also suggested that gender differences in variability may not be consistent across different levels of the motor system.