Using swing resistance and assistance to improve gait symmetry in individuals post-stroke

A major characteristic of hemiplegic gait observed in individuals post-stroke is spatial and temporal asymmetry, which may increase energy expenditure and the risk of falls. The purpose of this study was to examine the effects of swing resistance/assistance applied to the affected leg on gait symmetry in individuals post-stroke. We recruited 10 subjects with chronic stroke who demonstrated a shorter step length with their affected leg in comparison to the non-affected leg during walking. They participated in two test sessions for swing resistance and swing assistance, respectively. During the adaptation period, subjects counteracted the step length deviation caused by the applied swing resistance force, resulting in an aftereffect consisting of improved step length symmetry during the post-adaptation period. In contrast, subjects did not counteract step length deviation caused by swing assistance during adaptation period and produced no aftereffect during the post-adaptation period. Locomotor training with swing resistance applied to the affected leg may improve step length symmetry through error-based learning. Swing assistance reduces errors in step length during stepping; however, it is unclear whether this approach would improve step length symmetry. Results from this study may be used to develop training paradigms for improving gait symmetry of stroke survivors.     

Horizontal Plane Head Stabilization During Locomotor Tasks

Frequency characteristics of head stabilization were examined during locomotor tasks in healthy young adults (N = 8) who performed normal walking and 3 walking tasks designed to produce perturbations primarily in the horizontal plane. In the 3 walking tasks, the arms moved in phase with leg movement, with abnormally large amplitude, and at twice the frequency of leg movement. Head-in-space angular velocity was examined at the predominant frequencies of trunk motion. Head movements in space occurred at low frequencies (< 4.0 Hz) in all conditions and at higher frequencies (> 4.0 Hz) when the arms moved at twice the frequency of the legs. Head stabilization strategies were determined from head-on-trunk with respect to trunk frequency profiles derived from angular velocity data. During natural walking at low frequencies (< 3.0 Hz), head-on-trunk movement was less than trunk movement. At frequencies 3.0 Hz or greater, equal and opposite compensatory movement ensured head stability. When arm swing was altered, compensatory movement guaranteed head stability at all frequencies. Head stabilization was successful for frequencies up to 10.0 Hz during locomotor tasks Maintaining head stability at high frequencies during voluntary tasks suggests that participants used feedforward mechanisms to coordinate head and trunk movements. Maintenance of head stability during dynamic tasks allows optimal conditions for vestibulo-ocular reflex function.     

Perceptions of an over-ground induced temporal gait asymmetry by healthy young adults

Nearly 60% of individuals with stroke walk with temporal gait asymmetry (TGA; a phase inequality between the legs during gait). About half of individuals with TGA are unable to correctly identify the presence or direction of their asymmetry. If patients are unable to perceive their gait errors, it will be harder to correct them to improve their gait pattern. Perception of gait pattern error may be affected by the stroke itself; therefore, the objectives of this study were to determine how the gait of neurotypical individuals changes with an induced temporal asymmetry, and how perception of that TGA compares to actual asymmetry both before and after 15-min of exposure to the induced asymmetry. After baseline symmetry (measured as symmetry index (SI)) was assessed with a pressure sensitive mat, participants (n = 29) walked for 15 min over-ground with cuff weights (7.5% of body weight) on their non-dominant leg to induce TGA. Presence, direction, and magnitude of TGA was measured at five time points: 1) baseline, 2) immediately after unilateral loading (early adaptation (EA)), 3) at the end of 15 min of walking (late adaptation (LA)), 4) immediately after load removal (early deadaptation (EDA)), and 5) after the participant indicated that their gait had returned to baseline symmetry (late deadaptation (LDA). Presence, direction, and magnitude of perceived TGA was measured by self-report. Measured and perceived TGA changes over time were assessed with separate one-way repeated measures analyses of variance. Agreement between measured and perceived TGA was assessed. During EA, all participants walked asymmetrically, spending more time on the non-loaded limb compared to baseline (−12.67 [95%CI −14.56, −10.78], p < 0.0001). All but one participant perceived this TGA, however only fifteen (52%) correctly perceived both TGA presence and direction. At LA, the group remained asymmetric (−9.22 [95%CI −11.32, −7.12], p < 0.0001), but only 9 participants (31%) correctly perceived both the presence and direction of their TGA. Visual inspection of the data at each time point revealed most participants perceived TGA magnitude as greater than actual TGA. Overall, we find that TGA can be induced and maintained in neurotypical young adults. Perception of TGA direction is inaccurate and perception of TGA magnitude is grossly overestimated. Perceptions of TGA do not improve after a period of exposure to the new walking pattern. These preliminary findings indicate that accurately perceiving an altered gait pattern is a difficult task even for healthy young adults.     

Gait training facilitates push-off and improves gait symmetry in children with cerebral palsy

BackgroundHuman walking involves a rapid and powerful contraction of ankle plantar flexors during push-off in late stance.ObjectiveHere we investigated whether impaired push-off force contributes to gait problems in children with cerebral palsy (CP) and whether it may be improved by intensive gait training.MethodsSixteen children with CP (6–15 years) and fourteen typically developing (TD) children (4–15 years) were recruited. Foot pressure was measured by insoles and gait kinematics were recorded by 3-dimensional video analysis during treadmill and overground walking. The peak derivative of ground reaction force at push off (dPF) was calculated from the foot pressure measurements. Maximal voluntary plantar flexion (MVC) was measured while seated. Measurements were performed before and after a control period and after 4 weeks of 30 minutes daily inclined treadmill training.ResultsdPF and MVC were significantly lower in children with CP on the most affected (MA) as compared to TD children (p < .001). dPF was lower on the MA leg as compared to the less affected (LA) leg in children with CP (p < .05). Following gait training, increases in dPF (p < .001) and MVC (p < .01) were observed for the MA leg. Following gait training children with CP showed similar timing of dPF and similar stance phase duration on both legs indicating improved symmetry of gait. These effects were also shown during overground walking.ConclusionImpaired ability to voluntarily activate ankle plantar flexors and produce a rapid and powerful push-off during late stance are of importance for impaired gait function in children with CP. Intensive treadmill training may facilitate the drive to ankle plantar flexors and reduce gait asymmetry during both treadmill and overground walking.     

Human Odometry with a Two-Legged Hopping Gait: A Test of the Gait Symmetry Theory

Abstract

Biological odometry refers to the capacity for perceptually measuring distances traveled during locomotion. In the case of haptic odometry, information about distance traversed is generated from the movements of the legs, with coordinated leg motions (i.e., gait patterns) producing patterns of tissue deformation detectable by the haptic perceptual system. The gait symmetry theory of haptic odometry classifies gaits based upon the symmetry of muscle activation patterns. This classification identifies candidate higher-order variables of haptic odometry and provides a promising basis for understanding the associated patterns of tissue deformation detected by the haptic perceptual system. The theory successfully predicts biases (i.e., underestimations/overestimations) resulting from the manipulation of the gait patterns used in the outbound and return phases of homing tasks. We test gait symmetry theory by considering a previously unexamined key prediction. Two-legged hopping and walking have the same symmetry group classification, therefore, a homing task completed using any combination of two-legged hopping and walking as the outbound/return gaits should produce no systematic biases. Contrary to this prediction we observed systematic biases. We discuss the possibilities for modifying gait symmetry theory to account for our findings, and we present a new alternative theory based upon spatial reference frames.     

Assessment of the relationship of cerebral hemisphere arousal asymmetry to perceptual asymmetry.

This study examined the hypothesis that characteristic individual differences in cerebral hemisphere arousal asymmetry are related to individual differences in perceptual asymmetry observed in verbally based visual half-field tasks. The study used electrophysiological measures of arousal asymmetry rather than behaviorally derived measures (Levy, Heller, Banich, & Burton, 1983). Measures of alpha asymmetry were obtained from 20 right-handed males during a baseline relaxation condition and during a visual half-field version of the lexical decision task. Reaction time measures of perceptual asymmetry were obtained during this task. The results indicated that a basal arousal asymmetry measured at the temporal recording location during the baseline condition was significantly related to individual perceptual asymmetry during the subsequent lexical decision task. This basal arousal asymmetry was relatively stable across different task conditions. A task-related arousal asymmetry measured at the parietal location during the lexical decision task also made a significant contribution in predicting individual perceptual asymmetry. These two measures of individual arousal asymmetry were able to predict 50% of the variance in perceptual asymmetry. The implications of the results for explaining more wide-ranging individual differences in behavioral style and personality are discussed.     

The pendular mechanism does not determine the optimal speed of loaded walking on gradients

The pendular mechanism does not act as a primary mechanism in uphill walking due to the monotonic behavior of the mechanical energies of the center of mass. Nevertheless, recent evidence shows that there is an important minimization of energy expenditure by the pendular mechanism during walking on uphill gradients. In this study, we analyzed the optimum speed (OPT) of loaded human walking and the pendulum-like determining variables (Recovery R, Instantaneous pendular re-conversion R_int, and Congruity percentage %Cong). Ten young men walked on a treadmill at five different speeds and at three different treadmill incline gradients (0, +7 and +15%), with and without a load carried in their backpacks. We used indirect calorimetry and 3D motion analysis, and all of the data were analyzed by computational algorithms. R_int increased at higher speeds and decreased with increasing gradient. R and %Cong decreased with increasing gradient and increased with speed, independent of load. Thus, energy conversion by the pendular mechanism during walking on a 15% gradient is supported, and although this mechanism can explain the maintenance of OPT at low walking speeds, the pendular mechanism does not fully explain the energy minimization at higher speeds.     

Self-Optimization of Walking in Nondisabled Children and Children With Spastic Hemiplegic Cerebral Palsy

Children voluntarily adopt a frequency and movement pattern for walking. The force-driven harmonic oscillator (FDHO) model was used in this study for accurate prediction of the preferred walking frequency of nondisabled children and children with spastic hemiplegic cerebral palsy. Four potential optimality criteria with which the preferred walking pattern was forced to comply were examined: minimization of physiological costs, maximization of mechanical energy conservation, minimization of asymmetry in lower limb movements and minimization of variability of interlimb and intralimb coordination. Age and gender-matched nondisabled children (n = 6) and children with spastic hemiplegic cerebral palsy (n = 6) were tested under six frequency conditions of walking at a constant speed on a treadmill. For the nondisabled children, the results indicated that their preferred walking frequency could be accurately predicted by the FDHO model. They freely adopted a walking pattern that minimized physiological costs, asymmetry, and variability of inter- and intralimb coordination. For the children with spastic hemiplegic cerebral palsy, the prediction of preferred overground walking frequency required that the FDHO model be modified to account for muscle mass and leg length discrepancies between limbs and increased stiffness. Most of the children achieved the same optimality goals as the nondisabled when walking at the preferred frequency. However, the children were found to use different mechanisms to attain these goals: for example, a steeper increase observed in physiological cost at higher frequencies; a lowered center of gravity of the body, which allowed for angular symmetry; and greater variability of between-joint coordination in the nonaffected limb and less variability in the affected limb.     

Susceptibility to walking balance perturbations in young adults is largely unaffected by anticipation

Despite progress in understanding the mechanisms governing walking balance control, the number of falls in our older adult population is projected to increase. Falls prevention systems and strategies may benefit from understanding how anticipation of a balance perturbation affects the planning and execution of biomechanical responses to mitigate instability. However, the extent to which anticipation affects the proactive and reactive adjustments to perturbations has yet to be fully investigated, even in young adults. Our purpose was to investigate the effects of anticipation on susceptibility to two different mechanical balance perturbations – namely, treadmill-induced perturbations and impulsive waist-pull perturbations. Twenty young adults (mean ± standard deviation age: 22.8 ± 3.3 years) walked on a treadmill without perturbations and while responding to treadmill belt (200 ms, 6 m/s²) and waist-pull (100 ms, 6% body weight) perturbations delivered in the anterior and posterior directions. We used 3D motion capture to calculate susceptibility to perturbations during the perturbed and preceding strides via whole-body angular momentum (WBAM) and anterior-posterior margin of stability (MoS_AP). Contrary to our hypotheses, anticipation did not affect young adults' susceptibility to walking balance challenges. Conversely, perturbation direction significantly affected walking instability. We also found that susceptibility to different perturbation contexts is dependent on the outcome measure chosen. We suggest that the absence of an effect of anticipation on susceptibility to walking balance perturbations in healthy young adults is a consequence of their having high confidence in their reactive balance integrity. These data provide a pivotal benchmark for the future identification of how anticipation of a balance challenge affects proactive and reactive balance control in populations at risk of falls.     

Measured and predicted mechanical internal work in human locomotion

Predictive methods estimating mechanical internal work (W_int, i.e., work to accelerate limbs with respect to BCOM during locomotion) are needed in absence of experimental measurements. A previously proposed model equation predicts such a parameter based upon velocity, stride frequency, duty factor, and a compound critical term (q) accounting for limb geometry and inertial properties. That first predicted W_int estimate (PW_int) has been validated only for young males and for a limited number of horses. The present study aimed to extend the comparison between model predictions and experimentally measured W_int (MW_int) data on humans with varying gender, age, gait, velocity, and gradient. Seventy healthy subjects (males and females; 7 age groups: 6-65 years) carried out level walking and running on treadmill, at different velocities. Moreover, one of the subject groups (25-35 years) walked and ran also at several uphill/downhill gradients. Reference values of q represent the main important results: (a) males and females have similar q values; (b) q is independent on velocity and gradient. Also, different data filtering depth was found to affect MW_int and, indirectly, PW_int, thus also the reference q values here obtained (0.08 in level, 0.10 in gradient) suffer a - 20% underestimation with respect to the previous predicting model. Despite of this effect, the close match between MW_int and PW_int trends indicates that the model equation could be satisfactorily applied, in various locomotion conditions.     

Kinematic patterns during walking in children: Application of principal component analysis

The relative displacements of body segments during walking can be reduced to a small number of multi-joint kinematic patterns, pm_k, through Principal Component Analysis (PCA). These patterns were extracted from two groups of children (n = 8, aged 6–9 years, 4 males, and n = 8, aged 10–13 years, 4 males) and 7 adults (21–29 years, 1 male), walking on a treadmill at various velocities, normalized to body stature (adimensional Froude number, Fr). The three-dimensional coordinates of body markers were captured by an optoelectronic system.Five components (pm₁ to pm₅) explained 99.1% of the original dataset variance. The relationship between the variance explained (“size”) of each pm_k and the Fr velocity varied across movement components and age groups. Only pm₁ and pm₂, which described kinematic patterns in the sagittal plane, showed significant differences (at p < 0.05) across pairs of age groups. The time course of the size of all the five components matched various mechanical events of the step cycle at the level of both body system and lower limb joints. Such movement components appeared clinically interpretable and lend themselves as potential markers of neural development of walking.     

Effects of heel height on knee rotation and gait

A triaxial electrogoniometer was used along with a Locam camera to measure knee rotation and gait characteristics of nineteen female college students while walking on a treadmill under three experimental conditions (barefoot, running shoes and high heels). Range of valgus-varus, flexion-extension and internal-external rotation during the swing and support phases, and maximum flexion during the swing walking step phase were studied. Significant differences (p < 0.01) were found among the three heel height treatments for range of knee flexion-extension during the swing walking phase and for internal-external rotation during the swing walking phase. Significant differences (p < 0.01) were also found between the high heeled swing phase mean value for internal-external rotation and the barefoot treatment mean values. ANOVA indicated a significant difference among the three experimental treatments for all distance and temporal variables studied.     

Sex and handedness differences in EEG measures of hemispheric specialization

EEG alpha asymmetry was studied in 90 normal adults: right-handed, left-handed, and ambidextrous, male and female. Recordings were made from homologous central, parietal, and occipital leads, referenced to vertex, while subjects engaged in writing, speaking, reading, listening to speech, singing, and block design construction. These data confirm our previous findings that alpha asymmetry is task-dependent and extend them to a broader range of tasks, subjects, and leads. Among right-handers significant differences were found between the language tasks and the musical and spatial tasks: the $\text{R}\text{L}$ alpha ratio is higher in the language tasks. In addition, significant ordering of $\text{R}\text{L}$ alpha ratios was found among the language tasks themselves: WRITE å SPEAK > READ > LISTEN. No one “verbal” task can be considered representative of all language behaviors. Task differences in asymmetry were greater at the central than at the parietal leads, and no differences were found at the occiput. Differences among the handedness groups were found in $\text{R}\text{L}$ alpha ratio in specific tasks, in the relationship among tasks, and in alpha power level. Non-right-handers showed less task-dependent asymmetry. On some measures ambidexters appear to be a distinct group, not simply representing the middle range of a left-handed/right-handed continuum. Reversal of the “expected” right-handed pattern (SPEAK $\text{R}\text{L}$ ratio > BLOCKS $\text{R}\text{L}$ ratio) was seen in 10% of right-handers, and in 36% of left-handers, particularly among left-handed females (46%), suggesting a possible sex difference among non-right-handers. No sex difference was found among right-handers on any task with any measure at any lead.     

Route learning in Korsakoff's syndrome: Residual acquisition of spatial memory despite profound amnesia

Korsakoff's syndrome (KS) is characterized by explicit amnesia, but relatively spared implicit memory. The aim of this study was to assess to what extent KS patients can acquire spatial information while performing a spatial navigation task. Furthermore, we examined whether residual spatial acquisition in KS was based on automatic or effortful coding processes. Therefore, 20 KS patients and 20 matched healthy controls performed six tasks on spatial navigation after they navigated through a residential area. Ten participants per group were instructed to pay close attention (intentional condition), while 10 received mock instructions (incidental condition). KS patients showed hampered performance on a majority of tasks, yet their performance was superior to chance level on a route time and distance estimation tasks, a map drawing task and a route walking task. Performance was relatively spared on the route distance estimation task, but there were large variations between participants. Acquisition in KS was automatic rather than effortful, since no significant differences were obtained between the intentional and incidental condition on any task, whereas for the healthy controls, the intention to learn was beneficial for the map drawing task and the route walking task. The results of this study suggest that KS patients are still able to acquire spatial information during navigation on multiple domains despite the presence of the explicit amnesia. Residual acquisition is most likely based on automatic coding processes.     

Manipulating perception versus action in recalibration tasks

We conducted six experiments to examine how manipulating perception versus action affects perception–action recalibration in real and imagined blindfolded walking tasks. Participants first performed a distance estimation task (pretest) and then walked through an immersive virtual environment on a treadmill for 10 min. Participants then repeated the distance estimation task (posttest), the results of which were compared with their pretest performance. In Experiments 1a, 2a, and 3a, participants walked at a normal speed during recalibration, but the rate of visual motion was either twice as fast or half as fast as the participants' walking speed. In Experiments 1b, 2b, and 3b, the rate of visual motion was kept constant, but participants walked at either a faster or a slower speed. During pre- and posttest, we used either a blindfolded walking distance estimation task or an imagined walking distance estimation task. Additionally, participants performed the pretest and posttest distance estimation tasks in either the real environment or the virtual environment. With blindfolded walking as the distance estimation task for pre- and posttest, we found a recalibration effect when either the rate of visual motion or the walking speed was manipulated during the recalibration phase. With imagined walking as the distance estimation task, we found a recalibration effect when the rate of visual motion was manipulated, but not when the walking speed was manipulated in both the real environment and the virtual environment. Discussion focuses on how spatial-updating processes operate on perception and action and on representation and action.     

Temporal links to performing under pressure in international soccer penalty shootouts

ObjectivesThis study examined the temporal characteristics of performing under pressure in a high-stakes real-world sport situation.DesignBehavior observation analyses were conducted of televised soccer games.MethodsVideos were obtained from all penalty shootouts ever held in three major international soccer tournaments (World Cup, European Championships, and UEFA Champions League). In these events, 296 players performed 366 penalty kicks. The time periods that were analyzed in relation to shot outcomes were: walking, ball placement, back-up, signal waiting, signal response, and run-up.ResultsSeveral time intervals were linked to performance. For example, longer times to respond to the referee's ready signal were related to more goals and shorter times were related to more misses. A similar weak trend was found for ball placement. Time to wait for the referee signal went in the other direction, with shorter times giving more goals.ConclusionsShorter self-imposed times were linked to worse performance than longer times. Plausible reasons for this result may be the extreme levels of pressure that are induced by major penalty shootouts, causing performers to attempt escaping the emotional distress by getting the situation “over with” as soon as possible. These results are consistent with a model of choking as a case of self-regulatory breakdown.     

Age and walking conditions differently affect domains of gait

IntroductionAnalysing gait in controlled conditions that resemble daily life walking could overcome the limitations associated with gait analysis in uncontrolled real-world conditions. Such analyses could potentially aid the identification of a walking condition that magnifies age-differences in gait. Therefore, the aim of the current study was to determine the effects of age and walking conditions on gait performance.MethodsTrunk accelerations of young (n = 27, age: 21.6) and older adults (n = 26, age: 68.9) were recorded for 3 min in four conditions: walking up and down a university hallway on a track of 10 m; walking on a specified path, including turns, in a university hallway; walking outside on a specified path on a pavement including turns; and walking on a treadmill. Factor analysis was used to reduce 27 computed gait measures to five independent gait domains. A multivariate analysis of variance was used to examine the effects of age and walking condition on these gait domains.ResultsFactor analysis yielded 5 gait domains: variability, pace, stability, time & frequency, complexity, explaining 64% of the variance in 27 gait outcomes. Walking conditions affected all gait domains (p < 0.01) but age only affected the time & frequency domain (p < 0.05). Age and walking conditions differently affected the domains variability, stability, time & frequency. The largest age-differences occurred mainly during straight walking in a hallway (variability: 31% higher in older adults), or during treadmill walking (stability: 224% higher, time&frequency: 120% lower in older adults).ConclusionWalking conditions affect all domains of gait independent of age. Treadmill walking and walking on a straight path in a hallway, were the most constrained walking conditions in terms of limited possibilities to adjust step characteristics. The age by condition interaction suggests that for the gait domains variability, stability, and time & frequency, the most constrained walking conditions seem to magnify the age-differences in gait.     

The long and the short of it: On the nature and origin of functional overlap between representations of space and time

When we describe time, we often use the language of space (The movie was long; The deadline is approaching). Experiments 1–3 asked whether—as patterns in language suggest—a structural similarity between representations of spatial length and temporal duration is easier to access than one between length and other dimensions of experience, such as loudness. Adult participants were shown pairings of lines of different length with tones of different duration (Experiment 1) or tones of different loudness (Experiment 2). The length of the lines and duration or loudness of the tones was either positively or negatively correlated. Participants were better able to bind particular lengths and durations when they were positively correlated than when they were not, a pattern not observed for pairings of lengths and tone amplitudes, even after controlling for the presence of visual cues to duration in Experiment 1 (Experiment 3). This suggests that representations of length and duration may functionally overlap to a greater extent than representations of length and loudness. Experiments 4 and 5 asked whether experience with and mastery of words like long and short—which can flexibly refer to both space and time—itself creates this privileged relationship. Nine-month-old infants, like adults, were better able to bind representations of particular lengths and durations when these were positively correlated (Experiment 4), and failed to show this pattern for pairings of lengths and tone amplitudes (Experiment 5). We conclude that the functional overlap between representations of length and duration does not result from a metaphoric construction processes mediated by learning to flexibly use words such as long and short. We suggest instead that it may reflect an evolutionary recycling of spatial representations for more general purposes.     

Disentangling the effects of choice and intensity on affective response to and preference for self-selected- versus imposed-intensity physical activity

ObjectiveTo examine the independent effects of physical activity (PA) intensity and choice of PA intensity when comparing affective response to and relative preference for self-selected-intensity versus imposed higher intensity PA.DesignWithin-subjects experiment.MethodsTwenty-nine healthy, low-active women completed four PA bouts over two sessions. The first session consisted of a one-third mile self-selected-intensity treadmill walk during which the speed was recorded, but was not visible to the participants. The second session consisted of three, counterbalanced, one-third mile treadmill conditions: (a) self-selected intensity, (b) same intensity as recorded for the first-session-self-selected-intensity walk, but with the intensity imposed by the experimenter (i.e., yoked-self-selected intensity), and (c) intensity set at 20% higher than the first-session-self-selected-intensity walk (imposed higher intensity). Acute affective valence (pleasure/displeasure) was recorded prior to, during, and following each walking bout. Preference for each walking intensity was assessed using a behavioral-choice paradigm.ResultsContrary to hypotheses, there was no effect of condition on acute affective valence. However, consistent with hypotheses, there was a linear trend, F(1, 22) = 11.00, p = .003, indicating preference in descending order from self-selected-intensity to yoked-self-selected-intensity to imposed higher intensity PA.ConclusionsBoth choice over the intensity and a lower intensity per se contributed to greater preference for self-selected-intensity over imposed higher intensity PA among healthy low-active women; however, there was no evidence to support the notion that affective response to PA mediated this relationship.