Changes in lower limb co-contraction and stiffness by toddlers with Down syndrome and toddlers with typical development during the acquisition of independent gait

During gait acquisition, children learn to use their changing resources to meet the requirements of the task. Compared to typically developing toddlers (TD), toddlers with Down syndrome (DS) have functionally different musculoskeletal characteristics, such as hypotonia, and joint and ligament laxity, that could produce a reduced passive stiffness. The interplay between this inherently lower passive stiffness and the demands of walking may result in different strategies during gait acquisition. This study compared normalized global stiffness and lower limb's co-contraction indices (CCI) used by toddlers with TD (n=12) and with DS (n=12), during the early stages of gait acquisition. Stiffness and CCI were normalized by gravitational torque (mLg) in both phases of gait (stance, swing). Five longitudinal evaluations were conducted from the onset of locomotion until three months post-acquisition. All children were video taped and had electromyographic (EMG) recordings from muscle pairs of one leg, which were used to calculate CCI of hip, knee, ankle, and total leg CCI. Body and lower limb stiffness were calculated according to a hybrid pendulum resonance equation. Results from ANOVAs revealed no group differences on stiffness or on CCI's during stance but children with DS showed greater CCI during swing. Despite the structural musculoskeletal differences between toddlers with TD and with DS, the similarities observed in their processes of gait development suggest functional equivalences.     

Developmental trajectory of dynamic resource utilization during walking: toddlers with and without Down syndrome

After years of walking practice 8-10-year-old children with typical development (TD) and those with Down syndrome (DS) show uniquely different but efficient use of dynamic resources to walk overground and on a treadmill [Ulrich, B.D., Haehl, V., Buzzi, U., Kubo, M., & Holt, K.G. (2004). Modeling dynamic resource utilization in populations with unique constraints: Preadolescents with and without Down syndrome. Human Movement Science, 23, 133-156]. Here we examined the use of global stiffness and angular impulse when walking emerged and across the ensuing months of practice in eight toddlers with TD and eight with DS. Participants visited our lab when first able to walk four to six steps, and at one, three, four, and six months of walking experience. For all visits, toddlers walked overground at their preferred speeds and for the last two visits on a treadmill. Toddlers with TD and DS demonstrated clear and similar developmental trajectories over this period with more similarities than differences between groups. At six months stiffness and impulse values were higher than previously observed for 8-10-year-old children. Stiffness values increased significantly throughout this period, though rate of change slowed for the TD group by three months of experience. Impulse values rose sharply initially and slowed to plateau during the latter months. Treadmill data illustrated toddlers' capacity to adapt dynamic resource use to imposed changes in speed, particularly well after six months of practice. Consistent with our studies of preadolescents and older adults, toddlers with DS produced significantly wider normalized step width than their TD peers. We propose that the challenge of upright bipedal locomotion constrains toddlers with TD and DS to generate similar, necessary and sufficient stiffness and impulse values to walk as they gain control and adapt to playful and self-imposed perturbations of gait over the first six months. The plateau in impulse and slow-down of stiffness increases over the latter months may be the first signs of a downward trend to the lower values produced by older children with several years of walking experience.     

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.     

Changes in mechanical control of movement during the first 5 months of independent walking: a longitudinal study

Insight into neuromuscular control of movement is gained through an understanding of the mechanical causes of movement. Data on new walkers' net joint moments is scarce, however, although those moments can be considered the direct cause of movement. The authors' goal in this research project was to characterize net joint moments in toddlers (N = 10) during the first 5 months of independent walking and to discuss their role in mechanical control of walking. The authors modeled leg segments as oscillating pendulums fixed at the proximal joint and investigated the relationship between force and movement. Their investigation revealed that at the onset of independent gait, walking was primarily hip driven. Furthermore, the toddlers seemed to experience problems in uncoupling active and passive control around the joints. Changes in mechanical control of walking were observed after 3 to 4 months of independent walking. The changes were more obvious at the hip and the knee joint than at the ankle.     

Domestic cat walking parallels human constrained optimization: Optimization strategies and the comparison of normal and sensory deficient individuals

To evaluate how fundamental gait parameters used in walking (stride length, frequency, speed) are selected by cats we compared stride characteristics selected when walking on a solid surface to those selected when they were constrained to specific stride lengths using a pedestal walkway. Humans spontaneously select substantially different stride length–stride frequency–speed relationships in walking when each of these parameters is constrained, as in walking to a metronome beat (frequency constrained), evenly spaced floor markers (stride length constrained) or on a treadmill (speed constrained). In humans such adjustments largely provide energetic economy under the prescribed walking conditions. Cats show a similar shift in gait parameter selection between conditions as observed in humans. This suggests that cats (and by extension, quadrupedal mammals) also select gait parameters to optimize walking cost-effectiveness. Cats with a profound peripheral sensory deficit (from pyridoxine overdose) appeared to parallel the optimization seen in healthy cats, but without the same level of precision. Recent studies in humans suggest that gait optimization may proceed in two stages – a fast perception-based stage that provides the initial gait selection strategy which is then fine-tuned by feedback. The sensory deficit cats appeared unable to accomplish the feedback-dependent aspect of this process.     

Dynamic balance assessment during gait in children with Down and Prader-Willi syndromes using inertial sensors

Down (DS) and Prader-Willi (PWS) syndromes are chromosomal disorders both characterized by obesity, ligament laxity, and hypotonia, the latter associated with gait instability. Although these shared features may justify a common rehabilitation approach, evidence exists that adults with DS and PWS adopt different postural and walking strategies. The development of an instrumented protocol able to describe these strategies and quantify patients’ gait stability in the current clinical routine would be of great benefit for health professionals, allowing them to design personalized rehabilitation programs. This is particularly true for children with DS and PWS, where motor development is dramatically constrained by severe hypotonia and muscle weakness. The aim of this study was, thus, to propose an instrumented protocol, integrated with the clinical routine and based on the use of wearable inertial sensors, to assess gait stability in DS and PWS children.Fifteen children with DS, 11 children with PWS, and 12 typically developing children (CG) were involved in the study. Participants performed a 10-meter walking test while wearing four inertial sensors located at pelvis, sternum, and both distal tibiae levels. Spatiotemporal parameters (walking speed, stride frequency, and stride length) and a set of indices related to gait symmetry and upper-body stability (Root Mean Square, Attenuation Coefficient and Improved Harmonic Ratio) were estimated from pelvis and sternum accelerations. The Gross Motor Functional Measures (GMFM-88) and Intelligence Quotient (IQ Wechsler) were also assessed for each patient. A correlation analysis among the GMFM-88 and IQ scales and the estimated parameters was then performed.Children with DS and PWS exhibit reduced gait symmetry and higher accelerations at pelvis level than CG. While these accelerations are attenuated by about 40% at sternum level in CG and DS, PWS children display significant smaller attenuations, thus reporting reduced gait stability, most likely due to their typical “Trendelenburg gait”. Significant correlations were found between the estimated parameters and the GMFM-88 scale when considering the whole PWS and DS group and the PWS group alone.These results promote the adoption of wearable technology in clinical routines to monitor gait patterns in children with DS and PWS: the proposed protocol allows to markedly characterize patient-specific motor limitations even when clinical assessment scores provide similar results in terms of pathology severity. This protocol could be adopted to support health professionals in designing personalized treatments that, in turn, could help improving patients’ quality of life in terms of both physical and social perspectives.     

Analysis of toddlers' gait after six months of independent walking to identify autism: a preliminary study

This research analyzed gait in toddlers and tested the hypothesis that movement can be used as an early indicator of Autistic Disorder. It was proposed that an early identification method could indicate differences in the gait of toddlers with autism as opposed to those with typical development or with mental retardation. Observational methods were applied to retrospective home videos of 42 children after 6 mo. of independent walking. In particular, the Walking Observation Scale was used, which includes 11 items that analyze gait through three axes of foot movements, arm movements, and global movements. Analysis showed different distributions for the three groups, i.e., the autistic group differed from the other two on scores for the Walking Observation Scale and each axis. After 6 mo. of independent walking, different patterns in gait among groups were evident. These results agree with recently published evidence which acknowledges the importance of movement as an early indicator for differential diagnosis of autism.     

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.     

Relationships between dual-task related changes in stride velocity and stride time variability in healthy older adults

Dual-task related gait changes have been previously reported for healthy older adults, suggesting that gait control requires attention. Compared to balance control, the involvement of attention in the control of the rhythmic stepping mechanism, as reflected by stride time variability, is not well known. In particular, under dual-task, the relative contributions of a second, attention-demanding task and changes in walking speed remain unclear. Thus, the aims of this study were (1) to assess whether walking with a slow-selected speed or walking while performing an attention-demanding task affected stride time variability in a sample of healthy older participants, and (2) to establish whether stride time variability under dual-task conditions is related either to the decrease of walking speed or the simultaneous attention-demanding task, or to both. Forty-five healthy older participants performed four experimental conditions: (1) walking at a normal self-selected speed, (2) walking at a slow self-selected speed, (3) performing a verbal fluency task when sitting on a chair, and (4) performing the verbal fluency task while walking at self-selected walking speed. Gait parameters were recorded across 15 meters, using Physilog. Results showed a significant dual-task related decrease in mean values of stride velocity, as well as a significant increase in mean values and coefficients of variation of stride time. These dual-task related changes in stride time were explained by the simultaneous performance of the verbal fluency task, the decrease of gait speed and the variability between participants. Although a relationship exists between decreased walking speed and increased stride time variability, the dual-task related increase of stride time variability was also significantly associated with the attention-demanding task, suggesting some attentional control for the rhythmic stepping mechanism of walking in healthy older adults.     

Dual-task costs of texting while walking forward and backward are greater for older adults than younger adults

Cognitive-motor dual-tasking involves concurrent performance of two tasks with distinct cognitive and motor demands and is associated with increased fall risk. In this hypothesis-driven study, younger (18–30 years, n = 24) and older (60–75 years, n = 26) adults completed six walking tasks in triplicate. Participants walked forward and backward along a GAITRite mat, in isolation or while performing a verbal fluency task. Verbal fluency tasks involved verbally listing or typing on a smartphone as many words as possible within a given category (e.g., clothes). Using repeated measures MANOVA models, we examined how age, method of fluency task (verbal or texting), and direction of walking altered dual-task performance. Given that tasks like texting and backward walking require greater cognitive resources than verbal and forward walking tasks, respectively, we hypothesized older adults would show higher dual-task costs (DTCs) than younger adults across different task types and walking directions, with degree of impairment more apparent in texting dual-task trials compared to verbal dual-task trials. We also hypothesized that both age groups would have greater DTCs while walking backward than while walking forward, regardless of task.Independent of age group, velocity and stride length were reduced for texting compared to the verbal task during both forward and backward walking; cadence and velocity were reduced while walking forward compared to walking backward for the texting task; and stride length was reduced for forward walking compared to backward walking during the verbal task. Younger adults performed better than older adults on all tasks with the most pronounced differences seen in velocity and stride length during forward-texting and backward-texting. Interaction effects for velocity and stride length while walking forward indicated younger adults performed better than older adults for the texting task but similarly during the verbal task. An interaction for cadence during the verbal task indicated younger adults performed better than older adults while walking backward but similarly while walking forward.In summary, older adults experienced greater gait decrement for all dual-task conditions. The greater declines in velocity and stride length in combination with cadence being stable suggest reductions in velocity during texting were due to shorter strides rather than a reduced rate of stepping. Contrary to our hypotheses, we found greater DTCs while walking forward rather than backward, which may be due to reduced gait performance during single-task backward walking; thus, further decrements with dual-tasking are unlikely. These findings underscore the need for further research investigating fall risk potential associated with texting and walking among aging populations and how interventions targeting stride length during dual-task circumstances may improve performance.     

Level walking in adults with and without Developmental Coordination Disorder: An analysis of movement variability

Several studies have shown that Developmental Coordination Disorder (DCD) is a condition that continues beyond childhood. Although adults with DCD report difficulties with dynamic balance, as well as frequent tripping and bumping into objects, there have been no specific studies on walking in this population. Some previous work has focused on walking in children with DCD but variation in the tasks and measures used has led to inconsistent findings. The aim of the current study therefore was to examine the characteristics of level walking in adults with and without DCD. Fifteen adults with DCD and 15 typically developing (TD) controls walked barefoot at a natural pace up and down an 11 m walkway for one minute. Foot placement measures and velocity and acceleration of the body were recorded, as well as measures of movement variability. The adults with DCD showed similar gait patterns to the TD group in terms of step length, step width, double support time and stride time. The DCD group also showed similar velocity and acceleration to the TD group in the medio-lateral, anterior–posterior and vertical direction. However, the DCD group exhibited greater variability in all foot placement and some body movement measures. The finding that adults with DCD have a reduced ability to produce consistent movement patterns is discussed in relation to postural control limitations and compared to variability of walking measures found in elderly populations.     

The gait of visually impaired pedestrians

The stride lengths, stride durations and walking speeds of visually impaired pedestrians were recorded under two conditions: firstly accompanied by a sighted guide, secondly walking independently. The same outdoor route was used for both conditions. When accompanied subjects walked at approximately the same speed as they would have on a force platform. However, when independent they were significantly slower (p = 0.051), with smaller strides (p = 0.083) which were of a longer duration (p = 0.062). Research into the gait of visually impaired pedestrians needs to take account of the effect of route conditions and the type of mobility aid being used.     

The impact of speed and time on gait dynamics

To determine the effects of speed on gait previous studies have examined young adults walking at different speeds; however, the small number of strides may have influenced the results. The aim of this study was to investigate the immediate and long-term impact of continuous slow walking on the mean, variability and structure of stride-to-stride measures. Fourteen young adults walked at a constant pace on a treadmill at three speeds (preferred walking speed (PWS), 90% and 80% PWS) for 30 min each. Spatiotemporal gait parameters were computed over six successive 5-min intervals. Walking slower significantly decreased stride length, while stride period and width increased. Additionally, stride period and width variability increased. Signal regularity of stride width increased and decreased in stride period. Persistence of stride period and width increased significantly at slower speeds. While several measures changed during 30 min of walking, only stride period variability and signal regularity revealed a significant speed and time interaction. Healthy young adults walking at slower than preferred speeds demonstrated greater persistence and signal regularity of stride period while spatiotemporal changes such as increased stride width and period variability arose. These results suggest that different control processes are involved in adapting to the slower speeds.     

Emotional states influence forward gait during music listening based on familiarity with music selections

Music elicits a wide range of human emotions, which influence human movement. We sought to determine how emotional states impact forward gait during music listening, and whether the emotional effects of music on gait differ as a function of familiarity with music. Twenty-four healthy young adults completed walking trials while listening to four types of music selections: experimenter-selected music (unfamiliar-pleasant), its dissonant counterpart (unfamiliar-unpleasant), each participant’s self-selected favorite music (familiar-pleasant), and its dissonant counterpart (familiar-unpleasant). Faster gait velocity, cadence, and stride time, as well as longer stride length were identified during pleasant versus unpleasant music conditions. Increased gait velocity, stride length, and cadence as well as reduced stride time were positively correlated with subjective ratings of emotional arousal and pleasure as well as musical emotions such as happiness-elation, nostalgia-longing, interest-expectancy, pride-confidence, and chills, and they were negatively related to anger-irritation and disgust-contempt. Moreover, familiarity with music interacted with emotional responses to influence gait kinematics. Gait velocity was faster in the familiar-pleasant music condition relative to the familiar-unpleasant condition, primarily due to longer stride length. In contrast, no differences in any gait parameters were found between unfamiliar-pleasant and unfamiliar-unpleasant music conditions. These results suggest emotional states influence gait behavior during music listening and that such effects are altered by familiarity with music. Our findings provide fundamental evidence of the impact of musical emotion on human gait, with implications for using music to enhance motor performance in clinical and performance settings.     

Investigating the efficacy of a tactile feedback system to increase the gait speed of older adults

The objective of this study was to determine (1) if a novel haptic feedback system could increase the walking speed of older adults while it is being employed during overground walking and (2) whether the frequency at which this feedback was presented would have a differential impact on the ability of users to change walking speed while it was present. Given that peak thigh extension has been found to be a biomechanical surrogate for stride length, and consequently gait speed, vibrotactile haptic feedback was provided to the participants' thighs as a cue to increase peak thigh extension while the effect on gait speed was monitored. Ten healthy community-dwelling older adults (68.4 ± 4.1 years) participated. Participants' peak thigh extension, cadence, normalized stride length and velocity, along with their coefficients of variation (COV) were compared across baseline normal and fast walking (with no feedback) and three different frequency of feedback conditions. The findings indicated that, compared to self-selected normal and fast walking speeds, peak thigh extension was significantly increased when feedback was present and after it was withdrawn in a post-test. An increase in thigh extension led to an increase in stride length and, consequently, an increase in stride velocity compared to normal speed. There were no significant differences in the gait parameters as a function of feedback frequency during its application. In conclusion, while present, the haptic feedback system increased thigh extension and walking speed in older adults regardless of the feedback frequency and when the feedback was withdrawn, participants could maintain an increase in those parameters.     

Development of eating behavior by Japanese toddlers in a nursery school: relation to independent walking

The eating behavior of 32 toddlers in a nursery school at 10, 12, and 14 months old was observed in relation to the age at onset of independent walking. With increasing age, the frequency at which the toddlers ate food given by a teacher decreased, and the frequency at which the toddlers ate by themselves increased. The toddlers who started walking earlier also advanced faster in the development of eating behavior. The time when the frequency of eating by oneself surpassed the frequency of passive eating coincided with the time when the toddlers started walking.     

Changes in step variability of new walkers with typical development and with Down syndrome

Models of human gait are based on adult locomotion. C. E. Bauby and A. D. Kuo (2000) proposed that adults rely on passive mechanisms at the spinal level to control motion in the anteroposterior direction and rely on direct monitoring of postural control in the lateral direction. The authors' purpose in this study was to determine if that model applies to control at the onset of walking in typically developing toddlers (n = 9) and in toddlers with Down syndrome (n = 6). Their longitudinal data suggested that toddlers control gait in a distinctly different manner than adults do. An adult pattern of control emerges with experience. In addition, the effect of experience on the emergence of that pattern is magnified by task-specific early intervention. The present data support the emergence and discovery of efficient patterns of control in this fundamental human behavior.     

A biomechanical analysis of the 'high guard' position of arms during walking in toddlers

In this study, we investigated biomechanical contributions of the high guard position of the arms observed only in a subgroup of toddlers at very early stages of gait development. Six healthy toddlers who showed this peculiar arm posture were involved in this study. They participated in two data collection sessions (1 month apart). We used three-dimensional analysis of arm posture during gait to estimate the changes in forces and torques generated by the arms and acting on the upper trunk segment. Across visits, toddlers’ increase in walking speeds coincided with lowering arm postures. Despite the apparent trend of changes in arm posture in this group of toddlers, the interaction between arm posture and upper trunk position created a variety of changes in forces and torques among individuals. Findings of this study exhibited an example of the exploration of dynamics by toddlers in the early stage of gait development.     

Dominance of gait cycle duration in casual walking

In gait research, casual walking has been considered to be walking at a casual speed. However, it is unclear that walking speed is the most stable factor in casual walking compared to other factors such as cycle duration and stride length. Although walking speed can be calculated from cycle duration and stride length, it is not necessarily the case that these parameters are "stable" in the same manner. We therefore conducted an experiment to determine which of these three parameters is most stable, regarding walking speed as cycle speed and using the coefficient of variation across gait cycles as index of stability. Ten participants were invited to walk in their own casual manner, once a week for a period of four weeks. Cycle duration was measured by means of a foot switch attached to the right heel. To measure the moving distance, participants towed a distance meter. Stride length and cycle speed were measured using this device. Over the four-week period, cycle duration and stride length were stable, whereas cycle speed was the most variable parameter. Furthermore, in the results for each single day, the cycle duration was significantly more stable than the other parameters. These results suggest that, when we walk casually, cycle duration is the dominant factor, rather than stride length or walking speed.     

Gait and risk of falls associated with frontal cognitive functions at different stages of Alzheimer's disease

ABSTRACT The decline in frontal cognitive functions contributes to alterations of gait and increases the risk of falls in patients with dementia, a category which included Alzheimer's disease (AD). The objective of the present study was to compare the gait parameters and the risk of falls among patients at different stages of AD, and to relate these variables with cognitive functions. This is a cross-sectional study with 23 patients with mild and moderate AD. The Clinical Dementia Rating was used to classify the dementia severity. The kinematic parameters of gait (cadence, stride length, and stride speed) were analyzed under two conditions: (a) single task (free gait) and (b) dual task (walking and counting down). The risk of falls was evaluated using the Timed Up-and-Go test. The frontal cognitive functions were evaluated using the Frontal Assessment Battery (FAB), the Clock Drawing Test (CDT) and the Symbol Search Subtest. The patients who were at the moderate stage suffered reduced performance in their stride length and stride speed in the single task and had made more counting errors in the dual task and still had a higher fall risk. Both the mild and the moderate patients exhibited significant decreases in stride length, stride speed and cadence in the dual task. Was detected a significant correlation between CDT, FAB, and stride speed in the dual task condition. We also found a significant correlation between subtest Similarities, FAB and cadence in the dual task condition. The dual task produced changes in the kinematic parameters of gait for the mild and moderate AD patients and the gait alterations are related to frontal cognitive functions, particularly executive functions.