The effect of variable rest intervals and chronic ankle instability on triplanar ankle motion during performance of the Star Excursion Balance Test

Inadequate rest intervals may contribute to impaired performance during functional tests. However, the effect of different rest intervals on performance of the SEBT in individuals with and without CAI is not known. Our purposes were to determine whether different rest intervals impact ankle kinematics during the SEBT and whether there differences between those two populations. 24 controls and 24 CAI completed 3 trials in 3 reach directions (anteromedial; AM, medial; M, posteromedial; PM). The order of rest intervals and reach distance were randomized and counterbalanced. Three visits were required to complete the 3 rest interval conditions (10, 20, 40 s). Rest interval did not impact ankle kinematics between controls and CAI during the SEBT. Dorsiflexion (DF) (AM:partial η² = 0.18; M:partial η² = 0.23; PM:partial η² = 0.23) for all directions and tibial internal rotation (TIR) excursions (AM:partial η² = 0.20) for AM direction were greater in individuals with CAI regardless of rest interval length. Rest intervals ranging from 10 to 40 s did not influence ankle kinematics. Differences exist in DF and TIR between controls and CAI during the SEBT. These findings suggest that clinicians can use any rest interval between 10 and 40 s when administrating the SEBT. However, triplanar motion differs during a complex functional movement in controls compared to CAI.     

Propulsion strategy in the gait of primary school children; the effect of age and speed

The strategy used to generate power for forward propulsion in walking and running has recently been highlighted as a marker of gait maturation and elastic energy recycling. This study investigated ankle and hip power generation as a propulsion strategy (PS) during the late stance/early swing phases of walking and running in typically developing (TD) children (15: six to nine years; 17: nine to 13 years) using three-dimensional gait analysis. Peak ankle power generation at push-off (peakA2), peak hip power generation in early swing (peakH3) and propulsion strategy (PS) [peakA2/(peakA2 + peakH3)] were calculated to provide the relative contribution of ankle power to total propulsion. Mean PS values decreased as speed increased for comfortable walking (p < 0.001), fast walking (p < 0.001) and fast running (p < 0.001), and less consistently during jogging (p = 0.054). PS varied with age (p < 0.001) only during fast walking. At any speed of fast walking, older children generated more peakA2 (p = 0.001) and less peakH3 (p = 0.001) than younger children. While the kinetics of running propulsion appear to be developed by age six years, the skills of fast walking appeared to require additional neuromuscular maturity. These findings support the concept that running is a skill that matures early for TD children.     

High- compared to low-arched athletes exhibit smaller knee abduction moments in walking and running

High- (HA) and low-arched athletes (LA) experience distinct injury patterns. These injuries are the result of the interaction of structure and biomechanics. A suggested mechanism of patellofemoral pain pertains to frontal plane knee moments which may be exaggerated in LA athletes. We hypothesize that LA athletes will exhibit greater peak knee abduction moments than high-arched athletes.MethodsTwenty healthy female recreational athletes (10 HA and 10 LA) performed five over-ground barefoot walking and five barefoot running trials at a self-selected velocity while three-dimensional kinematics and ground reaction forces were recorded. Peak knee abduction moments and time-to-peak knee abduction moments were calculated using Visual 3D.ResultsHigh-arched athletes had smaller peak knee abduction moments compared to low-arched athletes during walking (KAM1: p = 0.019; KAM2: p = 0.015) and running (p = 0.010). No differences were observed in time-to-peak knee abduction moment during walking (KAM1: p = 0.360; KAM2: p = 0.085) or running (p = 0.359).ConclusionsThese findings demonstrate that foot type is associated with altered frontal plane knee kinetics which may contribute to patellofemoral pain. Future research should address the efficacy of clinical interventions including orthotics and rehabilitation programs in these athletes.     

Movement adjustments in preparation for single-leg jumps in individuals with functional ankle instability

There is some evidence showing that people with functional ankle instability (FAI) can present changes in postural control during the landing phase of a jump. These studies also show preliminary results indicating possible changes during phases prior to landing. Therefore, the objective of this study was to investigate whether movement adjustments prior to a jump are different between people with and without FAI. Sixty participants with (n = 30) and without (n = 30) FAI participated in this study. The main outcome measures were the variability of range of motion in ankle inversion/eversion and dorsiflexion/plantarflexion; and variability of center of pressure for the directions anterior-posterior and medio-lateral during the pre-jump period for drop jump, vertical jump and during single-leg stance. The group with instability showed more variability of center of pressure in anterior-posterior direction (p = 0.04) and variability of range of motion in ankle dorsiflexion/plantar flexion (p = 0.04) compared to control in the single-leg stance test. For the within-group comparisons, the group with instability showed more variability of center of pressure in anterior-posterior direction in the drop jump higher than single-leg stance and vertical jump. The same pattern was seen for the control group. Thus, this study suggests that people with FAI have greater ankle range of motion variability and center of pressure variability in the anterior-posterior axis when compared to healthy individuals during single-leg stance. For those same two variables, preparation for a drop jump causes more postural instability when compared to the preparation for a vertical jump and to single-leg stance.     

Walking impairs cognitive performance among people with multiple sclerosis but not controls

People with multiple sclerosis (MS) complain of problems completing two tasks simultaneously; sometimes called ‘dual-tasking’ (DT). Previous research in DT among people with MS has focused on how adding a cognitive task interferes with gait and few have measured how adding a motor task could interfere with cognition. We aimed to determine the extent to which walking affects a concurrent working memory task in people with MS compared to healthy controls. We recruited MS participants (n = 13) and controls (n = 10) matched by age (±3 years), education (±3 years) and gender. Participants first completed the cognitive task (subtracting 7’s from the previous number) and then again while walking on an instrumented walkway. Although there were no baseline differences in cognition or walking between MS participants and controls, MS participants demonstrated a 52% decrease in number of correct answers during DT (p < 0.001). Mental Tracking Rate (% correct answers/min) correlated strongly with MS-related disability measured using the Expanded Disability Status Scale (EDSS; r(11) = −0.68, p < 0.01). We propose that compromised mental tracking during walking could be related to limited neural resource capacity and could be a potentially useful outcome measure to detect ecologically valid dual tasking impairments.     

Asymmetrical loading affects intersegmental dynamics during the swing phase of walking

Much of the work related to lower extremity inertia manipulations has focused on temporal, kinematic and traditional inverse dynamics assessments during locomotion. Intersegmental dynamics is an analytical technique that provides further insights into mechanisms underlying linked-segment motion. The purpose of this study was to determine how intersegmental dynamics during the swing phase of walking are altered during asymmetrical lower extremity loading. Participants walked overground at a speed of 1.57 m s^?1 with 0, 0.5, 1.0, and 2.0 kg attached to one foot. Net, interaction, gravitational, and muscle moments were computed. Moment magnitudes at joints of the loaded leg increased systematically with increasing load, whereas unloaded leg moments were unaffected by loading. With increasing load, relative contributions of interaction moments about the knee and hip and gravitational moment about the ankle increased (i.e., 21%, 8%, and 44% increases, respectively), whereas the relative contributions of muscle moments about all three joints declined (i.e., ?4%, ?13%, and ?8% decreases for the ankle, knee, and hip, respectively for unloaded vs. 2.0 kg). These results suggest that altered inertia properties of the limb not only affected the amount of muscular effort required to swing the leg, but also changed the nature of the interaction between segments.     

How much does the human medial gastrocnemius muscle contribute to ankle torques outside the sagittal plane?

Ankle movements in the frontal plane are less prominent though not less relevant than movements in the plantar or dorsal flexion direction. Walking on uneven terrains and standing on narrow stances are examples of circumstances likely imposing marked demands on the ankle medio-lateral stabilization. Following our previous evidence associating lateral bodily sways in quiet standing to activation of the medial gastrocnemius (MG) muscle, in this study we ask: how large is the MG contribution to ankle torque in the frontal plane? By arranging stimulation electrodes in a selective configuration, current pulses were applied primarily to the MG nerve branch of ten subjects. The contribution of populations of MG motor units of progressively smaller recruitment threshold to ankle torque was evaluated by increasing the stimulation amplitude by fixed amounts. From smallest intensities (12–32 mA) leading to the firstly observable MG twitches in force-plate recordings, current pulses reached intensities (56–90 mA) below which twitches in other muscles could not be observed from the skin. Key results showed a substantial MG torque contribution tending to rotate upward the foot medial aspect (ankle inversion). Nerve stimulation further revealed a linear relationship between the peak torque of ankle plantar flexion and inversion, across participants (Pearson R > .81, p < .01). Specifically, regardless of the current intensity applied, the peak torque of ankle inversion amounted to about 13% of plantar flexion peak torque. Physiologically, these results provide experimental evidence that MG activation may contribute to stabilize the body in the frontal plane, especially under situations of challenged stability.     

Entrainment to a real time fractal visual stimulus modulates fractal gait dynamics

Fractal patterns characterize healthy biological systems and are considered to reflect the ability of the system to adapt to varying environmental conditions. Previous research has shown that fractal patterns in gait are altered following natural aging or disease, and this has potential negative consequences for gait adaptability that can lead to increased risk of injury. However, the flexibility of a healthy neurological system to exhibit different fractal patterns in gait has yet to be explored, and this is a necessary step toward understanding human locomotor control. Fifteen participants walked for 15 min on a treadmill, either in the absence of a visual stimulus or while they attempted to couple the timing of their gait with a visual metronome that exhibited a persistent fractal pattern (contained long-range correlations) or a random pattern (contained no long-range correlations). The stride-to-stride intervals of the participants were recorded via analog foot pressure switches and submitted to detrended fluctuation analysis (DFA) to determine if the fractal patterns during the visual metronome conditions differed from the baseline (no metronome) condition. DFA α in the baseline condition was 0.77 ± 0.09. The fractal patterns in the stride-to-stride intervals were significantly altered when walking to the fractal metronome (DFA α = 0.87 ± 0.06) and to the random metronome (DFA α = 0.61 ± 0.10) (both p < .05 when compared to the baseline condition), indicating that a global change in gait dynamics was observed. A variety of strategies were identified at the local level with a cross-correlation analysis, indicating that local behavior did not account for the consistent global changes. Collectively, the results show that a gait dynamics can be shifted in a prescribed manner using a visual stimulus and the shift appears to be a global phenomenon.     

Functioning of peripheral Ia pathways in leg muscles of newly walking toddlers

Monosynaptic and polysynaptic spinal level reflexes in the leg muscles of infants show significant dispersion across muscles, high variability, and no change in response patterns over the first 10 months. Here we tested the hypothesized relation between early walking experience and the tuning of these responses in three primary gait muscles of participants in four subgroups: cruisers (n = 7) and toddlers with one (n = 5), two (n = 5), or three (n = 5) months of walking experience. Reflex responses in multiple Ia pathways – tendon reflex (T-reflex), vibration-induced inhibition of the T-reflex (VIM-T-reflex), and tonic vibration-induced reflex (VIR), were elicited by mechanical stimuli applied to the distal tendons of the quadriceps, gastrocnemius-soleus, and tibialis anterior of both legs. Walking skill was assessed via a GAITRite mat. Generally, walking experience seemed to be related to slowly emerging improvements and, depending on muscle tested and pathway, progress was quite varied. Amplitude and latency of reflex responses were more clearly impacted by age or leg length while the ratio or distribution pattern of reflex response among antagonist pairs of muscles was impacted by walking experience and skill. As walking experience increased, the ratio of reflex responses tended to increase for the stimulated and decrease for the antagonist reflex loops with distribution of the pattern shifting gradually toward a single type of reflex response in all tested muscles. The very slow tuning of these reflexes may underlie the many missteps and falls reported to occur during early walking and suggest that subsequent studies should continue to follow the developmental trajectory through the first year of walking experience.     

Adaptations to walking on an uneven terrain for individuals with and without Developmental Coordination Disorder

Given the importance of walking in everyday life, understanding why this is challenging for some populations is particularly important. Studies focusing on gait patterns of individuals with Developmental Coordination Disorder (DCD) have shown that whilst increased variability is characteristic of walking patterns for this group, differences in spatio-temporal gait variables seem only to arise when task demands increase. However, these differences occur under rather artificial conditions, for example using a treadmill. The aim of this study, therefore was to examine the step characteristics of individuals with and without DCD whilst walking along an irregular terrain. Thirty-five individuals with DCD aged 8–32 years and 35 age and gender-matched controls participated in this study. Participants were divided into 3 age groups; 8–12 years (n = 12), 13–17 years (n = 12) and 18–32 years (n = 11). Participants walked up and down a 6 m walkway for two minutes on two terrains: level and irregular. VICON 3D motion analysis was used to extract measures of foot placement, velocity and angle of the head and trunk. Results showed that both groups adapted their gait to negotiate the irregular terrain, but the DCD group was more affected than their TD peers; walking significantly slower with shorter, wider steps and inclining their head more towards the ground. This suggests an adaptive approach used by individuals with DCD to preserve stability and increase visual sampling whilst negotiating an irregular terrain.     

Kinematic and ground reaction force accommodation during weighted walking

Weighted walking is a functional activity common in daily life and can influence risks for musculoskeletal loading, injury and falling. Much information exists about weighted walking during military, occupational and recreational tasks, but less is known about strategies used to accommodate to weight carriage typical in daily life. The purposes of the study were to examine the effects of weight carriage on kinematics and peak ground reaction force (GRF) during walking, and explore relationships between these variables. Twenty subjects walked on a treadmill while carrying 0, 44.5 and 89 N weights in front of the body. Peak GRF, sagittal plane joint/segment angular kinematics, stride length and center of mass (COM) vertical displacement were measured. Changes in peak GRF and displacement variables between weight conditions represented accommodation. Effects of weight carriage were tested using analysis of variance. Relationships between peak GRF and kinematic accommodation variables were examined using correlation and regression. Subjects were classified into sub-groups based on peak GRF responses and the correlation analysis was repeated. Weight carriage increased peak GRF by an amount greater than the weight carried, decreased stride length, increased vertical COM displacement, and resulted in a more extended and upright posture, with less hip and trunk displacement during weight acceptance. A GRF increase was associated with decreases in hip extension (|r| = .53, p = .020) and thigh anterior rotation (|r| = .57, p = .009) displacements, and an increase in foot anterior rotation displacement (|r| = .58, p = .008). Sub-group analysis revealed that greater GRF increases were associated with changes at multiple sites, while lesser GRF increases were associated with changes in foot and trunk displacement. Weight carriage affected walking kinematics and revealed different accommodation strategies that could have implications for loading and stability.     

Biomechanical analyses of prolonged handwriting in subjects with and without perceived discomfort

Since wrist-joint position affects finger muscle length and grip strength, we studied its biomechanical relevance in prolonged handwriting. We recruited participants from young adults, aged 18–24, and separated them into control (n = 22) and in-pain (n = 18) groups, based whether or not they experience pain while handwriting. The participants then performed a writing task for 30 min on a computerized system which measured their wrist-joint angle and documented their handwriting kinematics. The in-pain group perceived more soreness and had a less-extended wrist joint, longer on-paper time, and slower stroke velocity compared to control group. There was no significant difference in handwriting speed and quality between the two groups. The wrist extension angle significantly correlated with perceived soreness. Ergonomic and biomechanical analyses provide important information about the handwriting process. Knowledge of pen tip movement kinematics and wrist-joint position can help occupational therapists plan treatment for individuals with handwriting induced pain.     

Comparison of the trunk-pelvis and lower extremities sagittal plane inter-segmental coordination and variability during walking in persons with and without chronic low back pain

Inter-segmental coordination can be influenced by chronic low back pain (CLBP). The sagittal plane lower extremities inter-segmental coordination pattern and variability, in conjunction with the pelvis and trunk, were assessed in subjects with and without non-specific CLBP during free-speed walking. Kinematic data were collected from 10 non-specific CLBP and 10 non-CLBP control volunteers while the subjects were walking at their preferred speed. Sagittal plane time-normalized segmental angles and velocities were used to calculate continuous relative phase for each data point. Mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify the trunk-pelvis and bilateral pelvis-thigh, thigh-shank and shank-foot coordination pattern and variability over the stance and swing phases of gait. Mann-Whitney U test was employed to compare the means of DP and MARP values between two groups (same side comparison). Statistical analysis revealed more in-phase/less variable trunk-pelvis coordination in the CLBP group (P < 0.05). CLBP group demonstrated less variable right or left pelvis-thigh coordination pattern (P < 0.05). Moreover, the left thigh-shank and left shank-foot MARP values in the CLBP group, were more in-phase than left MARP values in the non-CLBP control group during the swing phase (P < 0.05). In conclusion, the sagittal plane lower extremities, pelvis and trunk coordination pattern and variability could be generally affected by CLBP during walking. These changes can be possible compensatory strategies of the motor control system which can be considered in the CLBP subjects.     

Variability of kinematic graphomotor fluency in adults with ADHD

Although graphomotor differences and variability of performance have been observed in children with attention deficit hyperactivity disorder (ADHD), no study has investigated whether this variability manifests in the kinematic graphomotor domain in adults with ADHD. Fourteen ADHD and 20 control participants wrote a novel grapheme and common word on a digitizing tablet 30 times each, with ADHD participants counterbalanced on and off stimulant medication. Variability of graphomotor fluency was significantly greater in ADHD versus control participants only in the novel writing task, both on, F(1, 31) = 5.988, p = .020, and off stimulant medication, F(1, 32) = 8.789, p = .006. Results suggest that motor control differences in ADHD are not limited to childhood and extend into adulthood. Given sufficient additional research, variability of kinematic graphomotor fluency may increase the sensitivity/specificity of differential diagnoses and/or represent a biomarker for ADHD.     

Arch structure is associated with unique joint work,relative joint contributions and stiffness during landing

To examine lower extremity joint contributions to a landing task in high-(HA) and low-arched (LA) female athletes by quantifying vertical stiffness, joint work and relative joint contributions to landing.MethodsTwenty healthy female recreational athletes (10 HA and 10 LA) performed five barefoot drop landings from a height of 30 cm. Three-dimensional kinematics (240 Hz) and ground reaction forces (960 Hz) were recorded simultaneously. Vertical stiffness, joint work values and relative joint work values were calculated using Visual 3D and MatLab.ResultsHA athletes had significantly greater vertical stiffness compared to LA athletes (p = 0.013). Though no differences in ankle joint work were observed (p = 0.252), HA athletes had smaller magnitudes of knee (p = 0.046), hip (p = 0.019) and total lower extremity joint work values (p = 0.016) compared to LA athletes. HA athletes had greater relative contributions of the ankle (p = 0.032) and smaller relative contributions of the hip (p = 0.049) compared to LA athletes. No differences in relative contributions of the knee were observed (p = 0.255).ConclusionsThese findings demonstrate that aberrant foot structure is associated with unique contributions of lower extremity joints to load attenuation during landing. These data may provide insight into the unique injury mechanisms associated with arch height in female athletes.     

Partial body weight support treadmill training speed influences paretic and non-paretic leg muscle activation,stride characteristics,and ratings of perceived exertion during acute stroke rehabilitation

BackgroundIntensive task-specific training is promoted as one approach for facilitating neural plastic brain changes and associated motor behavior gains following neurologic injury. Partial body weight support treadmill training (PBWSTT), is one task-specific approach frequently used to improve walking during the acute period of stroke recovery (<1 month post infarct). However, only limited data have been published regarding the relationship between training parameters and physiologic demands during this early recovery phase.ObjectiveTo examine the impact of four walking speeds on stride characteristics, lower extremity muscle demands (both paretic and non-paretic), Borg ratings of perceived exertion (RPE), and blood pressure.DesignA prospective, repeated measures design was used.MethodsTen inpatients post unilateral stroke participated. Following three familiarization sessions, participants engaged in PBWSTT at four predetermined speeds (0.5, 1.0, 1.5 and 2.0 mph) while bilateral electromyographic and stride characteristic data were recorded. RPE was evaluated immediately following each trial.ResultsStride length, cadence, and paretic single limb support increased with faster walking speeds (p ⩽ 0.001), while non-paretic single limb support remained nearly constant. Faster walking resulted in greater peak and mean muscle activation in the paretic medial hamstrings, vastus lateralis and medial gastrocnemius, and non-paretic medial gastrocnemius (p ⩽ 0.001). RPE also was greatest at the fastest compared to two slowest speeds (p < 0.05).ConclusionsDuring the acute phase of stroke recovery, PBWSTT at the fastest speed (2.0 mph) promoted practice of a more optimal gait pattern with greater intensity of effort as evidenced by the longer stride length, increased between-limb symmetry, greater muscle activation, and higher RPE compared to training at the slowest speeds.     

Mindfulness-Based Cognitive Therapy for Neuroticism (Stress Vulnerability): A Pilot Randomized Study

Objective: Neuroticism, a characteristic associated with increased stress vulnerability and the tendency to experience distress, is strongly linked to risk of different forms of psychopathology. However, there are few evidence-based interventions to target neuroticism. This pilot study investigated the efficacy and acceptability of mindfulness-based cognitive therapy (MBCT) compared with an online self-help intervention for individuals with high levels of neuroticism. The MBCT was modified to address psychological processes that are characteristic of neuroticism. Method: Participants with high levels of neuroticism were randomized to MBCT (n = 17) or an online self-help intervention (n = 17). Self-report questionnaires were administered preintervention and again at 4 weeks postintervention. Results: Intention-to-treat analyses found that MBCT participants had significantly lower levels of neuroticism postintervention than the control group. Compared with the control group, the MBCT group also experienced significant reductions in rumination and increases in self-compassion and decentering, of which the latter two were correlated with reductions in neuroticism within the MBCT group. Low drop-out rates, high levels of adherence to home practice, and positive feedback from MBCT participants provide indications that this intervention may be an acceptable form of treatment for individuals who are vulnerable to becoming easily stressed. Conclusions: MBCT specifically modified to target neuroticism-related processes is a promising intervention for reducing neuroticism. Results support evidence suggesting neuroticism is malleable and amenable to psychological intervention. MBCT for neuroticism warrants further investigation in a larger study.     

Falling for smartphones: A smartphone-centric data collection tool for measuring distracted walking

Falls and severe head injuries have been increasingly associated with the use of smartphones while walking. A growing body of academic research identifies cognitive, perceptual, and motor deficits caused by smartphone use while walking. Despite the dangers associated with smartphone use while walking, the true prevalence can be challenging to assess. To better address the growing injury risk related to smartphone-induced distraction, we have built a smartphone-based data collection tool to assess smartphone use frequency while walking. In the current study, 35 participants installed the data collection app on their Android smartphones. On average, the application collected 520 data points per day. The application also indicated participants walked 12% of their day, and 49% of their time walking included smartphone use. The current study demonstrates the prevalence of smartphone-induced distraction while walking and smartphone applications' potential efficacy to collect behavioral data.     

Weight discrepancy and body appreciation among women in Poland and Britain

Previous studies have suggested that the process of transmigration has detrimental effects on the body image of migrants relative to women in the country of origin. In the present work, we examined the body image of Polish migrants in Britain (n = 153), Polish women in Poland (n = 153), and a comparison group of British White women (n = 110). Participants completed a measure of actual-ideal weight discrepancy and the Body Appreciation Scale (BAS). Contrary to hypotheses, our results showed that Polish women in Poland had significantly higher weight discrepancy than their counterparts in Britain. Further analyses showed that the BAS reduced to two dimensions among Polish participants, with Polish participants in Poland having significantly lower body appreciation than Polish migrants. We suggest that the sociocultural changes that have taken place in Eastern Europe may place women in that region at relatively high risk for developing negative body image.     

Do kinematic metrics of walking balance adapt to perturbed optical flow?

Visual (i.e., optical flow) perturbations can be used to study balance control and balance deficits. However, it remains unclear whether walking balance control adapts to such perturbations over time. Our purpose was to investigate the propensity for visuomotor adaptation in walking balance control using prolonged exposure to optical flow perturbations. Ten subjects (age: 25.4 ± 3.8 years) walked on a treadmill while watching a speed-matched virtual hallway with and without continuous mediolateral optical flow perturbations of three different amplitudes. Each of three perturbation trials consisted of 8 min of prolonged exposure followed by 1 min of unperturbed walking. Using 3D motion capture, we analyzed changes in foot placement kinematics and mediolateral sacrum motion. At their onset, perturbations elicited wider and shorter steps, alluding to a more cautious, general anticipatory balance control strategy. As perturbations continued, foot placement tended toward values seen during unperturbed walking while step width variability and mediolateral sacrum motion concurrently increased. Our findings suggest that subjects progressively shifted from a general anticipatory balance control strategy to a reactive, task-specific strategy using step-to-step adjustments. Prolonged exposure to optical flow perturbations may have clinical utility to reinforce reactive, task-specific balance control through training.