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.     

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

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

Dynamic stability during running gait termination: Predictors for successful control of forward momentum in children and adults

Reported differences between children and adults with respect to COM horizontal and vertical position to maintain dynamic stability during running deceleration suggest that this relationship may not be as important in children. This study challenged the current dynamic stability paradigm by determining the features of whole body posture that predicted forward velocity and momentum of running gait termination in adults and children. Sixteen adults and 15 children ran as fast as possible and stopped at pre-determined location. Separate regression analyses determined whether COM posterior and vertical positions and functional limb length (distance between COM and stance foot) predicted velocity and momentum for adults and children. COM posterior position was the strongest predictor of forward velocity and momentum in both groups supporting the previously established relationship during slower tasks. COM vertical position also predicted momentum in children, not adults. Higher COM position in children was related to greater momentum; consistent with previously reported differences between children and adults in COM position across running deceleration. COM vertical position was related to momentum but not velocity in children suggesting that strategies used to terminate running may be driven by demands imposed not just by velocity, but also the mass being decelerated.     

Biomechanical analysis of gait termination in 11–17 year old youth at preferred and fast walking speeds

In populations where walking and/or stopping can be difficult, such as in children with cerebral palsy, the ability to quickly stop walking may be beyond the child’s capabilities. Gait termination may be improved with physical therapy. However, without a greater understanding of the mechanical requirements of this skill, treatment planning is difficult. The purpose of this study was to understand how healthy children successfully terminate gait in one step when walking quickly, which can be challenging even for healthy children. Lower extremity kinematic and kinetic data were collected from 15 youth as they performed walking, planned, and unplanned stopping tasks. Each stopping task was performed as the subject walked at his/her preferred speed and a fast speed. The most significant changes in mechanics between speed conditions (preferred and fast) of the same stopping task were greater knee flexion angles (unplanned: +16.49 ± 0.54°, p = 0.00; planned: +15.75 ± 1.1°, p = 0.00) and knee extension moments (unplanned: +0.67 ± 0.02 N/kgm, p = 0.00; planned: +0.57 ± 0.23 N/kgm, p = 0.00) at faster speeds. The extra range of motion in the joints and extra muscle strength required to maintain the stopping position suggests that stretching and strengthening the muscles surrounding the joints of the lower extremity, particularly the knee, may be a useful intervention.     

Effects of duration of wearing high-heeled shoes on plantar pressure

In the present study we investigated the effects of different durations of using high-heeled shoes on plantar pressure and gait. A questionnaire survey and dynamic plantar pressure measurements were performed in 20 control females and 117 females who had worn high-heeled shoes for a long time. According to the duration of using high-heeled shoes (as specified in the questionnaire), subjects were divided into a control group and five groups with different durations of use (i.e. <2 years, 2–5 years, 6–10 years, 11–20 years and >20 years). Parameters, including peak pressure, impulse and pressure duration, in different plantar regions were measured with the Footscan pressure plate. The 2–5 years group had smaller midfoot contact areas for both feet and higher subtalar joint mobility, while the 6–10 years group had larger midfoot contact areas for both feet and prolonged foot flat phase during gait. The peak pressure and impulse under the second and fourth metatarsus were increased with the prolonged wearing of high-heeled shoes, and the pressure and impulse under the midfoot were substantially reduced in the 2–5 years group. The findings suggest that long-term use of high-heeled shoes can induce changes in arch morphology: the longitudinal arch tends to be elevated within 2–5 years; the longitudinal arch tends to be flattened within 6–10 years; and the forefoot latitudinal arch tends to collapse in more than 20 years.     

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.     

Fighting patterns in young coyotes: Initiation,escalation, and assessment

The fighting patterns of young coyotes were studied and 2,350 fights were analyzed. Our results can be summarized as follows: 1) No major injuries were sustained by any of the infants, even in unritualized bouts. 2) In pairs, there was no relationship between social rank and the proportion of fights that were initiated by either animal. 3) Dominant animals were more likely than subordinate individuals to escalate first (perform the first unprovoked dangerous move) during short interactions and to escalate and then subsequently win short fights. 4) Highest-ranking (alpha) individuals in litters did not fight the most. 5) Alpha individuals initiated 73% of the fights in which they partook. Alpha coyotes initiated and then won 86% of the contests that they initiated. 6) For fourth-ranking coyotes in litters, there was a perfect positive correlation between the proportion of times that they initiated fights and the proportion of times that they initiated and then won encounters. They initiated interactions least with the first- to third-ranking animals. 7) Alpha and fourth-ranking animals escalated about the same proportion of the time, but alpha coyotes escalated and then won a greater proportion of fights. 8) Both alpha and fourth-ranking animals initiated and then escalated the greatest proportion of time with individuals nearest in rank, with whom they may have experienced the greatest difficulty in assessing relative social standing. 9) Our data suggested that individuals, especially in litters, were able to make pre-fight assessments but that they were not perfect with respect to this ability. During-fight assessments appeared to be easier to make, using escalation to test an opponent.     

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.     

Altered visual and somatosensory feedback affects gait stability in persons with multiple sclerosis

Persons with multiple sclerosis (PwMS) often report problems due to sensory loss and have an inability to appropriately reweight sensory information. Both of these issues can affect individual’s ability to maintain stability when walking under challenging conditions. The purpose of the current study was to determine how gait stability is adapted when walking under challenging sensory conditions where vision and somatosensation at the feet is manipulated. 25 healthy adults and 40 PwMS (15 fallers, 25 non-fallers) walked on a treadmill at their preferred normal walking speed under 3 conditions: normal walking, altered vision using goggles that shifted visual field laterally, and altered somatosensation using shoes with compliant foam soles. Inertial measurement united recorded acceleration at the lumbar and right ankle, and acceleration variability measures were calculated including root mean square (RMS), range, sample entropy (SaEn), and Lyapunov exponents (LyE). A gait stability index (GSI) was calculated using each of the four variability measures as the ratio of lumbar acceleration variability divided by foot acceleration variability in the frontal and sagittal planes. The sagittal and frontal GSI_RMS were larger in the somatosensory condition compared to the normal and visual conditions (p < 0.001). The frontal GSI_SaEn was greater in the visual condition compared to the somatosensory condition (p = 0.021). The frontal and sagittal GSI_LyE was greater in the somatosensory condition compared to the normal and visual conditions (p < 0.002). The current study showed that HC, MS non-fallers and MS fallers largely adapted to altered sensory feedback during walking in a similar manner. However, MS faller subjects may be more reliant on visual feedback compared to MS non-fallers and HC subjects.     

Tibialis posterior muscle pain effects on hip,knee and ankle gait mechanics

BackgroundTibialis posterior (TP) dysfunction is a common painful complication in patients with rheumatoid arthritis (RA), which can lead to the collapse of the medial longitudinal arch. Different theories have been developed to explain the causality of tibialis posterior dysfunction. In all these theories, pain is a central factor, and yet, it is uncertain to what extent pain causes the observed biomechanical alterations in the patients. The aim of this study was to investigate the effect of experimental tibialis posterior muscle pain on gait mechanics in healthy subjects.MethodsTwelve healthy subjects were recruited for this randomized crossover study. Experimental pain was induced by ultrasound-guided injection of 1 mL hypertonic saline into the upper part of the right tibialis posterior muscle with the use of isotonic saline as non-pain-inducing control. Subsequently, kinematic data during three self-paced over ground walking for each condition were collected. Ground reaction forces and external moments were measured from force plates installed in the floor. Painful areas were evaluated using body charts and pain intensity scoring via a verbal numerical rating scale.FindingsDecreased hip internal rotation was observed during the pain condition at the end of the stance phase. There were no changes in gait velocity and duration of stand phase between the pain and no pain conditions. Reduced external joint moment was found for external knee rotation and for external hip rotation.InterpretationThe study has demonstrated that induced pain in the TP muscle evokes kinematic alteration in the hip and the knee joints, but not in the ankle, which suggest an underlying early stage joint compensatory mechanism. These findings suggest the need to include those joints in current physical evaluations of tibialis posterior dysfunction.