Reliability and validity of an activity monitor (IDEEA) in the determination of temporal-spatial gait parameters in individuals with cerebral palsy

This study evaluated within- and between-session reliability and validity of temporal–spatial gait parameters derived from the intelligent device for energy expenditure and activity (IDEEA) activity monitor (Minisun, Fresno, CA) in subjects with cerebral palsy, using three-dimensional gait analysis (3-DGA) as the criterion standard. Twenty-five subjects with cerebral palsy (mean age 14.1 years, range 8–23) and 30 control subjects (mean age 14.2 years, range 7–24) completed two 3-DGA, 1 week apart with simultaneous IDEEA data collection. The IDEEA had lower within-session reliability than the 3-DGA for both groups, indicated by greater measurement errors and wider repeatability values for all temporal–spatial parameters. Between-session reliability of 3-DGA was high for both groups with intra-class correlation coefficients (ICC) >0.80. The IDEEA monitor showed high between-session reliability for control subjects (ICC 0.71–0.89), but lower reliability in subjects with cerebral palsy, particularly for walking velocity and stride length (ICC 0.53 and 0.62, respectively). Validity comparison between IDEEA and 3-DGA measures using Bland Altman 95% limits of agreement showed a measurement bias, with the IDEEA over-estimating step and stride length and underestimating cadence in both subject groups compared to 3-DGA. The 95% limits of agreement were smaller in controls (step ±0.20 m; stride ±0.27 m; walking velocity ±0.28 m/s) than in subjects with cerebral palsy (step ±0.36 m; stride ±0.37 m; velocity ±0.58 m/s). Modifications may be necessary to improve the reliability and validity of the IDEEA in children, particularly for use in neurological conditions.     

Concurrent validity and intrasession reliability of the IDEEA accelerometry system for the quantification of spatiotemporal gait parameters

The aim of this pilot study was to evaluate concurrent validity and intrasession reliability of the IDEEA (Minisun, Fresno, CA) accelerometry system (and associated software) with force plate measurements for spatiotemporal gait variables recorded during normal walking. Ten healthy individuals were asked to walk at a self-selected comfortable speed, over five multicomponent force plates embedded into the walkway floor. For each trial, spatiotemporal gait parameters (single support time, cadence, speed, step and stride length) obtained by the force plates were compared to those recorded by IDEEA. Concurrent (criterion-related) validity between the two systems was analysed with intraclass correlation (ICC) (2,1). Intrasession reliability was quantified by using coefficient of variations (CV) and ICC. For the ensemble of the parameters, ICC (2,1) ranged between 0.998 (cadence) and 0.784 (step length right) (p<0.001-0.01). However, speed, step length and stride length were significantly lower for IDEEA (~7%; p<0.001) compared to force plate data. Intrasession reliability of IDEEA was excellent, with CV lower than 5.7 and ICC higher than 0.961. The present accelerometry system demonstrated strong concurrent validity for the assessment of spatiotemporal gait parameters. However, spatial variables (stride and step length) and walking speed were significantly underestimated compared with analyses using force plates.     

DAid pressure socks system: Performance evaluation

BackgroundPlantar pressure measurement has been proven to produce crucial information for gait analysis. Socks with integrated textile pressure sensors are a promising tool for non-obtrusive plantar pressure acquisition and monitoring.Research questionCan the DAid Pressure Socks System be employed for the measurement of plantar pressure and temporal parameters during walking?MethodPlantar pressure measurement was acquired simultaneously by the DAid Pressure Socks System (DPSS) and Pedar® insole measurement system for a normal walking gait of 17 volunteers. The measurement from both systems was processed and gait temporal parameters were calculated. The calculated temporal parameters included stride time, step time, stance time, swing time, single support time, double support time, and cadence. The Intraclass Correlation Coefficient (ICC) was calculated to evaluate the agreement between the plantar pressure measurement and temporal parameters obtained from both systems.ResultsFor plantar pressure measurement, excellent agreement (ICC > 0.90) was achieved in approximately 23 % cases, while in roughly 37 %, 27 %, and 13 % cases the agreement was good (ICC > 0.75), moderate (ICC > 0.50), and poor (ICC < 0.50), respectively. The mean relative differences (as a percentage) between the temporal parameter values calculated from the measurement of both systems were 0.80 % (stride time), 3.06 % (step time), 3.15 % (stance time), 5.08 % (swing time / opposite single support time), 14.47 % (double support time), and 0.78 % (cadence).SignificanceThe ICC result calculated for the plantar pressure measurement indicated a reasonable agreement between both systems. Additionally, the relatively low mean difference was observed for 5 out of 6 calculated temporal gait parameters. Consequently, the presented DPSS could be considered as a substitute for the commercial gait analysis tools for applications that do not require great accuracy of the absolute plantar pressure measurement.     

Discriminant validity and reproducibility of spatiotemporal and kinetic parameters during treadmill walking in patients with knee osteoarthritis

BackgroundInstrumented treadmills are potentially useful tools for the assessment of gait parameters in orthopaedic clinical settings, but their measurement properties remain uncertain.Research questionWhat is the discriminant validity and reproducibility of spatiotemporal and kinetic gait parameters measured by a pressure-instrumented treadmill at different speeds and inclinations in patients with knee osteoarthritis (KOA)?MethodsA total of 54 patients with unilateral KOA and 23 healthy controls took part in the study. Step length, single-limb support duration and ground reaction force were recorded during level and uphill walking at 3 and 4 km/h using a commercially-available treadmill instrumented with an integrated pressure platform. We examined discriminant validity (difference between involved and uninvolved side as well as against healthy controls) and test-retest reproducibility (reliability and agreement).ResultsSignificant side differences were observed for single-limb support duration and ground reaction force at touchdown in all conditions (P < 0.05). All the investigated gait parameters showed acceptable reliability and agreement, except step length at 4 km/h uphill.SignificanceWe conclude that the pressure-instrumented treadmill used in this study may have good clinical utility for quantitative gait analysis in patients with KOA under different experimental conditions.     

Concurrent validity of the ZeroWire® footswitch system for the measurement of temporal gait parameters

BackgroundIn contrast to wearable tools (like in-shoe) sensors, lab-based gait assessment (using pressure-sensitive mats or cameras) only acquire data over short distances in non-ecological environments.Research questionTo examine the concurrent validity of a wearable ZeroWire® footswitch system (Aurion Srl, Milan, Italy) vs. the GAITRite® walkway (CIR systems Inc., NJ, USA) for recording temporal gait parameters.MethodsWe included 40 healthy participants in a prospective, single-center study. Temporal gait parameters were recorded simultaneously with the ZeroWire® and GAITRite® systems while each participant walked at three different speeds (slow (60steps/min), comfortable and maximum). To measure the validity, we calculated the interclass correlation coefficient (ICC) and the coefficient of variation (CV) for each parameter (gait cadence, stride time, step time, stance time, and single-support and double-support times). We also performed a graphical analysis using the Bland and Altman method.ResultsThe footswitch system showed moderate-to-excellent concurrent validity vs. the GAITRite mat. The degree of agreement between the two assessments was greatest at the maximum gait velocity showed, with very good validity (ICC > 0.91) seen for most parameters, whereas agreement ranged from moderate to very good for the other speeds. Independently of the gait speed, the highest levels of agreement were recorded for gait velocity, cadence, stride time, step time, and stance time. According to the CVs, both systems showed the same accuracy and double-support time was the more variable parameter.SignificanceThe ZeroWire® footswitch system appears to be valid for assessing temporal gait parameters (and particularly gait cadence and stride, step and stance times in healthy participants). It is likely to be well suited to the assessment of gait parameters under ecological conditions and in dual-task gait paradigms.     

Reproducibility of gait parameters at different surface inclinations and speeds using an instrumented treadmill system

Instrumented treadmill systems allow the practical assessment of gait parameters under several walking conditions. Aim of this study was to evaluate the reproducibility of gait parameters at different surface inclinations and walking speeds using an instrumented treadmill system in healthy individuals. A total of 20 subjects (10 women) with a mean age of 31 years were evaluated with an instrumented treadmill system (FDM-T, Zebris Medical GmbH) during two identical test sessions. Spatial (step length, step width, foot rotation), temporal (cadence, single-limb support, step time) and ground reaction force (heel force, toe force, time to heel force, time to toe force) gait parameters were assessed at three treadmill inclinations (level, uphill, downhill) and five speeds (2, 3, 4, 5, 6 km/h). Between-day reproducibility was evaluated with smallest detectable changes for agreement and intraclass correlation coefficients for reliability. Low agreement and reliability were observed for (i) step length, cadence and step time during slow (2 and 3 km/h) and uphill walking and (ii) time to heel force and time to toe force under the majority of walking conditions. The instrumented treadmill system used in this study provided reproducible measurements for the majority of the evaluated spatial, temporal and ground reaction force gait parameters in healthy individuals. The assessment of time to heel/toe force should be however avoided, and particular care should be taken for some spatial (step length) and temporal (cadence and step time) parameters while walking uphill and/or at slow speeds.     

The Primary Gait Screen in Parkinson’s disease: Comparison to standardized measures

BackgroundPersons with Parkinson’s disease exhibit gait deficits during comfortable-pace overground walking and data from pressure sensitive mats have been used to quantify gait performance. The Primary Gait Screen is a new assessment which includes gait initiation, overground walking, turning, and gait termination. Although overground assessments are useful, the Primary Gait Screen offers a more complex evaluation than traditional gait assessments.Research questionIs the overground walking portion of the Primary Gait Screen comparable to traditional gait assessments?MethodsPersons with Parkinson’s disease (N = 175; 47 F, 128 M; 67 ± 9 yrs) prospectively completed 4 passes at a self-selected speed and two trials of the Primary Gait Screen on an 8 m long pressure-sensing mat. Spatiotemporal gait variables were computed and a repeated-measures MANOVA with a Bonferroni correction compared the spatiotemporal variables from the Primary Gait Screen to the self-selected trials: gait velocity, cadence, step length, step time, and stride length.ResultsThe analyses failed to detect differences between the Primary Gait Screen and self-selected trials for gait velocity, step length, or stride length (p > .01). Post-hoc tests revealed decreased cadence and increased step time were the only differences between the Primary Gait Screen trials and the self-selected trial (p < .001).SignificanceDifferences seen in cadence and step time during the Primary Gait Screen may be attributed to patients’ strategy, but are likely not clinically meaningful. The Primary Gait Screen appears to be a comparable assessment of overground walking in persons with Parkinson’s disease, and may be a useful and accurate clinical assessment of walking.     

Temporal and spatial gait parameters in patients dependent on walking assistance after stroke: Reliability and agreement between simple and advanced methods of assessment

The aim of this study was to investigate the reliability of temporal and spatial gait parameters in patients dependent on walking assistance after severe stroke, and to examine agreement between simple and advanced methods. Twenty-one patients, admitted for in-patient multidisciplinary rehabilitation, were assessed repeatedly for walking function, both in a test corridor and a gait laboratory (3D camera system) before and after 11 weeks of rehabilitation. The test–retest reliability was examined using intraclass correlation (ICC_1.1), and measurement error was reported by within-subject standard deviation (S_w). The agreement between different methods for assessing walking speed, cadence and step length was explored by Bland–Altman plots. High to excellent test–retest reliability was found between trials, both when assessed in the corridor (ICC: 0.93–0.99) and in the laboratory (ICC: 0.88–0.99). Agreement between methods was satisfactory at baseline and was higher after the rehabilitation period. Agreement was found to be slightly better at lower walking speeds and for shorter step lengths. The results implicate that temporal–spatial gait parameters may be measured reliably by both simple and advanced methods in dependent walkers after stroke. A high level of agreement was found between the two methods for walking speed, cadence and average step length at both test points.     

Cognitive and visual demands,but not gross motor demand,of concurrent smartphone use affect laboratory and free-living gait among young and older adults

BackgroundAs smartphones are an integral part of daily activities, understanding the underlying mechanism associated with concurrent cell phone use while walking may help reduce the risks of injury.Research questionThis study examined the effect of cognitive, visual, and gross motor demands while using a phone during gait among young and older adults in the laboratory and free-living environments.MethodsTwelve young and twelve older adults walked along a 10-m walkway under five conditions: single-task walking (Walk), walking and bi-manually holding a phone (Walk-Hold), walking while looking at a phone held in front of the participants (Walk-Look), walking while answering questions (Walk-Answer), and walking while texting (Walk-Text). All conditions were performed in laboratory and free-living environments. Gait velocity, step time, step length, and cadence were obtained using a smartphone with a built-in accelerometer attached to the body. The dual-task cost (DTC) was also assessed. A three-way ANOVA was utilized for all parameters.ResultsWhile no three-way interactions were found for any parameter, group × condition interactions were significant for gait velocity, step time, step length, cadence and their corresponding DTC. Decreased gait velocity, step length and cadence, with increased step time was demonstrated during Walk-Look, Walk-Answer, and Walk-Text, compared to Walk and Walk-Hold. While older adults markedly changed their gait during Walk-Answer and Walk-Text, these changes were less pronounced among young adults.SignificanceVisual and cognitive demand while concurrently using a phone influenced gait, especially among the elderly. Environment did not accentuate gait alterations during concurrent phone use. Therefore, smartphone technology should be developed to detect dual-task walking and temporarily modify functionality to reduce risk of injury from divided attention.     

Juvenile idiopathic arthritis,gait characteristics and relation to function

BackgroundJuvenile Idiopathic Arthritis (JIA) is a chronic inflammatory arthritis that impacts biomechanical features of gait. This systematic review describes the effects of JIA on gait motion parameters and walking performance.MethodsSix databases were searched (PubMed/Medline, Cochrane, the EBSCOHost database SPORTDiscus, Web of Science, and Embase). Studies were restricted to children with any subtype of JIA who were assessed for gait motion features (kinematic, kinetic, temporalspatial) or walking performance (velocity or distance covered); could include intervention or treatment exposure with measures of gait and gait speed; could involve comparison of gait in JIA to healthy controls. Quality of evidence was assessed using the GRADE system. This systematic review was registered at PROSPERO (CRD42018109582)ResultsThe search yielded 625 papers, 23 of which described biomechanical features of gait and/or assessed walking performance. Twenty studies measured walking velocity and walking ability using simple field tests or laboratory methods. Eleven studies measured temporalspatial parameters such as cadence, step length, stride length, step width, single and double support time. Nine studies evaluated kinetic measurements including joint power, flexion and extension and joint moments. Nine studies evaluated kinematic parameters including range of motion, pelvic tilt, center of motion and trunk sway.ConclusionsKey features of gait in children with JIA include slower gait velocity, shortened step length, decreased range of motion at the hip, knee and ankle with trend towards flexion, decreased joint power, anteriorly tilted pelvis and trunk with shifted center of motion. There is a potential to ameliorate JIA-related gait changes with exercise and/or pharmaceutical interventions.     

Validity and test-retest reliability of the Stride Analyzer in people with knee osteoarthritis

IntroductionSubjects with knee osteoarthritis walk differently compared to healthy subjects. Managing these gait alterations has been proven effective for reducing pain and increasing function. The Stride Analyzer is a low cost gait analysis tool but its clinimetric properties have not been investigated yet in subjects with symptomatic knee osteoarthritis. The aim of this study was to investigate the reliability and validity of the SA compared with the Gold standard (Vicon) in persons with knee OA.MethodsFifteen subjects with symptomatic knee osteoarthritis were instructed to walk at a self-selected speed in a gait laboratory. Temporospatial (TS) gait parameters were recorded simultaneously by the Stride Analyzer and by a 16-camera-infrared optoelectronic motion capturing system (Vicon). Validity and test-retest reliability of the Stride Analyzer were examined by Bland-Altman plots, intra-class correlation coefficients (ICC) and the standard error of measurement (SEM).ResultsTest-retest analyses showed good agreement for all TS parameters with ICC values ranging from 0.805 (single limb support right) to 0.949 (velocity) and SEM% values ranging from 0.78% (stance phase right (% of gait cycle)) to 4.52% (double limb support right (% of gait cycle)). Good agreement between Stride Analyzer and Vicon was found for the following TS parameters: velocity (z = 1.01), cadence (z = −0.85), stride length (z = 1.63) and gait cycle (z = 0.86). All other gait parameters showed lower ICC values (<0.689).InterpretationOur results suggest that the Stride Analyzer can be used in the clinical field to perform gait analysis in subjects with symptomatic knee osteoarthritis.     

Reproducibility of spatio-temporal gait parameters under different conditions in older adults using a trunk tri-axial accelerometer system

The aim of this study was to determine intra- and interrater reliability of spatio-temporal gait parameters on different walking surfaces and under dual task conditions in an older adult population using a trunk tri-axial accelerometer (DynaPort^®MiniMod) system. Twenty-three independent living, older subjects (8 males, 15 females) aged 73.4 ± 4.3 years walked three times at their preferred walking speed in two test sessions under four different conditions over 24 m (gymnasium floor versus soft foam rubber walkway, with both normal and dual task walking conditions). Inter- and intrarater reliability was assessed. Subsequently intraclass correlation coefficients (ICC), coefficients of variation (CV) and ratios limits of agreement (RLOA) were calculated. The reliability of walking speed, cadence, step duration and step length was excellent with high ICCs and small CVs and RLOAs. ICCs of gait variability ranged from 0.12 to 0.88. The corresponding CVs ranged from 12% to 34% and RLOAs from 35% to 93% and appeared relatively large. The results of this study demonstrate that walking speed, cadence, step duration and step length under more challenging conditions can be reliably measured in independent living older adults using the DynaPort^®MiniMod system. Gait variability measures need to be viewed with caution and further research in older populations is needed to determine the value of these parameters derived from this measurement system.     

Inter- and intra-rater reliability of the GAITRite system among individuals with sub-acute stroke

Technology-based assessment tools with semi-automated processing, such as pressure-sensitive mats used for gait assessment, may be considered to be objective; therefore it may be assumed that rater reliability is not a concern. However, user input is often required and rater reliability must be determined. The purpose of this study was to assess the inter- and intra-rater reliability of spatial and temporal characteristics of gait in stroke patients using the GAITRite system. Forty-six individuals with stroke attending in-patient rehabilitation walked across the pressure-sensitive mat 2–4 times at preferred walking speeds, with or without a gait aid. Five raters independently processed gait data. Three raters re-processed the data after a delay of at least one month. The intraclass correlation coefficients (ICC) and 95% confidence intervals of the ICC were determined for velocity, step time, step length, and step width. Inter-rater reliability for velocity, step time, and step length were high (ICC > 0.90). Intra-rater reliability was generally greater than inter-rater reliability (from 0.81 to >0.99 for inter-rater versus 0.77 to >0.99 for intra-rater reliability). Overall, this study suggests that GAITRite is a reliable assessment tool; however, there still remains subjectivity in processing the data, resulting in no patients with perfect agreement between raters. Additional logic checking within the processing software or standardization of training could help to reduce potential errors in processing.     

Pelvis-shoulder coordination during level walking in patients with ankylosing spondylitis

Pelvis-shoulder coordination while walking may, as a consequence of changes in spinal structure and posture, be susceptible to modifications in ankylosing spondylitis (AS) sufferers. We designed an explanatory, cross-sectional trial to assess whether Pelvis-shoulder coordination during walking in AS patients differs from that in healthy subjects. Seventeen AS patients and 10 healthy sex- and age-matched subjects were enrolled. Gait analysis was performed in order to define the time-distance and kinematic characteristics during walking. Pelvis-shoulder coordination was calculated in terms of the continuous estimate of relative phase (CRP) between the pelvis and shoulder girdles on the transversal plane for the whole gait cycle (GC), as well as for its sub-phases. No differences were found between patients and controls as regards mean velocity, cadence and stride length. When kinematic variables were compared with those of healthy controls, AS patients displayed greater pelvic tilt and increased hip flexion in both the loading response (LR) and pre-swing (PSw) sub-phases. The CRP mean values significantly differed between groups. Moreover, patients displayed a peculiar CRP pattern, chiefly in the LR, terminal stance and PSw sub-phases. This visual consideration was confirmed by the analysis of the CRP mean values in these sub-phases of the GC. Our results suggest that the walking pattern of AS patients is characterized by altered Pelvis-shoulder coordination during the GC.     

Concurrent validity and reliability of wireless instrumented insoles measuring postural balance and temporal gait parameters

BackgroundThe OpenGo seems promising to take gait analysis out of laboratory settings due to its capability of long-term measurements and mobility. However, the OpenGo’s concurrent validity and reliability need to be assessed to determine if the instrument is suitable for validation in patient samples.MethodsTwenty healthy volunteers participated. Center of pressure data were collected under eyes open and closed conditions with participants performing unilateral stance trials on the gold standard (AMTI OR6-7 force plate) while wearing the OpenGo. Temporal gait data (stance time, gait cycle time, and cadence) were collected at a self-selected comfortable walking speed with participants performing test-retest trials on an instrumented treadmill while wearing the OpenGo. Validity was assessed using Bland-Altman plots. Reliability was assessed with Intraclass Correlation Coefficient (2,1) and smallest detectable changes were calculated.FindingsNegative means of differences were found in all measured parameters, illustrating lower scores for the OpenGo on average. The OpenGo showed negative upper limits of agreement in center of pressure parameters on the mediolateral axis. Temporal reliability ICCs ranged from 0.90–0.93. Smallest detectable changes for both stance times were 0.04 (left) and 0.05 (right) seconds, for gait cycle time 0.08 s, and for cadence 4.5 steps per minute.InterpretationThe OpenGo is valid and reliable for the measurement of temporal gait parameters during walking. Measurements of center of pressure parameters during unilateral stance are not considered valid. The OpenGo seems a promising instrument for clinically screening and monitoring temporal gait parameters in patients, however validation in patient populations is needed.     

Accelerometer-based determination of gait variability in older adults with knee osteoarthritis

Knee osteoarthritis (KOA) can affect the spatiotemporal (ST) aspects of gait as well as the variability of select ST parameters based on standard linear measures of variability (e.g., standard deviation (SD) and coefficient of variation). Non-linear measures (e.g., fractal scaling index (FSI) and sample entropy) can be more sensitive to changes in gait variability, and have been used to quantify differences in the stride patterns of patients with Parkinson’s disease and the motion of ACL-deficient knees. However, the effect of KOA on the dynamic complexity of the stride pattern has not been investigated. Therefore, the purpose of this study was to investigate the effect of KOA on gait variability (linear and non-linear measures) in a group of older adults, and to compare these results to a healthy control group. Participants walked for 10 min with a tri-axial accelerometer placed at the lower back. Mean and SDs of stride time and step time as well as the FSI for the entire series of stride times were calculated for each participant. Participants with KOA had significantly greater mean stride time (p = 0.031) and step time (p = 0.024) than control group participants. While stride and step time variability (SD) were greater in the KOA group, the differences were not significant, nor was the difference in the FSI. Low statistical power (β = 0.40 and 0.30 for stride and step time SD, respectively) combined with the confounding effects of walking speed and heterogeneous KOA severity likely prevented significant differences from being found.     

Reliability of spatial–temporal gait parameters during dual-task interference in people with multiple sclerosis. A cross-sectional study

PurposeTo evaluate the reliability and minimum detectable change (MDC) of spatial–temporal gait parameters in subjects with multiple sclerosis (MS) during dual tasking.MethodThis cross-sectional study involved 25 healthy subjects (mean age 49.9 ± 15.8 years) and 25 people with MS (mean age 49.2 ± 11.5 years). Gait under motor-cognitive and motor–motor dual tasking conditions was evaluated in two sessions separated by a one-day interval using the GAITRite^® Walkway System. Test–retest reliability was assessed using intraclass correlation coefficients (ICCs), standard errors of measurement (SEM), and coefficients of variation (CV). MDC scores were computed for the velocity, cadence, step and stride length, step and stride time, double support time, the % of gait cycle for single support and stance phase, and base of support.ResultsAll of the gait parameters reported good to excellent ICCs under both conditions, with healthy subject values of >0.69 and MS subject values of >0.84. SEM values were always below 18% for both groups of subjects. The gait patterns of the people with MS were slightly more variable than those of the normal controls (CVs: 5.88–41.53% vs 2.84–30.48%).ConclusionsThe assessment of quantitative gait parameters in healthy subjects and people with MS is highly reliable under both of the investigated dual tasking conditions.     

Reliability and minimum detectable change of measures of gait in children during walking and running on an instrumented treadmill

BackgroundInstrumented treadmills that incorporate pressure platforms are increasingly used to characterize gait in children. Although footprint size is known to influence the measurement performance of pressure platforms, published evidence on the reliability of such systems for children’s gait is lacking.Research questionThis study evaluated the test–retest reliability of temporospatial gait parameters and vertical ground reaction forces measured in healthy children during barefoot walking and running on a capacitance–based treadmill system.MethodsTemporospatial gait parameters, including cadence, stride length, stride duration, stance and swing phase durations and the magnitude and timing of conventional vertical ground reaction force peaks were determined on two occasions in 17 healthy children (mean age, 11 ± 2 years; height, 148.4 ± 9.3 cm; and mass, 43.3 ± 10 kg) during walking and running at preferred speed on an instrumented treadmill. Reliability was assessed using Intra Class Correlation Coefficients (ICC) and the standard error of measurement (SEM). The minimum detectable change (MDC95%) was also calculated.ResultsICC values ranged from 0.91–0.99 for all variables. When expressed as a percentage of the mean, the SEM was <5% for all gait parameters assessed during walking and running. The MDC95% values for gait parameters were typically higher during running than walking, and were ±4% of the gait cycle for temporal parameters, ±55 cm for stride length and ±0.1 bodyweights for peak vertical ground reaction force.SignificanceChildren’s gait parameters varied by <5% between test occasions and were more consistent during walking than running. These findings provide clinicians and researchers with an index of the reliability and sensitivity of the treadmill to detect changes in common spatiotemporal gait parameters and vertical ground reaction forces in children.     

Basic gait and symmetry measures for primary school-aged children and young adults whilst walking barefoot and with shoes

This study investigated the basic spatio-temporal gait measures of 898 primary school-aged children (5–13 years) and 82 young adults (18–27 years). Participants completed 6–8 walks at preferred speed along a GAITRite walkway whilst barefoot and whilst wearing athletic shoes or runners. Outcome measures (non-normalized and normalized) were gait speed, cadence, step and stride length, support base, single and double support, stance duration, foot angle and associated symmetry measures. Non-normalized measures of speed, step and stride length, support base and foot angle increased with age whereas cadence reduced. Normalized measures remained unchanged with age in children whereas the young adults (both conditions) exhibited a 2.3% reduction in single support, a 5.1% increase in double support and a 2.6% increase in stance duration (p < 0.0001). For the entire sample, shoes increased walking speed by 8 cm s⁻¹, step length by 5.5 cm, stride length by 11.1 cm and base of support by 0.5 cm. In contrast, foot angle and cadence reduced by 0.1° and 3.9 steps min⁻¹ respectively. Shoes increased both double support (1.6%) and stance time (0.8%), whereas single support reduced by 0.8%. Symmetry remained unaffected by age. On average, measures of step and stride symmetry (combining both conditions) fell around 0.7 cm, whereas measures of symmetry for step and stance time, single and double support fell around 0.6%. Footwear significantly affected gait (p < 0.0001). Gait may not be mature by age 13. Gait is symmetrical in healthy children and young adults but may change with pathology.     

The effects of metronome frequency differentially affects gait on a treadmill and overground in people with Parkinson disease

BackgroundTreadmills and rhythmic auditory cueing can influence stepping rhythm for individuals with Parkinson disease (PD). Of concern, however, is that auditory cueing directly addresses the temporal features of gait, whereas adjusting step length may be more important for people with PD. Stepping to a faster cadence when walking overground may increase gait speed, but without requiring an increased step length. Furthermore, given the potentially valuable role of walking on a treadmill for individuals with PD, we are concerned that increasing cadence with rhythmic auditory cueing while walking at a constant treadmill speed will induce even shorter steps.Research questionWhat is the effect of different metronome cue frequencies on spatiotemporal gait parameters when walking overground compared to walking on a treadmill in people with PD?MethodsUsing a repeated-measures design, 21 people with PD (stage 1–3) walked overground and on a treadmill with and without metronome cues of 85 %, 100 %, and 115 % of their baseline cadence frequency for one minute each. We assessed step length, and cadence during all conditions. Gait speed was assessed during overground gait.ResultsAn interaction effect between cue frequency and walking environment revealed that participants took longer steps during the 85 % condition on the treadmill only. When walking overground, metronome cues of 85 % and 115 % of baseline cadence yielded decreases and increases, respectively, in both cadence and gait speed with no associated change in step length.SignificanceThese data suggest that people with PD are able to alter spatiotemporal gait parameters immediately when provided the appropriate metronome cue and walking environment. We propose to target shortened step lengths by stepping to the beat of slow frequency auditory cues while walking on a treadmill, whereas the use of fast frequency cues during overground walking can facilitate faster walking speeds.