The effects of high custom made shoes on gait characteristics and patient satisfaction in hemiplegic gait

ObjectiveTo determine the effects of a temporary high custom made orthopaedic shoe on functional mobility, walking speed, and gait characteristics in hemiplegic stroke patients. In addition, interference of attentional demands and patient satisfaction were studied.DesignClinical experimental study.SettingUniversity Medical Centre.ParticipantsNineteen stroke patients (12 males; mean age 55 years (standard deviation (SD) 10 years); mean time post onset 3.6 months (SD 1.4 months)) with a spastic paresis of the lower extremity.Main outcome measuresFunctional mobility was assessed with the timed up and go test, walking speed and gait characteristics were measured with clinical gait analysis and performed with and without a verbal dual task. Patient satisfaction was determined with a questionnaire.ResultsWalking with the high orthopaedic shoe resulted in improved functional mobility (22%; p < .001), walking speed (37%; p < .001) and gait characteristics compared to walking with normal shoes. The dual task interfered with functional mobility during walking. The interference was equally big for normal shoes as for the orthopaedic shoe. Patients evaluated walking with the high orthopaedic shoe as an improvement (p < .001). An average of 84% reported improvements in foot lifting, swing progression, taking weight, confidence while walking, safety, walking distance and walking speed.ConclusionIn the early recovery phase after stroke, when regaining walking ability, a temporary high orthopaedic shoe can improve hemiplegic gait, even with dual task interference.     

U-turn speed is a valid and reliable smartphone-based measure of multiple sclerosis-related gait and balance impairment

BackgroundPeople living with multiple sclerosis (MS) experience impairments in gait and mobility, that are not fully captured with manually timed walking tests or rating scales administered during periodic clinical visits. We have developed a smartphone-based assessment of ambulation performance, the 5 U-Turn Test (5UTT), a quantitative self-administered test of U-turn ability while walking, for people with MS (PwMS).Research questionWhat is the test-retest reliability and concurrent validity of U-turn speed, an unsupervised self-assessment of gait and balance impairment, measured using a body-worn smartphone during the 5UTT?Methods76 PwMS and 25 healthy controls (HCs) participated in a cross-sectional non-randomised interventional feasibility study. The 5UTT was self-administered daily and the median U-turn speed, measured during a 14-day session, was compared against existing validated in-clinic measures of MS-related disability.ResultsU-turn speed, measured during a 14-day session from the 5UTT, demonstrated good-to-excellent test-retest reliability in PwMS alone and combined with HCs (intraclass correlation coefficient [ICC] = 0.87 [95 % CI: 0.80–0.92]) and moderate-to-excellent reliability in HCs alone (ICC = 0.88 [95 % CI: 0.69–0.96]). U-turn speed was significantly correlated with in-clinic measures of walking speed, physical fatigue, ambulation impairment, overall MS-related disability and patients’ self-perception of quality of life, at baseline, Week 12 and Week 24. The minimal detectable change of the U-turn speed from the 5UTT was low (19.42 %) in PwMS and indicates a good precision of this measurement tool when compared with conventional in-clinic measures of walking performance.SignificanceThe frequent self-assessment of turn speed, as an outcome measure from a smartphone-based U-turn test, may represent an ecologically valid digital solution to remotely and reliably monitor gait and balance impairment in a home environment during MS clinical trials and practice.     

Effects of bi-axial ankle strengthening on muscle co-contraction during gait in chronic stroke patients: A randomized controlled pilot study

IntroductionAnkle dysfunction in patients with stroke is a common but serious cause of balance and gait impairments. However, comprehensive paretic ankle training seldom exists. Thus, we investigated the effects of a bi-axial ankle muscle training program using visual feedback as a means to improve ankle strength and performance of functional activities in patients with stroke.MethodsThis study was a randomized controlled pilot trial with concealed allocation and assessor blinding and intention-to-treat analysis. Twenty-five patients with stroke and difficulty in walking (e.g., foot drop) or ankle muscle weakness receiving inpatient rehabilitation were included. The experimental group underwent ankle muscle training consisting of passive stretching, control of ankle muscles, and active-resistive strengthening using visual feedback for 40 min per day, 5 times per week for 4 weeks. The control group underwent ankle-related physical therapy, including ankle range-of-motion exercises. The amount of time for training was equal between the two groups. The outcome measurements were isometric ankle contraction force to assess the strength of ankle muscles, ankle proprioception, Fugl–Meyer lower extremity score, Berg balance scale score, walking speed, and ankle co-contraction index to assess muscle efficiency during gait.ResultsThe analysis revealed significant between-group differences in the ankle muscle strength in each direction (P < 0.05), Fugl–Meyer score (P < 0.01), and stance-phase co-contraction index (P < 0.05). After training, the experimental group displayed significant within-group differences in the strength of the ankle muscles in each direction (P < 0.01), ankle proprioception (P < 0.05), and walking speed (P < 0.05).ConclusionsOur findings demonstrate the significant short-term effects of ankle muscle training on strength, walking speed, and muscle efficiency in patients with chronic stroke.     

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.     

Changes to gait speed when romantic partners walk together: Effect of age and obstructed pathway

BackgroundWalking at a brisk pace is widely recommended to promote health. When partners walk together, walking activity is increased and maintained due to enhanced social support and accountability, but at least one person must adjust their gait speed. Decreased gait speed could compromise health benefits, which may be especially relevant for the aging population.Research questionDo adults change gait speed when walking with their romantic partner, relative to walking alone, and is the change in speed affected by age or pathway conditions?MethodsParticipants were 141 individuals from 72 romantic couples; age range 25−79 years. The three couple conditions were walking alone, walking with their partner, and walking while holding hands with their partner. The two pathway conditions were clear pathway and pathway with obstacles. Gait speed was modeled as a function of the couple conditions, pathway conditions, and covariates (gender, age, relationship duration, and physical activity) using mixed-effects (3-level) regression.ResultsIn both pathway conditions, both partners reduced speed when walking together (p < 0.001), and reduced speed further while holding hands (p < 0.001), when compared to walking alone. These effects were unchanged when covariates were included in the model. Further, speed was slower on the obstructed pathway for all participants, but the magnitude of slowing was greater with increasing age (p < 0.001) and in females (p=0.03).SignificanceAcross the adult lifespan, when walking together, both partners decreased gait speed by a clinically meaningful amount (≥0.05 m/s). While walking with a partner may increase walking activity due to social support, reduced speed when walking together may unintentionally reduce health benefits and gait quality in both partners. Future research should identify how health is impacted by the trade-off between increased walking activity and reduced gait speed when romantic partners walk together.     

Effects of walking speed on asymmetry and bilateral coordination of gait

The mechanisms regulating the bilateral coordination of gait in humans are largely unknown. Our objective was to study how bilateral coordination changes as a result of gait speed modifications during over ground walking. 15 young adults wore force sensitive insoles that measured vertical forces used to determine the timing of the gait cycle events under three walking conditions (i.e., usual-walking, fast and slow). Ground reaction force impact (GRFI) associated with heel-strikes was also quantified, representing the potential contribution of sensory feedback to the regulation of gait. Gait asymmetry (GA) was quantified based on the differences between right and left swing times and the bilateral coordination of gait was assessed using the phase coordination index (PCI), a metric that quantifies the consistency and accuracy of the anti-phase stepping pattern. GA was preserved in the three different gait speeds. PCI was higher (reduced coordination) in the slow gait condition, compared to usual-walking (3.51% vs. 2.47%, respectively, p = 0.002), but was not significantly affected in the fast condition. GRFI values were lower in the slow walking as compared to usual-walking and higher in the fast walking condition (p < 0.001). Stepwise regression revealed that slow gait related changes in PCI were not associated with the slow gait related changes in GRFI. The present findings suggest that left–right anti-phase stepping is similar in normal and fast walking, but altered during slow walking. This behavior might reflect a relative increase in attention resources required to regulate a slow gait speed, consistent with the possibility that cortical function and supraspinal input influences the bilateral coordination of gait.     

Inertial sensors identified asymmetries in shank angular velocity at different gait speeds in individuals with anterior cruciate ligament reconstruction

BackgroundInertial sensors can detect between-limb asymmetries in shank angular velocity (SAV) during loading response of walking in individuals with ACL reconstruction (ACLR), which may be indicative of abnormal knee joint loading. However, it is unknown whether these SAV asymmetries would exist up to 6 months post-ACLR and how they differ from SAV asymmetries in uninjured healthy subjects.Research questionTo investigate whether patients with ACLR show significant and meaningful between-limb SAV asymmetries during walking and walking fast at 4 and 6 months post-surgery and to determine whether limb asymmetries are related across gait tasks and time.MethodsFifteen individuals with ACLR participated in this prospective study. Testing occurred in clinical settings. Participants were instructed to walk and walk fast while wearing one inertial sensor on each shank. The average of sagittal plane SAV peaks during loading response of gait was calculated bilaterally. The smallest meaningful between-limb difference for SAV was calculated from uninjured healthy subjects (n = 16) to define the limit of meaningful SAV asymmetries in patients with ACLR.ResultsAt 4 and 6 months post-ACLR, the involved limb had significantly smaller peak SAV during walking (P < .01, d = 0.69−0.85) and walking fast (P < .005, d = 1.03−1.07) compared to the uninvolved limb. A significant main effect of gait task on SAV asymmetries was found (P = .006, η_p² = 0.451). Further, patients with ACLR exhibited meaningful SAV asymmetries at both time points for both gait speeds. Limb SAV asymmetries correlated between gait tasks and across time (r = 0.760−0.860, P < .001).SignificanceIndividuals with ACLR presented with significant and meaningful SAV asymmetries during walking and walking fast at 4 and 6 months post-surgery. Greater limb SAV asymmetries persisted across gait tasks and time, with greater asymmetry was observed at a faster walking speed. Thus, inertial sensors are feasible to be used in clinical settings to identify SAV asymmetry during gait post-ACLR.     

Characteristics of functional gait among people with and without peripheral neuropathy

It is advantageous from a rehabilitation standpoint to determine physiological factors associated with functional gait. These factors may be fundamentally different in those with peripheral neuropathy (PN) compared to age-matched healthy individuals. The purpose of this investigation was to examine associations between functional gait and measures of leg strength, standing balance, and locomotor kinematics in people with and without PN.MethodsIndividuals with PN and age-matched controls were assessed for functional gait by the 6-min walk and timed up-and-go tests. Leg strength was measured as isokinetic peak torque of the knee extensors. Standing balance was assessed by center-of-pressure sway velocity and area during quiet stance. Locomotor kinematics from treadmill walking were used to compute stride duration variability and local instability (i.e., finite-time Lyapunov exponents), which estimate kinematic divergence caused by small-scale perturbations.ResultsLeg strength and locomotor kinematics – in particular local instability – correlated with functional gait performance in controls. Conversely, reduced functional gait performance in the PN group was primarily mediated by impaired standing balance control.DiscussionLocomotor kinematics predicts functional gait, and the magnitude of variability and local instability should be calculated to fully evaluate locomotor system health. The observation that different factors associated with functional gait between groups speaks to the uniqueness of the PN-related movement disorder. Functional gait-related rehabilitation programs for PN patients should be tailored toward this uniqueness.     

Comparison of forward and backward gait characteristics between those with and without a history of breast cancer

BackgroundDecreased muscular strength and poorer postural stability impact the physical function of breast cancer survivors (BCS) and increases their risk of falls. Gait assessment, particularly in the backward direction, is often used as an indicator of fall risk in several populations. However this information is unknown in BCS.Research questionWhat are the differences in forward, backward, and accelerated forward walking in BCS in comparison to individuals without a prior cancer diagnosis?Methods17 postmenopausal BCS (mean age: 58.5 (8.5) years) and 17 age-matched women without a prior cancer diagnosis (mean age: 59.11 (5.55) years) completed 5 trials each of forward, backward, and fast forward walking conditions. Absolute (Means) and variability (Coefficient of variation) estimates were obtained for spatio-temporal gait parameters. Lower body, upper body and handgrip strengths were measured.ResultsFor absolute estimates of gait, significant group main effects indicated that BCS had 7% shorter step length (P = 0.019) and 8% slower gait speed (P = 0.048). For variability estimates of gait, there was a significant interaction for stance time (P = 0.035). BCS had greater stance time variability during forward and fast forward conditions, but lesser variability during backward condition. Averaged across all the conditions, BCS had 38% greater step length variability (P = 0.043), 50% greater gait speed variability (P = 0.028), and 28.5% greater single support time variability (P = 0.004). Averaged across both the groups, all the variables except for swing time variability were significantly different among the conditions (all P< = 0.013). BCS also had significantly reduced upper body strength (P = 0.036).SignificanceSlower and shorter steps while walking both forwards and backwards could be indicative of a more cautious gait strategy by BCS. Also, BCS possibly focused on controlling spatial parameters during forward walking but temporal parameters while backward walking. Whether these alterations are related to an increased fall risk within BCS needs to be determined.     

Trunk inclination and hip extension mobility,but not thoracic kyphosis angle,are related to 3D-accelerometry based gait alterations and increased fall-risk in older persons

BackgroundOnly a portion of the increased variability in gait parameters observed in ageing can be explained by age and gait speed alone. Other factors, like musculoskeletal changes of the spine, might contribute to higher variability of gait parameters, slower walking speed and subsequently increased fall-risk in ageing.Research questionAre spinal posture and mobility related to 3D-accelerometry based gait analysis, functional performance and fall-risk in ageing?MethodsForty elderly presenting increased fall-risk (OFR, 80.6 ± 5.4yrs), 41 old controls (OC, 79.1 ± 4.9yrs), and 40 young controls (YC, 21.6 ± 1.4yrs) were assessed for spinal posture and mobility (SpinalMouse®), gait analysis (DynaPort MiniMod), and functional performance (grip strength, grip work, timed-get-up-and-go-test, performance-oriented mobility assessment).ResultsCompared to OC, OFR showed significantly (p < .05) larger trunk inclination angle (INC), smaller sacral extension mobility, slower walking speed, and lower medio-lateral step and stride regularity. Thoracic kyphosis angle (TKA) was similar in all groups. INC and sacral extension mobility showed the highest correlation with walking speed, gait parameters, functional performance and fall-risk. INC (OR = 1.14) and sacral extension mobility (OR = 1.12) can moderately explain fall-risk in elderly participants and showed fair capacity to discriminate OFR from OC, the diagnostic value on fall-risk is however low (best probabilistic cut-off value, INC: -0.83° [sensitivity = 70%, specificity = 61%, PPV = 64%, NPV = 68%, LR+ = 1.79, LR- = 0.49, AUC = 0.71]; sacral extension mobility: 8.5° [sensitivity = 70%, specificity = 73%, PPV = 72%, NPV = 71%, LR+ = 2.61, LR -= 0.41, AUC = 0.71]).SignificanceLarger trunk inclination and smaller sacral extension mobility (i.e. hip extension mobility) are moderately related to increased fall-risk, gait alterations, lower muscle performance and worse functional mobility in ageing. Contrary to our hypothesis, TKA showed no relation with parameters of gait and/or fall-risk. INC and sacral extension mobility have fair discriminative power to distinguish older persons with increased fall-risk from those without and might be considered as therapeutic targets.     

Evidence of slow and variable choice-stepping reaction time in cancer survivors with chemotherapy-induced peripheral neuropathy

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is reported to affect up to 70 % of cancer survivors. Despite evidence that CIPN-related impairments often translate into balance and mobility deficits, the effects on stepping and quality of gait, well-documented risk factors for falls, are unclear.Aims(i) Establish choice-stepping reaction time (CSRT) performance in survivors with CIPN compared to young and older healthy controls and people with Parkinson’s disease; (ii) document walking stability; (iii) investigate relationships between stepping and gait data to objective and patient-reported outcomes.Methods41 cancer survivors with CIPN (mean (SD) age: 60.8 (9.7) years) who were ≥3months post chemotherapy, performed tests of simple and inhibitory CSRT. Walking stability measures were derived from 3-D accelerometry data during the 6-minute walk test. CIPN was assessed using neurological grading and patient-reported outcome measures (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire in CIPN Questionnaire scale EORTC CIPN20).ResultsIn both stepping tests, CIPN participants performed at the level of adults aged 10 years older and people with mild to moderate Parkinson’s disease. Mean (SD) total stepping response times in both CSRT (1160 (190) milliseconds) and inhibitory CSRT (1191 (164) milliseconds) tests were not associated with objective neurological grading but were correlated with increased difficulty feeling the ground. Participants with lower-limb vibration sensation deficit had slower and more variable CSRT times. There were no associations between walking stability and objective measures of CIPN, and limited correlations with the EORTC-CIPN20.ConclusionsCancer survivors with CIPN showed deficits in voluntary stepping responses and seemed to compensate for their sensory and motor deficits by walking slower to maintain stability. Objective and patient-reported outcomes of CIPN were correlated with slower and more variable stepping response times. Future studies should aim to identify the causes of the apparent premature decline in cognitive-motor function and develop remediating interventions.     

Performance-based physical function correlates with walking speed and distance at 3 months post unilateral total knee arthroplasty

BackgroundAfter total knee arthroplasty (TKA), walking speed and distance are main concerns of patients.Research questionWhich physical functions affect walking speed and distance after TKA?MethodsCross-sectional data from 149 patients who underwent unilateral primary TKA and completed performance-based physical function tests. Instrumental gait evaluation for spatiotemporal parameters, isometric knee extensor and flexor strength of both knees, 6-minute walk test (6MWT), timed up-and-go (TUG) test, timed stair climbing test (SCT), and knee flexion and extension range of motion (ROM) of surgical knee were examined. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol five dimensions (EQ-5D) questionnaires were also performed.ResultsUnivariate analyses revealed that post-operative walking speed showed significant positive correlations with cadence, stride length, propulsion index of surgical and non-surgical knee, peak torque (PT) of the extensor of surgical and non-surgical knee and flexor of surgical and non-surgical knee, 6MWT, EQ-5D, and significant negative correlations with gait cycle duration, TUG, SCT-ascent and descent, and WOMAC-pain scores. Post-operative walking distance had significant positive correlations with walking speed, cadence, stride length, swing phase duration, propulsion index of surgical and non-surgical knee, PT of the extensor of surgical and non-surgical knee, EQ-5D, and significant negative correlation with gait cycle duration, double support duration, TUG, SCT-ascent and descent. In the multivariate linear regression analyses, TUG, cadence, stride length and propulsion index of non-surgical knee were factor correlated with post-operative walking speed. The SCT-ascent and descent, TUG and propulsion index of surgical knee were factor correlated with post-operative walking distance.SignificancePhysical performance factors correlated with walking speed and distance at 3 months after surgery. Based on these observations, rehabilitation of bilateral muscle strength and functional mobility would be important for functional recovery after unilateral TKA.     

Factors influencing gait speed in community-dwelling older women: A Bayesian approach

BackgroundHuman gait is a complex task resulting from the interaction of sensory perception, muscle force output, and sensory-motor integration, which declines with the aging process and impacts gait speed in older women.Research questionWhat are the separate and combined impacts of sensory-motor factors on gait speed of older women?MethodsSixty healthy older women (69.3 ± 5.9 years) volunteered for this study. A previous screening using Pearson’s correlation selected variables significantly correlated with gait speed: age, plantar tactile perception, lower limb explosive force, and mean velocity (MV) of the center of pressure (CoP). Simple and multivariate regression models were performed with selected variables. The magnitude of evidence was obtained using Bayesian inference, determining posterior probabilities based on our data.ResultsGait speed was negatively correlated with age and positively correlated with plantar tactile perception, MV (Romberg index), and lower limb explosive force. The coefficient of determination (R²) varied between 0.06 for plantar tactile perception and 0.22 for explosive force (p < 0.05). The multivariate model, including age, MV (Romberg index), and lower limb explosive force, explained 44% (R² = 0.44) of the variance in gait speed, with a small standard error of estimate (0.14 m/s). Bayesian inference confirmed the good posterior probability of the model.SignificanceAge, plantar tactile perception, MV (Romberg index), and lower limb explosive force impact gait speed, whereas the combination of the first three factors has an excellent posterior probability of predicting or affecting gait speed.     

Talus mobilization-based manual therapy is effective for restoring range of motion and enhancing balance in older adults with limited ankle mobility: A randomized controlled trial.

BackgroundThe ankle plays a key role in balance, but ankle range of motion decreases with ageing.Research questionTo establish whether a talus mobilization-based manual therapy intervention may be effective for increasing range of motion and balance in older adults with limited ankle mobility due to the ageing process.MethodsRandomized clinical trial in which 42 community-dwelling older adults with limited ankle mobility were allocated to an experimental or a control group. The experimental intervention consisted of six sessions of anteroposterior talus mobilization, whereas the control intervention was a sham treatment. Baseline change in weight and non-weight bearing ankle range of motion (ROM), balance outcome in terms of the Timed up and go (mobility and dynamic balance), Single-leg stand (static balance and stability), Functional reach (margins of stability) and Romberg tests (static balance) were assessed. Analysis of variance based on a mixed-linear model of repeated measures looked for group interactions.ResultsForty participants completed the study. Participants who received six sessions of manual therapy showed greater improvements in the Timed up and go, Functional reach and Single-leg stand tests than participants who received a sham intervention (p < 0.001). Both groups presented similar performance in post-treatment static balance measures (p > 0.05).SignificanceAn anteroposterior talus mobilization-based manual therapy intervention is effective for increasing ankle ROM, with a positive effect on dynamic balance, mobility and stability in community-dwelling older adults with limited ankle mobility.     

Effectiveness of an innovative hip energy storage walking orthosis for improving paraplegic walking: A pilot randomized controlled study

BackgroundThe high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia.MethodsThe cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3 m/min on a treadmill) were measured at the end of the 4-week training session.ResultsCompared to the RGO, the HESWO increased continuous walking distance by 24.7% (P < 0.05), maximum walking speed by 20.4% (P < 0.05) and the comfortable walking speed by 15.3% (P < 0.05), as well as decreasing energy expenditure by 13.9% (P < 0.05).ConclusionOur preliminary results provide support for the use of the HESWO as an alternative support for paraplegic walking.     

Analysis of center of mass and center of pressure displacement in the transverse plane during gait termination in children with cerebral palsy

BackgroundWhile gait termination is challenging for children with spastic cerebral palsy (CCP), few studies have quantitatively assessed this issue.Research questionWhat are the characteristics of center of mass (COM) and center of pressure (COP) displacement during gait termination in CCP, and how do they compare with those in children with typical development (CTD)?MethodsThis cross-sectional study included 13 adults with typical development (19.85 ± 0.52 years), 12 CTD (10.41 ± 2.98 years), and 16 CCP (11.15 ± 2.71 years). Participants were instructed to immediately stop walking when a stop sign appeared on a screen, which was placed at the end of an 8-m walkway. COM and COP were determined via 3-dimensional motion analysis and force plate data. Differences between the groups were assessed using the two sample t-test or Wilcoxon rank sum test. The level of statistical significance was set at P < 0.05.ResultsThe normalized time for stopping in CCP (4.556 ± 0.602) was higher than that in CTD (3.617 ± 0.545, P < 0.001). The normalized COP displacement (P < 0.001) and divergence between COM and COP (P < 0.001) in the mediolateral (ML) direction were significantly higher in CCP than CTD. However, the normalized divergence between COM and COP in the anteroposterior (AP) direction in CCP was lower than that in CTD (P = 0.034).SignificanceThe more minor divergence between COM and COP in the AP direction and the more significant COP displacement in the ML direction cause difficulty to exert braking force during gait termination. Thus, CCP require a longer time for gait termination. This finding may facilitate the development of interventions for improving gait in CCP.     

Exercise effects on backward walking speed in people with dementia: A randomized controlled trial

BackgroundMultidirectional walking, including backward walking, is integral to daily activities, and seems particularly challenging in older age, and in people with pathology affecting postural control such as dementia.Research QuestionDoes exercise influence backward walking speed in people with dementia, when tested using habitual walking aids and without, and do effects differ according to walking aid use?MethodsThis study included 141 women and 45 men (mean age 85 years) with dementia from the Umeå Dementia and Exercise (UMDEX), a cluster-randomized controlled trial study set in 16 nursing homes in Umeå, Sweden. Participants were randomized to a High-Intensity Functional Exercise (HIFE) program targeting lower limb strength-, balance and mobility exercise or to a seated attention control activity. Blinded assessors measured 2.4-meter usual backward walking speed, at baseline, 4 - (intervention completion) and 7-month follow-up; tested 1) with habitual walking aids allowed, and 2) without walking aids.ResultsLinear mixed models showed no between-group effect in either backward walking speed test at 4 or 7 months; test 1) 0.005 m/s, P = .788 and –0.006 m/s, P = .754 and test 2) 0.030 m/s, P = .231 and 0.015 m/s, P = .569, respectively. In interaction analyses, exercise effects differed significantly between participants who habitually walked unaided compared with those that used a walking aid at 7 months (0.094 m/s, P = .027).SignificanceIn this study of older people with dementia living in nursing homes, the effects of exercise had no overall effects on backwards walking speed. Nevertheless, some benefit was indicated in participants who habitually walked unaided, which is promising and merits further investigation in future studies.     

Words matter: instructions dictate “self-selected” walking speed in young adults

BackgroundVariability in gait speed is influenced by age and health status. However, no study has investigated the effects of different instructions on gait speed.Research questionThis study investigated how walking prompts contributed to variability in gait speed.MethodsParticipants walked on a pressurized walkway. Gait speed variability was assessed using multilevel modeling.Results61% of the variance in gait speed was due to instruction, while 14% was due to individual differences.SignificanceReference values for gait speed across a number of prompts will be highly useful for assessing gait performance in young adults. Further, the instruction given produces a large amount of variability in selected walking speed. This finding urges researchers to maintain consistency when delivering walking instructions.     

Faster or longer steps: Maintaining fast walking in older adults at risk for mobility disability

BackgroundThe ability to walk at various speeds is essential to independence for older adults. Maintaining fast walking requires changes in spatial-temporal measures, increasing step length and/or decreasing step time. It is unknown how mobility affects the parameters that change between preferred and fast walking.Research QuestionHow does preferred walking performance and measures of strength and mobility relate to the approach (decreasing step time or increasing step length) older adults at risk for mobility disability use to maintain fast walking speeds?.MethodsPeak isokinetic dynamometry of knee and ankle and several mobility evaluations, including the Timed Up-and-Go, Short Physical Performance Battery, and Dynamic Gait Index, assessed mobility and strength in 57 participants, aged 65–80. Biomechanical gait analysis was used to analyze step length, step time, gait speed at preferred and fast gait speeds and ground reaction force during preferred walking. A score combining the differences between step length and time at fast and preferred speeds (Length-Time Difference) separated participants into two groups: (1) Length, representing a predominant increase in step length to walk fast and (2) Time, a predominant decrease in step time.ResultsThose who decreased step time to produce increased speed performed worse during repeated chair stands (p = .006) with no difference in isokinetic strength (p ≥ .15). During preferred walking, the Time group displayed increased propulsive impulse compared to the Length group (p = .007), despite no differences in preferred speed, step length, or time (p ≥ .50).SignificanceWhile kinetics of preferred walking differed between groups separated by Length-Time Difference, basic spatial-temporals of preferred walking did not in this homogenous population. Length-Time Difference relates to a common mobility assessment and could be easily calculated by clinicians to provide a quantitative and more sensitive measure of ambulatory performance.     

Parental subjective assessment of gait limitations: Comparison with objective gait variables

BackgroundSubjective assessment is an important part of clinical examination providing quality insights into impairments of body structure and functions. Research into the associations between parental perceptions of gait in children with cerebral palsy (CP) and objective clinical gait measures is limited.Research questionWhat are the parental perceived gait limitations in children with CP and are these perceptions associated with objective clinical gait analysis?MethodsParent questionnaires were retrospectively analysed for children with CP who attended our gait analysis laboratory over a 24-month period. Perceived walking limitations caused by pain, weakness, lack of endurance, mental ability, safety concerns, and balance were recorded on a 5-point Likert scale. Normalised gait speed, normalised step length and the Gait Deviation Index (GDI) were calculated. Differences between responses were assessed using Chi-squared tests with Dunn’s post hoc test with Bonferroni adjustment. Spearman’s rank correlations were performed to determine the relationship between responses and gait parameters.ResultsData from 251 participants were included, mean age 9 ± 3.4 years, Gross Motor Function Classification System (GMFCS) level I = 158, II = 64 and III = 29. Balance was perceived to limit walking to the greatest extent, followed by weakness, lack of endurance, safety concerns, pain and mental ability. This rank was consistent across GMFCS levels I, II and III. Perceived balance limitations showed the strongest correlations with objective gait variables, GDI (r = −0.31 p = 0.000), normalised step length (r = −0.30 p = 0.0000) and normalised gait speed (r = −0.24 p = 0.0001).SignificanceSubjective gait perceptions provide a valuable indication of gait function but are weakly associated with objective clinical gait analysis. Outcome measures that are sensitive to changes in balance may be more responsive to parental concerns and help to satisfy their goals and expectations.