Construct validity of the walk ratio as a measure of gait control in people with multiple sclerosis without mobility aids

Ambulatory limitations are a key component of disability in people with multiple sclerosis (PwMS). Various tools are employed to assess walking performance in PwMS; however, no ideal measure has as yet been attained. In this situation, a walk ratio might be more advantageous compared with other gait measures. The walk ratio, a simple index for describing temporal and spatial co-ordination, denotes the relationship between step length and cadence during walking. Hence, the primary objective of this study was to determine the relationship between the walk ratio and measures of other theoretically related constructs. The walk ratio was studied using the GAITRite™ system (CIR Systems, Inc. Havertown, USA). The study group included 229 PwMS (143 women) and a mean disease duration of 5.8 (SD = 7.1) years. The walk ratio score of the total sample was 5.3 (SD = 0.8). Significant differences based on the expanded disability status scale (EDSS) scores (F = 11.616, P < 0.001) were observed between the neurological disability subgroups. Scores of the very mild (EDSS 0–2.0), mild (EDSS 2.5–4.0) and moderate (EDSS 4.5–5.5) groups were 5.5 (SD = 0.7), 5.2 (SD = 0.7), 4.9 (SD = 0.9), respectively. In terms of fall status, the MS fallers demonstrated a significant lower walk ratio compared to the MS non-fallers; 5.1 (SD = 0.8) vs. 5.5 (SD = 0.7); P < 0.001. Modest significant correlation scores were found between walk ratio and ambulation tests. Scores were slightly higher in the short walking tests, timed 25-foot walk and timed up and go tests (Pearson's rho = 0.369, 0.364) compared to the 6 and 2-min walk time tests (Pearson's rho = 0.344, 0.308). Collectively, the current study supports the construct validity of the walk ratio index in PwMS without mobility aids.     

Influence of visual inputs on quasi-static standing postural steadiness in individuals with spinal cord injury

Postural steadiness while standing is impaired in individuals with spinal cord injury (SCI) and could be potentially associated with increased reliance on visual inputs. The purpose of this study was to compare individuals with SCI and able-bodied participants on their use of visual inputs to maintain standing postural steadiness. Another aim was to quantify the association between visual contribution to achieve postural steadiness and a clinical balance scale. Individuals with SCI (n = 15) and able-bodied controls (n = 14) performed quasi-static stance, with eyes open or closed, on force plates for two 45 s trials. Measurements of the centre of pressure (COP) included the mean value of the root mean square (RMS), mean COP velocity (MV) and COP sway area (SA). Individuals with SCI were also evaluated with the Mini-Balance Evaluation Systems Test (Mini BESTest), a clinical outcome measure of postural steadiness. Individuals with SCI were significantly less stable than able-bodied controls in both conditions. The Romberg ratios (eyes open/eyes closed) for COP MV and SA were significantly higher for individuals with SCI, indicating a higher contribution of visual inputs for postural steadiness in that population. Romberg ratios for RMS and SA were significantly associated with the Mini-BESTest. This study highlights the contribution of visual inputs in individuals with SCI when maintaining quasi-static standing posture.     

A method to investigate discrepancies between perceived and actual balance in older women

Despite the established relationship between low balance confidence and poorer balance and gait performance, discrepancies may occur between an individual's perceived and actual abilities. This study determined if trunk sway measures could assist in identifying potential discrepancies between perceived and actual balance. Older women completed the Activities-specific Balance Confidence (ABC) scale and performed a series of 16 stance, gait and tandem gait tasks. Duration (or completed steps for tandem gait tasks) and trunk pitch and roll angle and angular velocity were calculated. Low (mean ABC score ≤ 70%, n = 33) and high (mean ABC score ≥ 90%, n = 99) balance confidence groups were identified from a pool of 204 participants. The low balance confidence group had greater stance trunk pitch and roll sway, shorter one leg stance durations, reduced gait trunk roll sway, longer gait durations, less tandem gait trunk roll sway and completed fewer tandem gait steps compared to the high balance confidence group. Stepwise linear discriminant analysis identified four variables that were used to achieve a classification accuracy of 75.8% for low and 90.9% for high balance confidence groups. This study reinforces the influence of low balance confidence on stance and gait control and provides direction for the identification and treatment of individuals with discrepancies between perceived and actual balance.     

Symmetry in vertical ground reaction force is not related to walking and balance difficulties in people with multiple sclerosis

Analysis of vertical ground reaction force (GRF) symmetry may benefit people with multiple sclerosis (PwMS) since it can detect important differences in gait mechanics which have not previously been discussed in the related literature. Therefore, the primary objective of the current study was to determine whether symmetry of the vertical GRF during gait is associated with validated gait and balance tests in PwMS. Additionally, we examined whether the symmetry of the vertical GRF differs between MS fallers, non-fallers and between neurological disability levels. Gait and balance data were collected from 402 PwMS (249 women) with a mean age of 42.1 (S.D = 14.1) years. Vertical GRF parameters were obtained using the Zebris FDM-T Treadmill (Zebris Medical GmbH, Germany). Clinical gait and balance tests included the 2 and 6-min Walk Test, Timed Up and Go Test, Timed 25 Foot Walk, Four Square Step Test, Multiple Sclerosis Walking Scale questionnaire, Modified Fatigue Impact Scale and the Falls Efficacy Scale International questionnaire. The vertical GRF symmetry index score of the total sample was 3.7 (SD = 3.1). In terms of fall status, non-significant differences were observed between the fallers and non-faller groups and between the neurological disability subgroups. Non-significant correlation scores were found between the vertical GRF symmetry index, all clinical walking and balance tests and self-reported questionnaires. We suggest clinicians, especially those involved in physical rehabilitation, accord low priority to this gait phenomenon in the MS population.     

The effects of localized muscle and whole-body fatigue on single-leg balance between healthy men and women

The purpose was to examine the effects of localized muscle and whole-body fatigue on indices of single-leg balance between healthy young men (n = 10) and women (n = 10). Subjects performed 10, 10-s single-leg balance trials on a force platform prior to performing each of three conditions (local, whole-body, and control), in a randomized order, on separate days. Localized muscle and whole-body fatigue consisted of single-leg, weight-bearing heel raises on an inclined platform, and exercise on a rowing ergometer, respectively, to the point of volitional failure. During the control condition, subjects remained in a seated position for 5 min. Immediately following each condition, five, 10-s, single-leg balance trials were performed. The localized muscle and whole-body fatigue protocols produced significant (p < 0.05) increases in medial/lateral (M/L) and total sway (TS). Men experienced a greater (p < 0.05) increase in anterior/posterior (A/P) sway following the localized muscle, than whole-body, fatigue protocol, whereas A/P sway increased more following the whole-body, than localized muscle, fatigue protocol for the women. Total sway variability increased significantly (p < 0.05) more following the localized muscle fatigue protocol than the whole-body fatigue protocol for both men and women. The major findings of the present investigation demonstrated that measures of postural control, namely M/L, A/P sway and total sway, were adversely affected following fatiguing exercise, with differential effects between men and women.     

The correlation between symptomatic fatigue to definite measures of gait in people with multiple sclerosis

There is a general consensus relating to the multidimensional aspects of fatigue in people with multiple sclerosis (PwMS), however, the exact impact of this symptom on gait is not fully understood. Our primary aim was to examine the relationship between definite parameters of gait with self-reported symptomatic fatigue in PwMS according to their level of neurological impairment. Spatio-temporal parameters of gait were studied using an electronic walkway. The Multiple Sclerosis Walking Scale (MSWS-12) questionnaire, a patient-rated measure of walking ability was collected. The Modified Fatigue Impact Scale (MFIS) questionnaire was used to determine the level of symptomatic fatigue. One hundred and one PwMS (61 women) were included in the study analysis. Subjects were divided into mild and moderate neurological impaired groups. Fatigue was correlated with 5 (out of 14) spatiotemporal parameters. However, correlation scores were all <0.35, thus considered as weak correlations. In the mild group, the double support period was the only variable positively correlated to fatigue (Spearman's rho = 0.28, P = 0.05). In the moderate group, step and stride length were solely negatively correlated to fatigue (Spearman's rho = 0.32, P = 0.03). In contrast to the definite gait parameters, the MSWS-12 self-questionnaire was moderately positively correlated to the level of fatigue. Scores for the total, mild and moderate groups were 0.54, 0.57 and 0.51; P < 0.01, respectively. The present results indicate that modifications in spatio-temporal parameters of gait are not closely related to symptomatic fatigue in PwMS. On the contrary, the self-reported MSWS-12 questionnaire is predisposed to level of fatigue in PwMS.     

Effect of gait retraining for reducing ambulatory knee load on trunk biomechanics and trunk muscle activity

The purpose of this study was to test the hypothesis that walking with increased medio-lateral trunk sway is associated with lower external knee adduction moment and lower extremity muscle activation, and higher external ipsilateral trunk moment and trunk muscle activity than walking with normal trunk sway in healthy participants. Fifteen participants performed walking trials with normal and increased medio-lateral trunk sway. Maximum trunk sway, first maximum knee adduction moment, lateral trunk bending moment, and bilateral vastus medialis, vastus lateralis, gluteus medius, rectus abdominis, external oblique and erector spinae muscle activity were computed. Walking with increased trunk sway was associated with lower maximum knee adduction moment (95% confidence interval (CI): 0.50–0.62 Nm/kg vs. 0.62–0.76 Nm/kg; P < .001) and ipsilateral gluteus medius (−17%; P = .014) and erector spinae muscle activity (−24%; P = .004) and greater maximum lateral trunk bending moment (+34%; P < .001) and contralateral external oblique muscle activity (+60%; P = .009). In all participants, maximum knee adduction moment was negatively correlated and maximum trunk moment was positively correlated with maximum trunk sway. The results of this study suggest that walking with increased trunk sway not only reduces the external knee adduction moment but also alters and possibly increases the load on the trunk. Hence, load-altering biomechanical interventions should always be evaluated not only regarding their effects on the index joint but on other load-bearing joints such as the spine.     

Time dependent structure of postural sway in individuals with multiple sclerosis

Non-linear analyses, which examine the time dependent structure of physiological output have been found to be able to detect subtle differences in postural control between pathological groups and healthy controls while traditional linear parameters do not. This investigation examines whether a specific non-linear metric, approximate entropy, may provide a novel biomarker for balance impairment in individuals with multiple sclerosis (MS) who have normal sway. This analysis included a sample of 30 individuals with MS with normal postural sway and 36 controls. Participants stood on a force platform for two trials of 30 s with eyes open. Postural control was indexed by sway area, mean velocity along the antero-posterior (AP) and mediolateral (ML) axis. The time dependent structure of the COP along the AP and ML axes was indexed with approximate entropy (ApEn_AP; ApEn_ML). T-tests and Mann–Whitney U tests were utilized to analyze differences between groups. Per design there were no differences in sway area between the MS and control groups. Additionally, there were no differences in sway velocity. The MS group had lower ApEn_ML values compared to the control group (U = 376, p = .026). The results indicate that individuals with MS who have normal sway area had greater time dependent structure in ML sway. This investigation highlights the utility of non-linear analyses when assessing balance impairment in MS samples that present with minimal sway area.     

Haptic feedback from manual contact improves balance control in people with Parkinson's disease

Parkinson's disease (PD) degrades balance control. Haptic (touch and proprioception) feedback from light contact with a stationary surface inadequate to mechanically stabilize balance improves balance control in healthy people. In this study we tested whether PD impairs use of haptic cues independent of mechanical support to control balance. We measured postural sway in thirteen individuals with PD (H&Y 1–3, median = 2, Q₁ = 2, Q₃ = 2) and thirteen age-matched controls balancing in a widened, sharpened Romberg stance in four conditions: eyes-closed, no manual contact; eyes-closed light-touch contact (<1 N), eyes-closed, unrestricted contact; and eyes-open, no contact. To determine whether PD-severity affects any of these balance strategies, PD participants were tested on- and off-medication, and using the more- and less-affected body side in the stance and manual contact.Individuals with PD simultaneously maintained non-supportive fingertip contact and balance in this task without practice. PD participants swayed more than control participants (ML CP p = 0.010; shoulder p < 0.001), but manual contact reduced sway. Non-supportive manual contact stabilized balance more than vision (p < 0.05). PD-severity factors had no significant effect (p > 0.05).We conclude the effect of PD on balance is not specific to vision or haptic feedback. Nevertheless, haptic cues from manual contact, independent of mechanical support, improve balance control in individuals with PD. We discuss the implication that PD or associated dopaminergic pathways do not directly affect haptic feedback balance control mechanisms, including arm/posture coordination and proprioceptive integration.     

Forward and backward locomotion in individuals with dizziness

The vestibular system plays an important role in locomotion. Individuals with vestibular pathology present with gait abnormalities, which may increase their fall frequency. Backward walking (BW) has been suggested as a predictor of falls in other patient populations; however it has not been studied in individuals with dizziness. Our aims were: (1) to investigate the differences in forward walking (FW) and BW both between and within 3 groups: Healthy controls, individuals with dizziness and vestibular pathology, and individuals with dizziness without vestibular pathology, (2) describe differences in FW and BW between individuals that have fallen and those that have not. We studied 28 healthy controls (mean 53.8 ± 17 years), 21 individuals with pathophysiology of the vestibular system (mean 68.5 ± 13 years), and 18 individuals without a vestibular cause for their dizziness (mean 67.4 ± 17 years). Subjects performed 2 FW and 2 BW trials over the GAITRite walkway. Data on history of falls in the preceding year were collected. We found BW was different to FW within each group. When comparing between groups and correcting for age and gender, only BW velocity (beta = −11.390, p = 0.019), cadence (beta = −8.471, p = 0.021), step time (beta = 0.067, p = 0.007) and stride time (beta = 0.137, p = 0.005) were significantly affected by having dizziness, with no differences in FW characteristics. There were no differences between FW and BW between fallers and non-fallers. BW appears to be a better biomarker than FW for identifying individuals with symptoms of dizziness; though it does not appear to characterize those who fall.     

Forward and backward locomotion in individuals with dizziness

The vestibular system plays an important role in locomotion. Individuals with vestibular pathology present with gait abnormalities, which may increase their fall frequency. Backward walking (BW) has been suggested as a predictor of falls in other patient populations; however it has not been studied in individuals with dizziness. Our aims were: (1) to investigate the differences in forward walking (FW) and BW both between and within 3 groups: Healthy controls, individuals with dizziness and vestibular pathology, and individuals with dizziness without vestibular pathology, (2) describe differences in FW and BW between individuals that have fallen and those that have not. We studied 28 healthy controls (mean 53.8 ± 17 years), 21 individuals with pathophysiology of the vestibular system (mean 68.5 ± 13 years), and 18 individuals without a vestibular cause for their dizziness (mean 67.4 ± 17 years). Subjects performed 2 FW and 2 BW trials over the GAITRite walkway. Data on history of falls in the preceding year were collected. We found BW was different to FW within each group. When comparing between groups and correcting for age and gender, only BW velocity (beta = −11.390, p = 0.019), cadence (beta = −8.471, p = 0.021), step time (beta = 0.067, p = 0.007) and stride time (beta = 0.137, p = 0.005) were significantly affected by having dizziness, with no differences in FW characteristics. There were no differences between FW and BW between fallers and non-fallers. BW appears to be a better biomarker than FW for identifying individuals with symptoms of dizziness; though it does not appear to characterize those who fall.     

Quantitative trunk sway and prediction of incident falls in older adults

Poor balance and balance impairments are major predictors of falls. The purpose of the current study was to determine the clinical validity of baseline quantitative static trunk sway measurements in predicting incident falls in a cohort of 287 community-dwelling non-demented older Americans (mean age 76.14 ± 6.82 years; 54% female). Trunk sway was measured using the SwayStar™ device, and quantified as angular displacement in degrees in anterior-posterior (pitch) and medio-lateral (roll) planes. Over a one-year follow-up period, 66 elders (23%) reported incident falls. Anterior-posterior angular displacement was a strong predictor of incident falls in older adults in Cox proportional hazards models (hazard ratio adjusted for age, gender, education, RBANS total score, medical comorbidities, geriatric depression scale score, sensory impairments, gait speed, and history of fall in the past 1 year ((aHR) = 1.59; p = 0.033) whereas, angular displacement in the medio-lateral plane was not predictive of falls (aHR = 1.35; p = 0.276). Our results reveal the significance of quantitative trunk sway, specifically anterior-posterior angular displacement, in predicting incident falls in older adults.     

Motor performance differentiates individuals with Lewy body dementia,Parkinson’s and Alzheimer’s disease

IntroductionDifferential diagnosis of dementia with Lewy bodies (DLB), Parkinson’s disease with dementia (PDD), Parkinson’s disease (PD) and Alzheimer’s disease (AD) is challenging. Comparative motor profiles of these neurodegenerative disorders may aid in earlier diagnosis but have not been extensively studied.MethodsGroups were rigorously matched by age, education, and sex. DLB/PDD participants were matched by Mini-Mental State Examination Score to individuals with AD and by Unified Parkinson’s Disease Rating Scale motor scores to individuals with PD. Gait, balance, dual task walking and hand dexterity measures were compared between a combined group (n = 21) of individuals with Lewy body dementia (LBD) consisting of those with DLB (n = 11) and PDD (n = 10) to individuals with PD (n = 21) or AD (n = 21).ResultsIndividuals at the same disease stage with LBD walked significantly slower with shorter stride lengths (p < 0.05), demonstrated poorer balance on both the Tinetti and Berg Balance Scale, and poorer performance on dual-task and figure-of-eight walking compared to PD and AD (p < 0.05 for all) groups. Upper extremity coordination on the 9-hole peg test differentiated LBD from both PD and AD and was the only motor test in which individuals with AD performed worse than those with PD. Tinetti balance subscores were significantly lower in PDD compared to DLB participants (10.4 ± 2.3 versus 12.8 ± 2.3; p = 0.027).ConclusionsMotor features distinguish individuals with LBD from those with AD and PD. Measures of gait, balance and finger dexterity provide an additional means of differentiating individuals with LBD from those with AD and PD.     

Improvements in balance control in individuals with PCS detected following vestibular training: A case study

Concussed individuals have been found to experience balance deficits in the anterior-posterior (AP) direction as indicated by greater Center of Pressure (COP) displacement and velocity. One possible reason for this change in balance control could be due to damage to the lateral vestibulospinal tract which sends signals to control posterior muscles, specifically ankle extensors leading to compensatory torques about the ankle. The purpose of the study was to quantify balance assessments in individuals experiencing persistent post-concussion symptoms (PCS) to determine balance control changes following a vestibular training intervention. Participants (N = 6, >26 days symptomatic), were tested during their first appointment with a registered physiotherapist (PT) and during each follow up appointment. Participants were prescribed balance, visual, and neck strengthening exercises by the PT that were to be completed daily between bi-weekly appointments. Balance assessments were quantified using a Nintendo Wii board to record ground reaction forces. Participants completed 4 balance assessments: 1) Romberg stance eyes open (REO); 2) Romberg stance eyes closed (REC); 3) single leg stance eyes open (SEO); and 4) single leg stance eyes closed (SEC). The balance assessments were conducted on both a firm and compliant surfaces. Significant improvements in balance control were noted in ML/AP displacement and velocity of COP for both SEC and Foam REC conditions, with additional improvements in AP velocity of COP for Foam REC and in ML displacement of COP during Foam SEC. Overall, findings indicate that objectively quantifying balance changes for individuals experiencing persistent PCS allows for a more sensitive measure of balance and detects changes unrecognizable to the naked eye.     

Dynamical analysis of balance in vestibular schwannoma patients

The analysis of the complexity of postural fluctuations is a recent method for assessing postural control. Complexity relates to the irregularity of the center of pressure time series and characterizes the ability of postural control to meet a changing environment. In our study, we used the sample entropy (SampEn) parameter to evaluate the complexity of postural sway velocity time series in patients with vestibular schwannoma (n = 19) compared to healthy controls (n = 20), using the sensory organization test. Patients performed postural assessments three days before surgical ablation of the tumor, then three times after surgery, at eight, thirty, and ninety days. The control group underwent posturographic tests only once. Our results demonstrated that SampEn values distinguished both groups before surgery only in postural tasks where vestibular afferences significantly contribute to maintaining balance. We also found an immediate decrease of complexity after the surgical resection of the tumor. Our results are in line with the theory of complexity loss of physiological systems stating that reducing the number of their structural components or altering their coupling leads to a decrease in complexity. Finally, our findings showed that progressive restoration of complexity over time was such that no difference was found between the two groups ninety days after surgery, due to the implementation of central adaptive mechanisms and the substitution by other sensory afferences. Thus, the SampEn parameter can highlight the postural effects of vestibular pathology, and complexity analysis appears to be a valuable tool for investigating the temporal structure of CoP time series.     

Immediate effects of perturbation treadmill training on gait and postural control in patients with Parkinson’s disease

The study investigates immediate adaptations of gait and balance to a single session of perturbed treadmill walking in patients with Parkinson’s disease. 39 Parkinson’s patients in stage 1–3.5 of the Hoehn and Yahr Scale were randomized into one of two groups, stratified by disease severity: The experimental group (n = 19) walked on a treadmill prototype which constantly applied perturbation by small three-dimensional tilting movements of the walking surface. The control group (n = 20) trained on the identical treadmill without perturbations. Patients walked on the treadmill for 20 min. Primary outcome measure was overground walking speed. Secondary outcomes were postural sway during quiet standing and spatiotemporal gait parameters during treadmill walking. Outcomes were measured repeatedly throughout the training session and after 10 min retention. The experimental group significantly increased overground walking speed after intervention compared to the control group (p = 0.014; ES = +0.41). Gait variability during treadmill walking significantly decreased after walking with perturbation. Sway area increased with treadmill walking only in the control group (p = 0.009; ES = +0.49). No other postural sway measures changed over time. Subgroup analyses revealed that in the experimental group patients with more pronounced motor impairment demonstrated larger increases in overground walking speed (p = 0.016; ES = +0.40) and stance phase symmetry (p = 0.011; ES = −0.42). In conclusion, a single session of perturbation treadmill training led to gait improvements, which were more pronounced compared to unperturbed treadmill walking. Effects on static postural sway were less pronounced.     

Cognitive-motor interference in multiple sclerosis: What happens when the gait speed is fixed?

During the last decade, numerous studies have confirmed a coupling between walking performance and cognition in people with multiple sclerosis (PwMS). Our aim was to provide new insights into a walking-cognitive dual-task (DT) in PwMS. We tested the DT phenomenon by controlling the walking speed using an instrumented treadmill. Thirty PwMS (20 women) with a mean age 40.1 (SD = 12.0) participated in the study. Twenty-one healthy subjects served as controls. Each subject completed a sequence of tests: a) Normal walking (ST) − the participant walked on the instrumented treadmill at a comfortable walking speed for 1 min; b) Cognitive evaluation (ST) − subjects performed two cognitive tests while seated; c) DT cognitive tests performed while walking on the treadmill at the identical speed performed during normal walking. Outcome measures were spatio-temporal parameters of gait (mean and variability), the Word List Generation Test (WLG) and the Serial-3 Subtraction Test. MS participants significantly decreased their cadence while increasing their stride length during the DT condition compared to the ST condition. Non-significant differences were observed for the WLG and Serial-3 Subtraction Cognitive Tests between the ST condition and the DT condition in both the MS and healthy groups. In terms of gait variability parameters, MS subjects demonstrated a 2 to 3-fold greater gait variability compared to the healthy controls. Non-significant differences in gait variability parameters were observed between the ST and DT conditions in both the MS and control groups. This study provides new insights into the DT phenomenon in the MS population.     

Mechanical efficiency and balance in adolescents and young adults with cerebral palsy

Mechanical efficiency (ME) during stair-climbing measures ambulation ability. This study investigated the relationship between ME and age, anthropometric, functional walking, and balance parameters in 52 adolescents with cerebral palsy (CP), age 13.5–23.3 yrs, who participated in an intervention study to improve walking. Measurements included ME, 6-min and 10-m walk tests and the Berg balance scale (BBS). Walk test measures correlated significantly with ME, as expected, as did BBS (r = 0.68) and age (r = 0.51). The multiple correlation coefficient with both age and BBS increased to 0.80. The measurements were divided into two groups of low (<40, n = 19) and high (>40, n = 33) BBS scores. Repeating regression analyses, demonstrated that in the low BBS group ME was significantly related to BBS, but not age, in contrast to opposite results in the high BBS group. Regressions were calculated for each of the 14 items of the BBS with ME. For the whole group, 12 items correlated significantly, but only three in the high BBS group (one leg standing, reach while standing and tandem standing). In the low BBS group 10 of the items correlated significantly, with the former three ranking near the top. Balance is an important component of ambulation in children with CP. Mobility in those scoring >40 is related to age, but in those more deficient in balance (<40) mobility is more closely associated with balance than age. Effective therapy to improve walking in younger children might incorporate more balance-focused exercises, similar to those related to BBS items strongly associated with ME.     

Light finger contact concurrently reduces postural sway and enhances signal detection performance in children with developmental coordination disorder

The current study examined the effects of light finger touch on postural sway and signal detection performance in children with developmental coordination disorder (DCD). Children with DCD (n = 30; 18 boys, 12 girls; age = 11.87 ± 0.48 years) and typically developing children (n = 30; 14 boys, 16 girls; age = 11.73 ± 0.52 years) were recruited from schools in Pintung County, Taiwan. Participants completed a signal detection task under no finger touch (NT) and light finger touch (LT) conditions, while postural sway in both anteroposterior (AP) and mediolateral (ML) axes was recorded. In both conditions, children with DCD exhibited significantly higher levels of postural sway (p < 0.05) and lower signal detection performances (p < 0.05) than TDC. Additionally, both groups significantly reduced postural sway (p < 0.05) and enhanced signal detection performance (p < 0.05) when engaged in light finger touch compared with no finger touch. While the effect of LT on postural sway was greater among TDC relative to children with DCD (p < 0.05), the effect of LT on signal detection was greater in children with DCD compared with TDC (p < 0.05). These results suggest that light finger touch is effective in concurrently reducing postural sway and enhancing signal detection in both groups.     

Trunk sway during walking among older adults: Norms and correlation with gait velocity

The aim of this study was to establish quantitative norms for trunk sway during walking for older male and female ambulatory adults at different age groups (65–70, 71–75, 76–80, ≥81). We also assessed the relationship between dynamic trunk sway and gait velocity in older individuals with clinically normal or abnormal gaits. Trunk sway in medio-lateral (roll) and antero-posterior (pitch) planes was measured using a body-mounted gyroscope (SwayStar) during walking on a 4.5 m long instrumented walkway. Of the 284 older adults (mean age 76.8, 54.6% women) in this sample, the mean ± SD value of roll and pitch angles were 6.0 ± 2.0° and 6.7 ± 2.2° respectively. Older women showed significantly greater trunk sway in both roll and pitch angles than older men (p < 0.01). In both men and women, there was no significant association of roll angle with age although gait velocity decreased with increasing age. The relationship between roll angle and gait velocity was U-shaped for the overall sample. Among the subgroup with clinically normal gait, increased roll angle was associated with increased gait velocity (p < 0.001). However, there was no significant relationship between roll angle and gait velocity among the subgroup with abnormal gait. Therefore, the relationship between medio-lateral trunk sway and gait velocity differs depending on whether gait is clinically normal.We conclude that trunk sway during walking should be interpreted with consideration of both gait velocity and presence of gait abnormality in older adults.