Non-Powered automatic velocity-controlled wheeled walker improves gait and satisfaction in patients with hip fracture when walking downhill: A cross-over study

BackgroundA standard four-wheeled walker is commonly used after surgery for hip fracture to aid ambulation. However, elderly patients experience some difficulties and are at risk for falls; therefore, attempts are being made to address these issues.Research questionDoes the non-powered automatic velocity-controlled (NPAVEC) wheeled walker improves the gait and satisfaction of patients with hip fractures when walking downhill using it?MethodsIn this cross-over study, 21 participants performed three trials of walking downhill with two walkers (an NPAVEC wheeled walker and a standard four-wheeled walker) at a self-selected speed. We compared the lower limb surface electromyography data and self-reported satisfaction scores for both walkers.ResultsRegarding the affected limb, the NPAVEC wheeled walker increased contraction in the vastus medialis (p = 0.003) and tibialis anterior (p = 0.014), and biceps femoris of the unaffected limb (p = 0.01). Additionally, participants reported greater satisfaction when using the NPAVEC wheeled walker (p < 0.001).SignificanceAn NPAVEC wheeled walker, compared to a four-wheeled walker, can assist patients recovering from hip fracture when walking downhill by improving the gait and increasing satisfaction.     

Long-term effects of shoe mileage on knee and ankle joints muscle co-contraction during walking in females with genu varus

BackgroundShoe mileage may influence the risk of sustaining injuries during walking.Research questionWhat are the effects of shoe mileage on knee and ankle muscle co-contraction during walking in females with genu varus?MethodsFifteen healthy and 15 women diagnosed with genu varus received a new pair of running shoes. They were asked to wear these shoes over 6 months. Pre and post intervention, muscle activities of the dominant limb were recorded during a walking test at preferred gait speed. Two dependent variables were assessed to examine muscle co-contraction: (1) directed co-contraction ratios of agonists and antagonists, and (2) general joint muscle co-contraction.FindingsResults demonstrated significant main effects of the “shoe” factor for general ankle co-contraction during the push-off phase (p = 0.013, d = 1.503). Irrespective of experimental group, paired comparisons revealed significantly lower general ankle co-contraction during the push-off phase after the intervention. A significant main effects of “shoe” for general knee co-contraction during loading phase (p = 0.025, d = 0.895) was also observed. In both groups, paired comparison revealed significantly lower general knee co-contraction during the push-off phase in the post condition. We did not find any significant main effect of group nor group-by-shoe interaction for general ankle co-contraction during the stance phase. Likewise, we did not observe any significant main effect of “shoe”, “group” and “group-by-shoe” interaction for mediolateral directed knee co-contraction during stance phase of walking (p > 0.05).SignificanceOur findings showed that the shoe mileage but not the genu varus condition affects the general and directed co-contraction of the muscles stabilizing the knee and ankle joints. Together with the observed findings on ankle and knee muscle co-contraction, it is essential to change running shoes after a long wearing time in both healthy and genu varus females.     

Quantitative evaluation of gait features after total knee arthroplasty: Comparison with age and sex-matched controls

BackgroundGait function after total knee arthroplasty (TKA) is suboptimal. However, quantified analysis with comparing a control group is lacking.Research questionThe aims of this study were 1) to compare the gait before and after TKA and 2) to compare postoperative gait to that of an age-sex matched control group.MethodsThis study consisted of 46 female and 38 male patients with end-stage knee osteoarthritis who underwent bilateral TKA, and 84 age- and sex-matched controls without knee pain and osteoarthritis. Seven gait parameters, including lower extremity alignment, knee adduction moment (KAM), knee flexion angle, external knee flexion moment, hip adduction angle, external hip adduction moment, and the varus-valgus arc during the stance phase, were collected using a commercial opto-electric gait analysis system. Principal component analysis was used for data processing and the standardized mean differences (SMDs) of the principal component scores were compared.ResultsThe most significant gait change after TKA was the alignment (SMD 1.62, p < 0.001). The average stance phase alignment changed from varus 7.3° to valgus 0.5°. The second significant change was a decrease of the KAM (SMD 1.08, p < 0.001). These two features were closely correlated (r = 0.644, p < 0.001). The gait feature that differed most from the controls was the varus-valgus arc during the stance phase (SMD 1.68, p < 0.001), which was constrained by 31% after TKA (p < 0.001) and was only 37% compared to the controls (p < 0.001).SignificanceImprovement in gait after TKA was obtained through alignment correction. However, TKA significantly constrained coronal knee motion. TKA improved gait suboptimally; the gait was significantly different from that of controls.     

Balance control and lower limb joint work in children with bilateral genu valgum during level walking

BackgroundGenu valgum results in lower limb malalignment and altered joint mechanics. The study aimed to identify the effects of genu valgum on balance control and muscular work at the joints during gait in children.Research questionWould bilateral genu valgum affect balance control and muscular work at the joints during gait in children?MethodsThirteen children with genu valgum and thirteen healthy peers walked at their preferred speed while the body’s motions and ground reaction forces were measured to calculate the inclination angles (IA) and the rates of change of IA (RCIA) of the body’s center of mass (COM) relative to the center of pressure (COP), as well as the muscular work done at the joints. An independent t-test was used to compare the variables between groups (α = 0.05).ResultsCompared to the controls, the patients showed significantly increased step width with altered frontal IA and RCIA variables (p < 0.05), including increased average IA over single-limb support and increased peak RCIA during double-limb support (p < 0.05). The patients significantly increased posterior RCIA at heel-strike but decreased anterior RCIA at toe-off (p < 0.05). The patients showed increased muscular work at both the hip and knee during single-limb support (p < 0.05).SignificanceThe children with genu valgum showed a specific balance control strategy during gait. In the frontal plane, greater hip and knee muscular work was needed to maintain balance under an increased IA, likely owing to increased step width associated with the valgus alignment. In the sagittal plane, less smooth and less stable COM−COP control with increased RCIA at the key gait events indicates faster weight transfer between double-limb and single-limb support. It is suggested that patients with genu valgum, especially in more severe cases, should be monitored for signs of decreased ability and/or muscular strength in maintaining balance during gait.     

Correlation between lower limb isometric strength and muscle structure with normal and challenged gait performance in older adults

BackgroundMuscular parameters have been considered to influence gait of older adults, but it is still unclear which specific lower limb muscular parameters correlate with kinematics of overground and obstacle crossing in older adults.Research questionWhat lower limb muscular parameters correlate and explain kinematics of overground walking and obstacle crossing ability in the elderly?MethodsMuscle structure was evaluated in 15 older individuals (75.4 ± 5 years) through measures of architecture (muscle thickness, fascicle length, and pennation angle) and muscle quality (echo intensity) from lower limb muscles (vastus lateralis, biceps femoris, rectus femoris, tibialis anterior, and gastrocnemius medialis). Muscle function was assessed through isometric strength of hip, knee and ankle joint muscles. Gait kinematics (toe and heel clearances, step length and gait speed) was evaluated during walking with and without obstacle crossing at preferred and maximal gait speeds. Correlation and regression analyses were performed considering a significance level of 0.05.ResultsIsometric strength did not correlate with gait kinematics and gait speed. Tibialis anterior thickness correlated with lead limb toe clearance, and vastus lateralis thickness with gait speed and step length. Vastus lateralis echo intensity correlated with step length and gait speed.SignificanceTibialis anterior and vastus lateralis muscles deserve attention in physical training to improve gait of older adults. Specifically, tibialis anterior should receive more attention on exercise programs aiming at improvement of obstacle crossing, and knee extensors when aiming at improving gait speed and step length.     

Changes in gait mechanics and muscle activity with wedge height in an orthopaedic boot

BackgroundOrthopaedic boots with wedging are commonly used in the treatment of individuals with Achilles tendon rupture to immobilize the foot in plantar flexion and approximate tendon ends.Research questionTo describe changes in muscle activity of the triceps surae and gait mechanics with the use of wedges in an orthopaedic boot immediately and after an accommodation period.MethodsMuscle activity of the triceps surae and gait parameters (vertical ground reaction force, knee extension power, gait speed) were collected using surface electromyography and motion capture in 12 healthy individuals. Participants walked in an instrumented orthopaedic boot with 0, 3, and 5 wedges tested in random order. Participants were provided a one hour accommodation period where time spent walking was collected. This was followed by a repeat assessment of triceps surae activity and gait.ResultsPeak and integrated EMG in the medial gastrocnemius (p = 0.001, p < 0.001) and soleus (p = 0.010, p < 0.001) significantly decreased with increasing number of wedges. Peak and integrated EMG had a slight but non-significant decrease with increasing number of wedges in the lateral gastrocnemius (p = 0.151, p = 0.077). Vertical ground reaction force decreased (p = 0.019) and peak knee extension power increased (p = 0.003) with increasing number of wedges. There were no statistically significant differences in gait speed with wedges (p = 0.450). There were no significant changes in EMG or gait parameters from pre- to post-accommodation period.SignificanceA combination of factors yield decreased triceps surae activity in individuals wearing an orthopaedic boot with wedges – decreasing loading on the immobilized limb and shifting power generation proximally.     

Hip-Knee-Ankle (HKA) angle modification during gait in healthy subjects

BackgroundAchieving a neutral static Hip-Knee-Ankle angle (sHKA) measured on radiographs has been considered a factor of success for total knee arthroplasty (TKA). However, recent studies have shown that sHKA seems to have no effect on TKA survivorship. sHKA is not representative of the dynamic loading occurring during gait, unlike the dynamic HKA (dHKA).Research questionThe primary objective was to see if the sHKA is predictive of the dynamic HKA (dHKA). A secondary objective was to document to what degree the dHKA changes during gait.MethodsWe analysed 3D knee kinematics during gait of a cohort of 90 healthy individuals with the KneeKG™ system. dHKA was calculated and compared with sHKA. Knees were considered “Stable” if the dHKA remained in valgus or varus for greater than 95% of the corresponding phase, and “Changer” otherwise. Patient characteristics of the Stable and Changer knees were compared to find associated factors.ResultsAbsolute variation of dHKA during gait was 10.9 ± 5.3° for the whole cohort. The variation was less for the varus knees (10.3 ± 4.8°), than for the valgus knees (12.8 ± 6.1°, p = 0.008). We found low to moderate correlations (r = 0.266 to 0.553, p < 0.001) between sHKA and dHKA values for varus knees and no significant correlation for valgus knees. Twenty two percent (36/165) of the knees were considered Changers. The proportion of knees that were Changers was 15% of the varus versus 39% of the valgus (p < 0.001).SignificanceLower limb radiographic measures of coronal alignment have limited value for predicting dynamic measures of alignment during gait.     

Analysis of ground reaction forces and muscle activity in individuals with anterior cruciate ligament reconstruction during different running strike patterns

BackgroundAnterior cruciate ligament reconstruction provides successful clinical outcomes. However, reconstruction cannot restore normative lower limb mechanics during running. While numerous studies have investigated running characteristics in individuals with anterior cruciate ligament reconstruction, no study has been compared foot strike patterns among them.Research questionIf ground reaction forces and lower extremity muscle activities in individuals with anterior cruciate ligament reconstruction and healthy control ones differ during three running strike patterns?MethodsIn this cross-sectional study, fourteen healthy adult males and fourteen adult males with anterior cruciate ligament reconstruction were recruited to participate. Surface electromyography of selected lower limb muscles and ground reaction forces were measured during three-strike patterns: rearfoot strike pattern, midfoot strike pattern, and forefoot strike pattern during barefoot running (∼ 3.3 m/s).ResultsThe results revealed that the strike patterns influenced the peak lateral ground reaction force (P < 0.001) and peak vertical impact ground reaction force (P = 0.002) during the stance phase of running for both groups. The strike pattern also influenced the tibialis anterior (P < 0.001) and vastus lateralis (P = 0.035) activities during the early stance phase for both groups. However, the vastus medialis (P = 0.030) presented reduced activity, and the biceps femoris (P = 0.039) presented increased activity in the anterior cruciate ligament reconstruction group. Tibialis anterior (P = 0.021), gastrocnemius medialis (P < 0.001) and vastus medialis (P < 0.001) presented lesser activity irrespective of strike patterns in the anterior cruciate ligament reconstruction group.SignificanceRunning with a forefoot strike pattern may be associated with lesser rearfoot eversion due to lower peak lateral ground reaction forces than running with a rearfoot strike pattern or midfoot strike pattern. Moreover, the altered muscle activities could contribute to the elevated risk of future joint injury in the anterior cruciate ligament reconstruction population.     

Kinematic changes in patients with severe knee osteoarthritis are a result of reduced walking speed rather than disease severity

BackgroundKinematic changes in patients with knee osteoarthritis (OA) have been extensively studied. Concerns have been raised whether the measured spatiotemporal and kinematic alterations are associated with disease progression or merely a result of reduced walking speed.Research question: The purpose of this study was to investigate the effect of walking speed on kinematic parameters in patients with knee OA using statistical parametric mapping (SPM).MethodsTwenty-three patients with unilateral knee OA scheduled for a total knee replacement and 28 age matched control subjects were included in this study. Spatiotemporal parameters and sagittal plane kinematics were measured in the hip, knee, and ankle using the inertial sensors system RehaGait® while walking at a self-selected normal (patients and controls) and slow walking speed (controls) for a distance of 20 m. Gait parameters were compared between groups for self-selected walking speed and for matched walking speed using SPM with independent sample t tests.ResultsAt self-selected walking speed, patients had significantly lower knee flexion during stance (maximum difference, -6.8°) and during swing (-11.0°), as well as higher ankle dorsiflexion during stance phase (+12.5°) and lower peak hip extension at the end of stance compared to controls (+4.2°). At matched speed, there were no significant differences in joint kinematics between groups.SignificanceDifferences in sagittal plane gait kinematics between patients with knee OA and asymptomatic controls appear to be mainly a result of reduced walking speed. These results emphasize the importance of considering walking speed in research on gait kinematics in patients with knee OA and in clinical trials using gait parameters as outcome measures.     

A quantitative description of self-selected walking in adults with Achondroplasia using the gait profile score

BackgroundAchondroplasia is characterised by a shorter appendicular limb-to-torso ratio, compared to age matched individuals of average stature (controls). Previous work shows gait kinematics of individuals with Achondroplasia differing to controls, but no global quantification of gait has been made in adults with Achondroplasia.AimThe aim of this study was to quantify gait differences between a group of adult males with Achondroplasia and controls during self-selected walking (SSW) using the Gait Profile Score (GPS).DesignWhole body motion analysis of 10 adults with Achondroplasia (22 ± 3 yrs) who had not undergone leg lengthening and 17 adult controls (22 ± 2 yrs) was undertaken using a 14 camera VICON system (100 Hz). For each group, fifteen root mean squared Gait Variable Scores (GVS, units °) were computed from lower limb kinematic data and then summed to calculate GPS (°).ResultsThe group with Achondroplasia had higher GVSs than controls in 10 of the 15 measures (P < 0.05) with the largest differences found in ankle plantar/dorsiflexion (P < 0.001), knee flexion/extension (P < 0.001), and hip internal/external rotation (P < 0.001). The GPS value of the group with Achondroplasia was 64% higher than controls (11.4° (2.0) v 4.1° (1.8), P < 0.001).ConclusionGait is quantitatively different in adults with Achondroplasia compared to controls. The differences in GPS between groups are due to differences in joint kinematics, which are possibly manifested by maintaining toe-clearance during swing. Gait models derived from the anatomy of individuals with Achondroplasia may improve these data.     

Reliability and validity of knee angles and moments in patients with osteoarthritis using a treadmill-based gait analysis system

BackgroundAlthough commonly used to study knee osteoarthritis (OA), relatively little is known about the reliability and validity of three-dimensional (3D) gait biomechanics derived from treadmill-based systems.Research questionUsing a treadmill-based gait analysis system, our objectives were to: 1) estimate the test-retest reliability of frontal and sagittal plane knee angles and moments in knee OA patients; 2) examine concurrent validity by estimating the associations between treadmill-based and overground (gold standard) measures; and 3) examine known-groups validity by comparing measures between knee OA patients and matched healthy controls.Methods34 patients and 16 controls completed 3D gait analyses using treadmill-based and overground systems. Treadmill walking speed was matched to self-selected overground speed. Marker set, knee angle and moment calculations were consistent for both systems. Patients completed a second test session using the treadmill-based system <24 h later but within 1 week of the first test session. Variables calculated from knee angle and moment gait waveforms during stance were evaluated using Bland and Altman plots, Intraclass Correlation Coefficients (ICC), Pearson correlations (r) and t-tests.ResultsVisual inspection of the Bland and Altman plots did not reveal any systematic differences between test and retest sessions; however, limits of agreement (LoA) were larger for the sagittal plane than the frontal plane. Mean differences between sessions for knee angles were <0.25 degrees and <0.18 %BW*ht for knee moments. ICCs ranged from 0.57-to-0.93 for test-retest reliability. Pearson correlations between treadmill and overground systems ranged from 0.56-to-0.97. Although highly associated, there were substantial differences in the moments, emphasizing they cannot be used interchangeably. Patients had greater first peak knee adduction moments (KAM) than controls [mean difference (95 %CI): 0.55 (−1.07, −0.04), p = 0.03].SignificanceResults suggest frontal and sagittal plane knee angles and moments in patients with knee OA evaluated using a treadmill-based system are reliable and valid.     

Prediction of mild anatomical leg length discrepancy based on gait kinematics and linear regression model

BackgoundLeg length discrepancy (LLD) can be related to different pathologies, due to an inadequate distribution of mechanical loads, as well as gait kinematics asymmetries resulted from LLD.Research questionTo validate a model to predict anatomical LLD (ALLD) based on gait kinematics.MethodsGait of 39 participants with different lower limb pathologies and mild discrepancy were collected. Pelvic, hip, knee and ankle kinematics were measured with a 3D motion analysis system and ALLD, femur discrepancy (FD) and tibia discrepancy (TD) were measured by a computerized digital radiograph. Three multiple linear regression models were used to identify the ability of kinematic variables to predict ALLD (model 1), FD (model 2) and TD (model 3).ResultsDifference between peak knee and hip flexion of the long and short lower limb was selected by models 1 (p < 0.001) and 2 (p < 0.001). Hip adduction was selected as a predictor only by model 1 (p = 0.05). Peak pelvic obliquity and ankle dorsiflexion were not selected by any model and model 3 did not retain any dependent variable (p > 0.05). Regression models predicted mild ALLD with moderate accuracy based on hip and knee kinematics during gait, but not ankle strategies. Excessive hip flexion of the longer limb possibly occurs to reduce the limb to equalize the LLD, and discrepancies of the femur and tibia affects gait cycle in a different way.SignificanceThis study showed that kinematic variables during gait could be used as a screening tool to identify patients with ALLD, reducing unnecessary x-ray exposure and assisting rehabilitation programs.     

Barefoot walking changed relative timing during the support phase but not ground reaction forces in children when compared to different footwear conditions

BackgroundThere is a paucity of available biomechanical kinetic data comparing shod and barefoot conditions in children.Research questionDo children wearing footwear have comparable gait velocity, ground reaction forces (GRF), spatiotemporal parameters, propulsive and braking impulses when compared to children walking barefoot?MethodsSeventy-five children were divided into four groups: Group 1 females aged 4–9 years old (n = 29). Group 2 females aged 3–5 years old (n = 16). Group 3 males aged 6–9 years old (n = 13). Group 4 males aged 4–8 years old (n = 17). Children walked at a self-selected pace over a walkway of force platforms. Each footwear and barefoot represented a separate condition. The order of conditions was randomized. A repeated-measures ANOVA was performed to investigate the effects of the footwear type on gait parameters in each group. Multiple comparisons with Bonferroni corrections were conducted when appropriate.ResultsThere were no statistical differences in velocity or in vertical and anteroposterior GRF across conditions for all groups. There was a significant effect of the footwear worn on time to loading response peak (p = 0.008), time to midstance force (p = 0.006), and time to propulsive peak (p < 0.001). For Group 3, there was a significant effect of the footwear worn on time to braking peak (p < 0.001) and time to propulsive peak (p < 0.001). Regarding impulses for Group 1, there was a significant effect of the footwear worn on the loading response impulse (p = 0.016) and terminal stance and pre-swing impulse (p = 0.001). For Group 4, there was a significant effect of the footwear worn on the loading response impulse (p = 0.028).SignificanceThere is no influence of the evaluated children’s footwear on gait velocity or GRF.     

Determining the relationship between the impairment of selective voluntary motor control and gait deviations in children with cerebral palsy using simple video-based analyses

BackgroundThe impairment of selective voluntary motor control (SVMC) in children with cerebral palsy (CP) has been shown to correlate with their gait characteristics using complex 3D gait analysis systems (3DGA); however, this relationship has not been investigated using simple video-based observational gait analysis (VBOGA). The aim of this study was to determine the relationship between VBOGA and SVMC of the lower extremities in children with CP.MethodsForty-two CP children 10.9 ± 5.7 years old with Gross Motor Function Classification System (GMFCS) levels I–III participated in the study. Their gait characteristics were assessed using the Edinburgh Visual Gait Score (EVGS), and selective voluntary motor control was tested using the Selective Control Assessment of the Lower Extremity (SCALE). Spearman’s rho correlation test with Cohen’s classification were used in the statistical analyses.ResultsThe GMFCS levels (r = 0.604, p < 0.001), foot clearance (r = −0.584. p < 0.001), and maximum ankle dorsiflexion (r =−0.567, p < 0.001) during the swing phase had strong correlations with total SCALE scores. There was also a moderate correlation between total SCALE scores and total EVGS (r =−0.494, p < 0.001), knee extension in the terminal swing phase (r = −0.353, p < 0.001), peak sagittal trunk position (r = −0.316, p < 0.005), and maximum lateral shift (r = −0.37, p < 0.001).ConclusionImpaired lower extremity SVMC was noticeably related to the foot and ankle movements in the swing phase and initial stance during walking as well as the total EVGS scores and sagittal and frontal trunk movements. The SCALE correlations with VBOGA were similar those observed in the complex 3DGA in the literature; therefore, we suggest that SVMC impairment of gait could be evaluated using simple VBOGA. These findings may help to tailor physical therapy programs for CP children to increase their motor control and walking quality.     

Extrinsic foot muscle forces and joint contact forces in flexible flatfoot adult with foot orthosis: A parametric study of tibialis posterior muscle weakness

BackgroundThe posterior tibialis tendon dysfunction (PTTD) is typically associated with progressive flatfoot deformity, which could be alleviated with foot orthosis. However, the evaluation of tibialis posterior (TP) weakness on lower limb mechanics of flatfoot adults with foot orthoses is scarce and requires further investigation.Research questionThis study aimed to examine the effects of TP weakness on lower limb mechanics in flatfoot adults with foot orthosis through gait analysis and musculoskeletal modelling.MethodsFifteen young adults with flatfoot were recruited from University to perform a gait experiment with and without foot orthoses. Data collected from the motion capture system were used to drive the musculoskeletal modelling for the estimation of the joint force and extrinsic muscle forces of the lower limb. A parametric analysis was conducted by adjusting the TP muscle strength from 40 % to 100 %. Two-way repeated measures ANOVA was used to compare the peak extrinsic foot muscle forces and joint forces among different levels of TP weakness and insole conditions.ResultsTP weakness significantly increased ankle joint force superoinferiorly (F = 125.9, p < 0.001) and decreased anteroposteriorly (F = 125.9, p < 0.001), in addition to a significant increase in the muscle forces of flexor hallucis longus (p < 0.001) and flexor digitorum longus (p < 0.001). Besides, the foot orthosis significantly reduced most peak muscle forces whilst significantly reduced the second peak knee force and peak ankle force compared to the control condition (F = 8.79–30.9, p < 0.05).SignificanceThe increased extrinsic foot muscle forces (flexor hallucis longus and flexor digitorum longus) and ankle joint forces in the TP weakness condition indicated that TP weakness may induce compensatory muscle activation and attenuated joint load. The abnormal muscle and joint mechanics in flatfoot adults with TP weakness might be restored by the orthosis.     

The effect of high-heeled shoes on overground gait kinematics in young healthy women

Purpose

The purpose of this study was to assess the modifications in body center of mass (CoM), total mechanical work and walking characteristics during low-heeled and high-heeled gait performed in ecological conditions.

Methods

The 3D coordinates of 19 body landmarks were recorded by an optoelectronic motion analyzer in 13 women while walking overground at self-selected speed with either low-heeled or high-heeled shoes (minimum height, 70 mm). Using mean anthropometric data, the CoM was estimated, and its position evaluated during normalized gait cycles. Shoulders, pelvic and knee orientations were also assessed together with estimates of total mechanical work.

Results

High-heeled walking was performed with significantly lower horizontal speed (p < 0.05) but with the same cadence than low-heeled walking. During the whole gait cycle, the CoM (calculated from the malleolus landmarks) was 3 % lower during high-heeled walking (p < 0.05), had higher vertical displacements and vertical velocity modifications (p < 0.001), and it was significantly more anterior (p < 0.01). On average, walking with high heels at self-selected speed required a 16 % higher total mechanical work, but the difference was not significant. At heel strike with high heels, the shoulders were more inclined (p < 0.05), the support limb knee was significantly more flexed (p < 0.05), with a 12 % reduced total range of motion (p < 0.001), while the back limb knee was less flexed (p < 0.05).

Conclusions

Wearing high-heeled shoes significantly alters the normal displacement of human CoM; high-heeled gait exaggerated female walking characteristics with a more anterior CoM position, a wider vertical movement and a slower velocity.     

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.     

Is pregnancy brain real? Comparison of dual task cost during overground walking in pregnant versus control women

BackgroundMany pregnant women report that their memory is impaired compared to non-pregnancy, but results of studies of cognitive abilities are mixed. The effect of pregnancy on dual tasking, or performance of two tasks simultaneously, has not been studied, however.Research questionWhat is the effect of walking overground at a self-selected speed while also performing a cognitive task on gait and cognitive performance during 3rd trimester of pregnancy compared to non-pregnant controls?MethodsA total of n = 22 3rd trimester pregnant women (mean 33.3 ± 3.3 weeks gestation, age 32.1 ± 4.7 years) and n = 21 non-pregnant controls (age 31.9 ± 3.3 years) were recruited to participate. All participants performed single task walking on a GAITRite gait analysis system and performed three cognitive tests while walking: serial 3 and 7 subtraction tests and a phoneme monitoring test. Participants completed the same assessments while seated and order of the testing was counterbalanced. Dual task cost (DTC) was calculated using the formula (Single task score – Dual task score)/Single task score)*100. Independent t-tests or Mann Whitney U tests were used to compare the two groups depending on normality of data.ResultsThere were no significant differences in cognitive test performance between control and pregnant women while walking or seated (p > 0.05). There were no significant differences between groups for DTC during any cognitive tests, but DTC was significantly greater for walking velocity in pregnant women compared to controls for serial 3 (p < 0.001) and serial 7 (p = 0.005) but not phoneme monitoring (p = 0.061).SignificancePregnant women had elevated cost of dual tasking, though the decrements were not in cognitive tests but in gait, specifically with greater DTC of walking velocity. This suggests that pregnant women modify their walking velocity to preserve cognitive function during activities requiring focus on both cognitive and physical tasks.     

Differential deficits in spatial and temporal interlimb coordination during walking in persons with incomplete spinal cord injury

BackgroundReturning to community walking remains a major challenge for persons with incomplete spinal cord injury (iSCI) due, in part, to impaired interlimb coordination. Here, we examined spatial and temporal features of interlimb coordination during walking and their associations to gait deficits in persons with chronic iSCI.Research QuestionDo deficits in spatial and temporal interlimb coordination correspond differentially to clinical indicators of walking performance in persons with iSCI?MethodsSixteen persons with chronic iSCI and eleven able-bodied individuals participated in this study. Participants walked at self-selected gait speeds along an instrumented walkway that recorded left and right step lengths and times. We quantified interlimb coordination in terms of normalized differences between left and right step lengths (spatial asymmetry index) and step times (temporal asymmetry index), as well as, gap and phase coordination indices. We then assessed the extent to which these indices independently associated with clinical measures of walking performance.ResultsParticipants with iSCI demonstrated greater spatial and temporal asymmetry, as well as, reduced gap and phase interlimb coordination as compared to age-matched controls (p < 0.001). We found no linear relationships between spatial and temporal asymmetry indices (p > 0.05) or between gap and phase coordination indices (p > 0.05). Spatial and temporal asymmetry indices weakly correlated with SCI-FAI composite scores (r² = 0.26; p = 0.04). However, only spatial asymmetry indices strongly correlated with slower walking speed (r² = 0.51; p < 0.002). We also found participants who used a hand-held assistive device (walker) demonstrated great spatial asymmetry as compared to those who did not (p < 0.03).SignificanceDifferential impairments in spatial and temporal interlimb coordination correspond to overground walking deficits in persons with chronic iSCI. Spatial asymmetry associated with decreased walking speed and increased reliance on hand-held assistive devices. Gait training methods that target well-defined space and time domains of interlimb coordination may enhance overground gait training in persons with iSCI.