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1.
《Gait & posture》2015,41(4):676-681
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.  相似文献   

2.
《Gait & posture》2014,39(4):676-681
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.  相似文献   

3.
Perturbations are often used to study movement control and balance, especially in the context of falling. Most often, discrete perturbations defined prior to the experiment are used to mimic external disturbances to balance. However, the largest proportion of falls is due to self-generated errors in weight shifting. Inspired by self-generated weight shifting errors, we created a novel, continuous mediolateral perturbation proportional to subjects' mediolateral center of mass movement with minimal delays. This perturbation was delivered by a robotic platform controlled by a real time Matlab Simulink model using kinematic data from a marker positioned at subjects' L5 as input. Fifteen healthy young adults stood as still as possible atop the robotic platform with their eyes closed. We evaluated the performance of the perturbation in terms of accuracy and delay relative to the input signal by using cross-correlations. The perturbations were accurate (r = −0.984), with delays of 154 ms. Such systematic perturbation significantly affected mediolateral sway, increasing its range (from 5.56 ± 3.72 to 9.58  ± 4.83 mm, p = 0.01), SD (from 1.08 ± 0.74 to 1.72 ± 0.74 mm, p  = 0.02), and mean power frequency (from 0.08 ± 0.05 to 0.25 ± 0.17 Hz, p < 0.01). These perturbation characteristics enable inducing systematic, movement-dependent perturbations and open the door for future studies investigating self-generated movement errors.  相似文献   

4.
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.  相似文献   

5.
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.  相似文献   

6.
The awareness of potential slip risk has been shown to cause protective changes to human gait during overground walking. It remains unknown if such adaptations to walking pattern also exist when ambulating on a treadmill. This study sought to determine whether and to what extent individuals, when being aware of a potential slip risk during treadmill walking, could adjust their gait pattern to improve their dynamic stability against backward balance loss in response to the impending slip hazard. Fifty-four healthy young subjects (age: 23.9 ± 4.7 years) participated in this study. Subjects’ gait pattern was measured under two conditions: walking on a treadmill without (or normal walking) and with (or aware walking) the awareness of the potential slip perturbation. During both walking conditions, subjects’ full body kinematics were gathered by using a motion capture system. Spatial gait parameters and the dynamic gait stability against backward balance were compared between the two walking conditions. The results revealed that subjects proactively adopted a “cautious gait” during aware walking compared with the normal walking. The cautious gait, which was achieved by taking a shorter step and a more flatfoot landing, positioned the body center of mass closer to the base of support, improving participants’ dynamic stability and increasing their resistance against a possible slip-related fall. The finding from this study could provide insights into the dynamic stability control when individuals anticipate potential slip risk during treadmill walking.  相似文献   

7.
8.
A major health concern faced by individuals with Multiple Sclerosis (MS) is the heightened risk of falling. Reasons for this increased risk can often be traced back to declines in neurophysiological mechanisms underlying balance control and/or muscular strength. The aim of this study was to assess differences between persons with MS and age-matched healthy adults in regards to their falls risk, strength, reactions and directional control of balance. Twenty-two persons with multiple sclerosis (mean age 56.3 ± 8.9 years) and 22 age-matched healthy adults (mean age 59.1 ± 7.1 years) participated in the study. Assessments of falls risk, balance, fear of falling, lower limb strength, and reaction time were performed. Balance control was assessed under four conditions where the combined effects of vision (eyes open/closed) and standing surface (firm/pliable surface) were evaluated. Results demonstrated that, in comparison to healthy older adults, persons with MS had a significantly higher falls risk, slower reaction times, and weaker lower- limb strength. For balance, persons with MS exhibited greater overall COP motion in both the medio-lateral (ML) and anterior-posterior (AP) directions compared to older adults. Additionally, during more challenging balance conditions, persons from the MS group exhibited greater ML motion compared to sway in the AP direction. Overall, the results confirm that persons with MS are often at a heightened risk of falling, due to the multitude of neuromuscular changes brought about by this disease process. However, the increased ML sway for the MS group could reflect a decreased ability to control side-to-side motion in comparison to controlling AP sway.  相似文献   

9.
Sagittal alignment is known to greatly vary between asymptomatic adult subjects; however, there are no studies on the possible effect of these differences on gait. The aim of this study is to investigate whether asymptomatic adults with different Roussouly sagittal alignment morphotypes walk differently. Ninety-one asymptomatic young adults (46 M & 45 W), aged 21.6 ± 2.2 years underwent 3D gait analysis and full body biplanar X-rays with three-dimensional (3D) reconstructions of their spines and pelvises and generation of sagittal alignment parameters. Subjects were divided according to Roussouly’s sagittal alignment classification. Sagittal alignment and kinematic parameters were compared between Roussouly types. 17 subjects were classified as type 2, 47 as type 3, 26 as type 4 but only 1 as type 1. Type 2 subjects had significantly more mean pelvic retroversion (less mean pelvic tilt) during gait compared to type 3 and 4 subjects (type 2: 8.2°; type 3:11.2°, type 4: 11.3°) and significantly larger ROM pelvic obliquity compared to type 4 subjects (type 2: 11.0°; type 4: 9.1°). Type 2 subjects also had significantly larger maximal hip extension during stance compared to subjects of types 3 and 4 (type 2: −11.9°; type 3: −8.8°; type 4: −7.9°) and a larger ROM of ankle plantar/dorsiflexion compared to type 4 subjects (type 2: 31.1°; type 4: 27.9°). Subjects with type 2 sagittal alignment were shown to have a gait pattern involving both increased hip extension and pelvic retroversion which could predispose to posterior femoroacetabular impingement and consequently osteoarthritis.  相似文献   

10.
Objective: To determine whether Mulligan ankle tape influenced the performance in subjects with unilateral chronic ankle instability (CAI) during static balance; postural sway recovery patterns after hopping and dynamic tracking balance tasks.Design: A cross-sectional, within-subjects experimental study design between 4 ankle conditions (taped; untaped: injured and uninjured).Participants: 20 volunteer recreational athletes with unilateral CAI were recruited. Means and standard deviations highlighted the athletes' characteristics: age = 23 ± 1 years; height = 173.1 ± 2.4 cm; weight = 69.3±3 kg; Functional Ankle Disability Index (FADI) = 93.5 ± 5.1% and FADI Sport = 84.2 ± 9.4%.Interventions: Mulligan ankle taping.Main Outcome Measurements: Static balance (10 s); postural sway recovery patterns after a 30 s functional hop test (immediately, 30 and 60 s); dynamic tracking balance tasks (wandering, target overshoot and reaction-time).Results: Between the four conditions, static balance showed no significant differences (p = 0.792); significant changes occurred in postural sway over time (p < 0.001); no significant changes were reported for the dynamic tracking tasks. Wandering was highly correlated with reaction-time and overshooting (p < 0.01).Conclusion: Under resting and fatigued conditions, Mulligan ankle taping did not impact on the neuromuscular control during static and dynamic balance in subjects with healthy and unstable ankles.  相似文献   

11.
Postural control relies on the integration of inputs from the visual, somatosensory and vestibular systems which are frequently impaired in people with Multiple Sclerosis (PwMS). In this situation, examining the Romberg ratio can be useful. This parameter can be interpreted as a gross indicator of a vestibular and proprioceptive contribution to postural control. Therefore, the primary objective of the current study was to examine whether the Romberg ratio differs between MS fallers, non-fallers and neurological disability levels. In addition, we clarified the association between the Romberg ratio values with validated gait and the balance tests in PwMS. Romberg ratio values were calculated according to the sway rate, total sway area and center of pressure (CoP) path length. The patient group included 542 PwMS (337 women) with a mean age of 42.3 (S.D = 13.8). In terms of fall status, significant differences were observed between the faller (n = 287) and non-faller (n = 255) groups solely in terms of the Romberg ratio-ellipse sway area: 2.76 (S.D = 2.46) vs. 2.24 (S.D = 2.01), P-value = 0.01. A significant increase in the Romberg ratio was found between the severe group (n = 50), the very mild (n = 245), mild (n = 186) and moderate (n = 61) groups for each of the three Romberg ratio quotients. Significant weak correlation scores were found between the Romberg ratio-ellipse sway area and all walking and balance outcome measures; the Pearson’s rho ranged from 0.172 to 0.270. The present data suggest that an elevated Romberg ratio quotient, especially according to the sway area, is an indicator of poor walking and balance capabilities in PwMS.  相似文献   

12.
Postural sway is defined as the movement of a body's center of mass within the base of support to maintain postural equilibrium. Deficits in postural sway are present after ACL injury; however, current evidence linking it to future injury risk is unclear. The purpose of this study was to determine if postural sway deficits persist after ACL reconstruction (ACLR). The hypothesis tested was that after ACLR, patients who return to sport (RTS) would demonstrate differences in postural sway compared to control (CTRL) subjects. Fifty-six subjects with unilateral ACLR released to RTS, and 42 uninjured CTRL subjects participated. Dynamic postural sway was assessed and 3-way (2 × 2 × 2) ANOVA was used to analyze the variables. A side × group × sex (p = 0.044) interaction in postural sway was observed. A side × group analysis also revealed an interaction (p = 0.04) however, no effect of sex was observed (p = 0.23). Analysis within the ACLR cohort showed less (p = 0.001) postural sway on the involved side (1.82 ± 0.84°) versus the uninvolved side (2.07 ± 0.96°). No side-to-side differences (p = 0.73) were observed in the CTRL group. The involved limb of subjects after ACLR demonstrated the least postural sway. In conclusion, these findings indicate that dynamic postural sway may be significantly altered in a population of athletes after ACLR and RTS compared to CTRL subjects. Further investigation is needed to determine if deficits in postural sway can be used as an effective criterion to assist in the decision to safely RTS after ACLR.  相似文献   

13.
Specific patterns of pelvic and thorax motions are required to maintain stability during walking. This cross-sectional study explored older-adults’ gait kinematics and their kinematic adaptations to different walking speeds, with the purpose of identifying mechanisms that might be related to increased risk for falls. Fifty-eight older adults from self-care residential facilities walked on a treadmill, whose velocity was systematically increased with increments of 0.1 meters/second (m/s) from 0.5 to 0.9 m/s, and then similarly decreased. Thorax, pelvis, trunk, arms, and legs angular total range of motion (tROM), stride time, stride length, and step width were measured. Twenty-one of the subjects reported falling, and 37 didn’t fall. No significant effect of a fall history was found for any of the dependent variables. A marginally significant interaction effect of fall history and walking speed was found for arms’ tROM (p = 0.098). Speed had an effect on many of the measures for both groups. As the treadmill’s velocity increased, the non-fallers increased their arm (15.9 ± 8.6° to 26.6 ± 12.7°) and trunk rotations (4.7 ± 1.9° to 7.2 ± 2.8°) tROM, whereas for the fallers the change of arm (14.7 ± 14.8° to 20.8 ± 13°) and trunk (5.5 ± 2.9° to 7.3 ± 2.3°) rotations tROM were moderate between the different walking speeds. We conclude that walking speed manipulation exposed different flexibility trends. Only non-fallers demonstrated the ability to adapt trunk and arm ROM to treadmill speed i.e., had a more flexible pattern of behavior for arm and trunk motions, supporting the upper-body’s importance for stability while walking.  相似文献   

14.
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.  相似文献   

15.
The use of real-time biofeedback has been shown to enable individuals to make changes to their gait patterns. It remains unknown whether the short-term improvements reported in previous studies are retained in the longer term. In this study, the paradigm used to investigate the short and long-term effects of real-time biofeedback was modifying knee range of motion during gait to prevent knee hyperextension in women. The purpose of this study was to investigate the short-term (1-month follow up) and long-term (8-month follow up) effects of a gait retraining program using real-time biofeedback to correct knee hyperextension in young women. Seventeen healthy women, ages 18–35 years, with asymptomatic knee hyperextension underwent a three-week (6 sessions) treadmill gait retraining program. Real-time feedback of kinematic data (Visual 3D) was provided during treadmill training. Knee extension range of motion was monitored during overground gait evaluations and training sessions. Gait evaluations were performed pretraining, posttraining (2 days after), and 1-month, and 8-month after the last training session. This study showed significant reduction in knee hyperextension patterns immediately following training (mean ± SD, 10.9° ± 4°), and at 1-month (7.5° ± 5°) and 8-month (6.3° ± 3.5°) follow ups. There was an increase in knee extension between posttraining and 1-month follow up (3.4° ± 5°). Reduction in knee hyperextension range of motion was retained at 8-month follow up evaluation. The present study shows the effects of real-time biofeedback in facilitating the acquisition and retention of proficiency in reducing knee hyperextension gait patterns, documenting that the retention is sustained for up to 8 months.  相似文献   

16.
We investigated the effects of reduction in plantar skin temperature on gait. Thirty-four healthy subjects (20 men and 14 women; mean age 22.2 ± 2.5 years; mean height 166.8 ± 8.3 cm) walked 16 m under two different conditions – normal conditions (NC) with the skin at a basal temperature, and cold conditions (CC) after cooling of the plantar skin to about 15 °C. Wireless motion-recording sensor units were placed on the back at the level of L3 and on both heels to measure acceleration and angular velocity. Gait velocity and mean stride, stance and swing times were calculated. The variability of lower limb movement was represented by the coefficients of variation (CVs) of stride, stance and swing times, and that of trunk movement was represented by autocorrelation coefficients (ACs) in three directions (vertical: VT; mediolateral: ML; and anteroposterior: AP). Gait velocity was significantly lower under CC conditions than under NC (p < 0.0001). None of the temporal parameters were changed by plantar cooling. However, all parameters of gait variability were significantly worse under CC, and AC-VT, AC-ML, and AC-AP were significantly lower under CC than under NC, even after adjusting for gait velocity (p = 0.0005, 0.0071, and 0.0126, respectively). Our results suggest that reducing plantar skin temperature induces gait variability among healthy young adults. Further studies are now needed to explore the relationship between plantar skin temperature and gait in the elderly.  相似文献   

17.
Since the correlation between spinal and lower extremity alignments is high, high tibial osteotomy (HTO) surgery may also affect spinal alignment, where the spinal alignment parameters are the most important parameters for the evaluation of spinal disorders. In this study, the effect of HTO surgery on spinal alignment during gait was investigated by comparing spinal alignment parameters between patients with knee osteoarthritis (OA) and healthy young controls. Eight patients (age, 55.0 ± 5.1 years; height, 160.3 ± 7.0 cm; weight, 71.3 ± 14.1 kg) with a medial compartment knee OA participated in the gait experiment two times approximately one week before and one year after HTO surgery and eight healthy young controls (age, 26.7 ± 1.7 years; height, 163.4 ± 6.5 cm; weight, 58.4 ± 11.3 kg) participated only once. Cervical curvature angle, thoracic curvature angle, lumbar curvature angle, coronal vertical axis, and coronal pelvic tilt in the coronal plane and cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, and sagittal pelvic tilt in the sagittal plane were estimated using motion analysis system with skin markers. All spinal alignment parameters after HTO surgery were significantly closer to those of healthy young subjects than those before HTO, especially in the coronal plane. These findings suggest that the HTO had a positive effect on spinal alignment, as well as lower extremity alignment, and moreover, reduced the abnormality that may result in spinal problems such as degeneration or pain.  相似文献   

18.
ObjectiveWe aimed to study postural balance in preclinical Spinocerebellar ataxia type 1 (SCA1) mutation carriers to identify and observe specific motor functional deficit before evident clinical manifestation.MethodsParticipants were 9 asymptomatic SCA1 mutation carriers (6 M/3F), aged 31.8 ± 7 years (range 22–44), and 17 age-matched non-carrier controls (5 M/12F) (age 18–42). Subjects underwent postural tests on a force platform (Tetrax®-IBS, Sunlight Medical Ltd.) with and without visual feedback. Amount of body sway was represented by stability index (ST). Tests were repeated after 2- and 4-years. Estimated years to onset were calculated.ResultsIn controls, ST was unchanged from baseline to 4-year evaluations in all standing conditions. SCA1 mutation carriers performed similarly to controls in the postural tasks with open eyes, whereas in conditions without visual feedback SCA1 carriers had significantly higher ST than controls at all longitudinal evaluations. Close-to-disease onset carriers (≤7years) showed more prominent time-dependent stance abnormalities (p < 0.0001 for all comparisons).ConclusionsTraceable and progressive postural abnormalities can be observed in preclinical close-to-onset SCA1 carriers. Quantitative analysis of stance could represent a promising outcome measure in clinical trials including preclinical subjects.  相似文献   

19.
Increased anterior pelvic and trunk tilt is a common finding in patients with bilateral cerebral palsy especially during walking with assistive devices. As previous studies demonstrate various gait alterations when using assistive devices, the assessment of surgical interventions may be biased when the patients become independent of (or dependent on) assistive devices after therapy. Furthermore, some of these patients in fact are able to walk without devices even though in daily life they prefer to use them. Consequently, for such patients the classification into GMFCS level II or III may be ambiguous. The specific aim of this study was therefore to assess the influence of the use of forearm crutches and posterior walker during walking and to set this influence in relation to outcome effects of surgical intervention studies.26 ambulatory patients with spastic bilateral CP (GMFCS II–III) were included who underwent 3D gait analysis. All patients used forearm crutches or posterior walkers in everyday life even though they were able to walk without assistive devices for short distances.Independent of the type of assistive devices, the patients walk on average with more anterior trunk tilt and pelvic tilt (7° ± 6° and 3° ± 2°) and with a maximum ankle dorsiflexion decreased by 2° (±3°) when walking with assistive devices, enhancing the mal-positioning present without device. Oppositely, the knees on average are more extended by 6° (±4°) when using the assistive devices.These effects have to be taken into account when assessing gait patterns or when monitoring the outcome after intervention as assistive devices may partially hide or exaggerate therapeutic effects.  相似文献   

20.
PurposeTo evaluate the effect of ocular dominance on balance performance in healthy adult subjects.MethodsOcular dominance was determined in 24 healthy subjects using the hole-in-the-paper test. Balance function was evaluated by computerized dynamic platform posturography (CDPP). Sway index (SI), antero-posterior sway (APS) and lateral sway (LS) were served as outcome parameters.ResultsThe outcome parameters did not differ significantly between dominant and non-dominant eye fixation both in static and angular balance tests (SI—5.47 ± 0.42, 6.23 ± 0.52, p = 0.146 and 18.4 ± 1.07, 19.11 ± 1.15, p = 0.142, respectively; APS—?2.26 ± 4.68, ?5.1 ± 4.6, p = 0.082 and ?1.94 ± 3.33, ?3.64 ± 2.6, p = 0.48, respectively; LS—?1.21 ± 1.46, ?1.12 ± 1.66 p = 0.94 and ?1.98 ± 1.16, ?1.55 ± 1.39, p = 0.69, respectively).ConclusionsOcular dominance does not seem to affect postural function in the monovision and far viewing condition.  相似文献   

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