Executive dysfunction and attention contribute to gait interference in ‘off’ state Parkinson's Disease

Motor and cognitive processes are required for successful ‘real world’ walking. We explored the specific contribution of motor function, executive function, and attention to functional gait performance in people with Parkinson's Disease (PD) when ‘off’ medication. Twenty-nine people with PD wearing an accelerometer were tested in their home whilst walking under four task conditions. Explanatory characteristics included age, motor function, executive function, sustained attention and divided attention. Repeated measures ANOVA compared gait speed under different task conditions. Multiple regression analysis explored the effect of characteristics on gait speed and gait interference (difference between dual and single task). Gait performance deteriorated under complex conditions (F = 51.0, P < .001). Motor function and attention explained up to 65% variance in gait speed. Motor function, attention and executive function explained up to 66% variance in gait interference. Sustained attention explained up to 10% variance in gait speed; executive function explained up to 21% variance in gait interference and divided attention explained up to 22% variance in gait interference. Motor function, executive function and attention contribute to gait speed and gait interference in PD during a functional walking task whilst ‘off’ medication. When both executive function and attention are included as explanatory variables, attention discriminates gait performance more effectively. Whilst both contribute to functional gait, they are used selectively to optimise performance for different conditions and to meet complex task requirements.     

Spatial and temporal gait characteristics of elderly individuals during backward and forward walking with shoes and barefoot

Backward walking (BW) is an inherent component of mobility and function in daily activities, particularly indoors, when it is more likely that a person is barefoot. No studies to date have compared the spatio-temporal characteristics of BW with and without shoes in elderly individuals.This study compared spatio-temporal measures of BW and forward walking (FW) among elderly individuals while barefoot or wearing shoes. Forty-seven elderly individuals (13 men and 34 women, 76.7 ± 7.7 years of age) were evaluated. Participants were requested to walk at a comfortable, self-selected pace across the GAITRite^® walkway for three trials under each of four conditions: walking forward (FW) and BW wearing their own comfortable low-heeled walking shoes and FW and BW walking without shoes. Gait speed, stride length and cadence were significantly reduced in BW versus FW, with an increase in double limb support (DLS), both with and without shoes. Barefoot BW resulted in significantly increased gait speed and cadence, and decreased DLS compared to BW with shoes. BW stride length was not affected by footwear. While barefoot FW was also associated with a significant increase in cadence and decrease in DLS time compared to walking with shoes, it decreased stride length and had no detrimental effect on gait speed. Assessment of the spatio-temporal parameters of walking barefoot and with shoes during FW and BW can contribute to our understanding of the ability of elderly individuals to adapt to changing walking conditions, and should be included in the assessment of functional mobility of elderly individuals.     

Cognitive motor interference during dual-task gait in essential tremor

BackgroundFunctional ambulation requires concurrent performance of motor and cognitive tasks, which may create interference (degraded performance) in either or both tasks. People with essential tremor (ET) demonstrate impairments in gait and cognitive function. In this study we examined the extent of interference between gait and cognition in people with ET and controls during dual-task gait.MethodsWe tested 62 controls and 151 ET participants (age range: 72–102). ET participants were divided into two groups based on median score on the modified Mini Mental State Examination. Participants walked at their preferred speed, and performed a verbal fluency task while walking. We analyzed gait velocity, cadence, stride length, double support time, stride time, step width, step time difference, coefficient of variation (CV) of stride time and stride length.ResultsVerbal fluency performance during gait was similar across groups (p = 0.68). Velocity, cadence and stride length were lowest whereas step time difference (p = 0.003), double support time (p = 0.009), stride time (p = 0.002) and stride time CV (p = 0.007) were highest for ET participants with lower cognitive scores (ETp-LCS), compared with ET participants with higher cognitive scores (ETp-HCS) and controls. ETp-LCS demonstrated greatest interference for double support time (p = 0.005), step time difference (p = 0.013) and stride time coefficient of variation (p = 0.03).ConclusionsETp-LCS demonstrated high levels of cognitive motor interference. Gait impairments during complex tasks may increase risk for falls for this subgroup and underscore the importance of clinical assessment of gait under simple and dual-task conditions.     

Shod wear and foot alignment in clinical gait analysis

Sagittal plane alignment of the foot presents challenges when the subject wears shoes during gait analysis. Typically, visual alignment is performed by positioning two markers, the heel and toe markers, aligned with the foot within the shoe. Alternatively, software alignment is possible when the sole of the shoe lies parallel to the ground, and the change in the shoe’s sole thickness is measured and entered as a parameter. The aim of this technical note was to evaluate the accuracy of visual and software foot alignment during shod gait analysis. We calculated the static standing ankle angles of 8 participants (mean age: 8.7 years, SD: 2.9 years) wearing bilateral solid ankle foot orthoses (BSAFOs) with and without shoes using the visual and software alignment methods. All participants were able to stand with flat feet in both static trials and the ankle angles obtained in BSAFOs without shoes was considered the reference. We showed that the current implementation of software alignment introduces a bias towards more ankle dorsiflexion, mean = 3°, SD = 3.4°, p = 0.006, and proposed an adjusted software alignment method. We found no statistical differences using visual alignment and adjusted software alignment between the shoe and shoeless conditions, p = 0.19 for both. Visual alignment or adjusted software alignment are advised to represent foot alignment accurately.     

3D gait analysis with and without an orthopedic walking boot

IntroductionOrthopedic walking boots have been widely used in place of traditional fiberglass casts for a variety of orthopedic injuries and post-surgical interventions. These walking boots create a leg length discrepancy (LLD). LLD has been shown to alter the kinematics and kinetics of gait and are associated with lumbar and lower limb conditions such as: foot over pronation, low back pain, scoliosis, and osteoarthritis of the hip and knee joints. Past gait analyses research with orthopedic boots is limited to findings on the ipsilateral limb. Thus, the purpose of the study was to examine bilateral gait kinematics & kinetics with and without a walking boot.MethodsForty healthy participants (m = 20, f = 20, age 20.7 ± 1.8 yrs., ht. 171.6 ± 9.5 cm, wt. 73.2 ± 11.0 kg, BMI 24.8 ± 3.2) volunteered. An eight camera Vicon Motion Capture System with PIG model and two AMTI force plates were utilized to record the walking trial conditions: (1) bilateral tennis shoes (2) boot on right foot, tennis shoe on left foot (3) boot on right foot, barefoot on left foot. Data were processed in Nexus 2.2.3 and exported to Visual 3D for analysis.ResultsWhen wearing the boot, there were significant differences in most joint angles and moments, with larger effects on long limb.ConclusionThe walking boot alters the gait in the same way as those with existing LLD, putting them at risk for development of secondary knee, hip, and low back pain during treatment protocol.     

The effect of a dual task on gait speed in community dwelling older adults: A systematic review and meta-analysis

Background and purposeReduced walking speed in older adults is associated with adverse health outcomes. This review aims to examine the effect of a cognitive dual-task on the gait speed of community-dwelling older adults with no significant pathology affecting gait.Data sources and study selectionElectronic database searches were performed in, Web of Science, PubMed, SCOPUS, Embase and psychINFO. Eligibility and methodological quality was assessed by two independent reviewers. The effect size on gait speed was measured as the raw mean difference (95% confidence interval) between single and dual-task performance. Pooled estimates of the overall effect were computed using a random effects method and forest plots generated.Data extraction and data synthesis22 studies (27 data sets) with a population of 3728 were reviewed and pooled for meta-analysis. The mean walking speed of participants included in all studies was >1.0 m/s and all studies reported the effect of a cognitive dual-task on gait speed. Sub-analysis examined the effect of type of cognitive task (mental-tracking vs. verbal-fluency). Mean single-task gait speed was 1.21 (0.13) m/s, the addition of a dual-task reduced speed by 0.19 m/s to 1.02 (0.16) m/s (p < 0.00001), both mental-tracking and verbal-fluency tasks resulted in significant reduction in gait speed.Limitations and conclusionThe cross-sectional design of the studies made quality assessment difficult. Despite efforts, high heterogeneity remained, possibly due to participant characteristics and testing protocols. This meta-analysis shows that in community-dwelling older adults, the addition of a dual-task significantly reduces gait speed and may indicate the value of including dual-task walking as part of the standard clinical assessment of older people.     

Biomechanics of slow running and walking with a rocker shoe

Evidence suggests a link between the loading of the Achilles tendon and the magnitude of the ankle internal plantar flexion moment during late stance of gait, which is clinically relevant in the management of Achilles tendinopathy. Some studies showed that rocker shoes can reduce the ankle internal plantar flexion moment. However, the existing evidence is not conclusive and focused on walking and scarce in running. Sixteen healthy runners participated in this study. Lower extremity kinetics, kinematics and electromyographic (EMG) signals of triceps surae and tibialis anterior were quantified for two types of shoes during running and walking. The peak ankle plantar flexion moment was reduced significantly in late stance of running (0.27 Nm/kg; p < 0.001) and walking (0.24 Nm/kg; p < 0.001) with the rocker shoe compared to standard shoe. The ankle power generation and plantar flexion moment impulse were also reduced significantly when running and walking with the rocker shoe (p < 0.001). No significant changes in the knee and hip moments were found in running and walking. A significant delay of the EMG peak, approximately 2% (p < 0.001), was present in the triceps surae when walking with rocker shoes. There were no significant changes in the EMG peak amplitude of triceps surae in running and walking. The peak amplitude of tibialis anterior was significantly increased (64.7 μV, p < 0.001) when walking with rocker shoes. The findings show that rocker shoes reduce the ankle plantar flexion moment during the late stance phase of running and walking in healthy people.     

Long-term effects of adolescent concussion history on gait,across age

The aim of this study was to examine the possible long-term effects of high school concussion history on gait performance across the lifespan. Individuals with and without a concussion history were grouped into 20-year-old (yo) (n = 40), 40yo (n = 19), and 60yo (n = 18) age groups. Participants completed five trials of four walking conditions: a normal walk, a dual task walk, an obstructed walk, and an obstructed, dual task walk. Spatiotemporal gait parameters for gait analyses during single and dual task conditions. Gait velocity, step width, stride length, percent of time in double support, and obstacle toe clearance were the gait variables assessed along with number correct from dual task. Gait was analyzed via optical motion capture. Data were analyzed by two-factor, multivariate ANOVAs and significant interactions were explored using post hoc contrasts. A significant (F = 2.62, p = 0.03) interaction was observed for the obstructed walk condition. Further analyses yielded no significant concussion history and control group differences, within age. The data indicate that an adolescent concussion history has a non-observable effect on gait across the lifespan.     

Can people with Parkinson's disease improve dual tasking when walking?

BackgroundGait disorders in people with Parkinson's disease (PD) are accentuated when they perform another task simultaneously. This study examines whether practice enables people with PD to walk with large steps while performing added tasks, and to determine if training people with PD to walk with added working memory tasks leads to improvements in gait when walking and performing other tasks simultaneously.MethodsWalking patterns were recorded pre and post a 20 min dual task training session in 20 people with PD. Participants performed a series of 10 m walking trials under seven conditions: gait only, and with six different added tasks varying by task type (e.g. motor, cognitive), domain (e.g. postural, manual manipulation, language, calculation, auditory, visuospatial), and difficulty level. Dual task training aimed to improve step length while simultaneously undertaking a variety of language and counting working memory tasks that were different to those used in assessment.ResultsFollowing training, step length increased when performing five of the six added tasks, indicating transfer of dual task training when walking occurred across task types and domains. Improvements in gait speed occurred in three of the six added tasks. When other gait variables were examined, such as step length variability, few improvements with training were found.ConclusionsTraining can lead to larger steps when walking under dual task conditions in people with PD. The gait variable emphasised during dual task training appears to be an important factor in enabling the transfer of training improvements across tasks.     

Bracing the trunk and neck in young adults leads to a more aged-like gait

Older individuals typically walk at slower speeds, with shorter step lengths, greater step widths and spend a larger proportion of the gait cycle in double stance. Changes in neck and trunk mobility may underlie some of the changes in walking seen with increasing age. Consequently, this study was designed to assess whether externally increasing trunk/neck stiffness in young adults leads to similar changes in gait pattern observed with aging. Twelve young adults (20–29 years), sixteen old adults (60–69 years) and fifteen older adults (70–79 years) walked across a 20′ pressure sensitive GAITRite© instrumented walkway at their preferred speed. The young adults also walked under three bracing conditions: (1) Neck braced, (2) Trunk braced, and (3) Neck and Trunk braced. The results revealed that the old and older age groups walked significantly slower, with a shorter step length and with a narrower base of support (p’s < 0.05) compared to the young adults. In young adults, combined neck and trunk bracing led to reduced walking speed, shorter step length, wider base of support and a larger proportion of the gait cycle spent in double stance (p’s < 0.05). The walking speed and step length of older adults remained less than fully braced young adults (p’s < 0.05). Overall these results indicate that artificially stiffening the trunk and neck of young individuals leads to systematic gait changes similar to aging. Consequently, age-related changes in mobility of the neck and torso may in part contribute to the decrements in walking seen for older adults.     

Meaningful change in measures of gait variability in older adults

ObjectivesGait variability is an important indicator of impaired mobility in older adults; however, little is known about the meaning of change in gait variability over time. This study estimated clinically meaningful change in measures of gait variability using both distribution- and anchor-based approaches.DesignCommunity-based observational cohort study.SettingBronx County and the research center at Albert Einstein College of Medicine.ParticipantsOf 1148 participants in the Einstein Aging Study, 241 had quantitative gait assessments in two consecutive years between 2001 and 2005.MeasurementsGait variables were collected using a 12-foot instrumented walkway as participants walked at their normal walking speed. Gait variability was defined as the within-person standard deviation (SD) across steps in two 12-foot walks. Distribution-based meaningful change estimates used Cohen's effect size (0.2 for small and 0.5 for moderate effects). Anchor-based estimates were obtained using dichotomous and ordinal self-reported walking ability ratings as anchors.ResultsDistribution-based estimates for small and substantial changes of variability measures were: stance time 0.005 and 0.014 s; swing time 0.003 and 0.009 s; step length 0.24 and 0.61 cm; and step width 0.03 and 0.08 cm. Among those reporting no change in walking ability, measures of gait variability were stable over 1 year. Among those reporting a decline in walking, stance time and swing time variability increased. Among those reporting an improvement in walking, only step length variability improved.ConclusionPreliminary criteria for meaningful change are 0.01 s for stance time and swing time variability and 0.25 cm for step length variability. These estimates may identify important changes over time in both clinical settings and research studies.     

Variability of gait,bilateral coordination,and asymmetry in women with fibromyalgia

PurposeTo analyze how fibromyalgia affected the variability, asymmetry, and bilateral coordination of gait walking at comfortable and fast speeds.Methods65 fibromyalgia (FM) patients and 50 healthy women were analyzed. Gait analysis was performed using an instrumented walkway (GAITRite system). Average walking speed, coefficient of variation (CV) of stride length, swing time, and step width data were obtained and bilateral coordination and gait asymmetry were analyzed.ResultsFM patients presented significantly lower speeds than the healthy group. FM patients obtained significantly higher values of CV_StrideLength (p = 0.04; p < 0.001), CV_SwingTime (p < 0.001; p < 0.001), CV_StepWidth (p = 0.004; p < 0.001), phase coordination index (p = 0.01; p = 0.03), and p_CV (p < 0.001; p = 0.001) than the control group, walking at comfortable or fast speeds. Gait asymmetry only showed significant differences in the fast condition.ConclusionFM patients walked more slowly and presented a greater variability of gait and worse bilateral coordination than healthy subjects. Gait asymmetry only showed differences in the fast condition. The variability and the bilateral coordination were particularly affected by FM in women. Therefore, variability and bilateral coordination of gait could be analyzed to complement the gait evaluation of FM patients.     

Carotid flow pulsatility is higher in women with greater decrement in gait speed during multi-tasking

AimCentral arterial hemodynamics is associated with cognitive impairment. Reductions in gait speed during walking while performing concurrent tasks known as dual-tasking (DT) or multi-tasking (MT) is thought to reflect the cognitive cost that exceeds neural capacity to share resources. We hypothesized that central vascular function would associate with decrements in gait speed during DT or MT.MethodsGait speed was measured using a motion capture system in 56 women (30–80y) without mild-cognitive impairment. Dual-tasking was considered walking at a fast-pace while balancing a tray. Multi-tasking was the DT condition plus subtracting by serial 7′s. Applanation tonometry was used for measurement of aortic stiffness and central pulse pressure. Doppler-ultrasound was used to measure blood flow velocity and β-stiffness index in the common carotid artery.ResultsThe percent change in gait speed was larger for MT than DT (14.1 ± 11.2 vs. 8.7 ± 9.6%, p < 0.01). Tertiles were formed based on the percent change in gait speed for each condition. No vascular parameters differed across tertiles for DT. In contrast, carotid flow pulsatility (1.85 ± 0.43 vs. 1.47 ± 0.42, p = 0.02) and resistance (0.75 ± 0.07 vs. 0.68 ± 0.07, p = 0.01) indices were higher in women with more decrement (third tertile) as compared to women with less decrement (first tertile) in gait speed during MT after adjusting for age, gait speed, and task error. Carotid pulse pressure and β-stiffness did not contribute to these tertile differences.ConclusionElevated carotid flow pulsatility and resistance are characteristics found in healthy women that show lower cognitive capacity to walk and perform multiple concurrent tasks.     

The reasons why stroke patients expend so much energy to walk slowly

BackgroundThe energy consumed per covered distance (C) is increased in hemiparetic stroke adults during walking.ObjectiveTo ascertain if increased C in stroke patients is a result of increased mechanical work, of decreased efficiency of work production by muscles or of slow walking speed.MethodsC and mechanical work were computed in 20 patients walking on a force measuring treadmill at speeds ranging from 1 km h^?1 to their own maximum speed (WS_MAX). Works done by healthy and pathological limbs were computed separately.ResultsFor hemiparetic patients, C was around 1.7 times greater than normal. When these patients had a slower WS_MAX, they had greater C and mechanical work (r = ?0.44 and ?0.57, respectively). The increased C was related to the external work performed to lift the center of body mass when the healthy limb was supporting the body weight (r = 0.77).ConclusionsThe increase of C in stroke patients is more pronounced when WS_MAX is slow. Moreover, this increase is related to increased mechanical work done by muscles and is not related to slow walking speed or decreased efficiency. As in healthy subjects, C and external work presented optimum speeds, indicating a preserved pendular mechanism of walking.     

The interacting effect of cognitive and motor task demands on performance of gait,balance and cognition in young adults

Mobility limitations and cognitive impairments, each common with aging, reduce levels of physical and mental activity, are prognostic of future adverse health events, and are associated with an increased fall risk. The purpose of this study was to examine whether divided attention during walking at a constant speed would decrease locomotor rhythm, stability, and cognitive performance. Young healthy participants (n = 20) performed a visuo-spatial cognitive task in sitting and while treadmill walking at 2 speeds (0.7 and 1.0 m/s).Treadmill speed had a significant effect on temporal gait variables and ML-COP excursion. Cognitive load did not have a significant effect on average temporal gait variables or COP excursion, but variation of gait variables increased during dual-task walking. ML and AP trunk motion was found to decrease during dual-task walking. There was a significant decrease in cognitive performance (success rate, response time and movement time) while walking, but no effect due to treadmill speed. In conclusion walking speed is an important variable to be controlled in studies that are designed to examine effects of concurrent cognitive tasks on locomotor rhythm, pacing and stability. Divided attention during walking at a constant speed did result in decreased performance of a visuo-spatial cognitive task and an increased variability in locomotor rhythm.     

Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole

The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0 cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe + sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.     

Effects of dual task on turning ability in stroke survivors and older adults

BackgroundTurning is an integral component of independent mobility in which stroke survivors frequently fall.ObjectiveThis study sought to measure the effects of competing cognitive demands on the stepping patterns of stroke survivors, compared to healthy age-match adults, during turning as a putative mechanism for falls.MethodsWalking and turning (90°) was assessed under single (walking and turning alone) and dual task (subtracting serial 3 s while walking and turning) conditions using an electronic, pressure-sensitive walkway. Dependent measures were time to turn, variability in time to turn, step length, step width and single support time during three steps of the turn. Turning ability in single and dual task conditions was compared between stroke survivors (n = 17, mean ± SD: 59 ± 113 months post-stroke, 64 ± 10 years of age) and age-matched healthy counterparts (n = 15).ResultsBoth groups took longer, were more variable, tended to widen the second step and, crucially, increased single support time on the inside leg of the turn while turning and distracted.ConclusionsIncreased single support time during turning may represent biomechanical mechanism, within stepping patterns of turning under distraction, for increased risk of falls for both stroke survivors and older adults.     

Effects of dual task on turning ability in stroke survivors and older adults

BackgroundTurning is an integral component of independent mobility in which stroke survivors frequently fall.ObjectiveThis study sought to measure the effects of competing cognitive demands on the stepping patterns of stroke survivors, compared to healthy age-match adults, during turning as a putative mechanism for falls.MethodsWalking and turning (90°) was assessed under single (walking and turning alone) and dual task (subtracting serial 3 s while walking and turning) conditions using an electronic, pressure-sensitive walkway. Dependent measures were time to turn, variability in time to turn, step length, step width and single support time during three steps of the turn. Turning ability in single and dual task conditions was compared between stroke survivors (n = 17, mean ± SD: 59 ± 113 months post-stroke, 64 ± 10 years of age) and age-matched healthy counterparts (n = 15).ResultsBoth groups took longer, were more variable, tended to widen the second step and, crucially, increased single support time on the inside leg of the turn while turning and distracted.ConclusionsIncreased single support time during turning may represent biomechanical mechanism, within stepping patterns of turning under distraction, for increased risk of falls for both stroke survivors and older adults.     

Attentional requirements of walking according to the gait phase and onset of auditory stimuli

A dual-task paradigm was used to examine the influence of an attention demanding cognitive task on each phase of gait. Twenty-three participants (aged 18–27) walked on a treadmill at a 20% increase of their self-selected speed, either alone or while performing a cognitive task. Muscle activity was measured with electromyography (iEMG) for eight muscles of the dominant leg. The cognitive task consisted of subtracting one (EASY) or seven (HARD) from aurally presented numbers. Reaction time (RT) and accuracy were recorded. iEMG events were selected according to stimulus onset (0–150 ms, 150–300 ms and 300–450 ms) prior to phases of gait (double-leg stance, single-leg stance and swing). There was a decrease in iEMG amplitude of fibularis longus (p = .013) and a trend in the same direction for vastus lateralis (p = .065) while walking and performing the cognitive task. When stimulus onset was considered, iEMG of medial gastrocnemius (p = .021) and lateral gastrocnemius (p = .004) were reduced during single-leg stance, when stimuli occurred between 300 and 450 ms prior to this phase. Cognitive performance was affected by task difficulty (RT, accuracy) and by dual-task load (RT). Dual-task costs were observed in both the motor and the cognitive tasks, suggesting that walking requires attention. There was a specific moment (300 ms after stimulus onset) during single-leg stance when dual-task costs were most pronounced, corroborating supraspinal involvement in the control of normal walking. Time-based approaches should be considered when analyzing attentional demands of a dynamic task such as gait.     

The association between intersegmental coordination in the lower limb and gait speed in elderly females

Human multi-segmental motion is a complex task requiring motor coordination. Uncoordinated motor control may contribute to the decline in mobility; however, it is unknown whether the age-related decline in intersegmental coordination relates to the decline in gait performance. The aim of this study was to clarify the association between intersegmental coordination and gait speed in elderly females. Gait measurements were performed in 91 community-dwelling elderly females over 60 years old. Foot, shank, and thigh sagittal motions were assessed. Intersegmental coordination was analyzed using the mean value of the continuous relative phase (mCRP) during four phases of the gait cycle to investigate phase differences in foot–shank and shank–thigh motions during a normal gait. The results showed that foot–shank mCRP at late stance had negative correlations with gait speed (r = −0.53) and cadence (r = −0.54) and a positive correlation with age (r = 0.25). In contrast, shank–thigh mCRP at late stance had positive correlations with gait speed (r = 0.37) and cadence (r = 0.56). Moreover, partial correlation, controlling age, height, and weight, revealed that foot–shank mCRP at late stance had negative correlations with gait speed (r = −0.52) and cadence (r = −0.54). Shank–thigh mCRP at late stance had a positive correlation with gait speed (r = 0.28) and cadence (r = 0.51). These findings imply that the foot–shank and shank–thigh coordination patterns at late stance relate to gait speed, and uncoordinated lower limb motion is believed to be associated with the age-related decline in cadence.