A comparison of young children’s spatiotemporal measures of walking and running in three common types of footwear compared to bare feet

BackgroundClinicians and footwear manufacturers often advise young children to wear soft-soled footwear when they are first learning to walk. There is limited evidence as to why this advice is given, and if soft-soled shoes are as close to barefoot as thought.Research questionWhat are the differences in spatiotemporal measures of gait during walking and running in three common types of children’s footwear with a soft-soled compared to barefoot in young children?MethodsThe study used a quasi-experimental design, with the condition order randomised using a Latin square sequence. Forty-seven children were recruited (2 - 4 years). Participants walked or ran the length of a GAITrite mat in a randomized order for barefoot and soft-soled sneaker, boot and sandal conditions. Linear regression analyses were used to investigate the main effect of each soft-soled footwear compared to bare feet in the different gait parameters.ResultsFor walking and running trials, cadence decreased whereas step time and stride length increased in all footwear types compared to the barefoot condition. While wearing sneakers and sandals increased the stance percentage for walking and running trials, compared to barefoot, this difference was only apparent during the running trial for the boots. Likewise, although double support time increased for both the boots and sneakers in walking and running, compared to barefoot, this difference was only observed in the sandals during walking.SignificanceThis research found that various types of soft-soled footwear impacted gait compared to the barefoot condition, with some differences seen between walking and running trials. These findings challenge the assumption that soft-soled footwear facilitate a similar gait to barefoot walking and running, although the clinical significance of these differences is unknown.     

Increased knee flexion and varus moments during gait with high-heeled shoes: A systematic review and meta-analysis

BackgroundHigh-heeled shoes have been thought to alter lower extremity joint mechanics during gait, however its effects on the knee remain unclear.Research questionThis systematic review and meta-analysis aimed to determine the effects of high-heeled shoes on the sagittal- and frontal-plane knee kinetics/kinematics during gait.Methods1449 studies from 6 databases were screened for the following criteria: 1) healthy adult females, 2) knee joint kinematics/kinetics reported for the early stance phase during gait under varying shoe heel heights (including barefoot). Excluded studies included those mixing different shoe styles in addition to altering the heel heights. A total of 14 studies (203 subjects) met the selection criteria, resulting in 51 and 21 Cohen’s d effect sizes (ESs) comparing the differences in knee sagittal- (flexion) and frontal-plane (varus) moment/angle, respectively, between shoes with higher heels and shoes with lower heels/barefoot.ResultsMeta-analyses yielded a significant medium-to-large effect of higher heels compared to lower heels on increasing knee flexion moment (overall ES = 0.83; P < 0.01), flexion angle (overall ES=0.46; P < 0.01), and varus moment (overall ES=0.52; P < 0.01) during the early stance phase of gait. The results of meta-regressions used to explore factors explaining the heterogeneity among study ESs revealed that a greater ES in the knee flexion moment was associated with an elevated heel height of the high-heeled shoes (P = 0.02) and greater body mass of the individuals (P = 0.012). A greater ES in the knee varus moment during high-heeled gait was associated with a greater body height (P = 0.003) and mass (P = 0.006).SignificanceGiven the association between increased knee flexion/varus moments and risk of developing knee osteoarthritis (OA), women who wear high-heel shoes frequently and for a long period may be more susceptible to knee OA. Preventive treatments, such as lower extremity muscle strengthening, may help improve shock absorption to decrease knee loading in high-heel users.     

Spatial and temporal gait parameters in Alzheimer's disease and aging

Spatial and temporal gait parameters in 40 patients with early Alzheimer's disease (AD) were compared to that of 34 normal controls (NC) on a level ground and on a treadmill. Over-ground velocity, cycle-time, cadence, stride-length, stride-width and double-support time were captured on an electronic walkway. On the treadmill, cadence, cycle-time and double-support time were recorded at a preferred velocity using footswitches. The AD group were significantly slower on the Timed Up and Go task compared to NC (p < 0.05). AD patients differed significantly from the NC on their over-ground gait velocity (99 ± 19 cm/s vs 119 + 15 cm/s, p < 0.001), cadence (101 ± 9 steps/min vs 109 ± 9 steps/min, p = 0.001) and stride-length (118 ± 18 cm vs 131 ± 17 cm, p < 0.01). On the treadmill, only preferred speed was significantly different in the AD group compared to the NC group (60 ± 20 cm/s vs 74 ± 23 cm/s, p = 0.02). These results indicate that patients with early AD walk slower and with shorter strides than healthy older adults.     

Functional characterization of plantar pressure patterns in gait of typically developing children using dynamic pedobarography

BackgroundAbnormal foot posture is a common complaint presented in pediatric and pediatric orthopedic clinics. Functional, objective assessment of foot posture, with the potential for early identification of pathologic foot deformities, has, however, been lacking to date. While quantifying functional and regional impulses via dynamic pedobarography can improve the clinical assessment of children’s feet, normative values have not yet been reported or characterized.Research QuestionThe objectives of this study were to: (1) quantify and characterize the pattern and spectrum of foot impulses in walking-aged, typically developing children; and (2) compare these to impulses from non-disabled adults.MethodsFoot impulses of 102 participants (52 female) in five pre-determined age groups (2−3, 4–6, 7–10, 11−14, 15−17 years) were examined using dynamic pedobarography. Each pressure map (3 per foot per child) was divided according to anatomical foot regions: the hallux, heel, medial forefoot, lateral forefoot, lesser toes (D2 to D5), and midfoot. The impulse was calculated for each region and used to generate regional percent impulses and impulse ratios to assess anteroposterior and mediolateral balance within the foot.ResultsThe impulse through the midfoot was highest in the youngest age group, with a corresponding lower impulse through the medial forefoot. As age advanced, the midfoot impulse decreased (p = 0.001), and the forefoot balance shifted slightly more medially (%Medial Forefoot: p = 0.004; Medial-Lateral Forefoot Balance: p = 0.019). When compared to adults, there were no significant differences between 15−17 year old children and adults in any of the regional percent impulses and impulse ratios. This indicates that skeletal maturity of the foot by late adolescence results in functional characteristics seen in adults.SignificanceThe age-standardized norms of functional and regional impulse measures in children reported in this study can be used as a comparative benchmark in the clinical assessment of children presenting with various foot deformities.     

Variability of centre of pressure movement during gait in young and middle-aged women

The variability of the centre of pressure (COP) movement is a tool that is often used for stability assessments during standing; however, this variable can provide relevant findings during dynamic conditions, which are more related to fall risks. The aim of this study was to investigate age-related differences in the variability of COP movement. Healthy young (younger group – 25 subjects, age 22.2 ± 1.8 years) and middle-aged (elder group – 25 subjects, age 56.6 ± 4.9 years) females participated in this study. The ground reaction forces and COP movement during walking at a self-selected speed were recorded using two force platforms. Each stance phase was divided into four subphases: loading response (LR), mid-stance (MSt), terminal stance (TSt) and preswing (PS). Standard deviations of the medial–lateral, anterior–posterior and total COP displacements were assessed. For statistical comparisons, one-way ANOVA and the Bonferroni post-hoc test were used. These results showed significantly higher COP movement variability in selected variables in the PS, LR and MSt subphases in the elder group (p < 0.05) compared with the younger group; no differences were found in the TSt subphase. A comparison of the subphases within the groups revealed significant differences (p < 0.001 for all cases and both groups) between the parameters in the LR × MSt, LR × TSt, MSt × PS and TSt × PS subphases. The LR and PS subphases showed significantly higher values for the variability parameters.     

Differences in predictors for gait speed and gait endurance in Parkinson’s disease

IntroductionBoth gait speed and gait endurance directly impact independence and community engagement for individuals with Parkinson’s disease (PD). However, factors accounting for variability in gait speed and gait endurance performance are unclear. The purpose of this study was to investigate whether key factors associated with gait speed in individuals with PD also predicted gait endurance.MethodsCommunity dwelling ambulatory individuals with PD were recruited for a single session. Key measures included 10 Meter Walk Test (10MWT) and 6 Minute Walk Test (6MWT) and key factors: age, disease severity [Movement Disorders Society United Parkinson’s Disease Rating Scale (motor scale only) (MDS-UPDRS motor)], plantar flexor strength [Calf Raise Senior (CRS)], fatigue [Fatigue Severity Scale (FSS)], cognition [Montreal Cognitive Assessment (MoCA)], and balance [Four Square Step Test (FSST)]. Multiple linear regression analyses were conducted to determine clinical relationships.ResultsSeventy-two individuals with PD (mean (standard deviation) (age = 70.83 (7.91) years; 50 males; MDS-UPDRS motor = 30.67 (13.50)) completed all assessments. The model predicting gait speed was significant, F(6, 65) = 15.143, p <.001, accounting for 54 % of the variance. Of the predictor variables age, MDS-UPDRS motor, CRS, MoCA and FSST scores were significant predictors. The model predicting gait endurance was significant, F(6, 65) = 15.608, p <.001, accounting for 55 % of the variance. Of the predictor variables, age, MDS-UPDRS motor scale, and CRS scores were significant predictors.DiscussionGait speed and gait endurance are similarly influenced by age, motor impairment, and plantarflexion strength. However, cognition and balance were predictors only of gait speed, which may suggest unique task differences exist between gait speed and gait endurance.     

Changes in lower limb biomechanics when following floor-projected foot placement visual cues for gait rehabilitation

BackgroundLately, the projection of foot placement visual cues onto the floor has been considered for use in gait rehabilitation. While promising, this approach needs further basic assessment to ensure proper uses.Research questionDoes following floor-projected foot placement visual cues of one’s natural walking pattern induce gait mechanics changes immediately or after a practice period?MethodsGait mechanics data from fifteen healthy individuals (7 female, 25.4 ± 5.0 years, 21.5 ± 1.68 kg/m²) was collected during normal walking without visual cues, and during two testing phases (immediate and after 45−60 min of practice) of walking with floor-projected visual cues depicting their normal spatial parameters. Magnitudes and variabilities of spatial gait parameters and sagittal plane lower limb kinematics and kinetics were compared between the three testing phases using repeated measures ANOVA and post-hoc paired t-tests.ResultsCompared to normal walking without foot placement visual cues, there was a statistically significant (p < 0.05) increase in stride length (maximum change of 0.01 ± 0.01 m), stance phase knee flexion (2.0 ± 2.5°), and swing phase hip flexion (1.2 ± 1.3°) in both immediate and post-practice testing phases, along with an increase in terminal stance hip (0.28 ± 0.38 %BW*Ht) and knee (0.25 ± 0.25 %BW*Ht) flexion moments in the immediate testing phase. All of these changes between testing phases were smaller than their corresponding normal gait smallest real differences (SRD). With the addition of visual cues, variability was statistically significantly decreased in spatial parameters and increased in knee flexion angle at heel strike and knee flexion moment in terminal stance.SignificanceWhile biomechanical changes were observed, their magnitudes were small enough to suggest that floor-projected visual cues can be used in gait retraining without introducing unintended gait changes. Furthermore, the results suggested that lengthy practice periods are not necessary. The validity of these observations will, however, need to be confirmed in cases of severe impairments.     

Cortical activity and gait parameter characteristics in people with multiple sclerosis during unobstructed gait and obstacle avoidance

BackgroundPeople with Multiple Sclerosis (PwMS) present higher cortical activity during walking. However, the cortical activity during gait while avoiding an obstacle is still not clear.ObjectiveTo investigate cortical activity and gait spatial-temporal parameters in PwMS during two different gait tasks (i.e., unobstructed and obstacle avoidance).MethodFifteen PwMS and 15 healthy controls (CG) were recruited. Participants performed ten trials in each gait condition, wearing a 64-electrode cap electroencephalogram (EEG) at 1024 Hz. Kinematic data were obtained through 10 Vicon® cameras at 200 Hz. EEG was analyzed through four cortical areas (frontal, motor, parietal, and occipital cortex areas) and five frequency bands (delta, theta, alpha, beta, and gamma) obtained through the power spectral density. In addition, spatial-temporal gait parameters (e.g., step length and velocity) were measured. Two-way ANOVA (group x gait condition) and MANOVA (group x gait condition) were used to compare gait and EEG parameters, respectively. One-way ANOVA was used to compare groups in the crossing phase of the obstacle avoidance condition.ResultsPwMS presented lower step length and velocity, and higher cortical activity in frontal (beta and gamma) and parietal (gamma) cortical areas in both gait conditions compared to CG. Moreover, PwMS presented increased cortical activation (frontal and parietal) and decreased step length and velocity in obstacle avoidance compared with unobstructed gait. In addition, PwMS required more cortical resources (frontal and parietal) than CG to accomplish both gait conditions. During the obstacle avoidance task, it was further observed that PwMS positioned their feet closer to the obstacle, before and after the task, compared to CG.ConclusionPwMS demand higher cortical resources to accomplish gait tasks, mainly when it is necessary to negotiate an obstacle in the pathway. This higher cortical activity may be a compensatory mechanism to deal with damage in subcortical structures caused by multiple sclerosis.     

The effect of laboratory and real world gait training with vibration feedback on center of pressure during gait in people with chronic ankle instability

BackgroundExternal feedback has can medially shift the center of pressure (COP) location in people with chronic ankle instability(CAI) during walking. However, previous modalities are restricted to controlled environments which limits motor learning. Vibration feedback during gait may maximize motor learning by allowing for training in the laboratory and real world (RW) but has not been investigated in those with CAI.Research questionDoes vibration feedback change COP location in people with CAI following laboratory and RW training?MethodsNineteen CAI participants walked for 10 min on a treadmill (lab training) and a one mile loop on a sidewalk (RW training) with vibration feedback. When pressure under the 5th metatarsal exceeded a threshold, a vibration stimulus was applied to the lateral malleolus encouraging the participant to medially shift the COP. One minute baseline, posttest, and short term retention gait assessments were taken for each environment. The stance phase of gait was divided into 10 subphases and data were averaged within each subphase. Repeated measures ANOVAs were completed for each subphase to compare COP location over time.ResultsAfter lab based training the COP was more medial at posttest for the first 90 % of stance versus baseline (Mean differences (MD): −0.57 to −5.12 mm, p < 0.023). Relative to baseline, the COP remained more medial at retention from 20 to 90% of stance (MD: −1.69 to −4.40 mm, p < 0.049). For RW training, the COP was more medial at posttest for the first 70 % of stance versus baseline (MD: −4.24 to −8.27 mm, p < 0.017) and the first 60 % of stance at retention versus baseline (MD: −4.14 to −6.42 mm, p < 0.049).SignificanceVibration feedback during laboratory and RW gait training has the ability to immediately shift the COP location medially and retain this shift for a short period in individuals with CAI.     

Accuracy,sensitivity and robustness of five different methods for the estimation of gait temporal parameters using a single inertial sensor mounted on the lower trunk

In the last decade, various methods for the estimation of gait events and temporal parameters from the acceleration signals of a single inertial measurement unit (IMU) mounted at waist level have been proposed. Despite the growing interest for such methodologies, a thorough comparative analysis of methods with regards to number of extra and missed events, accuracy and robustness to IMU location is still missing in the literature. The aim of this work was to fill this gap. Five methods have been tested on single IMU data acquired from fourteen healthy subjects walking while being recorded by a stereo-photogrammetric system and two force platforms. The sensitivity in detecting initial and final contacts varied between 81% and 100% across methods, whereas the positive predictive values ranged between 94% and 100%. For all tested methods, stride and step time estimates were obtained; three of the selected methods also allowed estimation of stance, swing and double support time. Results showed that the accuracy in estimating step and stride durations was acceptable for all methods. Conversely, a statistical difference was found in the error in estimating stance, swing and double support time, due to the larger errors in the final contact determination. Except for one method, the IMU positioning on the lower trunk did not represent a critical factor for the estimation of gait temporal parameters. Results obtained in this study may not be applicable to pathologic gait.     

Accuracy,sensitivity and robustness of five different methods for the estimation of gait temporal parameters using a single inertial sensor mounted on the lower trunk

In the last decade, various methods for the estimation of gait events and temporal parameters from the acceleration signals of a single inertial measurement unit (IMU) mounted at waist level have been proposed. Despite the growing interest for such methodologies, a thorough comparative analysis of methods with regards to number of extra and missed events, accuracy and robustness to IMU location is still missing in the literature. The aim of this work was to fill this gap. Five methods have been tested on single IMU data acquired from fourteen healthy subjects walking while being recorded by a stereo-photogrammetric system and two force platforms. The sensitivity in detecting initial and final contacts varied between 81% and 100% across methods, whereas the positive predictive values ranged between 94% and 100%. For all tested methods, stride and step time estimates were obtained; three of the selected methods also allowed estimation of stance, swing and double support time. Results showed that the accuracy in estimating step and stride durations was acceptable for all methods. Conversely, a statistical difference was found in the error in estimating stance, swing and double support time, due to the larger errors in the final contact determination. Except for one method, the IMU positioning on the lower trunk did not represent a critical factor for the estimation of gait temporal parameters. Results obtained in this study may not be applicable to pathologic gait.     

Three-dimensional head and trunk movement characteristics during gait in children with spastic diplegia

This study uses a recently developed trunk model to determine which head and trunk kinematic parameters differentiate children with spastic diplegia from typically developing (TD) children while walking. Differences in head and trunk parameters in relation to the severity of the motor involvement (GMFCS levels) were additionally examined. The trunk model consisted of five segments (pelvis, thorax, head, shoulder line, spine). Discrete kinematic parameters (ROM, mean position) and angular waveforms were compared between 20 children with spastic diplegia (age 9.8 years ± 2.9 years; GMFCS I: n = 10, GMFCS II: n = 10) and 20 individually age-matched TD children (9.7 years ± 3 years). A new measure for overall trunk pathology, the trunk profile score (TPS), was proposed and included in the comparative analysis. Compared to TD children, children with GMFCS II showed a significantly higher TPS and increased ROM for pelvis tilt, for thorax and head in nearly all planes, and the angle of kyphosis. In children with GMFCS I, only ROM of thorax lateral bending was significantly increased. Sagittal ROM differentiated best between GMFCS levels, with higher ROM found in children with GMFCS II. Current results provide new insights into head and trunk kinematics during gait in children with spastic diplegia.     

Change in gait after high tibial osteotomy: A systematic review and meta-analysis

We conducted a meta-analysis to analyze how high tibial osteotomy (HTO) changes gait and focused on the following questions: (1) How does HTO change basic gait variables? (2) How does HTO change the gait variables in the knee joint? Twelve articles were included in the final analysis. A total of 383 knees was evaluated. There were 237 open wedge (OW) and 143 closed wedge (CW) HTOs. There were 4 level II studies and 8 level III studies. All studies included gait analysis and compared pre- and postoperative values. One study compared CWHTO and unicompartmental knee arthroplasty (UKA), and another study compared CWHTO and OWHTO. Five studies compared gait variables with those of healthy controls. One study compared operated limb gait variables with those in the non-operated limb. Gait speed, stride length, knee adduction moment, and lateral thrust were major variables assessed in 2 or more studies. Walking speed increased and stride length was increased or similar after HTO compared to the preoperative value in basic gait variables. Knee adduction moment and lateral thrust were decreased after HTO compared to the preoperative knee joint gait variables. Change in co-contraction of the medial side muscle after surgery differed depending on the degree of frontal plane alignment. The relationship between change in knee adduction moment and change in mechanical axis angle was controversial. Based on our systematic review and meta-analysis, walking speed and stride length increased after HTO. Knee adduction moment and lateral thrust decreased after HTO compared to the preoperative values of gait variables in the knee joint.     

The relative and absolute reliability of center of pressure trajectory during gait initiation in older adults

It has been thought that for scientific acceptance of a parameter, its psychometric properties such as reliability, validity and responsiveness have critical roles. Therefore, this study was conducted to estimate how many trials are required to obtain a reliable center of pressure (COP) parameter during gait initiation (GI) and to investigate the effect of number of trials on the relative and absolute reliability. Twenty older adults participated in the study. Subjects began stepping over the force platform in response to an auditory stimulus. Ten trials were collected in one session. The displacement, velocity, mean and median frequency of the COP in the mediolateral (ML) and anteroposterior (AP) directions were evaluated. Relative reliability was determined using the intraclass correlation coefficient (ICC), and absolute reliability was evaluated using the standard error of measurement (SEM) and minimal detectable change (MDC₉₅). The results revealed with respect to parameter, one to five trials should be averaged to ensure excellent reliability. Moreover, ICC, SEM% and MDC₉₅% values were between 0.39–0.89, 4.84–41.5% and 13.4–115% for single trial and 0.86–0.99, 1.74–19.7% and 4.83–54.7% for ten trials averaged, respectively. Moreover, the ML and AP COP displacement in locomotor phase had the most relative reliability as well as the ML and AP median frequency in locomotor phase had the most absolute reliability. In general, the results showed that the COP-related parameters in time and frequency domains, based on average of five trials, provide reliable outcome measures for evaluation of dynamic postural control in older adults.     

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

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

The test–retest reliability and minimal detectable change of spatial and temporal gait variability during usual over-ground walking for younger and older adults

Gait variability is a marker of gait performance and future mobility status in older adults. Reliability of gait variability has been examined mainly in community dwelling older adults who are likely to fluctuate over time. The purpose of this study was to compare test–retest reliability and determine minimal detectable change (MDC) of spatial and temporal gait variability in younger and older adults. Forty younger (mean age = 26.6 ± 6.0 years) and 46 older adults (mean age = 78.1 ± 6.2 years) were included in the study. Gait characteristics were measured twice, approximately 1 week apart, using a computerized walkway (GaitMat II). Participants completed 4 passes on the GaitMat II at their self-selected walking speed. Test–retest reliability was calculated using Intra-class correlation coefficients (ICCs_(2,1)), 95% limits of agreement (95% LoA) in conjunction with Bland-Altman plots, relative limits of agreement (LoA%) and standard error of measurement (SEM). The MDC at 90% and 95% level were also calculated. ICCs of gait variability ranged 0.26–0.65 in younger and 0.28–0.74 in older adults. The LoA% and SEM were consistently higher (i.e. less reliable) for all gait variables in older compared to younger adults except SEM for step width. The MDC was consistently larger for all gait variables in older compared to younger adults except step width. ICCs were of limited utility due to restricted ranges in younger adults. Based on absolute reliability measures and MDC, younger had greater test–retest reliability and smaller MDC of spatial and temporal gait variability compared to older adults.     

The effects of cognitive versus motor concurrent task on gait in individuals with transtibial amputation,transfemoral amputation and in a healthy control group

BackgroundLower limb amputation causes difficulties in mobility together with motor and sensory loss. Challenging situations such as concurrent tasks cause gait parameters to deteriorate. Understanding the effect of concurrent tasks on gait is important for the rehabilitation of amputees.Research questionAre the effects of concurrent cognitive and motor tasks on gait parameters at fixed speed different in individuals with transtibial amputation, or transfemoral amputation compared to healthy individuals?MethodsThe gait parameters were evaluated of 20 individuals with transtibial amputation, 13 individuals with transfemoral amputation and 20 healthy individuals while walking on a motorized treadmill under single task (ST), cognitive dual task (CDT) and motor dual task (MDT) conditions. The self-selected comfortable velocity, which was determined in the single-task gait, was used in all three walking tests.ResultsST, CDT and MDT gait parameters of individuals with transtibial amputation, transfemoral amputation and healthy individuals were significantly different (p < 0.01). Covariance of step length variability increased in amputees when walking under MDT (p < 0.05). The dual task cost (DTC) for all the gait parameters was similar in all three groups (p > 0.05). The motor DTC of covariance of step length was greater than cognitive DTC (p < 0.05).SignificanceIndividuals with lower limb amputation have the capacity to walk with cognitive and motor tasks without changing velocity on the treadmill, but concurrent motor tasks cause an increase in gait variability. The results of this study suggest that there is an increase in gait variability especially with motor tasks, which may cause a higher risk of falling.Trial number: NCT04392466 (clinicaltrials.gov)     

Gait Profile Score in able-bodied and post-stroke individuals adjusted for the effect of gait speed

Background: The Gait Profile Score (GPS) measures the quality of an individual’s walking by calculating the difference between the kinematic pattern and the average walking pattern of healthy individuals.Research questions: The purposes of this study were to quantify the effect of speed on the GPS and to determine whether the prediction of gait patterns at a specific speed would make the GPS outcome insensitive to gait speed in the evaluation of post-stroke individuals.Methods: The GPS was calculated for able-bodied individuals walking at different speeds and for the comparison of post-stroke individuals with able-bodied individuals using the original experimental data (standard GPS) and the predicted gait patterns at a given speed (GPS velocity, GPS^v). We employed standard gait analysis for data collection of the subjects. Sixteen participants with a stroke history were recruited for the post-stroke group, and 15 age-matched, able-bodied participants formed the control group.Results: Gait speed significantly affects the GPS and the method to predict the gait patterns at any speed is able to mitigate the effects of gait speed on the GPS. Overall, the gap between the GPS and GPS^v values across the post-stroke individuals was small (0.5° on average, range from 0.0° to 1.4°) and not statistically significant. However, there was a significant negative linear relationship in the absolute difference between the GPS and GPS^v values for the participants of the post-stroke group with gait speed, indicating that a larger difference between the speeds of the post-stroke participant and the reference dataset resulted in a larger difference between the GPS and GPS^v.Significance: The modified version of the GPS, the GPS^v, is effective in reducing the impact of gait speed on GPS; however, the observed difference between the two methods was only around 1° for the slowest individuals in comparison to the reference dataset.     

Gait characteristics under single-/dual-task walking conditions in elderly patients with cerebral small vessel disease: Analysis of gait variability,gait asymmetry and bilateral coordination of gait

BackgroundDual-task walking (DTW) is common in daily life and represents an ideal paradigm for elucidating gait irregularity. Under single-task walking (STW) and DTW conditions, the symmetric and bilaterally coordinated human gait pattern found in healthy individuals is absent in individuals with neurological ailments such as Parkinson’s disease, Alzheimer’s disease and post-stroke issues. Cerebral small vessel disease (CSVD) is a neuropathological and radiological issue that has been reported to be associated with cognitive and motor disorders. However, few gait analyses have focused on elderly individuals with CSVD under DTW conditions.Research questionAre parameters of gait analysis helpful in elucidating gait abnormalities in elderly patients with CSVD under DTW conditions?MethodsA total of 46 elderly patients with CSVD (CSVD group) and 22 healthy, age-matched individuals (HE group) were recruited. Gait data were collected from both groups under STW and DTW conditions. Direct parameters and metrics reflecting gait variability, gait asymmetry, and bilateral coordination of gait in the two groups were compared.ResultsUnder STW conditions, elderly individuals with CSVD showed markedly shorter stride length, were slower, and had higher gait asymmetry (GA) and phase coordination index (PCI) than healthy controls after adjusting for age, sex and level of education. Under DTW conditions, there were statistically significant differences between the two groups in stride time, stride length, cadence, stride time variability, GA and PCI after adjusting for age, sex, and level of education.SignificanceReanalysis-generated parameters, such as gait variability, GA, and PCI, are biomarkers for gait dysfunction in elderly patients with CSVD. In this study, elderly individuals with CVSD showed abnormal gait features under both STW and DTW conditions.     

Comparison of upper limb burn injury versus simulated pathology in terms of gait and footprint parameters

BackgroundLittle is known about whether a simulated upper limb condition reflects a real (burn-injury) upper limb pathology in terms of gait/footprint parameters.Research questionThe main aim of this study was to investigate the differences in these parameters between two conditions (real-simulation).MethodsThe study included burn patients (n = 30) and a control group of 30 healthy subjects. Gait and footprint parameters were evaluated using the GAITRite electronic walkway. Kinesiophobia and pain were assessed with the Tampa Kinesiophobia Scale and Visual Analog Scale, respectively. Gait evaluation of the control group was performed randomly in two conditions:1. Normal arm swing (control group) 2.Elbow flexed at 90° with a bandage (simulated group).ResultsStep and stride length in the burn group were significantly shorter than in the other groups (p < 0.05). Stance phase was significantly higher while swing phase, velocity and cadence were lower in the burn group (p < 0.05). Peak time in the midfoot for both sides were significantly higher in the burn group (p < 0.05). Peak time in the hindfoot for the affected side was significantly lower while peak time in the hindfoot for the intact side was significantly higher in the burn group compared to the simulated group (p < 0.05). There were significant correlations between pain, kinesiophobia and velocity, and cadence in the burn group (p < 0.05).SignificanceCompared to the other groups, patients with burn injury have different gait/footprint parameters due to increased pain and kinesiophobia. To determine the effects of upper limb injury and arm swing on gait parameters, a real pathology should be considered rather than a simulated pathology.