A three-dimensional kinematic and kinetic comparison of overground and treadmill walking in healthy elderly subjects

Background

Instrumented treadmills offer a number of advantages for the biomechanical analysis of elderly gait, yet it is unclear how closely treadmill gait approximates overground gait. Although studies have indicated that the kinematics and kinetics of overground and treadmill gait are very similar in young adults, it still needs to be determined whether data collected in elderly adults during treadmill walking can be generalized to overground gait. The purpose of this study, therefore, was to compare the three-dimensional kinematics and kinetics of treadmill gait to overground gait in a group of healthy elderly subjects.

Methods

Three-dimensional kinematic and kinetic data for 18 healthy, nondisabled elderly subjects, age 65–81 years, were collected for speed-matched overground and treadmill walking conditions.

Findings

Overall, the kinematics and kinetics of gait during treadmill and overground walking in the elderly had very similar patterns. However, during treadmill walking elderly subjects showed greater cadence, smaller stride length and stride time as well as reductions in the majority of joint angles, moments and powers when compared to overground walking.

Interpretation

The large increase in cadence suggests that an effective method of acclimation to treadmill walking still needs to be determined. Because of the differences, we believe that in order for instrumented treadmills to become a suitable tool for research and training purposes in healthy elderly, subjects must be adequately acclimated to the treadmill.     

A comparison of treadmill walking and overground walking in independently ambulant stroke patients: A pilot study

Purpose. The purpose of the study was to compare the spatio-temporal and joint kinematic gait parameters of stroke patients walking on a treadmill and overground, to examine the assumption that patients walking on a treadmill will approximate the requirements of walking overground.

Methods. Ten independently ambulant chronic stroke patients were included in the study. Vicon? was used to collect spatio-temporal and joint kinematic data during overground walking at comfortable speed and at matched speed on the treadmill.

Results. Walking on the treadmill demonstrated statistically significantly lower cadence, and longer step times of the non-hemiplegic and hemiplegic limbs. Absolute stance times of both limbs, absolute double support time, relative stance time and relative double support time were significantly longer during treadmill walking. Compared to overground walking, the inter-limb symmetries of step time, stance time, and stance/swing time ratio were significantly greater on the treadmill. During treadmill walking, joint kinematic data showed statistically significant changes with greater flexion of the nonhemiplegic knee and hip at initial contact, and less hip extension of the hemiplegic limb. Maximal ankle plantarflexion and knee extension of the hemiplegic limb occurred later in the gait cycle on the treadmill.

Conclusion. These differences suggest it may be useful to use treadmill in conjunction with overground walking to focus on improving specific walking deficits in patients with stroke.     

Gender differences in lower extremity gait biomechanics during walking using an unstable shoe

Background

In recent years several unstable shoe designs that cause increased instability at the ankle joint have been developed with the aims of training static and dynamic posture and postural control. However, earlier research found significant gender differences in the generation of ankle torque and in the reaction times after a perturbation. Therefore it is possible that men and women are affected differently by the instability that unstable shoes create. The purpose of this study was to investigate if gender differences exist a) during bilateral quiet stance or b) in lower extremity gait kinematics and kinetics when using unstable shoes.

Methods

Seventeen females and seventeen males were included in this study. Masai Barefoot Technology® shoes were used as test shoes. Center of pressure excursion was recorded during 30 s bilateral quiet stance trials using a force plate. Joint angles, resultant joint moments and joint moment impulses during walking were determined using standard gait analysis methods.

Findings

In bipedal stance, female subjects had significantly greater anterior–posterior center of pressure excursion than male subjects. In the stance phase of the gait cycle gender differences were found in the ankle joint moments which had not been reported in earlier studies using barefoot or normal shoe conditions.

Interpretation

The results suggest that women and men use different strategies to control the ankle joint when standing or walking in unstable shoes. Gender effects should therefore be taken into consideration if functional or therapeutic effects of unstable shoes are assessed.     

Kinematic, kinetic and metabolic parameters of treadmill versus overground walking in healthy older adults

Background

Although treadmill and overground walking appear to be biomechanically similar in healthy, young adults it is not known whether this can be generalized to older subjects or if the metabolic demands are correspondingly comparable.

Methods

Ten healthy adults between 50 and 73 years of age walked at the same speed overground and on a treadmill. Temporal parameters, angular kinematics and vertical ground reaction forces were recorded during walking once subjects were in steady state as determined from their heart rate and oxygen uptake.

Findings

Step, stride and joint angular kinematics were similar for both modes of walking with the exception of the maximum hip flexion and knee extension which were more pronounced with treadmill or overground walking, respectively but in both instances differed by less than 3°. Vertical ground reaction force profiles were similar although the peak associated with push-off was 5.5% smaller with treadmill walking. The metabolic requirements of treadmill walking were about 23% higher than that associated with overground walking.

Interpretation

While treadmill and overground walking are biomechanically similar, the metabolic cost of treadmill walking is higher. Clinically this may be important when using a treadmill for gait retraining in patient populations as it may lead to premature fatigue or undesirable physiologic challenge.     

Quantitative gait analysis in Parkinson's disease: comparison with a healthy control group

OBJECTIVE: To compare gait parameters in Parkinson's disease (PD) during the on-phase of medication cycle with those of healthy elderly control subjects. DESIGN: A group-comparison study. SETTING: Gait analysis laboratory of a university hospital. PARTICIPANTS: Fifteen patients with PD and 9 healthy elderly controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Spatiotemporal, kinematic, and kinetic gait parameters. RESULTS: The PD spatiotemporal results showed a significant reduction in step length and walking velocity compared with controls. In the kinematics, the major feature of the PD group was a markedly reduced ankle plantarflexion excursion (at 50%-60% of the gait cycle). Most important, the kinetics showed reduced ankle push-off power and hip pull-off power. Unlike the control subjects, the patients with PD did not show any correlation between ankle generation (push-off) power and stride length ( r =.19) or with gait speed ( r =.29). Correction for walking velocity did not result in significant changes in the kinetics between the groups. CONCLUSIONS: Reduced ankle (push-off) power generation and reduced hip flexion (pull-off) power persisted in PD gait despite being tested in the on-phase of the medication cycle. Lack of a correlation between ankle and hip power generation and walking velocity suggests that peripheral and central factors contribute to lack of forward progression. Patients with PD may benefit from intervention strategies that correct the kinematic and the kinetic gait components.     

Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study

McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.

Objective

To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke.

Design

Parallel group, posttest only.

Setting

Inpatient rehabilitation center.

Participants

Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7).

Interventions

Locomotor treadmill training with partial BWS or traditional gait training methods.

Main Outcome Measures

Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult.

Results

Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group.

Conclusions

Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation.     

A comparison of treadmill walking and overground walking in independently ambulant stroke patients: a pilot study

Purpose. The purpose of the study was to compare the spatio-temporal and joint kinematic gait parameters of stroke patients walking on a treadmill and overground, to examine the assumption that patients walking on a treadmill will approximate the requirements of walking overground. Methods. Ten independently ambulant chronic stroke patients were included in the study. Vicon was used to collect spatio-temporal and joint kinematic data during overground walking at comfortable speed and at matched speed on the treadmill. Results. Walking on the treadmill demonstrated statistically significantly lower cadence, and longer step times of the non-hemiplegic and hemiplegic limbs. Absolute stance times of both limbs, absolute double support time, relative stance time and relative double support time were significantly longer during treadmill walking. Compared to overground walking, the inter-limb symmetries of step time, stance time, and stance/swing time ratio were significantly greater on the treadmill. During treadmill walking, joint kinematic data showed statistically significant changes with greater flexion of the nonhemiplegic knee and hip at initial contact, and less hip extension of the hemiplegic limb. Maximal ankle plantarflexion and knee extension of the hemiplegic limb occurred later in the gait cycle on the treadmill. Conclusion. These differences suggest it may be useful to use treadmill in conjunction with overground walking to focus on improving specific walking deficits in patients with stroke.     

Gait parameters and stride-to-stride variability during familiarization to walking on a split-belt treadmill

Background

Subjects unfamiliar to walking on a split-belt treadmill may initially demonstrate an altered gait pattern or increased variability of gait parameters. While previous investigations have examined kinematic variables associated with familiarization time, the objective of this study was to determine the familiarization period required to obtain the most reproducible gait pattern through the assessment of kinetic, kinematic and spatio-temporal parameters during a single session of treadmill walking.

Methods

Eleven healthy subjects participated in a single bout of treadmill walking which lasted 9 min. Kinematic and kinetic data were collected from the first 30 s of each minute, beginning when the treadmill reached full speed. Means and standard deviations for knee flexion at heel strike, ground reaction forces, step width and step length were obtained to examine the changes in each variable over the 9 min. Mean r² values were evaluated for changes in variability from one stride to the subsequent stride for sagittal plane hip, knee and ankle joint angles and moments, as well as for vertical and horizontal ground reaction forces.

Findings

Significant reductions in variability were found for vertical and horizontal ground reaction forces, knee flexion at heel strike and step length over 9 min. Only step width showed a change in the mean value across trials. There were no increases in r² values after the 5th min for any of the gait variables.

Interpretation

The results suggest that in order to collect accurate data for gait analysis, subjects should be familiarized to the split-belt treadmill for at least 5 min prior to data collection.     

Ageing and limb dominance effects on foot-ground clearance during treadmill and overground walking

Background

Foot-ground clearance during the gait cycle swing phase is a critical locomotor adaptation to uneven terrain and non-optimal lower limb control has been linked to tripping and falling. The aim of this research was to determine ageing effects on bilateral foot-ground clearance during overground and treadmill walking.

Methods

Ageing and walking surface effects on bilateral foot trajectory control were investigated in 11 older (mean age 73.8 years) and 11 young (mean age 22.5 years) participants. First maximum clearance after toe-off, minimum foot-ground clearance and second maximum clearance prior to heel contact were determined from sampled 3-dimensional marker coordinates during preferred-speed treadmill walking and walking overground.

Findings

Preferred walking speed was lower in treadmill walking for both groups. In both groups non-dominant minimum foot-ground clearance and first maximum clearance were greater than for the dominant foot. A high positive correlation was found between these two swing foot clearances when older adults walked on the treadmill. Second maximum clearance was reduced in the older group but this was the only overall age effect. Treadmill walking reduced minimum foot-ground clearance relative to overground locomotion except in the older adults' non-dominant limb that revealed greater vertical clearance height in the non-dominant foot.

Interpretation

Decreased second maximum clearance in the older group may be linked to reduced dorsiflexion. Greater minimum foot-ground clearance in the older adults' non-dominant foot may reflect functional asymmetry, in which the non-dominant limb primarily secures or stabilizes gait. The high positive correlation between first maximum and minimum foot-ground clearances suggests that intervention designed to increase first maximum clearance may also increase minimum foot-ground clearance. A direction for future research is to further understand ageing effects on lower limb trajectory variables in response to a range of walking surface characteristics.     

Gastrocnemius inflexibility on foot progression angle and ankle kinetics during walking

Background

Gastrocnemius inflexibility is a major problem in many orthopedic and neurological patients. Clinically, inflexible gastrocnemius muscles interfere with the performance of functional abilities and associate with many overuse injuries of the lower extremity. The purpose of this study was to investigate the effects of the gastrocnemius inflexibility on the foot progression angle and ankle kinetics during walking.

Methods

There were 50 subjects, 23 patients with the inflexible gastrocnemius and 27 normal subjects, included in this investigation. Participants were asked to walk at two preset cadences of 100 steps/min and 140 steps/min. Data were collected from a motion analysis system and force plates. Kinematic and kinetic variables of gait were computed and analyzed.

Findings

Compared with the control group, greater toe-out foot progression angle (P = 0.001, effect size = 0.314) and knee external rotation (P = 0.008, effect size = 0.136) were found in the inflexible group during stance phase. Furthermore, significant greater plantarflexion moment (P = 0.032, effect size = 0.093) and medial ground reaction force (P = 0.009, effect size = 0.135) during midstance were discovered in the inflexible group.

Interpretation

The present results indicate that gastrocnemius inflexibility might bring about the changes in the joint angles, ankle moments and ground reaction forces. The abnormal joint alignment in the lower extremities and greater force upon joint tissue might be significant for the clinical considerations on soft tissue injuries for the patients with inflexible gastrocnemius muscles.     

Motor function and joint position sense in relation to gait performance in chronic stroke patients

OBJECTIVES: To determine the association between joint position sense (JPS) and motor function of the lower extremity and gait performance of patients with chronic stroke. DESIGN: Single-group cross-sectional design. SETTING: University gait laboratory. PARTICIPANTS: Twenty-one patients with stroke onset of more than 6 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The isometric strength, Fugl-Meyer Assessment (FMA) motor status, and JPS of the lower extremity were tested. Spatiotemporal gait characteristics were measured using a 6-camera motion analysis system, with patients walking at their comfortable speeds while using their usual devices. RESULTS: Lower-extremity muscle strength and FMA motor score correlated significantly with the spatiotemporal characteristics of gait and contributed significantly to the variance in gait velocity, stride length, and double-stance time. The JPS was not related to gait performance, except that the ankle JPS contributed significantly to the variance in gait velocity and stride length. CONCLUSIONS: For patients with chronic stroke, motor function was significantly related to gait performance. Although the JPS was not, that of the ankle joint made a significant contribution. When enhancing gait performance is desired, improving the motor function is recommended, and the role of JPS should also be taken into consideration.     

Comparative biomechanical gait analysis of patients with central cord syndrome walking with one crutch and two crutches

Background

Ambulatory people with central cord syndrome often require assistive devices. The selection of a suitable assistive device should be based on an objective assessment. Our objective in this study was to determine whether there was any difference in using two crutches over one crutch, considering that these patients have bilateral upper-limb involvement.

Methods

Kinematic gait analysis was conducted in 12 patients with central cord syndrome of more than one year of evolution and functional capacity for walking with one crutch or without crutches. Patients were asked to walk with one crutch and with two crutches at a freely chosen walking speed through a 10-m walkway. Three-dimensional kinematic equipment based on active markers was used to analyze temporospatial and articular parameters (maximum, minimum, and range of motion, ROM, throughout the cycle)

Findings

During two-crutch versus one-crutch walking, speed was lower (P = 0041), stride time and step time were longer (P = 0.004 and P = 0.005) and there were fewer strides/minute and steps/minute (P = 0.005 and P = 0.006). The duration of the single support stance was longer during two-crutch walking (P = 0.008). With respect to the articular parameters, both ankle ROMs (dorsi-plantar flexion P = 0.003 and pronation–supination P = 0.004) were greater with one-crutch walking than with two-crutch walking.

Interpretation

In patients with central cord syndrome capable of walking with one crutch or without crutches, walking with two crutches decreases speed, increases stride time and step time and improves stability by increasing single support, and diminishes ankle plantar flexion during swing phase.     

Three-dimensional motions of trunk and pelvis during transfemoral amputee gait

Goujon-Pillet H, Sapin E, Fodé P, Lavaste F. Three-dimensional motions of trunk and pelvis during transfemoral amputee gait.

Objectives

To identify characteristics of upper-body kinematics and torque transmission to the ground during locomotion in a group of patients with transfemoral amputation as compared with a group of asymptomatic subjects; and to investigate the influence of walking velocity and residual limb length on several characteristics of upper-body motion.

Design

Three-dimensional gait analysis with an optoelectronic device.

Setting

Gait laboratory.

Participants

Twenty-seven patients with transfemoral amputation and a control group of 33 nondisabled subjects.

Interventions

Not applicable.

Main Outcome Measures

Three-dimensional kinematics of the pelvis and the thorax and ground reaction force for amputees and control subjects.

Results

For subjects with transfemoral amputation, it was observed that upper-body angular ranges of motion (ROMs) increased globally as walking velocity decreased. For these subjects, specific patterns of pelvic rotation and torque transmission by the lower limbs around the vertical axis were found. The counter-rotation between the pelvic and scapular girdles was reduced. This reduction proved to be linked with the decrease of walking velocity. Walking velocity also affected all the parameters describing the motion of upper body. Pelvic ROM increased with the length of the limb decreasing.

Conclusions

The huge differences found between subjects with and without amputation suggest that the motion of the upper body must be considered to enhance gait.     

Effect of treadmill walking with ankle stretching orthosis on ankle flexibility and gait

[Purpose] The purpose of this study was to evaluate the kinematics of the ankle in thelunge to estabilish effectiveness of an ankle stretching orthosis (ASO) on the ankledorsiflexion range of motion (ROM) of individuals with limited dorsiflexion ROM. [Subjectsand Methods] Forty ankles with decreased dorsiflexion ROM of 20 participants wereevaluated in this study. After wearing the ASO, participants walked on a treadmill for 15minutes. Participants walked on the treadmill at a self-selected comfortable speed. Ankledorsiflexion ROM, maximum dorsiflexion ROM before heel-off, and time to heel-off duringthe stance phase of gait were measured before and after 15 minutes of treadmill walkingwith the ASO. The differences in all variables between before and after treadmill walkingwith ASO were analyzed using the paired t-test. [Results] Ankle active and passive ROM,and dorsiflexion ROM during lunge increased significantly after treadmill walking withASO. Treadmill walking with the ASO significantly increased the angle of maximaldorsiflexion before heel-off and time to heel-off during the stance phase. [Conclusion]The results of this study show that treadmill walking with the ASO effectively improvedankle flexibility and restored the normal gait pattern of the ankle joint by increasingdorsiflexion ROM, maximal angle of dorsiflexion, and time to heel-off in the stancephase.     

Bilateral coordination and gait symmetry after body-weight supported treadmill training for persons with chronic stroke

Background

Locomotor interventions are commonly assessed using functional outcomes, but these outcomes provide limited information about changes toward recovery or compensatory mechanisms. The study purposes were to examine changes in gait symmetry and bilateral coordination following body-weight supported treadmill training in individuals with chronic hemiparesis due to stroke and to compare findings to participants without disability.

Methods

Nineteen participants with stroke (> 6 months) who ambulated between 0.4 and 0.8 m/s and 22 participants without disability were enrolled in this repeated-measures study. The stroke group completed 24 intervention sessions over 8 weeks with 20 minutes of walking/session. The non-disabled group served as a comparison for describing changes in symmetry and coordination. Bilateral 3-dimensional motion analysis and gait speed were assessed across 3 time points (pre-test, immediate post-test, and 6-month retention). Continuous relative phase was used to evaluate bilateral coordination (thigh–thigh, shank–shank, foot–foot) and gait symmetry was assessed with spatiotemporal ratios (step length, swing time, stance time).

Findings

Significant improvements in continuous relative phase (shank–shank and foot–foot couplings) were found at post-test and retention for the stroke group. Significant differences in spatiotemporal symmetry ratios were not found over time. Compared to the non-disabled group, changes in bilateral coordination moved in the direction of normal recovery. Most measures of continuous relative phase were more responsive to change after training than the spatiotemporal ratios.

Interpretations

After body-weight supported treadmill training, the stroke group made improvements toward recovery of normal bilateral coordination. Bilateral coordination and gait symmetry measures may assess different aspects of gait.     

Vaulting quantification during level walking of transfemoral amputees

Background

Vaulting is a gait compensatory mechanism used by transfemoral amputees to assist toe clearance during the prosthetic swing phase. It is defined by a plantar flexion of the contralateral ankle during the single-limb support phase. The aim of the study is to propose a method to quantify vaulting of transfemoral amputees.

Methods

17 transfemoral amputees and 28 asymptomatic subjects participated in the data collection. Kinematics and kinetics of the whole body were recorded while subjects were walking on a level surface. Biomechanical gait analysis was focused on a reduced set of parameters linked to the contralateral ankle, the contralateral knee and the trajectory of the center of pressure. The patients were classified in two groups: with or without vaulting using video recordings. Differences between both groups and the control group were analyzed.

Findings

A higher generated ankle power was found during the single support phase of the contralateral limb of transfemoral amputees presenting vaulting. These subjects presented also a higher dissipated knee flexion power before the peak in ankle flexion power. The trajectory of the center of pressure was also modified by the vaulting.

Interpretation

Vaulting for transfemoral amputees is characterized by a propulsive plantar flexion at the contralateral ankle. Quantifying the ankle flexion power during the contralateral single support phase will help in understanding vaulting.     

The effect of environment and task on gait parameters after stroke: A randomized comparison of measurement conditions

OBJECTIVES: To assess the effect of environment and a secondary task on gait parameters in community ambulant stroke survivors and to assess the contribution of clinical symptoms to gait performance. DESIGN: A 2x3 randomized factorial design with 2 main factors: task (no task, motor task, cognitive task) and environment (clinic, suburban street, shopping mall). SETTING: Subjects were assessed in 1 of 3 settings: 2 in the community (a suburban street and shopping mall) and 1 clinical environment. PARTICIPANTS: Twenty-seven people with stroke (mean age, 61+/-11.6y; mean time since stroke onset, 45.8+/-34.2mo), living at home, were recruited from community stroke groups and from a local rehabilitation unit. Selection criteria included the following: ability to give informed consent, unilateral first ever or recurrent stroke at least 6 months previously, walking independently in the community, a gait speed between 24 and 50 m/min, Mini-Mental State Examination score of 24 or higher, and no severe comorbidity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gait speed (in m/min), cadence, and step length were assessed by using an accelerometer with adjustable thresholds. Clinical measures hypothesized to influence gait parameters in community environments were also assessed including fatigue, anxiety and depression, and attentional deficit. RESULTS: Twenty-seven people with a mean baseline gait speed of 42.2+/-5.9 m/min were randomly allocated to 1 of 9 conditions in which the setting and distraction were manipulated. Analysis of variance showed a significant main effect for environment (P = .046) but not for task (P = .37). The interaction between task and environment was not significant (P = .73). Adjusting for baseline gait speed, people walked on average 8.8m/min faster in the clinic (95% confidence interval, 0.3-17.3m/min) than in the mall. Scores for fatigue, anxiety and depression, and attentional deficit were higher than normative values but did not influence gait performance. CONCLUSIONS: This study suggests that people with chronic stroke cope well with the challenges of varied environments and can maintain their gait speed while performing a secondary task. Despite moderate levels of gait impairment, gait automaticity may be restored over time to a functional level.