Lower extremity joint moments throughout gait at two speeds more than 4 years after ACL reconstruction

BackgroundLong-term gait adaptations after anterior cruciate ligament reconstruction (ACLR) have been reported. However, it is still unclear if they persist more than 4 years after surgery and if they are affected by gait speed.Research question: To investigate differences between groups, legs and walking speeds for ankle, knee and hip joint moments in three planes throughout the stance phase of gait.MethodsReconstructed participants (n = 20 males, 32.5 years, 5.5 years post-ACLR) and healthy controls (n = 20 males, 30.6 years) took part in the study. Gait analysis was performed in two different speeds (self-selected and 30% faster). Sagittal, frontal and transverse plane external moments were measured for ankle, knee and hip and compared throughout the stance phase using 95% confidence intervals. Significant differences were established as a consecutive 5% of gait cycle in which 95% confidence interval did not overlap.ResultsThe reconstructed leg did not demonstrate higher joint moments; there were largely no differences while there was lower knee external rotation moment compared to the non-preferred leg of the control group. Higher joint moments were observed during fast speed walking on sagittal plane for knee and hip moments in both groups, and in the frontal and transverse plane for ankle moments.SignificanceGait kinetics appear to be largely normalized at a minimum of 4 years after ACLR. Faster walking speed increase lower extremity joint moments.     

Lower-extremity gait kinematics on slippery surfaces in construction worksites

PURPOSE: The purpose of this study was to investigate the lower-extremity kinematics when walking on potentially slippery surfaces in simulated construction worksite environments. METHODS: A survey was conducted to select two types of footwear, two floorings, and four contaminants to represent the local construction worksite environments, making 16 simulated conditions. A mechanical slip-resistance test was conducted to evaluate the slipping potential of the 16 conditions by the value of the dynamic coefficient of friction. The 16 conditions were classified into three groups by slipping potential. Fifteen harnessed Chinese male subjects were instructed to walk and avoid slips on each of the 16 simulated 5-m walkways 10 times at their natural cadence. The movements in the sagittal plane were videotaped, digitized, and analyzed by a motion analysis system. Gait pattern parameters were obtained. Lower-extremity kinematic data were time-normalized from foot strike (0% stance) to take-off (100% stance) and were extracted from foot strike to midstance (50% stance) at 10% stance intervals. RESULTS: ANOVA showed that with increased slipping potential, changes in gait pattern parameters included increased stance and stride time, shortened stride length, decreased propagation speed, and gentle heel strike. In lower-extremity kinematic parameters, significant differences were found mainly at the ankle joint rather than the knee joint. CONCLUSION: Strategies to prevent slips included increased stance and stride time, shortened stride length, decreased propagation speed, and gentle heel strike. The ankle joint played the most important role in adaptation strategy. Such strategy included reducing range of motion, maintaining a stiff joint, and achieving flatfoot landing or a plantarflexed ankle joint during the first 10% stance.     

Underwater gait analysis in Parkinson’s disease

Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p < 0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.     

Overground versus treadmill walking in Parkinson’s disease: Relationship between speed and spatiotemporal gait metrics

BackgroundTreadmills provide a safe and convenient way to study the gait of people with Parkinson’s disease (PD), but outcome measures derived from treadmill gait may differ from overground walking.ObjectiveTo investigate how the relationships between gait metrics and walking speed vary between overground and treadmill walking in people with PD and healthy controls.MethodsWe compared 29 healthy controls to 27 people with PD in the OFF-medication state. Subjects first walked overground on an instrumented gait walkway, then on an instrumented treadmill at 85%, 100% and 115% of their overground walking speed. Average stride length and cadence were computed for each subject in both overground and treadmill walking.ResultsStride length and cadence both differed between overground and treadmill walking. Regressions of stride length and cadence on gait speed showed a log-log relationship for both overground and treadmill gait in both PD and control groups. The difference between the PD and control groups during overground gait was maintained for treadmill gait, not only when treadmill speed matched overground speed, but also with ± 15% variation in treadmill speed from that value.SignificanceThese results show that the impact of PD on stride length and cadence and their relationship to gait speed is preserved in treadmill as compared to overground walking. We conclude that a treadmill protocol is suitable for laboratory use in studies of PD gait therapeutics.     

Development of temporal and distance parameters of gait in normal children

Temporal and distance parameters of 33 normal children were obtained from instrumented gait analysis prospectively over five consecutive years. The parameters were normalised to minimise the confounding effects of increasing height and leg length. Rank correlations were performed on normalised speed, normalised stride length, normalised cadence and normalised walk ratio across consecutive pairs of years to examine the ranking of these parameters for an individual child over time. Consistent trends of increasing rank correlation were observed in normalised stride length and normalised walk ratio suggesting that individual children were continuing to adjust these gait parameters towards their own characteristic position within the normal range. Consistent trends were not observed in the rank correlations for normalised speed and normalised cadence. These findings support the concept that individual children predominantly adjusted their cadence to effect changes in speed, while the development of stride length was dictated by other factors specific to the individual child. Rank correlation coefficients for walk ratio between consecutive years increased from the ages of 7-11 years of age and hence walk ratio appears be a feature of gait that matures beyond the age of 7 years. This accords with the proposal that it is an invariant parameter for an individual.     

Hip joint mechanics during walking in individuals with mild-to-moderate hip osteoarthritis

The purpose of this case-control study was to characterise hip joint kinematics and moments during gait in people with mild-to-moderate hip osteoarthritis (OA). Eligible participants were allocated to the hip OA group (n = 27) or the age-matched control group (n = 26) based on radiographic and symptomatically defined inclusion criteria. Participants walked barefoot along a 10-m walkway at their self-selected gait speed. Trajectories of 43 markers attached to the trunk, pelvis, upper and lower limbs were recorded using a 12-camera motion capture system. Ground reaction force data were simultaneously collected. Individuals in the hip OA group had a 10% higher body mass, 13% slower self-selected walking speed, 10% shorter step length, 2% and 9% longer relative stance and double support duration (% stride) respectively, 41% lower sagittal plane hip range of motion, and 28% and 45% lower peak sagittal and transverse plane hip joint moments respectively during gait compared to controls (p < 0.05). The finding that individuals with mild-to-moderate hip OA experienced less net hip joint loading over a reduced range of hip motion for a longer proportion of the gait cycle when walking at their preferred gait speed suggest that the mechanics of the hip joint are altered in hip OA, and could have implications for disease progression through altered mechano-biological processes within the joint.     

Effect of contralateral cane use on hip moment impulse in the frontal plane during the stance phase

BackgroundRecent reports have shown that the daily cumulative moment in the frontal plane (i.e., product of hip moment impulse in the frontal plane during the stance phase and mean steps per day) is a risk factor for hip osteoarthritis. This study aimed to clarify the effect of contralateral cane use on hip moment impulse in the frontal plane of the stance limb.MethodsThis study included 15 healthy subjects who walked under four experimental conditions: (1) without a cane and (2–4) contralateral cane use with 10%, 15%, and 20% body weight support (BWS), respectively. To maintain the same walking speed in all conditions, the cadence was set to 80 steps/min, and the step length was fixed. The hip moment impulses in the frontal plane (i.e., area under the hip ab-adduction moment waveform) and peak hip adduction moments in all conditions were calculated.ResultsContralateral cane use significantly decreased the hip moment impulse in the frontal plane and peak hip adduction moment compared to non-cane use. Moreover, the hip moment impulse in the frontal plane and peak hip adduction moment decreased significantly with increased cane BWS. There were no significant differences in walking speed, cadence, and step length between the four conditions.ConclusionContralateral cane use decreases the hip moment impulse in the frontal plane and peak hip adduction moment in the stance limb. These findings may help clarify how to delay the progression of hip osteoarthritis.     

Effect of walking speed during gait in water of healthy elderly

BackgroundWalking in water (WW) is frequently used as an aquatic exercise in rehabilitation programs for the elderly. Understanding gait characteristics of WW is of primary importance to effectively design specific water-based rehabilitation programs. Moreover, as walking speed in water is reduced with a possible effect on gait parameters, the age- and environment-related changes during WW have to be investigated considering the effects of instantaneous walking speed. Research question: how do gait kinematic characteristics differ in healthy elderly between WW and on land walking condition (LW)? Do elderly show different walking patterns compared to young adults? Can these kinematic changes be accounted only by the different environment/age or are they also related to walking speed?MethodsNine healthy elderly participants (73.5 ± 5.8 years) were acquired during walking in WW and LW at two different speeds. Kinematic parameters were assessed with waterproofed inertial magnetic sensors using a validated protocol. The influence of environment, age and walking speed on gait parameters was investigated with linear mixed models.ResultsShorter stride distances and longer stride durations were observed in WW compared to LW. In the sagittal plane, hip and knee joint showed larger flexion in WW (>10deg over the whole stride and ∼28deg at foot strike, respectively). Furthermore, lower walking speeds and stride distances were observed in elderly compared to young adults. In the sagittal plane, a slightly more flexed hip joint and a less plantarflexed ankle joint (∼9 deg) were observed in the elderly. Significance: The results showed the importance of assessing the walking speed during WW, as gait parameters can vary not only for the effect environment but also due to different walking speeds.     

Knee strength and knee adduction moments following arthroscopic partial meniscectomy

PURPOSE: This study investigated the relationship between muscular strength about the knee and knee joint moments during gait in patients who had undergone arthroscopic partial meniscectomy (APM). METHODS: One hundred and two APM patients and 42 age-matched nonoperated controls underwent strength testing and three-dimensional gait analysis. Patients were divided into weak and normal subgroups and compared with controls for spatiotemporal, kinematic, and kinetic gait parameters. RESULTS: Spatiotemporal parameters, kinematics, and sagittal plane kinetics were similar between APM patients and controls. The APM group displayed weaker concentric knee extension and flexion strength compared with controls. The weak APM subgroup had an increased average and peak knee adduction moments over stance compared with the APM subgroup with normal strength levels and controls. The normal strength APM subgroup had a larger peak knee adduction moment in early stance compared with controls. CONCLUSION: Achieving normal lower limb muscle strength following APM appears important to resume normal frontal plane loading of the knee while walking.     

Sagittal subtalar and talocrural joint assessment between barefoot and shod walking: A fluoroscopic study

BackgroundWhile wearing shoes is common in daily activities, most foot kinematic models report results on barefoot conditions. It is difficult to describe foot position inside shoes. This study used fluoroscopic images to determine talocrural and subtalar motion.Research QuestionWhat are the differences in sagittal talocrual and subtalar kinematics between walking barefoot and while wearing athletic walking shoes?MethodsThirteen male subjects (mean age 22.9 ± 2.9 years, mean weight 77.2 ± 6.9 kg, mean height 178.2 ± 3.7 cm) screened for normal gait were tested. A fluoroscopy unit was used to collect images during stance. Sagittal motion of the talocrural and subtalar joints of the right foot were analyzed barefoot and in an athletic walking shoe.ResultsShod talocrural position at heel strike was 6.0° of dorsiflexion and shod peak talocrural plantarflexion was 4.2°. Barefoot talocrural plantarflexion at heel strike was 4.2° and barefoot peak talocrural plantarflexion was 10.9°. Shod subtalar position at heel strike was 2.6° of plantarflexion and peak subtalar dorsiflexion was 1.5°. The barefoot subtalar joint at heel strike was in 0.4° dorsiflexion and barefoot peak subtalar dorsiflexion was 3.5°. As the result of wearing shoes, average walking speed and stride length increased and average cadence decreased. Comparing barefoot to shod walking there was a statistical significance in talocrural dorsiflexion and at heel strike and peak talocrural dorsiflexion, subtalar plantarflexion at heel strike and peak subtalar dorsiflexion, walking speed, stride length, and cadence.SignificanceThis work demonstrates the ability to directly measure talocrural and subtalar kinematics of shod walking using fluoroscopy. Future work using this methodology can be used to increase understanding of hindfoot kinematics during a variety of non-barefoot activities.     

On the expression of joint moments during gait

The purpose of the current study was to examine the effect of different reference frames on lower limb joint moments during gait with a view to identifying a recommended convention for clinical purposes. Data were collected from 10 subjects (nine able-bodied adults and one child with diplegic cerebral palsy) whilst walking at a self-selected speed. Calculations utilised a three-dimensional inverse dynamics model. For each joint, moments were expressed in four different reference frames. Three of the frames were orthogonal: laboratory frame; anatomical frame of proximal segment; anatomical frame of distal segment. The fourth reference frame was a non-orthogonal joint coordinate system (JCS). Significant differences in the joint moment profiles during gait were found with alternative references frames. This was apparent primarily for the transverse plane joint moments for able-bodied adult gait. For the pathological gait pattern presented, there were also marked differences in the frontal plane joint moments and more subtle ones in the sagittal plane. Whilst it is recognised that all possible reference frames for the expression of the net moment vector are mathematically valid, a decision needs to be made as to which one is more clinically useful. It is proposed that the non-orthogonal JCS is most logical on the basis of what, biomechanically, the joint moment actually represents.     

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.     

Changes in 3D joint dynamics during the first 5 months after the onset of independent walking: a longitudinal follow-up study

A longitudinal follow-up study of 10 normally developing children was performed in order to identify changes in mechanical control of gait during the first months after initiation of independent walking. Changes in spatio-temporal parameters and kinematics were recorded (336 trials spread over 83 recording sessions) and linked to kinetic features of gait. At the onset of independent walking, all children in our study group showed the same walking strategy: a dominance of the extending moments around the lower extremity joints was observed and could be linked to the flexed position of the hip and knee during stance. In a subset of our study population, the dominance of the extending moments disappeared with increasing walking experience, though reversal to immature patterns was frequently observed. A linear mixed model showed that with increasing walking experience, there was an increase in dimensionless walking speed, dimensionless cadence and dimensionless stride length (without correction for the increase in speed). Maximal hip extension in stance, knee flexion and ankle plantar flexion at foot contact also increased (even when the increase in speed is taken into account). Dimensionless step width, duty factor, double support time, maximal hip flexion in swing and hip abduction significantly decreased (with correction for speed). Important changes were also observed in ground reaction force patterns, evolving towards a double "hump". No significant changes could be observed in other kinetic parameters, probably due to the high degree of variability.     

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.     

Women with fibromyalgia walk with an altered muscle synergy

Most individuals can use different movement and muscle recruitment patterns to perform a stated task but often only one pattern is selected which optimizes an unknown global objective given the individual's neuromusculoskeletal characteristics. Patients with fibromyalgia syndrome (FS), characterized by their chronic pain, reduced physical work capacity and muscular fatigue, could exhibit a different control signature compared to asymptomatic control volunteers (CV). To test this proposal, 22 women with FS, and 11 CV, were assessed in a gait analysis laboratory. Each subject walked repeatedly at self-selected slow, comfortable, and fast walking speeds. The gait analysis provided, for each walk, each subject's stride time, length, and velocity, and ground reaction force, and lower extremity joint kinematics, moments and powers. The data were then anthropometrically scaled and velocity normalized to reduce the influence of subject mass, leg length, and walking speed on the measured gait outcomes. Similarities and differences in the two groups' scaled and normalized gait patterns were then determined. Results show that FS and CV walk with externally similar stride lengths, times, and velocities, and joint angles and ground reaction forces but they use internally different muscle recruitment patterns. Specifically, FS preferentially power gait using their hip flexors instead of their ankle plantarflexors. Interestingly, CV use a similar muscle fatiguing recruitment pattern to walk fast which parallels the common complaint of fatigue reported by FS walking at comfortable speed.     

Normative database of spatiotemporal gait parameters using inertial sensors in typically developing children and young adults

BackgroundInertial sensors are increasingly useful to clinicians and researchers to detect gait deficits. Reference values are necessary for comparison to children with gait abnormalities.ObjectiveTo present a normative database of spatiotemporal gait and turning parameters in 164 typically developing children and young adults ages 5−30 utilizing the APDM Mobility Lab® system.MethodsParticipants completed the i-WALK test at both self-selected (SS) and fast as possible (FAP) walking speeds. Spatiotemporal gait and turning parameters included stride length, stride length variability, gait speed, cadence, stance, swing, and double support times, and foot strike, toe-off, and toe-out angles, turn duration, peak turn velocity and number of steps to turn.ResultsAbsolute stride length and gait speed increased with age. Normalized gait speed, absolute and normalized cadence, and stride length variability decreased with age. Normalized stride length and all parameters of gait cycle phase and foot position remained unaffected by age except for greater FSA in children 7−8. Foot position parameters in children 5−6 were excluded due to aberrant values and high standard deviations. Turns were faster in children ages 5–13 and 7–13 in the SS and FAP conditions, respectively. There were no differences in number of steps to turn. Similar trends were observed in the FAP condition except: normalized gait speed did not demonstrate a relationship with age and children ages 5–8 demonstrated increased stance and double support times and decreased swing time compared to children 11−13 and young adults (ages 5−6 only). Females ages 5−6 demonstrated increased stride length variability in the SS condition; males ages 7−8 and 14–30 ha d increased absolute stride length in the FAP condition. Similarities and differences were found between our values and previous literature.SignificanceThis normative database can be used by clinicians and researchers to compare abnormal gait patterns and responses to interventions.     

Spinal fusion limits upper body range of motion during gait without inducing compensatory mechanisms in adolescent idiopathic scoliosis patients

IntroductionPrevious studies show a limited alteration of gait at normal walking speed after spinal fusion surgery for adolescent idiopathic scoliosis (AIS), despite the presumed essential role of spinal mobility during gait. This study analyses how spinal fusion affects gait at more challenging walking speeds. More specifically, we investigated whether thoracic-pelvic rotations are reduced to a larger extent at higher gait speeds and whether compensatory mechanisms above and below the stiffened spine are present.Methods18 AIS patients underwent gait analysis at increasing walking speeds (0.45 to 2.22 m/s) before and after spinal fusion. The range of motion (ROM) of the upper (thorax, thoracic-pelvic and pelvis) and lower body (hip, knee and ankle) was determined in all three planes. Spatiotemporal parameters of interest were stride length and cadence.ResultsSpinal fusion diminished transverse plane thoracic-pelvic ROM and this difference was more explicit at higher walking speeds. Transversal pelvis ROM was also decreased but this effect was not affected by speed. Lower body ROM, step length and cadence remained unaffected.DiscussionDespite the reduction of upper body ROM after spine surgery during high speed gait, no altered spatiotemporal parameters or increased compensatory ROM above or below the fusion (i.e. in the shoulder girdle or lower extremities) was identified. Thus, it remains unclear how patients can cope so well with such major surgery. Future studies should focus on analyzing the kinematics of individual spinal levels above and below the fusion during gait to investigate possible compensatory mechanisms within the spine.     

The influence of stride-length on plantar foot-pressures and joint moments

Purpose

Joint moments have been acknowledged as key factors in understanding gait abnormalities. Gait velocity is further known to affect joint moments and foot pressures. Keeping gait velocity constant is thus a strategy to cancel out the influence of different preferred gait speed between groups. But even if gait velocity is controlled, individuals can choose different stride length–stride frequency combinations to cope with an imposed gait velocity.

Scope

To understand the influence of stride frequency–stride length on joint moments and plantar pressures.

Methods

Twenty healthy young adults had to cross an 8 m walkway with a walking speed of 1.3 m s⁻¹. The wooden walkway was equipped with a force and a pressure platform. While walking speed was kept constant each participant walked with five different imposed stride lengths (SL): preferred (SL0); with a decrease of 10% (SL − 10); with a decrease of 20% (SL − 20); with an increase of 10% (SL + 10) and with an increase of 20% (SF + 20).

Results

Ankle and knee joint moments significantly decreased with a decrease in SL. A significant (p < .05) lower peak pressure was achieved with a decreased SL under the heel, toes and midfoot.

Discussion/conclusion

The results showed that a change in stride lengths alters both, joint moments and foot pressures with clinically interesting indications. Redistribution of joint moments in the elderly for example might rather result from decreased SL than from age.     

Juvenile idiopathic arthritis,gait characteristics and relation to function

BackgroundJuvenile Idiopathic Arthritis (JIA) is a chronic inflammatory arthritis that impacts biomechanical features of gait. This systematic review describes the effects of JIA on gait motion parameters and walking performance.MethodsSix databases were searched (PubMed/Medline, Cochrane, the EBSCOHost database SPORTDiscus, Web of Science, and Embase). Studies were restricted to children with any subtype of JIA who were assessed for gait motion features (kinematic, kinetic, temporalspatial) or walking performance (velocity or distance covered); could include intervention or treatment exposure with measures of gait and gait speed; could involve comparison of gait in JIA to healthy controls. Quality of evidence was assessed using the GRADE system. This systematic review was registered at PROSPERO (CRD42018109582)ResultsThe search yielded 625 papers, 23 of which described biomechanical features of gait and/or assessed walking performance. Twenty studies measured walking velocity and walking ability using simple field tests or laboratory methods. Eleven studies measured temporalspatial parameters such as cadence, step length, stride length, step width, single and double support time. Nine studies evaluated kinetic measurements including joint power, flexion and extension and joint moments. Nine studies evaluated kinematic parameters including range of motion, pelvic tilt, center of motion and trunk sway.ConclusionsKey features of gait in children with JIA include slower gait velocity, shortened step length, decreased range of motion at the hip, knee and ankle with trend towards flexion, decreased joint power, anteriorly tilted pelvis and trunk with shifted center of motion. There is a potential to ameliorate JIA-related gait changes with exercise and/or pharmaceutical interventions.