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

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

Different cognitive functions discriminate gait performance in younger and older women: A pilot study

AimCognitive dysfunction is associated with slower gait speed in older women, but whether cognitive function affects gait performance earlier in life has yet to be investigated. Thus, the objective of this study was to test the hypothesis that cognitive function will discriminate gait performance in healthy younger women.MethodsFast-pace and dual-task gait speed were measured in 30 young to middle-aged (30–45 y) and 26 older (61–80 y) women without mild cognitive impairment. Visuoperceptual ability, working memory, executive function, and learning ability were assessed using neuropsychological tests. Within each age group, women were divided by the median into lower and higher cognitive function groups to compare gait performance.ResultsYounger women with higher visuoperceptual ability had faster fast-pace (2.25 ± 0.30 vs. 1.98 ± 0.18 m/s, p ≤ 0.01) and dual-task gait speed (2.02 ± 0.27 vs. 1.69 ± 0.25 m/s, p ≤ 0.01) than women with lower visuoperceptual ability. The difference in dual-task gait speed remained significant (p = 0.02) after adjusting for age, years of education, and other covariates. Dividing younger women based on other cognitive domains showed no difference in gait performance. In contrast, working memory and executive function discriminated dual-task gait speed (p < 0.05) in older women after adjusting for age and education.ConclusionTo our knowledge, this is the first study to show that poorer cognitive function even at a relatively young age can negatively impact mobility. Different cognitive functions discriminated gait performance based on age, highlighting a possible influence of aging in the relationship between cognitive function and mobility in women.     

No differences in tandem gait performance between male and female athletes acutely post-concussion

ObjectivesTo test whether 1) concussed athletes demonstrate slower tandem gait times compared to controls and 2) concussed female athletes display greater post-injury deficits than males.DesignProspective longitudinalMethodFifty concussed collegiate student-athletes (32% female, age = 20.18 ± 1.27 years) completed tandem gait tests during pre-season (Time 1) and acutely (<72 hours) post-concussion (Time 2), and twenty-five controls (52% female, age = 21.08 ± 2.22 years) completed tandem gait at two time points, 1.96 ± 0.46 days apart. Participants completed four single-task (ST) and dual-task (DT) trials. During DT trials, they simultaneously completed a cognitive assessment. The best ST and DT times were recorded, along with cognitive accuracy, and the change score between the two assessments was calculated. A positive change in tandem gait time was indicative of worsening performance. A 2 × 2 (group*sex) ANOVA was used to examine change between pre-injury and post-injury tests for ST/DT tandem gait time and DT cognitive accuracy.ResultsThe change in tandem gait time from Time 1 to Time 2 was significantly higher for the concussion group relative to controls during both ST (Concussion: 1.36 ± 2.6 seconds, Controls: -1.16 ± 0.8 seconds, p < 0.001) and DT (Concussion: 1.70 ± 3.8 seconds, Controls: -0.94 ± 1.7 seconds, p = 0.002) tandem gait. There were no interactions or main effects of sex for tandem gait time or cognitive accuracy.ConclusionsThere were no sex-specific differences in the change in tandem gait performance among concussed collegiate athletes or controls. However, all concussed participants, regardless of sex, performed significantly worse on tandem gait than male and female controls, who both improved between testing time points.     

Self-esteem recognition based on gait pattern using Kinect

BackgroundSelf-esteem is an important aspect of individual’s mental health. When subjects are not able to complete self-report questionnaire, behavioral assessment will be a good supplement. In this paper, we propose to use gait data collected by Kinect as an indicator to recognize self-esteem.Methods178 graduate students without disabilities participate in our study. Firstly, all participants complete the 10-item Rosenberg Self-Esteem Scale (RSS) to acquire self-esteem score. After completing the RRS, each participant walks for two minutes naturally on a rectangular red carpet, and the gait data are recorded using Kinect sensor. After data preprocessing, we extract a few behavioral features to train predicting model by machine learning. Based on these features, we build predicting models to recognize self-esteem.ResultsFor self-esteem prediction, the best correlation coefficient between predicted score and self-report score is 0.45 (p < 0.001). We divide the participants according to gender, and for males, the correlation coefficient is 0.43 (p < 0.001), for females, it is 0.59 (p < 0.001).ConclusionUsing gait data captured by Kinect sensor, we find that the gait pattern could be used to recognize self-esteem with a fairly good criterion validity. The gait predicting model can be taken as a good supplementary method to measure self-esteem.     

Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson’s disease: A randomized controlled trial

Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson’s disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0 ± 8.8 years; UPDRS-III 38.1 ± 12.3; H&Y 2.7 ± 0.5) were randomly assigned to either the control (FWG; n = 14) or experimental group (BWG; n = 15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p = 0.03, d = 0.35; BWG: p < 0.01, d = 0.35) and height-normalized gait speed (FWG: p = 0.04, d = 0.35; BWG: p < 0.01, d = 0.57). Additionally, the BWG demonstrated improved cadence (p < 0.01, d = 0.67) and stride length (SL; p = 0.02, d = 0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community.     

Hypokinetic gait changes induced by bilateral pallidal deep brain stimulation for segmental dystonia

BackgroundDeep brain stimulation (DBS) of the globus pallidus internus (GPi) has been established as an effective and safe treatment for dystonia. In general, side effects are rare, but there is increasing evidence that GPi DBS in dystonia can induce hypokinetic symptoms like micrographia or freezing of gait. We aimed to evaluate and quantify possible changes of gait following bilateral chronic GPi DBS for dystonia by computerized gait analyses.MethodsWe prospectively performed computerized gait analysis in ten consecutive patients (mean age 57.8+/−14.3 years) with segmental dystonia but without involvement of lower trunk or legs who were treated with bilateral GPi DBS. Using pressure sensitive insoles, several parameters were measured preoperatively (pre-OP) and at a median of 7 months postoperatively.ResultsThe mean step length significantly decreased from 60.0+/−6.9 cm pre-OP to 54.3+/−6.4 cm with GPi DBS (p < 0.01). Due to only small changes of walking distance and gait velocity, the cadence correspondingly increased from 105.6+/−9.2 steps/min to 111.3+/−11.4 steps/min (p < 0.05). More importantly, the variance of several gait parameters significantly decreased postoperatively.ConclusionsIn patients with segmental dystonia, chronic DBS of the posteroventral lateral GPi is associated with only mild hypokinesia of gait, but with a relevant decrease in gait variability. Given other recently reported hypokinetic effects of GPi DBS for dystonia and recent results of electrophysiological coherence studies, these findings support the hypothesis of a general alteration of neuronal activity in striato-pallido-thalamo-cortical motor pathways following chronic stimulation of the posteroventral lateral GPi.     

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

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

Vitamin d is related to gait recovery after total hip arthroplasty: A prospective analysis

ObjectivesTo investigate the association between baseline serum levels of 25-hydroxyvitamin D (25(OH)D) and gait pattern in patients undergoing total hip arthroplasty (THA).MethodsProspective study of patients with hip osteoarthritis undergoing primary THA between January 2012 and December 2013. Blood samples were collected on the day of hospital admission. Gait analyses were performed before surgery and 3 months postoperatively. Internal moments were captured.ResultsMajor improvements were observed in gait data after THA. 25(OH)D levels correlated with change in peak extension (R = 0.25, p = 0.017) and peak power generation (R = 0.25, p = 0.04). Multiple linear regression analyses were performed. In model 1, 25(OH)D and change in gait speed explained the variability of peak extension (R2 = 0.1, p = 0.004). In model 2, only 25(OH)D explained the variability of peak power generation (R2 = 0.05, p = 0.044).Conclusions25(OH)D levels were correlated with change in peak extension and peak power generation. The effect of 25(OH)D on change in gait variables after THA is modest.     

Unplanned gait termination in individuals with multiple sclerosis

Despite the pervasive nature of gait impairment in multiple sclerosis (MS), there is limited information concerning the control of gait termination in individuals with MS. The purpose of this investigation was to examine unplanned gait termination with and without cognitive distractors in individuals with MS compared to healthy controls. Thirty-one individuals with MS and 14 healthy controls completed a series of unplanned gait termination tasks over a pressure sensitive walkway under distracting and non-distracting conditions. Individuals with MS were further broken down into groups based on assistive device use: (no assistive device (MS_noAD) n = 18; and assistive device (MS_AD) n = 13). Individuals with MS who walked with an assistive device (MS_AD: 67.8 ± 15.1 cm/s) walked slower than individuals without an assistive device (MS_noAD: 110.4 ± 32.3 cm/s, p < 0.01) and controls (120.0 ± 30.0 cm/s; p < 0.01). There was a significant reduction in velocity in the cognitively distracting condition (93.4 ± 32.1 cm/s) compared to the normal condition [108.8 ± 36.2 cm/s; F(1,43) = 3.4, p = 0.04]. All participants took longer to stop during the distracting condition (1.7±0.6 s) than the non-distracting condition (1.4 ± 0.4 s; U = 673.0 p < 0.01). After controlling for gait velocity, post-hoc analysis revealed the MS_AD group took significantly longer to stop compared to the control group (p = 0.05). Further research investigating the control of unplanned gait termination in MS is warranted.     

Spatio-temporal parameters and lower-limb kinematics of turning gait in typically developing children

Turning is a requirement for most locomotor tasks; however, knowledge of the biomechanical requirements of successful turning is limited. Therefore, the aims of this study were to investigate the spatio-temporal and lower-limb kinematics of 90° turning. Seventeen typically developing children, fitted with full body and multi-segment foot marker sets, having performed both step (outside leg) and spin (inside leg) turning strategies at self-selected velocity, were included in the study. Three turning phases were identified: approach, turn, and depart. Stride velocity and stride length were reduced for both turning strategies for all turning phases (p < 0.03 and p < 0.01, respectively), while stance time and stride width were increased during only select phases (p < 0.05 and p < 0.01, respectively) for both turn conditions compared to straight gait. Many spatio-temporal differences between turn conditions and phases were also found (p < 0.03). Lower-limb kinematics revealed numerous significant differences mainly in the coronal and transverse planes for the hip, knee, ankle, midfoot, and hallux between conditions (p < 0.05). The findings summarized in this study help explain how typically developing children successfully execute turns and provide greater insight into the biomechanics of turning. This knowledge may be applied to a clinical setting to help improve the management of gait disorders in pathological populations, such as children with cerebral palsy.     

Toddle temporal-spatial deviation index: Assessment of pediatric gait

This research aims to develop a gait index for use in the pediatric clinic as well as research, that quantifies gait deviation in 18–22 month-old children: the Toddle Temporal-spatial Deviation Index (Toddle TDI). 81 preterm children (≤32 weeks) with very-low-birth-weights (≤1500 g) and 42 full-term TD children aged 18–22 months, adjusted for prematurity, walked on a pressure-sensitive mat. Preterm children were administered the Bayley Scales of Infant Development—3rd Edition (BSID-III). Principle component analysis of TD children’s temporal-spatial gait parameters quantified raw gait deviation from typical, normalized to an average(standard deviation) Toddle TDI score of 100(10), and calculated for all participants. The Toddle TDI was significantly lower for preterm versus TD children (86 vs. 100, p = 0.003), and lower in preterm children with <85 vs. ≥85 BSID-III motor composite scores (66 vs. 89, p = 0.004). The Toddle TDI, which by design plateaus at typical average (BSID-III gross motor 8–12), correlated with BSID-III gross motor (r = 0.60, p < 0.001) and not fine motor (r = 0.08, p = 0.65) in preterm children with gross motor scores ≤8, suggesting sensitivity to gross motor development. The Toddle TDI demonstrated sensitivity and specificity to gross motor function in very-low-birth-weight preterm children aged 18–22 months, and has been potential as an easily-administered, revealing clinical gait metric.     

Center of pressure during stance and gait in subjects with or without persistent complaints after a lateral ankle sprain

Study aimTo investigate differences in the center of pressure (COP) during gait and single leg stance between subjects with persistent complaints (PC) and without persistent complaints (NPC) after a lateral ankle sprain.Methods44 patients who consulted the general practitioner, 6–12 months prior to inclusion, with a lateral ankle sprain were included for the current study purpose. Using a 7-point Likert scale patients were divided into the PC or NPC group. All subjects filled out an online questionnaire, walked along a walkway and performed a single leg stance, both on the RSscan. Primary outcomes included the COP displacement, range and percentage used in mediolateral and anterioposterior direction.ResultsThere was a trend (p < 0.05) towards a more medially COP trajectory during walking at 34–46% and 83–96% and more anteriorly at 21–31% and 91–100% of the stance phase in the PC group compared to NPC group. Additionally, the COP was more laterally located in the sprained leg compared to the non-sprained leg in the PC group in the loading response phase (p < 0.05). An interaction was found for the percentage of anterior–posterior range used in single leg stance without vision.ConclusionThe COP trajectory discriminates between patients with PC and NPC. This indicates that roll off during gait might play an important role in the recovery of patients after a lateral ankle sprain and could be used to monitor treatment.     

Biomechanical strategies implemented to compensate for mild leg length discrepancy during gait

Although mild leg length discrepancy is related to lower limb injuries, there is no consensus regarding its effects on the biomechanics of the lower limbs during gait. Biomechanical data of 19 healthy participants were collected while they walked under different conditions as described: (1) control condition—wearing flat thick sandals; (2) short limb condition—wearing a flat thick sandal on the left and a flat thin sandal on the right foot; (3) long limb condition: wearing flat thin sandal on the left and flat thick sandal on the right foot. The thick and thin sandals had 1.45 cm of mean thickness difference. The right lower limb data were analyzed for all conditions. Ankle, knee, hip and pelvis kinematics and internal moments were measured with a motion capture system and six force platforms. Principal component analysis was used to compare differences between conditions. The scores of the principal components were compared between conditions using one-way repeated measures ANOVA. Twelve gait variables were different between conditions: rearfoot dorsiflexion and inversion (p < 0.001); ankle dorsiflexion and inversion moments (p < 0.001); knee flexion angle and moment (p < 0.001); knee adduction moment (p < 0.001); hip flexion angle and moment (p < 0.001); hip adduction angle (p = 0.001) and moment (p = 0.022); and pelvic ipsilateral drop (p < 0.001). Mild leg length discrepancy caused compensatory changes during gait, apparently to equalize the functional length of the lower limbs. However, these strategies did not fully succeed, since both short and long limb conditions affected pelvic motion in the frontal plane. These results suggest that mild leg length discrepancy should not be overlooked in clinical settings.     

Trunk sway during walking among older adults: Norms and correlation with gait velocity

The aim of this study was to establish quantitative norms for trunk sway during walking for older male and female ambulatory adults at different age groups (65–70, 71–75, 76–80, ≥81). We also assessed the relationship between dynamic trunk sway and gait velocity in older individuals with clinically normal or abnormal gaits. Trunk sway in medio-lateral (roll) and antero-posterior (pitch) planes was measured using a body-mounted gyroscope (SwayStar) during walking on a 4.5 m long instrumented walkway. Of the 284 older adults (mean age 76.8, 54.6% women) in this sample, the mean ± SD value of roll and pitch angles were 6.0 ± 2.0° and 6.7 ± 2.2° respectively. Older women showed significantly greater trunk sway in both roll and pitch angles than older men (p < 0.01). In both men and women, there was no significant association of roll angle with age although gait velocity decreased with increasing age. The relationship between roll angle and gait velocity was U-shaped for the overall sample. Among the subgroup with clinically normal gait, increased roll angle was associated with increased gait velocity (p < 0.001). However, there was no significant relationship between roll angle and gait velocity among the subgroup with abnormal gait. Therefore, the relationship between medio-lateral trunk sway and gait velocity differs depending on whether gait is clinically normal.We conclude that trunk sway during walking should be interpreted with consideration of both gait velocity and presence of gait abnormality in older adults.     

Trunk sway during walking among older adults: Norms and correlation with gait velocity

The aim of this study was to establish quantitative norms for trunk sway during walking for older male and female ambulatory adults at different age groups (65–70, 71–75, 76–80, ≥81). We also assessed the relationship between dynamic trunk sway and gait velocity in older individuals with clinically normal or abnormal gaits. Trunk sway in medio-lateral (roll) and antero-posterior (pitch) planes was measured using a body-mounted gyroscope (SwayStar) during walking on a 4.5 m long instrumented walkway. Of the 284 older adults (mean age 76.8, 54.6% women) in this sample, the mean ± SD value of roll and pitch angles were 6.0 ± 2.0° and 6.7 ± 2.2° respectively. Older women showed significantly greater trunk sway in both roll and pitch angles than older men (p < 0.01). In both men and women, there was no significant association of roll angle with age although gait velocity decreased with increasing age. The relationship between roll angle and gait velocity was U-shaped for the overall sample. Among the subgroup with clinically normal gait, increased roll angle was associated with increased gait velocity (p < 0.001). However, there was no significant relationship between roll angle and gait velocity among the subgroup with abnormal gait. Therefore, the relationship between medio-lateral trunk sway and gait velocity differs depending on whether gait is clinically normal.We conclude that trunk sway during walking should be interpreted with consideration of both gait velocity and presence of gait abnormality in older adults.     

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

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

Ankle-foot orthoses that restrict dorsiflexion improve walking in polio survivors with calf muscle weakness

In polio survivors with calf muscle weakness, dorsiflexion-restricting ankle-foot orthoses (DR-AFOs) aim to improve gait in order to reduce walking-related problems such as instability or increased energy cost. However, evidence on the efficacy of DR-AFOs in polio survivors is lacking. We investigated the effect of DR-AFOs on gait biomechanics, walking energy cost, speed, and perceived waking ability in this patient group.Sixteen polio survivors with calf muscle weakness underwent 3D-gait analyses to assess gait biomechanics when walking with a DR-AFOs and with shoes only. Ambulant registration of gas-exchange during a 6 min walk test determined walking energy cost, and comfortable gait speed was calculated from the walked distance during this test. Perceived walking ability was assessed using purposely-designed questionnaires.Compared with shoes-only, walking with the DR-AFOs significantly increased forward progression of the center of pressure (CoP) in mid-stance and it reduced ankle dorsiflexion and knee flexion in mid- and terminal stance (p < 0.05). Furthermore, walking energy cost was lower (−7%, p = 0.052) and gait speed was higher (p = 0.005). Patients were significantly more satisfied, felt safer, and less exhausted with the DR-AFO, compared to shoes-only (p < 0.05). DR-AFO effects varied largely across patients. Patients who walked with limited forward CoP progression and persisting knee extension during the shoes-only condition seemed to have benefitted least from the DR-AFO.In polio survivors with calf muscle weakness, DR-AFOs improved gait biomechanics, speed, and perceived walking ability, compared to shoes-only. Effects may depend on the shoes-only gait pattern, therefore further study is needed to determine which patients benefit most from the DR-AFO.     

Manipulating walking path configuration influences gait variability and six-minute walk test outcomes in older and younger adults

This study determined whether manipulations to walking path configuration influenced six-minute walk test (6MWT) outcomes and assessed how gait variability changes over the duration of the 6MWT in different walking path configurations. Healthy older (ODR) and younger (YNG) (n = 24) adults completed familiarisation trials and five randomly ordered experimental trials of the 6MWT with walking configurations of; 5, 10 and 15 m straight lines, a 6 m by 3 m rectangle (RECT), and a figure of eight (FIG8). Six-minute walk distance (6MWD) and walking speed (m.s⁻¹) were recorded for all trials and the stride count recorded for experimental trials. Reflective markers were attached to the sacrum and feet with kinematic data recorded at 100 Hz by a nine-camera motion capture system for 5 m, 15 m and FIG8 trials, in order to calculate variability in stride and step length, stride width, stride and step time and double limb support time. Walking speeds and 6MWD were greatest in the 15 m and FIG8 experimental trials in both groups (p < 0.01). Step length and stride width variability were consistent over the 6MWT duration but greater in the 5 m trial vs. the 15 m and FIG8 trials (p < 0.05). Stride and step time and double limb support time variability all reduced between 10 and 30 strides (p < 0.01). Stride and step time variability were greater in the 5 m vs. 15 m and FIG8 trials (p < 0.01). Increasing uninterrupted gait and walking path length results in improved 6MWT outcomes and decreased gait variability in older and younger adults.     

Consistency and cost of dual-task gait balance measure in healthy adolescents and young adults

Matched control data are commonly used to examine recovery from concussion. Limited data exist, however, examining dual-task gait data consistency collected over time in healthy individuals. The study purposes were to: 1) assess the consistency of single-task and dual-task gait balance control measures, 2) determine the minimal detectable change (MDC) of gait balance control measures, and 3) examine the extent to which age and task complexity affect dual-task walking costs in healthy adolescents and young adults. Twenty-four adolescent (mean age = 15.5 ± 1.1 years) and 21 young adult (mean age = 21.2 ± 4.5 years) healthy participants completed 5 testing sessions across a two-month period, which involved analyses of gait balance control and temporal-distance variables during single-task and dual-task walking conditions in a motion analysis laboratory. Cronbach’s α and MDCs were used to determine the consistency of the gait balance control variables and the smallest amount of change required to distinguish true performance from change due to the performance/measurement variability, respectively. Dual-task costs were evaluated to determine the effect of task complexity and age across time using 3-way ANOVAs. Good to excellent test-retest consistency was found for all single-task and dual-task walking (Cronbach’s α range: 0.764–0.970), with a center-of-mass medial-lateral displacement MDC range of 0.835–0.948 cm. Greater frontal plane dual-task costs were observed during more complex secondary tasks (p < 0.001). The results revealed good-excellent consistency across testing sessions for all variables and indicated dual-task costs are affected by task complexity. Thus, healthy controls can be effective comparators when assessing injured subjects.     

Shod wear and foot alignment in clinical gait analysis

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