Effects of anteriorly-loaded treadmill walking on dynamic gait stability in young adults

BackgroundAnteriorly-loaded walking is common in many occupations and may increase fall risk. Dynamic gait stability, defined by the Feasible Stability Region (FSR) theory, quantifies the kinematic relationship between the body’s center of mass (COM) and base of support (BOS). FSR-based dynamic gait stability has been used to evaluate the fall risk.Research questionHow does front load carriage affect dynamic gait stability, step length, and trunk angle among young adults during treadmill walking?MethodsIn this between-subject design study, 30 healthy young adults were evenly randomized into three load groups (0%, 10%, or 20% of body weight). Participants carried their assigned load while walking on a treadmill at a speed of 1.2 m/s. Body kinematics were collected during treadmill walking. Dynamic gait stability (the primary variable) was calculated for two gait events: touchdown and liftoff. Step length and trunk angle were measured as secondary variables. One-way analysis of variance was conducted to detect any group-related differences for all variables. Post-hoc analysis with Bonferroni correction was performed when main group differences were found.ResultsNo significant differences but medium to large effect sizes were found between groups for dynamic gait stability at touchdown (p = 0.194, η² = 0.114) and liftoff (p = 0.122, η² = 0.139). Trunk angle significantly increased (indicating backward lean) with the front load at touchdown (p < 0.001, η² = 0.648) and liftoff (p < 0.001, η² = 0.543). No significant between-group difference was found related to the step length (p = 0.344, η² = 0.076).SignificanceCarrying a front load during walking significantly alters the trunk orientation and may change the COM-BOS kinematic relationship and, therefore, fall risk. The findings could inform the design of future studies focusing on the impact of anterior load carriage on fall risk during different locomotion.     

Tester and testing procedure influence clinically determined gait speed

BackgroundThere is a clinical need to be able to reliably detect meaningful changes (0.1 to 0.2 m/s) in usual gait speed (UGS) considering reduced gait speed is associated with morbidity and mortality.Research questionWhat is the impact of tester on UGS assessment, and the influence of test repetition (trial 1 vs. 2), timing method (manual stopwatch vs. automated timing), and starting condition (stationary vs. dynamic start) on the ability to detect changes in UGS and fast gait speed (FGS)?MethodsUGS and FGS was assessed in 725 participants on a 8-m course with infrared timing gates positioned at 0, 2, 4 and 6 m. Testing was performed by one of 13 testers trained by a single researcher. Time to walk 4-m from a stationary start (i.e. from 0-m to 4-m) was measured manually using a stopwatch and automatically via the timing gates at 0-m and 4-m. Time taken to walk 4-m with a dynamic start was measured during the same trial by recording the time to walk between the timing gates at 2-m and 6-m (i.e. after 2-m acceleration).ResultsTesters differed for UGS measured using manual vs. automated timing (p = 0.02), with five and two testers recording slower and faster UGS using manual timing, respectively. 95% limits of agreement for trial 1 vs. 2, manual vs. automated timing, and dynamic vs. stationary start ranged from ±0.15 m/s to ±0.20 m/s, coinciding with the range for a clinically meaningful change. Limits of agreement for FGS were larger ranging from ±0.26 m/s to ±0.35 m/s.SignificanceRepeat testing of UGS should performed by the same tester or using an automated timing method to control for tester effects. Test protocol should remain constant both between and within participants as protocol deviations may result in detection of an artificial clinically meaningful change.     

Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators.

Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls.

Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition).

Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05).

Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.     

Relationship between plantar pressure distribution under the foot and insole comfort

In this paper, four pairs of insoles with different comfort characteristics were used to investigate the relationship between the pressure distribution under the foot and running shoe comfort. Fourteen male subjects were tested in four insole conditions by walking and running on a treadmill. The pressure at the plantar surface of the foot was measured by using an EMED pressure-measuring insole. For walking there were significantly higher pressures and forces in the midfoot area and significantly lower pressures in the medial forefoot and hallux area by wearing the most comfortable insole compared with wearing the least comfortable insole. The shift of the pressure from forefoot to midfoot for the most comfortable insole provided an even distribution of the pressure at the plantar surface of the foot. The results also demonstrated that the path of centre of force at the plantar surface of the foot moved to the lateral aspect of the foot for the most comfortable insole. For running, only the pressure in the medial forefoot area was found significantly lower for the most comfortable insole than for the least comfortable insole. The results of this study indicated that the pressure distribution between the plantar surface of the foot and the shoe could detect the change of shoe comfort. Thus it is a suggestion that pressure measurement may be related to understand factors important for shoe comfort.

Comfort of sport shoes is important for the appropriate execution of sport activities. Additionally, comfort may influence fatigue and possibly the development of injuries. The quantification of comfort of sport shoes and the understanding of mechanical and/or biological functions related to it may be enhanced with the use of pressure measurements between the plantar surface of the foot and the shoe sole.     

劳动姿势对流量－容积曲线的影响─—波速学说的进一步验证

用“点值法”对健康工人４７３例［轻体力劳动工人（简称轻工）２４８例，重体力劳动工人（简称重工）２２５例］。作了流量一容积曲线和常规通气功能检查。结果表明：重工男女在４０岁以后其高肺容积流量下降，３０岁以后低肺容积流量上升，而且这些改变有随年龄增长而更加明显的倾向；轻工仅有个别年龄组的低肺容积流量上升。对７名健康坐位工作者模拟劳动的前倾姿势作多次通气功能检查，亦有明显高肺容积流量下降和低肺容积流量上升的现象，这一事实提示波速学说亦可应用于颈和躯干前倾进行重体力劳动工人的通气行为。     

Human balance and posture control during standing and walking

The common denominator in the assessment of human balance and posture is the inverted pendulum model. If we focus on appropriate versions of the model we can use it to identify the gravitational and acceleration perturbations and pinpoint the motor mechanisms that can defend against any perturbation.

We saw that in quiet standing an ankle strategy applies only in the A/P direction and that a separate hip load/unload strategy by the hip abd/adductors is the totally dominant defence in the M/L direction when standing with feet side by side. In other standing positions (tandem, or intermediate) the two mechanisms still work separately, but their roles reverse. In the tandem position M/L balance is an ankle mechanism (invertors/evertors) while in the A/P direction a hip load/unloading mechanism dominates.

During initiation and termination of gait these two separate mechanisms control the trajectory of the COP to ensure the desired acceleration and deceleration of the COM. During initiation the initial acceleration of the COM forward towards the stance limb is achieved by a posterior and lateral movement of the COP towards the swing limb. After this release phase there is a sudden loading of the stance limb which shifts the COP to the stance limb. The COM is now accelerated forward and laterally towards the future position of the swinging foot. Also M/L shifts of the COP were controlled by the hip abductors/adductors and all A/P shifts were under the control of the ankle plantar/dorsiflexors. During termination the trajectory of both COM and COP reverse. As the final weight-bearing on the stance foot takes place the COM is passing forward along the medial border of that foot. Hyperactivity of that foot's plantarflexors takes the COP forward and when the final foot begins to bear weight the COP moves rapidly across and suddenly stops at a position ahead of the future position of the COM. Then the plantarflexors of both feet release and allow the COP to move posteriorly and approach the COM and meet it as quiet stance is achieved. The inverted pendulum model permitted us to understand the separate roles of the two mechanisms during these critical unbalancing and rebalancing periods.

During walking the inverted pendulum model explained the dynamics of the balance of HAT in both the A/P and M/L directions. Here the model includes the couple due to the acceleration of the weight-bearing hip as well as gravitational perturbations. The exclusive control of A/P balance and posture are the hip extensors and flexors, while in the M/L direction the dominant control is with the hip abductors with very minor adductor involvement. At the ankle the inverted pendulum model sees the COM passing forward along the medial border to the weight-bearing foot. The model predicts that during single support the body is falling forward and being accelerated medially towards the future position of the swing foot. The model predicts an insignificant role of the ankle invertors/evertors in the M/L control. Rather, the future position of the swing foot is the critical variable or more specifically the lateral displacement from the COM at the start of single support. The position is actually under the control of the hip abd/adductors during the previous early swing phase.

The critical importance of the hip abductors/adductors in balance during all phases of standing and walking is now evident. This separate mechanism is important from a neural control perspective and clinically it focuses major attention on therapy and potential problems with some surgical procedures. On the other hand the minuscule role of the ankle invertors/evertors is important to note. Except for the tandem standing position these muscles have negligible involvement in balance control.     

步行量和体成分的中日比较研究

目的 为了解中日儿童及成人的步行和体成分及其相互关系.方法 以中国上海市和日本琦玉县的小学生和成人为对象,采用西铁城 TW02-001电子式步数计测定步行量,FUTREX-5000A体成分测定仪测量体脂百分比.结果 1.中国男女小学生的平均每日步行量分别为12426步和10387步,低于日本小学生(男15 340步,女11 617步),体脂百分比中国男女生分别为21.2%和15.8%,高于日本(男18.9%,女13.1%).中国男女成人的平均每日步行量分别为9826步和8748步,高于日本成人(男:8411步,女7599步);体脂百分比分别为17.5%(男)和25.8%(女),而日本男性为19.8%,女性为26.0%.2.不同活动水平的小学生和成人,其血压和体成分均有差异,步行量高者的血压和体脂百分比都较低.本研究还计算出以肱三头肌皮脂厚度以(X)推测儿童体脂百分比(Y)的回归方程为:Y=10.6646+0.5856X.结论 作为日常生活的步行可促进肥胖发生率的降低.