Altered Gait Research Articles

Surgical treatment of chronic Achilles tendon rupture results in improved gait biomechanics

BackgroundChronic Achilles tendon rupture is associated with persistent weakness at push-off with the affected foot and poor balance, resulting in significant alterations to normal gait. Surgical repair is the most common treatment for improving gait in patients with a Chronic Achilles tendon rupture, but, to date, the outcomes have not been quantified in the literature.MethodsA total of 23 patients with a Chronic Achilles tendon rupture (mean age 61 ± 15 years) underwent three-dimensional gait analysis according to a standardized protocol using an optical tracking system. Data of spatiotemporal, kinematic and kinetic variables were collected preoperatively and one year postoperatively. In addition, the postoperative gait biomechanics were compared with the gait biomechanics of a control group consisting of 70 healthy individuals (mean age 49 ± 20 years). The prospectively collected data were analyzed by an independent t test.ResultsPostoperatively, increments were found in gait speed (mean difference − 0.12 m/s), stride length (− 0.12 m), peak ankle moment (− 0.64 Nm/kg), peak ankle power (− 1.38 W/kg), peak knee power (− 0.36 m) and reduced step width (0.01 m), compared with preoperative gait biomechanics (p < 0.014). Compared with the control group, patients with a Chronic Achilles tendon rupture exhibited slower postoperative gait speed (mean difference 0.24 m/s), wider step width (− 0.02 m), shorter stride length (0.16 m), longer relative stance phase (− 2.15%), lower peak knee flexion (17.03 degrees), greater peak knee extension (2.58 degrees), lower peak ankle moment (0.35 Nm/kg), peak ankle power (1.22 W/kg) and peak knee power (1.62 W/kg), (p < 0.010).ConclusionSurgical intervention and postoperative rehabilitation can be an effective treatment for alterations in gait after a Chronic rupture of the Achilles tendon. However, at one year postoperatively, patients still exhibit impairments in spatiotemporal variables and knee and ankle power compared with healthy controls.

Shaping Individualized Impedance Landscapes for Gait Training via Reinforcement Learning

Assist-as-needed (AAN) control aims at promoting therapeutic outcomes in robot-assisted rehabilitation by encouraging patients' active participation. Impedance control is used by most AAN controllers to create a compliant force field around a target motion to ensure tracking accuracy while allowing moderate kinematic errors. However, since the parameters governing the shape of the force field are often tuned manually or adapted online based on simplistic assumptions about subjects' learning abilities, the effectiveness of conventional AAN controllers may be limited. In this work, we propose a novel adaptive AAN controller that is capable of autonomously reshaping the force field in a phase-dependent manner according to each individual's motor abilities and task requirements. The proposed controller consists of a modified Policy Improvement with Path Integral algorithm, a model-free, sampling-based reinforcement learning method that learns a subject-specific impedance landscape in real-time, and a hierarchical policy parameter evaluation structure that embeds the AAN paradigm by specifying performance-driven learning goals. The adaptability of the proposed control strategy to subjects' motor responses and its ability to promote short-term motor adaptations are experimentally validated through treadmill training sessions with able-bodied subjects who learned altered gait patterns with the assistance of a powered ankle-foot orthosis.

Occupation related gait alteration: A systematic review

Kinematics describes the way the body moves. The human anatomy is an extremely complex and comprehensive description of how all body parts move. The systemic study of human motion during walking is referred to as gait analysis and the related advanced analysis methods have been in practice in the medical field in current years. People while working maintains the same posture for a long time like workers in the field of construction, carrying heavy load, automotive, agriculture and army are highly exposed to fatigue and work-related injuries. In this review article, the occupational hazard as a threat to the kinematic alteration of the lower limb is reconsidered and can be approached for prevention and further research on occupational related gait changes. A wide variety number of studies have reported categorization prototypes of gait but the literature survey addressing exclusively the changes in the data with regard to gait categorization is very inadequate. To aim at the same a vivid electronic search was also done on Pubmed, Scopus, Embase, Physiotherapy evidence database, Cochrane library, and Web of Science databases. Research Questions and methodology arrived with the search. After the full-text screening of the literature 20 studies were selected for critical evaluation. The idea of the same enabled us to propose to evaluate and appraise the alterations in the gait of workers and would be helpful in the future to further research on the occupational impact. Keywords: Gait analysis, Occupational Gait Alteration, Kinematic Gait changes, Functional Gait Adaptation, Working postures.

Gait Alterations in the Prediction of Metabolic Syndrome in Patients With Schizophrenia: A Pilot Study With PODOSmart ® Insoles.

BackgroundSecond-generation antipsychotics (APs) are associated with metabolic syndrome (MetS), characterized by abnormal pro-inflammatory cytokine production and oxidative stress due to the reduced antioxidant systems, and neurological effects, including mobility impairment. This pilot study investigated relationships between inflammatory-metabolic biomarkers, MetS and gait alterations in patients with psychosis treated with APs.MethodsPatients with psychosis treated with APs, 20 with MetS (MPS group) and 20 without MetS (PS group) were studied, usinganthropometric data, blood measurements and gait analysis performed with the PODOSmart ® gait analysis device.Results and DiscussionThe MPS group had significantly higher mean body mass index (BMI) and arterial blood pressure (BP) than the PS group. PODOSmart ® gait analysis recorded significant differences between groups in pronation-supination at Heel Off (HO), gaitline HO and gaitline Toe Off (TO). Multifactorial elastic net regression models demonstrated significant association with MetS of inflammatory markers, specific AP2 treatment, gender, age; BMI; BP and smoking (accuracy λ = 0.08), and in relation to gait parameters (accuracy λ = 0.750), the three pronation- supination variables, i.e., at HO, flat foot in (AP2 related) and TO, and propulsion speed. The gait parameters were at the edges of the model, thus indicating a more significant role of these parameters compared to the other clinical variables. Early diagnosis of MetS in patients with schizophrenia via identification of gait alterations can be a screening measure for serious cardiovascular complications related to psychosis and APs, to enable timely dietary intervention that can control the pro-inflammatory state and reduce oxidative stress.

Identification of Gait Unbalance and Fallers Among Subjects with Cerebellar Ataxia by a Set of Trunk Acceleration-Derived Indices of Gait.

This study aimed to assess the ability of 25 gait indices to characterize gait instability and recurrent fallers among persons with primary degenerative cerebellar ataxia (pwCA), regardless of gait speed, and investigate their correlation with clinical and kinematic variables. Trunk acceleration patterns were acquired during the gait of 34 pwCA, and 34 age- and speed-matched healthy subjects (HSmatched) using an inertial measurement unit. We calculated harmonic ratios (HR), percent recurrence, percent determinism, step length coefficient of variation, short-time largest Lyapunov exponent (sLLE), normalized jerk score, log-dimensionless jerk (LDLJ-A), root mean square (RMS), and root mean square ratio of accelerations (RMSR) in each spatial direction for each participant. Unpaired t-tests or Mann-Whitney tests were performed to identify significant differences between the pwCA and HSmatched groups. Receiver operating characteristics were plotted to assess the ability to characterize gait alterations in pwCA and fallers. Optimal cutoff points were identified, and post-test probabilities were calculated. The HRs showed to characterize gait instability and pwCA fallers with high probabilities. They were correlated with disease severity and stance, swing, and double support duration, regardless of gait speed. sLLEs, RMSs, RMSRs, and LDLJ-A were slightly able to characterize the gait of pwCA but failed to characterize fallers.

Postural Control Differences between Patients with Posterior Tibial Tendon Dysfunction and Healthy People during Gait.

Background: Patients with posterior tibial tendon dysfunction (PTTD) may exhibit postural instability during walking likely due to a loss of medial longitudinal arch, abnormal foot alignment, and pain. While many studies have investigated gait alterations in PTTD, there is no understanding of dynamic postural control mechanisms in this population during gait, which will help guide rehabilitation and gait training programs for patients with PTTD. The purpose of the study was to assess dynamic postural control mechanisms in patients with stage II PTTD as compared to age and gender matched healthy controls. Methods: Eleven patients with stage II PTTD (4 males and 7 females; age 59 ± 1 years; height 1.66 ± 0.12 m; mass 84.2 ± 16.0 kg) and ten gender and age matched controls were recruited in this study. Participants were asked to walk along a 10 m walkway. Ten Vicon cameras and four AMTI force platforms were used to collect kinematic and center of pressure (COP) data while participants performed gait. To test differences between PTTD vs. control groups, independent t-tests (set at α < 0.05) were performed. Results: Patients with PTTD had significantly higher double stance ratio (+23%) and anterior-posterior (AP) time to contact (TTC) percentage (+16%) as compared to healthy control. However, PTTD had lower AP COP excursion (−19%), AP COP velocity (−30%), and medial-lateral (ML) COP velocity (−40%) as compared to healthy controls. Mean ML COP trace values for PTTD were significantly decreased (−23%) as compared to controls, indicating COP trace for PTTD tends to be closer to the medial boundary than controls during single-support phase of walking. Conclusion: PTTD patients showed more conservative and cautious postural strategies which may help maintain balance and reduce the need for postural adjustment during PTTD gait. They also showed more medially shifted COP patterns than healthy controls during single-support phase of walking. Dynamic postural control outcomes could be used to develop effective gait training programs aimed at alleviating a medial shift of COP (everted foot) for individuals with PTTD in order to improve their functionality and gait efficiency.

Multifactoriality of Parkinson's Disease as Explored Through Human Neural Stem Cells and Their Transplantation in Middle-Aged Parkinsonian Mice.

Parkinson’s disease (PD) is an age-associated neurodegenerative disorder for which there is currently no cure. Cell replacement therapy is a potential treatment for PD; however, this therapy has more clinically beneficial outcomes in younger patients with less advanced PD. In this study, hVM1 clone 32 cells, a line of human neural stem cells, were characterized and subsequently transplanted in middle-aged Parkinsonian mice in order to examine cell replacement therapy as a treatment for PD. In vitro analyses revealed that these cells express standard dopamine-centered markers as well as others associated with mitochondrial and peroxisome function, as well as glucose and lipid metabolism. Four months after the transplantation of the hVM1 clone 32 cells, striatal expression of tyrosine hydroxylase was minimally reduced in all Parkinsonian mice but that of dopamine transporter was decreased to a greater extent in buffer compared to cell-treated mice. Behavioral tests showed marked differences between experimental groups, and cell transplant improved hyperactivity and gait alterations, while in the striatum, astroglial populations were increased in all groups due to age and a higher amount of microglia were found in Parkinsonian mice. In the motor cortex, nonphosphorylated neurofilament heavy was increased in all Parkinsonian mice. Overall, these findings demonstrate that hVM1 clone 32 cell transplant prevented motor and non-motor impairments and that PD is a complex disorder with many influencing factors, thus reinforcing the idea of novel targets for PD treatment that tend to be focused on dopamine and nigrostriatal damage.

Gait Alterations in Adults after Ankle Fracture: A Systematic Review.

(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait cycle. Nevertheless, a common pattern of kinematic alterations has still not been defined. To this end, we analyzed the literature on instrumental gait assessment after ankle fracture, and its correlation with evaluator-based and patient-reported outcome measures. (2) Methods: We conducted a systematic search, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, of articles published from January 2000 to June 2021 in PubMed, Embase and PEDro on instrumental gait assessment after ankle fracture. (3) Results: Several changes in gait occur after ankle fracture, including a reduction in step length, swing time, single support time, stride length, cadence, speed and an earlier foot-off time in the affected side. Additionally, trunk movement symmetry (especially vertical) is significantly reduced after ankle fracture. The instrumental assessments correlate with different clinical outcome measures. (4) Conclusions: Instrumental gait assessment can provide an objective characterization of the gait alterations after ankle fracture. Such assessment is important not only in clinical practice to assess patients’ performance but also in clinical research as a reference point to evaluate existing or new rehabilitative interventions.

Freedom in Osteoarthritis of the Knee

The first peak of the external knee abduction moment (KAM) is often used as a surrogate measure of the medial compartment loading and has been correlated with pain and progression of knee osteoarthritis (OA). As a result, reducing the KAM is often the target of conservative interventions. OA should be considered as a “Whole Person” disease, including ecological psychosocial aspects. Scientists have developed gait alteration strategies to reduce the KAM. They attempted to force into a new position any particular part without reference to the pattern of the whole. We propose an alternative approach: in the vicinity of a special configuration of the knee, some or all of the components of the knee become overloaded. This study has shown that when six lines $1′,$2′,$3′,$4′,$5′,$6′ are so situated that forces acting along them equilibrate when applied to one degree of freedom, 1° F knee, a certain determinant vanishes. We wish to define the six lines as the knee complex in involution by virtue of some constraint upon the knee.

Synergies are minimally affected during emulation of cerebral palsy gait patterns

Muscle synergy analysis is commonly used to characterize motor control during dynamic tasks like walking. For clinical populations, such as children with cerebral palsy (CP), synergies are altered compared to nondisabled (ND) peers and have been associated with both function and treatment outcomes. However, the factors that contribute to altered synergies remain unclear. In particular, the extent to which synergies reflect altered biomechanics (e.g., changes in gait) or underlying neurologic injury is debated. To evaluate the effect that altered biomechanics have on synergies, we compared synergy complexity and structure while ND individuals (n = 14) emulated four common CP gait patterns (equinus, equinus-crouch, mild-crouch, and moderate crouch). Secondarily, we compared the similarity of ND synergies during emulation to synergies from a retrospective cohort of individuals with CP walking in similar gait patterns (n = 28 per pattern). During emulation, ND individuals recruited similar synergies as baseline walking. However, pattern-specific deviations in synergy activations and complexity emerged. In particular, equinus gait altered plantarflexor activation timing and reduced synergy complexity. Importantly, ND synergies during emulation were distinct from those observed in CP for all gait patterns. These results suggest that altered gait patterns are not primarily driving the changes in synergies observed in CP, highlighting the value of using synergies as a tool to capture patient-specific differences in motor control. However, they also highlight the sensitivity of both synergy activations and complexity to altered biomechanics, which should be considered when using these measures in clinical care.

Knee joint biomechanics during gait improve from 3 to 6 months after anterior cruciate ligament reconstruction.

Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two postoperative time points. Thirty-five individuals underwent motion analysis during overground walking 3 (3.2 ± 0.5) and 6 (6.4 ± 0.7) months after ACLR. Knee biomechanical variables were compared between limbs and across time points through 100% of stance using statistical parametric mapping; this included a 2 × 2 (Limb × Time) repeated measures analysis of variance and two-tailed t-tests. Smaller knee joint angles, moments, extensor forces, and medial compartment forces were present in the involved versus uninvolved limb. Interlimb asymmetries were present at both time points but were less prevalent at 6 months. The uninvolved limb's biomechanical variables stayed relatively consistent over time, while the involved limb's trended toward that of the uninvolved limb. Statement of Clinical Significance: Interventions to correct asymmetrical gait patterns after ACLR may need to occur early after surgery and may need to focus on multiple parts of stance phase.

Early Detection of Parkinson’s Disease by Neural Network Models

This paper develops neural network models that can recognize Parkinson’s disease (PD) at its early stage. PD is a common neurodegenerative disorder that presents with progressive slow movement, tremor, limb rigidity, and gait alterations, including stooped posture, shuffling steps, festination, freezing of gait, and falling. Early detection of PD enables timely initiation of therapeutic management that decreases morbidity. However, correct recognition of PD, especially in early-stage disease, is challenging because the aging population, which has a high PD prevalence, also commonly exhibits progressive gait slowness due to other disorders, such as joint osteoarthritis or sarcopenia. Therefore, developing a reliable and objective method is crucial for differentiating PD gait characteristics from those of the normal elderly. The aim of this study was to develop neural network models that could use the participants’ motion data during walking to identify PD. We recruited 32 drug-naïve PD patients with variable disease severity and 16 age/sex-matched healthy controls, and we measured their motions using inertial measurement unit (IMU) sensors. The IMU data were used to develop neural network models that could identify patients with advanced-stage PD with an average accuracy of 92.72% in validation processes. The models also differentiated patients with early-stage PD from normal elderly subjects with an accuracy of 99.67%. Another independent group of participants recruited to test the developed models confirmed the successful discrimination of PD-affected from healthy elderly, as well as patients at different severity stages. Our results provide support for early diagnosis and disease severity monitoring in patients with PD.

Electromyography activity of quadratus lumborum in individuals with chronic knee osteoarthritis: A cross-sectional study

Background: In osteoarthritis (OA) of the knee joint, a commonly seen gait alteration is lateral trunk lean gait. Quadratus lumborum (QL) has a role in controlling the pelvis and trunk during walking. This study has analyzed the electromyography (EMG) activity of QL muscle of the affected and nonaffected side during walking in individuals with chronic knee OA. Objectives: The objective of the study was to evaluate the muscle activation of QL in individuals with chronic knee OA during walking. Materials and Methods: EMG device, computer, video camera, abrasive gel (Nuprep gel), T20 paste, and two surface EMG triodes were used to record the QL muscle activity on the affected and nonaffected side. Twenty-seven patients with OA participated in the study. They were made to walk two rounds of 10 m distance and the EMG root mean square (RMS) value was noted down for both sides during the stance phase of the testing limb during walking activity. Results: Comparing the EMG activity of QL of the affected and nonaffected side, during the stance phase of walking, the result was found to be statistically nonsignificant, that is, P > 0.05. Conclusions: The results of this study found no difference in activity of QL in patients with OA between the affected and nonaffected sides.

Kinematic analysis and self-perceived exertion during the walking gait with a backpack in Brazilian scholars

Aim: The present study aimed to investigate the effects of different backpack loads on the walking gait kinematics and ratings of perceived exertion (RPE) in Brazilian scholars. Methods: The sample was composed of 25 male children and adolescents, from 10 to 14 years. The mean body mass and height were 45.3 kg ± 10.6 kg and 1.51 m ± 0.08 m, respectively. For the walking gait assessment, a tridimensional analysis system was used. In the backpack conditions, loads of 5%, 10%, 15%, and 20% were applied according to the body weight of everyone. Kinematic variables and angular amplitudes of head, shoulders, thorax, pelvis, and knees in the sagittal plane were collected. The OMNI scale was used to assess the RPE. Results: The loads of 5%, 10%, 15%, and 20% promoted postural adjustments and alterations in the walking gait, in which the RPE presented a correlation with those alterations. The step in the left cycle altered from the baseline in the 5% (p = 0.006). The stride length altered from baseline in the 5% (p = 0.030) and 10% (p < 0.001) load conditions. The single support time was different from baseline in all conditions (p = 0.003; p = 0.012; p = 0.005; p = 0.006). The walking gait cadence was different in the comparison between baseline in the 5% (p = 0.003). Thorax amplitude altered in the 10% (p = 0.023), 15% (p = 0.033) and 20% (p = 0.005) load conditions in the left cycle. Conclusion: We concluded that the posture, RPE, and the gait kinematic altered according to the increase in the backpack load.

Association between quadriceps function, joint kinetics, and spatiotemporal gait parameters in young adults with and without obesity

BackgroundIndividuals with obesity have impaired gait and muscle function that may contribute to reduced mobility and increased fall risk. Research questions(1) what is the difference in spatiotemporal gait parameters and joint kinetics between individuals with and without obesity; (2) what is the association between spatiotemporal gait parameters, joint kinetics, and quadriceps function? MethodsForty-eight young adults with obesity (BMI = 33.0 ± 4.1 kg/m2) and 48 without obesity (BMI = 21.6 ± 1.7 kg/m2) completed assessments of quadriceps function (peak torque and early/late rate of torque development (RTD)) and walking biomechanics at self-selected speed. Spatiotemporal gait parameters (stance time, double support time, double support to stance ratio, step width, step length, cadence, and gait stability ratio (GSR)) and joint kinetics (total support moment, and relative contribution from extensor moments) were compared using one-way MANOVAs. Partial correlation examined the association between the total support moment and quadriceps function, and spatiotemporal gait parameters controlling for sex and speed. ResultsIndividuals with obesity walked with longer stance (p = 0.01), longer double-limb support (p < 0.001), wider steps (p < 0.001), lower cadence (p = 0.03), and a greater absolute (p < 0.001) but lesser normalized total support moment (p = 0.03) compared with adults without obesity. In those with obesity, greater PT was associated with less double limb support (p = 0.011) and smaller double support to stance ratio (p = 0.006); greater early RTD was associated with less double limb support (r = −0.455, p = 0.0021), less stance time (r = −0.384, p = 0.008), and a smaller double support to stance ratio (r = −0.371, p = 0.011). In those without obesity, a larger total support moment was associated with longer step length (r = 0.512, p < 0.001), lesser cadence (r = −0.497, p < 0.001), and smaller GSR (−0.460, p = 0.001). SignificanceIndividuals with obesity walk with altered spatiotemporal gait parameters and joint kinetics that may compromise stability. Extended periods of support may be a strategy used by individuals with obesity to increase stability during gait and accomodate insufficient quadriceps function.

The effect of a multi-modal boxing exercise program on cognitive locomotor tasks and gait in persons with Parkinson disease.

Parkinson disease (PD) is a progressive neurological disease resulting in motor impairments, postural instability, and gait alterations which may result in self-care limitations and loss of mobility reducing quality of life. This study's purpose was to determine the impact of a community-based boxing program on gait parameters, dual task and backwards walking in individuals with PD. This study included 26 community dwelling individuals with PD who participated in 12-week boxing classes (1 hour, 2 times a week). The focus was on upper/lower extremity exercises using punching bags, agility drills, and strengthening activities. Pre/post testing was performed for dual task and gait parameters and was analyzed using t-tests. Analysis of the scores indicated participants performed significantly better at post-test compared to pre-test on self-selected walking velocity (P = 0.041), cadence (P = 0.021); backwards walking velocity (P = 0.003), step length (P = 0.022); dual task walking velocity (P = 0.044), step length (P = 0.023), and gait variability index (P = 0.008). No significant differences for fast walking. Multi-modal boxing produced improvements in gait velocity, dual task velocity, step length, and gait variability, as well as backwards walking velocity and step length. These improvements may impact independence with functional mobility and may improve safety but require further studies.

Spatiotemporal gait parameters while cross-slope residential roof walking

Falls from residential roofs account for 80% of roofing industry fatalities. Furthermore, roofing work represents 44.7% of work in residual construction specialty trades and residential roofers count for 2.1% of overall workers in construction, with an anticipated growth in roofers of 14.9% by 2024. The purpose of the study was to evaluate the alterations in spatiotemporal gait parameters while traversing along a 6/12 pitched residential roof segment. Eighteen of the nineteen calculated spatiotemporal variables were statistically, significantly changed by walking across a 6/12 pitched simulated residential roof. The study clearly demonstrates that spatiotemporal gait variables increase and decrease while traversing across a residential roof. The changes in spatiotemporal parameters might suggest alterations to a person's balance system resulting in an increased risk of falling. The knowledge generated in the current study will be relevant to the residential roofing industry when it can be used in educational materials to increase awareness of how a roofer's altered gait while working on a pitched roof may increase their falling risk.

Foot kinematics and leg muscle activation patterns are altered in those with limited ankle dorsiflexion range of motion during incline walking

BackgroundLarger ankle dorsiflexion (DF) is required when walking on inclined surfaces. Individuals with limited DF range of motion (ROM) may experience greater tissue stress on sloped surfaces and walk in altered gait patterns compared to the those with normal DF ROM. Research questionWould the individuals with limited DF ROM walk with distinctive ankle DF patterns compared to those with normal DF ROM on the inclined surfaces? MethodsTen Limited DF ROM (passive ROM=35.3 ± 2.7°) and nine Normal DF ROM (passive ROM=46.4 ± 4.2°) participants walked on a treadmill at five slope angles (0°, 5°, 10°, 15°, 20°) for 2 min at a self-selected speed. The peak DF angles and the peak myoelectric activity levels of the tibialis anterior (TA) and soleus (SOL) muscles were quantified during the swing and stance phases of each walking trial, and they were compared between the two groups. ResultsParticipants with limited DF ROM walked with smaller peak DF (3.1° at 0° slope ~ 8.4° at 20° slope) and greater peak TA activity in swing than those of the Normal ROM participants (3.4° ~ 12.2°), with significant differences at 20° slope. The peak DF angle in stance (Limited: 9.6° ~ 19.0°; Normal: 10.1° ~ 21.0°) did not differ between the two groups at all slopes, but the peak activity of the SOL muscle was significantly greater for the Limited group at slopes of 10° and higher. SignificanceStudy results indicate that incline walking could be more challenging to the individuals with limited DF ROM as they need to approach and push-off the sloped surfaces with more efforts of the dorsiflexor and the plantar flexor muscles, respectively. Prolonged walking on inclined surfaces may produce faster development of muscle fatigue or tissue damage than those with normal DF ROM.

Constraint manipulation as a feasible strategy for gait alteration and intervention: a scoping review

In this paper, we describe general information regarding the use of the partial body weight support (BWS) paradigm as a strategy to manipulate constraints during walking by individuals with and without gait impairments. We present two overground BWS systems implemented by our research group and the main studies that have been conducted so far. Non-disabled young adults, individuals with stroke, and children with cerebral palsy were considered in our investigations. Gait assessment with different amounts of body weight unloading on both the treadmill and the ground, as well as gait training protocols with BWS on these surfaces, were conducted, and general results are reported. Based on our investigations, we suggest that the use of a BWS system on a treadmill and on the ground, as a strategy for manipulating constraints, enables individuals with gait impairment to walk. More importantly, professionals in the field of gait rehabilitation can carry out training protocols throughout the manipulation of implements that assist walking, such as using a harness connected to a structure.

Gait characteristics in preclinical Alzheimer’s disease: Preliminary results of the RADAR‐AD study

AbstractBackgroundThe Remote Assessment of Disease and Relapse – Alzheimer’s Disease (RADAR‐AD) study is assessing functional decline in Alzheimer’s Disease (AD) using remote monitoring techniques (RMT’s). RMT’s allow for continuous and objective monitoring of function, potentially improving the sensitivity of assessment in AD. Gait is an important functional domain to maintain independent living. Yet, relatively little is known on gait impairments in the pre‐symptomatic stages of AD. Therefore, the aim of this study is to compare outcomes of in‐clinic gait assessments, using high frequency inertial measurement units, between healthy controls, preclinical AD patients, and cognitively impaired AD patients.MethodWe included early data from amyloid negative cognitively healthy participants (controls, n=9), amyloid positive cognitively healthy participants (preclinical AD, n=6) and amyloid positive cognitively impaired participants (n=3) participants (Table 1) from the RADAR‐AD study. Participants performed a one‐minute walking task, a one‐minute dual task (walking while counting backwards from 100) and timed up‐and‐go (TUG) task, while wearing GaitUp Physilog sensors1 on the left foot, right foot, and right hip. Metrics provided by the sensors include gait speed, steps per minute, double support time, and TUG task completion time.ResultRegression analyses with models corrected for age, sex, and education revealed no between‐group differences on the main outcomes. However, the preclinical AD group showed several interesting near‐significant trends that warrant further investigation (Figure 1). This included an apparent smaller difference in gait speed between the walking task and dual task compared to controls (β=‐10.78 (5.8), p=0.09), accompanied by a smaller difference in steps per minute (β=‐9.27 (5.05), p=0.09), and a larger difference in double support time (β=14.32 (7.28), p=0.07).ConclusionAlthough no between‐group differences in gait outcomes were found in this initial data, early near‐significant trends in the preclinical AD group appears to show altered gait patterns in particular during the dual task. These preliminary findings will be further investigated on possible pathological causality of such behavior as our dataset increases. Inclusion in the RADAR‐AD study is ongoing, and subsequent analyses will include larger sample sizes, more in‐depth analyses of gait behavior, and associations with rating scales of mobility. Reference: [1] https://research.gaitup.com/physilog/