Gait Changes Research Articles

The influence of wearing an ultrasound device on gait in children with cerebral palsy and typically developing children

BackgroundUltrasonography with motion analysis enables dynamic imaging of medial gastrocnemius (MG) muscles and tendons during gait. This revealed pathological muscle-tendon dynamics in children with spastic cerebral palsy (CP) compared to typically developing (TD) children. However, wearing an ultrasound probe on the lower leg could interfere with gait and bias muscle length changes observed with ultrasound. Research questionDoes wearing an ultrasound probe on the MG influence gait in children with CP and TD children? MethodsEighteen children with spastic CP and 16 age-matched TD children walked at comfortable walking speed on an instrumented treadmill. One baseline gait condition (BASE) and two conditions with an ultrasound probe and custom-made probe holder were measured: on the mid-muscle fascicles (FAS) and on the muscle-tendon junction (MTJ). The effect of condition and group on spatiotemporal parameters, hip, knee and ankle kinematics, ankle moment, ankle power, and modeled MG muscle-tendon unit (MTU) length was assessed using two-way repeated measures ANOVA’s. Statistical non-parametric mapping was applied for time-series. Post-hoc paired-samples t-tests were conducted, and the root mean square difference was calculated for significant parts. ResultsChildren took wider steps during FAS (CP, TD) and MTJ (TD) compared to BASE, and during FAS compared to MTJ (CP). Hip extension was lower (2.7°) during terminal stance for MTJ compared to FAS for TD only. There was less swing knee flexion (FAS 4.9°; MTJ 4.0°) and ankle plantarflexion around toe-off (FAS 3.0°; MTJ 2.4°) for both ultrasound placements, with no group effect. Power absorption during loading response was slightly increased for both ultrasound placements (0.12 W/kg), with no group effect. MTU shortened less in swing for both ultrasound placements (FAS 3.6 mm; MTJ 3.7 mm), with no group effect. SignificanceWearing an ultrasound probe causes minimal lower-limb gait alterations and MTU length changes that are mostly similar in CP and TD.

Effects of Resistance Training in Individuals with Lower Limb Amputation: A Systematic Review

Individuals with lower-limb amputations may have a significant strength deficit. This deficit may be related to the stump length and can lead to changes in gait, reduced energy efficiency, walking resistance, altered joint load, and increased risk of osteoarthritis and chronic low back pain. This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines to examine the effects of resistance training in lower limb amputees. Interventions with resistance training and other training methods were sufficient to achieve muscle strength gain in muscles of the lower limbs, improved balance, and improvements in gait pattern and speed when walking. However, it was impossible to determine from the results whether resistance training was mainly responsible for these benefits or even whether the positive effects presented would be observed with only this training method. When combined with other exercises, interventions with resistance training made possible gains for this population. Accordingly, it is noteworthy that the main finding of this systematic review is that the effects may be different according to the level of amputation, with mainly transtibial and transfemoral amputations studied.

Developmental changes in straight gait in childhood.

Understanding typical gait development is critical in developing suitable physical therapy methods for gait disorders. This study investigated the developmental changes and controlling mechanisms of straight gait. We conducted an experimental procedure among 90 participants, including 76 typically developing children and 14 healthy adults. The children were divided according to age into 3-4, 5-6, 7-8, and 9-10-year age groups. We created two indices to quantify straight gait using the extrapolated center of mass (XCOM; goal index, XCOMG and actual progress index, XCOMP), which were calculated and compared between the groups. Stepwise multiple regression was used to examine the effects of each gait variable on XCOMG and XCOMP. To eliminate the effects of multicollinearity, correlation coefficients were calculated for all gait variables. Both XCOMG and XCOMP decreased gradually with age and were significantly larger in the 3-4 and 5-6 year groups than in the adult group. Multiple regression analysis showed that step velocity, step width, and the coefficiente of variation (CV) of the step width had independent coefficients of variation for the XCOMG, and the symmetry index of step time, step width, and the CV of the step width had independent CV for the XCOMP. These variables were selected as significant variables. The results showed that meandering gait was more pronounced at younger ages. Furthermore, straight gait observed in adulthood was achieved by the age of 7. Pace (step velocity) and stability (step width and CV of step width) may contribute to XCOMG, which assesses the ability to proceed in the direction of the target. Stability and symmetry may contribute to XCOMP, which assesses the ability to walk straight in one's own direction of progress. Physical therapists could apply these indices in children to assess their ability to walk straight.

The effect of a modified elastic band orthosis on gait and balance in stroke survivors.

Gait is crucial for independent living for stroke survivors and assistive devices have been developed to support gait performance. Ankle foot orthosis (AFOs) are commonly provided to stroke survivors to prevent foot drop during walking. However, previous studies have reported limitations of AFOs including them being too heavy, creating skin irritation, and being a stigma of disability. The purpose was to compare the gait and balance improvement between elastic band orthosis (EBOs) and AFOs. Experimental study design. The AFOs and EBOs were provided to 17 stroke survivors, and changes in gait and balance were assessed compared to barefoot (control). Gait spatiotemporal parameters were measured using the zebris-FDM-Rehawalk® system, and balance ability was evaluated using the time up and go test (TUG). Satisfaction with the EBOs was determined using the Quebec user evaluation of satisfaction with assistive technology (QUEST2.0) questionnaire. The EBO showed significant differences in; gait speed, cadence, stride length, stride time, step length unaffected side, stance phase and swing phase on the affected side, and pre-swing on the unaffected side, and balance performance (TUG) (p<0.05) when compared to the AFO and control conditions. The participants were quite satisfied with the EBOs with QUEST2.0 scores greater than 4 out of 5. EBOs could be provided to stroke survivors given their acceptability and properties to improve gait and balance. The EBO used in this study offered clinically important improvements in gait and balance when compare to AFO and control conditions, and could mitigate against some of the limitations reported in the use of AFOs in stroke survivors.

The increased perceived exertion during the six minute walking test is not accompanied by changes in cost of walking, gait characteristics or muscle fatigue in persons with multiple sclerosis.

Persons with Multiple Sclerosis (pwMS) frequently experience walking difficulties, often expressed as a slower walking speed during the 6Minute Walking Test (6MWT). In addition, slower walking speeds are also related to higher levels of perceived exertion. PwMS are also known to have a higher energetic Cost of walking (Cw) and may experience muscle fatigue during prolonged walking. In this study, we aimed to explore changes in Rate of Perceived Exertion (RPE) and the Cw within participants during the 6MWT in pwMS. Additionally, concomitant changes in the mean and variability of gait characteristics and changes in muscle activation describing muscle fatigue were assessed. The 6MWT was performed on an instrumented treadmill while three-dimensional motion capture and gas exchange were measured continuously. RPE on the 6-20 borg-scale was questioned directly before and after the 6MWT. Cost of walking was expressed in Joules/kg/m. Muscle fatigue was assessed by increases in Root Median Square (RMdS) and decreases in Median Frequency (MF) of the recorded EMGs. Wilcoxon-Signed Rank test was used to assess a difference in RPE before and after the 6MWT. Linear mixed models, while controlling for walking speed, were used to assess changes in Cw, mean and variability of gait characteristics and RMdS and MF of muscle activation. 28 pwMS (23 females, mean ± standard deviation age 46±10 years, height 1.69±0.08meter, weight 76±18kilogram, EDSS 2.7±1.3) were included. Although the RPE increased from 8 to 12, no changes in Cw were found. Walking speed was the only spatiotemporal parameter which increased during the 6MWT and RMdS of the gastrocnemius and tibialis anterior muscles increased. The soleus muscle decreased in MF over time. The increases in RPE and walking speed was not accompanied by a change in Cw during the 6MWT which indicates that the perceived exertion was not accompanied by an increased physical exertion. Changes in muscle activation might give an indication for muscle fatigue but were inconclusive. Although the 6MWT reflects daily life walking challenges for pwMS, this test did not show the expected changes in gait parameters in our sample.

Classifying Changes in Amputee Gait following Physiotherapy Using Machine Learning and Continuous Inertial Sensor Signals.

Wearable sensors allow for the objective analysis of gait and motion both in and outside the clinical setting. However, it remains a challenge to apply such systems to highly diverse patient populations, including individuals with lower-limb amputations (LLA) that present with unique gait deviations and rehabilitation goals. This paper presents the development of a novel method using continuous gyroscope data from a single inertial sensor for person-specific classification of gait changes from a physiotherapist-led gait training session. Gyroscope data at the thigh were collected using a wearable gait analysis system for five LLA before, during, and after completing a gait training session. Data from able-bodied participants receiving no intervention were also collected. Models using dynamic time warping (DTW) and Euclidean distance in combination with the nearest neighbor classifier were applied to the gyroscope data to classify the pre- and post-training gait. The model achieved an accuracy of 98.65% ± 0.69 (Euclidean) and 98.98% ± 0.83 (DTW) on pre-training and 95.45% ± 6.20 (Euclidean) and 94.18% ± 5.77 (DTW) on post-training data across the participants whose gait changed significantly during their session. This study provides preliminary evidence that continuous angular velocity data from a single gyroscope could be used to assess changes in amputee gait. This supports future research and the development of wearable gait analysis and feedback systems that are adaptable to a broad range of mobility impairments.

Evaluation of Gait Development Trajectory in Mice

Background/Objective: Movement and walking are huge facets in how we go about our lives and experience the world. Gait is compromised in numerous conditions, from injury and chronic pain to neurological conditions and arthritis. Movement biomechanics have therefore been studied extensively in humans for decades. Although animal models are often used to examine the progression of various health conditions, translational gait research in animal models are less complete, and there is limited information on gait changes as mice grow.&#x0D; Methods: We recorded video segments of wild-type C57Bl/6J mice during skeletal growth (5 weeks to 16 weeks) walking (n = 4 Female, n = 2 Male) at 20 cm/s on the DigiGait system, a transparent treadmill equipped with a high-speed camera. Videos captured a ventral view of the mouse and were processed using DigiGait Analysis software, which uses local thresholding and position-finding algorithms to examine paw placement on the treadmill belt. Manual adjustments were made to eliminate artifacts and confirm heel-strike and toe-off times. After these corrections, the software returns stride parameters that were compared between sexes.&#x0D; Results: Over 30 gait metrics, including stride length, frequency, stance/swing times, and stance width, were calculated for all four limbs per animal for several time points. Stride length increased from 4.5 ± .5 cm at week 5 to 5.0 ± .8 cm at week 16, and frequency decreased from 4.6 ± .6 to 4.2 ± .6 steps per second. No notable changes in stance width, symmetry, or stance/swing ratio were identified.&#x0D; Conclusion and Potential Impact: Future directions for this research include conducting a principal component analysis to investigate the variability within the gait data. Identifying trends in gait parameters will help create a more complete picture of gait maturation. Establishing this baseline data allows for its comparison against treatment groups and the potentially meaningful investigation of translatable therapeutics and interventions.

Association between balance confidence and basic walking abilities in people with unilateral transtibial lower-limb amputations: A cross-sectional study.

Falls are common for people with lower-limb amputations (PLLA). Low balance confidence is also prevalent, is worse in PLLA not reporting walking automaticity, and is known to negatively affect prosthesis use, social engagement, and quality of life. Moreover, walking with a prosthesis requires continuous attention. Low balance confidence may act as a distractor imposing an additional cognitive load on the already cognitively demanding task of walking with a prosthesis. Adults with unilateral, transtibial amputations were recruited. The Activities-specific Balance Confidence (ABC) scale quantified balance confidence. The L Test assessed basic walking abilities under single-task (ST) (usual) and dual-task (DT) (walking while counting backwards) conditions. The relative change in gait and secondary task performance between conditions (ie, DT cost) was calculated. Separate multivariable linear regressions examined the association of balance confidence on the L Test. Forty-four PLLA (56.6 ± 12.6 years) participated. An independent association of the ABC to ST ( P < 0.001, R 2 = 0.56) and DT ( P = 0.008, R 2 = 0.43) L Test performance was observed. A 1% ABC increase was related with a 0.24 (95% confidence interval, 0.35-0.14) and 0.23 (95% confidence interval, 0.39-0.06) second reduction with the ST and DT L Test, respectively. No association to DT cost was observed. Balance confidence influences basic walking abilities yet does not modulate the added cognitive load associated with DT. Interventions that address balance confidence may be beneficial throughout rehabilitation. This research is novel and offers the possibility for alternative avenues for focus in rehabilitation and falls prevention in a population at high risk for falls.

Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson's Disease.

Fear of falling (FOF) is common in Parkinson's disease (PD) and associated with distinct gait changes. Here, we aimed to answer, how quantitative gait assessment can improve our understanding of FOF-related gait in hospitalized geriatric patients with PD. In this cross-sectional study of 79 patients with advanced PD, FOF was assessed with the Falls Efficacy Scale International (FES-I), and spatiotemporal gait parameters were recorded with a mobile gait analysis system with inertial measurement units at each foot while normal walking. In addition, demographic parameters, disease-specific motor (MDS-revised version of the Unified Parkinson's Disease Rating Scale, Hoehn & Yahr), and non-motor (Non-motor Symptoms Questionnaire, Montreal Cognitive Assessment) scores were assessed. According to the FES-I, 22.5% reported low, 28.7% moderate, and 47.5% high concerns about falling. Most concerns were reported when walking on a slippery surface, on an uneven surface, or up or down a slope. In the final regression model, previous falls, more depressive symptoms, use of walking aids, presence of freezing of gait, and lower walking speed explained 42% of the FES-I variance. Our study suggests that FOF is closely related to gait changes in hospitalized PD patients. Therefore, FOF needs special attention in the rehabilitation of these patients, and targeting distinct gait parameters under varying walking conditions might be a promising part of a multimodal treatment program in PD patients with FOF. The effect of these targeted interventions should be investigated in future trials.

CORR Insights®: A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population.

CORR Insights®: A Qualitative Study of Psychosocial Factors in Patients With Knee Osteoarthritis: Insights Learned From an Asian Population.

Effectiveness of the Pelvic Clock and Static Bicycle Exercises on Wisconsin Gait Scale and Trunk Impairment Scale in Chronic Ambulatory Hemiplegic Patients: A Single Group Pre-Post Design.

Most Hemiplegic patients achieve ambulatory function during the sub-acute stage of stroke. Though ambulatory, they still perform an unpleasant awkward gait with remarkable compensations requiring more energy expenditure. Fatigue arises at an early duration as a result of increased energy expenditure. The walking pattern becomes circumduction, featured by asymmetry with an extensor synergy of the lower limb. Each step is rotated away from the body then towards the body, forming a semicircle. This leads to changes in various parameters of gait (spatiotemporal, kinematic, and kinetic) in hemiparetic patients. Many studies reveal the effectiveness of various therapeutic techniques in managing hemiplegic circumduction gait. Pelvic clock exercises aid in improving pelvic rotation components and cause dissociation in impaired pelvic mobility due to spasticity. A static bicycle helps in enhancing proper control between the hamstrings and quadriceps. It also helps in improving knee flexion range. As the patient places the foot in the cycle's petals, it helps to enhance dorsiflexion and eversion functions as well. As the lower body is exercised, there could be relative changes in the upper body, i.e., the trunk. Thus, this study aimed to determine the changes in gait functions and trunk performance of chronic ambulatory hemiplegic patients in response to the above therapies for four weeks. Twenty-five subjects (post-stroke duration (2.8 ± 0.6) years) who could walk 10 m independently without assistance or support of aid participated in a pelvic clock and static bicycle exercise intervention. The session duration was 30 min a day, and therapy was delivered six days a week and continued for four weeks. The entire program was carried out in an outpatient neurorehabilitation center. After the intervention with pelvic clock and static bicycle exercises, there was a remarkable change in gait and trunk functions in chronic hemiplegic patients. The exercises comprising pelvic clock and static bicycle showed positive differences in gait and trunk functions in chronic stage hemiplegic patients. Later, randomized controlled studies involving larger sample sizes, advanced activation techniques, and increased intervention duration will explore in-depth information on their effectiveness and clinical significance.

Changes in gait pattern and quality of life of adolescents with flexible flat foot after Calcaneal Lengthening Osteotomy

BackgroundCalcaneal Lengthening Osteotomy is a surgical technique to correct flexible flat foot deformities in patients who did not show any change in their symptoms after conservative treatment. In this study, the effects of CLO on the kinematic and kinetic changes of gait was analyzed and the clinical and quality of life improvements in children treated by CLO for moderate to severe symptomatic flexible flat foot deformities were assessed. MethodsParticipants were seven adolescents (13 feet) with symptomatic FFF who underwent during 2019–2022 and seven (10 feet) healthy children as control group. Three items were evaluated in each foot before and after surgery including: 1. Clinical examination 2.quality of life (using Pediatric Quality of Life Inventory version 4 questionnaire) 3. Gait analysis (Vicon motion systems, Oxford metrics Inc., UK). Also, the kinetic and kinematic analysis between patients and healthy groups were compared. ResultsKinematic results of control was significantly better than FFF group. Ankle range of motion(32.94 ± 13.39 compared to 32.94 ± 13.39,P-Value:0.01),foot progression angle (−9.26 ± 7.67 compared to −16.07 ± 9.00,P-Value:0.01),and internal rotation of ankle was higher in control group compared to FFF. FFF patients demonstrated improvement in kinematic results after CLO surgery. Foot progression angle was improved after surgery (−11.31 ± 6.07 compared to −16.19 ± 7.06, P-value:0.00), maximum plantar flexion decreased after CLO surgery due to achil tendon procedure during CLO surgery. Kinetic results of FFF patients showed significant increase in ankle Power in coronal and transverse plane, Also knee and hip power showed similar results.Quality of life parameters showed significant improve in all parameters (Physical,Social, emotional and school function), Also ADKE and ADKF improved after surgery. ConclusionCLO surgery significantly improved patients' quality of life of patients with symptomatic FFF. Also, kinetic results showed improvement in some parameters of gait results after CLO surgery. Thus, our study suggested CLO surgery as an excellent surgical option for symptomatic FFF.

The Effect of Human Settlement Pedestrian Environment on Gait of Older People: An Umbrella Review.

Older people are limited by the pedestrian environment in human settlements and are prone to travel difficulties, falls, and stumbles. Furthermore, we still lack systematic knowledge of the pedestrian environment affecting the gait of older people. The purpose of this review is to synthesize current evidence of effective human settlement pedestrian environments interfering with gait in older people. The systematic effects of the human settlement pedestrian environment on gait in older people are discussed. Databases such as Web of Science, Medline (via PubMed), Scopus, and Embase were searched for relevant studies up to June 2022. The literature was screened to extract relevant evidence from the included literature, assess the quality of the evidence, and analyze the systematic effects of the pedestrian environment on gait in older people. From the 4297 studies identified in the initial search, 11 systematic reviews or meta-analysis studies were screened, from which 18 environmental factors and 60 gait changes were extracted. After removing duplicate elements and merging synonymous features, a total of 53 relationships between environmental factors and gait change in older people were extracted: the main human settlement pedestrian environmental factors affecting gait change in older people in existing studies were indoor and outdoor stairs/steps, uneven and irregular ground, obstacles, walking path turns, vibration interventions, mechanical perturbation during gait, and auditory sound cues. Under the influence of these factors, older people may experience changes in the degree of cautiousness and conservatism of gait and stability, and their body posture performance and control, and muscle activation may also be affected. Factors such as ground texture or material, mechanical perturbations during gait, and vibration interventions stimulate older people's understanding and perception of their environment, but there is controversy over the results of specific gait parameters. The results support that human settlements' pedestrian environment affects the gait changes of older people in a positive or negative way. This review may likely contribute evidence-based information to aid communication among practitioners in public health, healthcare, and environmental construction. The above findings are expected to provide useful preference for associated interdisciplinary researchers to understand the interactions among pedestrian environments, human behavior, and physiological characteristics.

Whole-Body Vibration Therapy as a Modality for Treatment of Senile and Postmenopausal Osteoporosis: A Review Article.

Whole-body vibration therapy is an intentional biomechanical stimulation of the body using various frequencies of vibrations with the motive of health improvement. Ever since its discovery, this therapy has been extensively used in physiotherapeutic measures and the sports industry. For its property of increasing bone mass and density, space agencies use this therapy on astronauts who return to Earth after long-term space missions to regain lost bone and muscle mass. The potential of this therapy to restore bone mass encouraged researchers to look for its scope in the treatment of age-related bone degenerative diseases such as osteoporosis and sarcopenia, as well as in the correction of posture control and gait in geriatrics and post-menopausal women. Osteoporosis and osteopenia account for roughly half of all fractures worldwide. These degenerative diseases also cause gait and posture changes. Bisphosphonates, monoclonal antibodies, parathyroid hormone fragments, hormone replacement therapies, and calcium and vitamin D supplementation are among the medical treatments available. Lifestyle changes and physical exercise are advised. However, vibration therapy's scope as a treatment option is yet to be explored. The safe range of frequency, amplitude, duration, and intensity of the therapy is still to be determined. This article is a review of the results of various clinical trials done in the last 10 years that target the effect of vibration therapy in both osteoporotic women and the elderly for the treatment of such ailments and deformities. We collected data from PubMed using advanced search and applied the exclusion criteria. In total, we analyzed nine clinical trials.

Abnormal gait and motor cortical processing in drug‐resistant juvenile myoclonic epilepsy

Juvenile myoclonic epilepsy (JME) is characterized by generalized seizures. Nearly 30% of JME patients are drug-resistant (DR-JME), indicating a widespread cortical dysfunction. Walking is an important function that necessitates orchestrated coordination of frontocentral cortical regions. However, gait alterations in JME have been scarcely investigated. Our aim was to assess changes in gait and motor-evoked responses in DR-JME patients. Twenty-nine subjects (11 JME drug-responder, 8 DR-JME, and 10 healthy controls) underwent a gait analyses during usual walking and dual-task walking. Later, subjects underwent 64-channel EEG recordings while performing a simple motor task. We calculated the motor-evoked current source densities (CSD) at a priori chosen cortical regions. Gait and CSD measures were compared between groups and tasks using mixed model analysis. DR-JME patients demonstrated an altered gait pattern that included slower gait speed (p=.018), reduced cadence (p=.003), and smaller arm-swing amplitude (p=.011). The DR-JME group showed higher motor-evoked CSD in the postcentral gyri compared to responders (p=.049) and both JME groups showed higher CSD in the superior frontal gyri compared to healthy controls (p<.011). Moreover, higher CSD in the superior frontal gyri correlated with worse performance in dual-task walking (r>|-0.494|, p<.008). These alterations in gait and motor-evoked responses in DRE-JME patients reflect a more severe dysfunction of motor-cognitive neural processing in frontocentral regions, leading to poorer gait performance. Further studies are needed to investigate the predictive value of altered gait and cortical motor processing as biomarkers for poor response to treatment in JME and other epilepsy syndromes.

Effects of simulated hypo-gravity on lower limb kinematic and electromyographic variables during anti-gravitational treadmill walking.

Introduction: This study investigated kinematic and EMG changes in gait across simulated gravitational unloading levels between 100% and 20% of normal body weight. This study sought to identify if each level of unloading elicited consistent changes-particular to that percentage of normal body weight-or if the changes seen with unloading could be influenced by the previous level(s) of unloading. Methods: 15 healthy adult participants (26.3 2.5years; 53% female) walked in an Alter-G anti-gravity treadmill unloading system (mean speed: 1.49 mph) for 1min each at 100%, 80%, 60%, 40% and 20% of normal body weight, before loading back to 100% in reverse order. Lower-body kinematic data were captured by inertial measurement units, and EMG data were collected from the rectus femoris, biceps femoris, medial gastrocnemius, and anterior tibialis. Data were compared across like levels of load using repeated measures ANOVA and statistical parametric mapping. Difference waveforms for adjacent levels were created to examine the rate of change between different unloading levels. Results: This study found hip, knee, and ankle kinematics as well as activity in the rectus femoris, and medial gastrocnemius were significantly different at the same level of unloading, having arrived from a higher, or lower level of unloading. There were no significant changes in the kinematic difference waveforms, however the waveform representing the change in EMG between 100% and 80% load was significantly different from all other levels. Discussion: This study found that body weight unloading from 100% to 20% elicited distinct responses in the medial gastrocnemius, as well as partly in the rectus femoris. Hip, knee, and ankle kinematics were also affected differentially by loading and unloading, especially at 40% of normal body weight. These findings suggest the previous level of gravitational load is an important factor to consider in determining kinematic and EMG responses to the current level during loading and unloading below standard g. Similarly, the rate of change in kinematics from 100% to 20% appears to be linear, while the rate of change in EMG was non-linear. This is of particular interest, as it suggests that kinematic and EMG measures decouple with unloading and may react to unloading uniquely.

Depth-Imaging for Gait Analysis on a Treadmill in Older Adults at Risk of Falling.

Accidental falls are a major health issue in older people. One significant and potentially modifiable risk factor is reduced gait stability. Clinicians do not have sophisticated kinematic options to measure this risk factor with simple and affordable systems. Depth-imaging with AI-pose estimation can be used for gait analysis in young healthy adults. However, is it applicable for measuring gait in older adults at a risk of falling? In this methodological comparison 59 older adults with and without a history of falls walked on a treadmill while their gait pattern was recorded with multiple inertial measurement units and with an Azure Kinect depth-camera. Spatiotemporal gait parameters of both systems were compared for convergent validity and with a Bland-Altman plot. Correlation between systems for stride length (r=.992, [Formula: see text]) and stride time (r=0.914, [Formula: see text]) was high. Bland-Altman plots revealed a moderate agreement in stride length (-0.74 ± 3.68 cm; [-7.96 cm to 6.47 cm]) and stride time (-3.7±54 ms; [-109 ms to 102 ms]). Gait parameters in older adults with and without a history of falls can be measured with inertial measurement units and Azure Kinect cameras. Affordable and small depth-cameras agree with IMUs for gait analysis in older adults with and without an increased risk of falling. However, tolerable accuracy is limited to the average over multiple steps of spatiotemporal parameters derived from the initial foot contact. Clinical Translation Statement- Gait parameters in older adults with and without a history of falls can be measured with inertial measurement units and Azure Kinect. Affordable and small depth-cameras, developed for various purposes in research and industry, agree with IMUs in clinical gait analysis in older adults with and without an increased risk of falling. However, tolerable accuracy to assess function or monitor changes in gait is limited to the average over multiple steps of spatiotemporal parameters derived from the initial foot contact.

Effectiveness of Serial Casting Alone and in Combination with Botulinum Neurotoxin in Pediatric Spastic Cerebral Palsy Patients

Purpose This study evaluated the changes in gait of pediatric cerebral palsy patients after serial casting alone and serial casting in conjunction with botulinum neurotoxin treatments. Methods Retrospective data of 31 children were investigated. Sixteen children were treated with serial casting combined with BoNT injection and 15 children were treated only with serial casting treatment. GAITRite was used to collect velocity, cadence, swing %, stance %, step length, stride length, and step time parameters to compare the outcomes of the treatments. Results Combined treatment group unaffected side swing % showed a statistically significant difference at completion (M = 35.16 ±1.21; M = 32.46 ± 1.38; t (15) = 2.12, p = 0.049). Unaffected side stance % at pre-intervention was statistically different for serial casting only and the combined treatment groups (M = 61.69± 0.73; M = 64.88±1.20; t (14) = -2.273, p = 0.039). Pre- and post-intervention hemiplegic side swing % comparison was statistically significant for the serial casting only group (M = 40.87± 0.57; M = 42.39±0.79, t (14) = -0.151, p = 0.032). The baseline velocity of the combined treatment group was slower than the serial casting-only group (88±11.2 vs. 107±14.4 (cm/s), p=0.007). Conclusions This investigation suggests that for patients, who have poor ambulation quality, abnormal spatiotemporal gait parameters, and significant spasticity at pre-intervention, BoNT in conjunction with serial casting is more effective for improving ambulation quality. Serial casting can be used in conjunction with botulinum neurotoxin, which is efficient in muscle morphology and function regulation by reducing spasticity.

Accurate COP Trajectory Estimation in Healthy and Pathological Gait Using Multimodal Instrumented Insoles and Deep Learning Models.

Measuring center-of-pressure (COP) trajectories in out-of-the-lab environments may provide valuable information about changes in gait and balance function related to natural disease progression or treatment in neurological disorders. Traditional equipment to acquire COP trajectories includes stationary force plates, instrumented treadmills, electronic walkways, and insoles featuring high-density force sensing arrays, all of which are expensive and not widely accessible. This study introduces novel deep recurrent neural networks that can accurately estimate dynamic COP trajectories by fusing data from affordable and heterogeneous insole-embedded sensors (namely, an eight-cell array of force sensitive resistors (FSRs) and an inertial measurement unit (IMU)). The method was validated against gold-standard equipment during out-of-the-lab ambulatory tasks that simulated real-world walking. Root-mean-square errors (RMSE) in the mediolateral (ML) and anteroposterior (AP) directions obtained from healthy individuals (ML: 0.51 cm, AP: 1.44 cm) and individuals with neuromuscular conditions (ML: 0.59 cm, AP: 1.53 cm) indicated technical validity. In individuals with neuromuscular conditions, COP-derived metrics showed significant correlations with validated clinical measures of ambulatory function and lower-extremity muscle strength, providing proof-of-concept evidence of the convergent validity of the proposed method for clinical applications.

Analysis of segmental coordination in the lower extremity using vector coding: a pilot return-to-play study of acute ankle sprain.

Purpose: Acute ankle sprain may affect ankle function during sport and daily activities. This study aimed to use vector coding technique to analyze the difference over time between injured and healthy lower limb during the first week of acute ankle sprain phase (P1) and post a 1-month recovery phase (P2) to understand the return-to-play coordination strategy in the lower extremity. Methods: Six females attended the gait experiments with attached 40 reflective markers using eight-camera Vicon motion capture system. All participants walked barefoot while turning in four directions (T0°, T45°, T90°, T135°) at their self-selected speed. Coordination patterns were classified as in-phase, anti-phase, proximal or distal dominancy between lower limb joints involving hip, knee, ankle, subtalar, metatarsophalangeal (MTP) joint and tarsometatarsal (TMT) joint. Results: P1 showed more proximal joint dominant in Hip-Knee coupling angles but P2 displayed more distal joint dominant in Knee-Ankle joint coordination pattern and mainly distal joint dominant in Ankle-MTP coupling angle mapping. The Ankle-TMT1 and Ankle-TMT5 coordination patterns matched best in straight walking but worst in T135 walking. Conclusions: Investigating inter-segmental coordination in different turning movements could provide insights into gait changes from acute ankle sprain from one-month return-to-play recovery. Knowledge of lower limb coordination pattern may provide clinical implications to improve dynamic balance and gait stability for individuals with acute ankle sprain.