Changes In Walking Pattern Research Articles

Association between land use features and changes in walking patterns from pre-pandemic to post-pandemic: A case study of city of Sydney (2013–2023)

While the impact of the pandemic on active mobility patterns is widely studied in several cities, the underlying characteristics that describe the heterogeneity in changes in active mobility are less understood. This is particularly important for post-pandemic active mobility planning. This study aims to investigate and describe the association between urban population and land-use features, as well as changes in the spatio-temporal patterns of walking from pre-pandemic to post-pandemic through a case study of the city of Sydney, Australia, using 11 years of pedestrian count data from 2013 to 2023. The findings indicate that during the pandemic, the average daily pedestrian traffic in Sydney decreased significantly compared to the pre-pandemic period. However, since experiencing the lowest pedestrian traffic in 2020, activities in the study area have shown signs of partial recovery, with a 51% increase observed in 2023. The observed changes in pedestrian activities are, however, spatially heterogeneous. Modeling results reveal that areas with greater commercial land use, more points of interest (POIs), higher population density, and higher network connectivity experienced a significant negative change in the number of walking trips from the pre-pandemic to the pandemic period. Areas with higher percentages of educational and residential use and with higher personal income experienced smaller changes in pedestrian activities during the pandemic compared to the pre-pandemic period. During the post-pandemic recovery, the influential features remain mostly unchanged; however, the association direction is the opposite.

The relationship between body mass index and lower extremity biomechanics in children aged 10-12 years: a comprehensive analysis

Childhood obesity has emerged as a global health concern leading to complications, such as bones and muscles misalignment of knees, flat feet and changes in walking patterns. Although some studies have individually linked these conditions to body mass index (BMI), the relationship between these variables needs to be explored. This study aimed to investigate the associations between BMI and knee position, foot position and plantar footprint in children aged 10 to 12 years. Data were collected from 59 children by measuring their BMI, knee alignment, foot position and plantar footprint. Spearman’s correlation coefficient was used to examine the relationship between BMI and inter-malleolar distance (DIM), foot position and plantar footprint. The Mann- Whitney U test was used to compare these variables between boys and girls (p-value < 0.05). Higher BMI values were associated with higher DIM in both boys and girls. Furthermore, we observed that genu valgum was positively correlated with foot pronation and a flattened plantar footprint. No significant differences were found in relation to BMI, variations in foot position or footprint types. Our research provides evidence that there is a connection, between BMI and genu valgum in children between the ages of 10 and 12. We have also found a correlation between genu valgum and foot pronation among children in this age group. These findings highlight the significance of addressing childhood obesity to prevent any health issues.

Barriers and facilitators of physical activity among Latina immigrant and Mexican mothers living in the US and Mexico: A qualitative study.

Latina immigrant women are among the least physically active when compared with women in other racial/ethnic groups in the US. Similarly, Mexican mothers in Mexico have low rates of physical activity. Motherhood and immigration experiences are recognized barriers to engage in physical activity among Latina immigrant mothers. Less is known about the factors that promote and limit physical activity engagement among Mexican mothers in Mexico, and how their experiences compare with their immigrant counterparts. This transnational qualitative study aimed to investigate the barriers and facilitators of physical activity of 25 Latina mothers in Mexico and the US. Low-income Mexican mothers of kindergarten aged children and Latino mothers of similar aged children were recruited in San Luis Potosí, Mexico and central Illinois, US. Semi-structured interviews were administered by two bilingual and bicultural researchers in participants language of preference. Interviews were transcribed verbatim and analyzed using a thematic network approach and multi-stage coding analysis guided by the Socio-Ecological Model framework. We found that at the macro-level: 1) familial obligations, and 2) cold weather after migrating; at the mezzo-level: 1) changes in walking patterns, and 2) social cohesion (e.g., lack of an invitation to engage in activities); and at the micro-level: 1) individual perceptions, particularly unattainable perceptions of physical activity and 2) shift exhaustion were perceived as barriers and occasionally facilitators of physical activity by mothers in both countries. Context-specific interventions are needed to increase women's physical activity levels in the US and Mexico.

Impact of plantar fasciitis on postural control and walking in young middle-aged adults

PurposeTo assess if plantar fasciitis has an impact on postural control and walking pattern from gait analysis across different experimental conditions. MethodsThirty participants (n = 15 with plantar fasciitis) performed 5 different balance tasks on a force platform, and the center of pressure (COP) was computed for postural control analysis. Participants were also asked to walk at 3 different speeds on a gait analysis system to compute the spatial-temporal parameters. Clinical foot measurements (pain, mobility) were also collected through all participants. ResultsClinical foot measurements showed no significant difference between the two groups; except for pain palpation in plantar fasciitis group. Significant differences were observed between the two groups for COP area displacement sway (p < 0.01; d = 0.08) and velocity (p = 0.022; d = 0.04), where the fasciitis group reported poorer postural control than control mainly during more challenging balance tasks (semi-tandem, unipodal). Plantar fasciitis group reported a decrease of gait velocity (p < 0.01; d = 0.12), step length (p < 0.01; d = 0.16) and step width (p < 0.01; d = 0.18) when compared to the healthy group across walking speed tests. ConclusionsIndividuals with plantar fasciitis report poor postural control and changes in walking pattern across three speeds performance.

Impact of COVID-19 policies on pedestrian traffic and walking patterns.

The spread of COVID-19 pandemic provoked new policies and restrictions, which had an unprecedented impact on urban mobility and traffic on local and global scales. While changes in motorized traffic were investigated and monitored throughout the recent pandemic crisis in many cities around the world, not much was done on the changes in pedestrian street-traffic and walking patterns during this time. This study aims to identify, quantify, and analyze the changes in pedestrian traffic and walking patterns induced by COVID-19 policies. The “first wave” period of COVID-19 policies in Tel-Aviv, Israel, is used as a case study in this work. The analysis includes over 116 million pedestrian movement records documented by a network of 65 Bluetooth sensors, between 1.2.2020 and 26.7.2020, with a comparison to the equivalent time in 2019 that signifies “normal” pre-COVID-19 conditions. The results show clear correlation between the various COVID-19 policy restrictions and pedestrian count. The shifts to work-from-home and closure of businesses were highly correlated with changes in walking patterns during weekdays, while distinguishing changes in commercial and residential street segments. Nevertheless, while the restrictions dramatically influenced pedestrian movement volume and time of walking, it did not significantly change where people chose to walk, signifying the essentialness of attractive streets, parks and squares for citizens living in urban areas. This study shows how policy affects walking behavior in cities, demonstrating the potential of passive crowdsourced sensing technologies to provide urban planners and decision makers an efficient tool for monitoring and evaluating pedestrian infrastructure implementation in cities.

Underactuated Soft Hip Exosuit Based on Adaptive Oscillators to Assist Human Locomotion

Reproducing the mechanisms of human locomotion is a hard challenge. Assistive wearable devices in this context need to be lightweight, portable, and to adapt to the wearer’s walking pattern. Aiming to combine the aforementioned features, we developed a soft wearable exosuit to assist hip flexion during walking. The main feature of the device is underactuation, i.e., a single actuator is used to assist bilateral hip flexion. A control strategy based on Adaptive Oscillators and gait phase estimation is implemented to deliver flexible assistance and to adapt to changes in walking pattern. The system was tested on six healthy subjects. Preliminary results show good performance of the control algorithm to track human gait and to deliver symmetrical assistance to both legs. First kinematic and muscular assessments revealed promising results at walking speeds near to the natural human walking, where the device did not alter hip kinematics and decreased the effort required by muscles contributing to hip flexion. Once validated on a larger sample of subjects, the device can have the potentialities to be used in clinical and wellness applications.

The role of loading in murine models of rotator cuff disease.

Rotator cuff disease pathogenesis is associated with intrinsic (e.g., age, joint laxity, muscle weakness) and extrinsic (e.g., mechanical load, fatigue) factors that lead to chronic degeneration of the cuff tissues. However, etiological studies are difficult to perform in patients due to the long duration of disease onset and progression. Therefore, the purpose of this study was to determine the effects of altered joint loading on the rotator cuff. Mice were subjected to one of three load-dependent rotator cuff tendinopathy models: underuse loading, achieved by injecting botulinum toxin-A into the supraspinatus muscle; overuse loading, achieved using downhill treadmill running; destabilization loading, achieved by surgical excision of the infraspinatus tendon. All models were compared to cage activity animals. Whole joint function was assessed longitudinally using gait analysis. Tissue-scale structure and function were determined using microCT, tensile testing, and histology. The molecular response of the supraspinatus tendon and enthesis was determined by measuring the expression of 84 wound healing-associated genes. Underuse and destabilization altered forepaw weight-bearing, decreased tendon-to-bone attachment strength, decreased mineral density of the humeral epiphysis, and reduced tendon strength. Transcriptional activity of the underuse group returned to baseline levels by 4 weeks, while destabilization had significant upregulation of inflammation, growth factors, and extracellular matrix remodeling genes. Surprisingly, overuse activity caused changes in walking patterns, increased tendon stiffness, and primarily suppressed expression of wound healing-related genes. In summary, the tendinopathy models demonstrated how divergent muscle loading can result in clinically relevant alterations in rotator cuff structure, function, and gene expression.

Fampridine-induced changes in walking kinetics are associated with clinical improvements in patients with multiple sclerosis

Gait dysfunction is common in patients with multiple sclerosis (PwMS). Treatment with prolonged-release fampridine (PR-fampridine) improves walking ability in some PwMS. Associated fampridine-induced changes in the walking pattern are still poorly understood but may provide a better understanding of the mechanisms underlying the beneficial drug effects.61 PwMS were treated with PR-fampridine in a randomized, monocentric, double-blind and placebo-controlled clinical trial with crossover design (FAMPKIN). Drug-induced improvements in walking speed (Timed-25-Foot Walk; T25FW) and endurance (6-Minute Walk Test; 6MWT) were quantified. In this sub-study of the FAMPKIN trial, fampridine-induced changes in kinetic gait patterns were analyzed by pressure-based foot print analysis during treadmill walking. Vertical ground reaction forces were analyzed during different gait phases.Kinetic data of 44 PwMS was eligible for analysis. During double-blind treatment with PR-fampridine, patients performed significantly better in the T25FW and 6MWT than during placebo treatment (p < 0.0001 for both). At the group level (n = 44), there were no significant changes of gait kinetics under PR-fampridine vs. placebo. However, we found relevant changes of walking kinetics regarding forces during loading, single limb and pre-swing phase in a patient sub-group (n = 8). Interestingly, this sub-group demonstrated superior responsiveness to PR-fampridine in the clinical walking tests compared to those patients without any fampridine-induced changes in kinetics (n = 36).Our results demonstrate fampridine-induced changes in gait kinetics in a sub-group of PwMS. These gait pattern changes were accompanied by improved clinical walking performance under PR-fampridine. These results shed some light on the biomechanical changes in walking patterns underlying enhanced fampridine-induced gait performance.

Muscle Synergies in Response to Biofeedback-Driven Gait Adaptations in Children With Cerebral Palsy.

BackgroundChildren with cerebral palsy (CP) often show impaired selective motor control (SMC) that induces limitations in motor function. Children with CP can improve aspects of pathological gait in an immediate response to visual biofeedback. It is not known, however, how these gait adaptations are achieved at the neural level, nor do we know the extent of SMC plasticity in CP.AimInvestigate the underlying SMC and changes that may occur when gait is adapted with biofeedback.MethodsTwenty-three ambulatory children with CP and related (hereditary) forms of spastic paresis (Aged: 10.4 ± 3.1, 6–16 years, M: 16/F: 9) were challenged with real-time biofeedback to improve step length, knee extension, and ankle power while walking on an instrumented treadmill in a virtual reality environment. The electromyograms of eight superficial muscles of the leg were analyzed and synergies were further decomposed using non-negative matrix factorization (NNMF) using 1 to 5 synergies, to quantify SMC. Total variance accounted for (tVAF) was used as a measure of synergy complexity. An imposed four synergy solution was investigated further to compare similarity in weightings and timing patterns of matched paired synergies between baseline and biofeedback trials.ResultsDespite changes in walking pattern, changes in synergies were limited. The number of synergies required to explain at least 90% of muscle activation increased significantly, however, the change in measures of tVAF1 from baseline (0.75 ± 0.08) were less than ±2% between trials. In addition, within-subject similarity of synergies to baseline walking was high (>0.8) across all biofeedback trials.ConclusionThese results suggest that while gait may be adapted in an immediate response, SMC as quantified by synergy analysis is perhaps more rigidly impaired in CP. Subtle changes in synergies were identified; however, it is questionable if these are clinically meaningful at the level of an individual. Adaptations may be limited in the short term, and further investigation is essential to establish if long term training using biofeedback leads to adapted SMC.

P38-S Evaluating effects of neurorehabilitation on gait pattern in multiple sclerosis with kinetic and electromyographic analyses

Gait deficit is a hallmark of multiple sclerosis (MS) and the walking capacity can be improved with rehabilitation. Technological advances in biomechanics offer opportunities to assess the effects of rehabilitation objectively. Here we employed wearable sensors to measure electromyography (EMG) and body acceleration during walking and to evaluate the changes in walking pattern after rehabilitation. Forty patients with MS (PwMS, mean EDSS: 5.51 ± 1) were enrolled. Ten-meter-walking-test (10MWT) were performed before and after rehabilitation. Clinical symptoms were assessed with self-reported questionnaires. An accelerator attached on the waist and 8 electrodes (BTS bioengineering, Italy) attached on bilateral thighs (Rectus and Biceps Femoris, RF-BF) and legs (Tibialis anterior and gastrocnemius, TA-GM) for measuring body acceleration and EMG recording. Time, cadence (pace/minutes), step-length and coactivation index(CoI) between antagonistic pairs pre- and post-rehabilitation were calculated on more and less affected side (MA/LA) for statistics. The time (p < 0.001) and cadence (p = 0.01) of 10MWT were significantly improved after rehabilitation. Though not statistically significant, CoI of RF-BF reduced in both sides post treatment (MA pre: 22.51 ± 10.10 v.s. post: 18.72 ± 7.14; LA pre: 20.35 ± 7.34 v.s. post: 17.45 ± 4.64). Further, reduced CoI of RF-BF pair on MA side correlated with less walking time in 10MWT (r = 0.43), while the reduction on LA sides correlated with less fatigue (r = 0.38, fatigue evaluated with Fatigue Severity Scale). Our results showed that the improvements of walking capacity after rehabilitation in PwMS may be related to reduced coactivation of the distal muscle. Combining objective assessments of EMG and accelerators allows us to better evaluate the effects of rehabilitation of gait and may benefit in future personalized rehabilitation program.

Muscle synergies demonstrate only minimal changes after treatment in cerebral palsy

BackgroundChildren with cerebral palsy (CP) have altered synergies compared to typically-developing peers, reflecting different neuromuscular control strategies used to move. While these children receive a variety of treatments to improve gait, whether synergies change after treatment, or are associated with treatment outcomes, remains unknown.MethodsWe evaluated synergies for 147 children with CP before and after three common treatments: botulinum toxin type-A injection (n = 52), selective dorsal rhizotomy (n = 38), and multi-level orthopaedic surgery (n = 57). Changes in synergy complexity were measured by the number of synergies required to explain > 90% of the total variance in electromyography data and total variance accounted for by one synergy. Synergy weights and activations before and after treatment were compared using the cosine similarity relative to average synergies of 31 typically-developing (TD) peers.ResultsThere were minimal changes in synergies after treatment despite changes in walking patterns. Number of synergies did not change significantly for any treatment group. Total variance accounted for by one synergy increased (i.e., moved further from TD peers) after botulinum toxin type-A injection (1.3%) and selective dorsal rhizotomy (1.9%), but the change was small. Synergy weights did not change for any treatment group (average 0.001 ± 0.10), but synergy activations after selective dorsal rhizotomy did change and were less similar to TD peers (− 0.03 ± 0.07). Only changes in synergy activations were associated with changes in gait kinematics or walking speed after treatment. Children with synergy activations more similar to TD peers after treatment had greater improvements in gait.ConclusionsWhile many of these children received significant surgical procedures and prolonged rehabilitation, the minimal changes in synergies after treatment highlight the challenges in altering neuromuscular control in CP. Development of treatment strategies that directly target impaired control or are optimized to an individual’s unique control may be required to improve walking function.

PP-19 Quantification of gait in children with mitochondrial disease: a validation study

Background Validated, clinically meaningful outcome measures should be used to detect clinically relevant effects of treatments. Since the clinical heterogeneity in mitochondrial disorders is extremely wide, the selection and validation of outcome measures is challenging. Espe-cially for children, whom are developing and growing and even have a larger phenotypic heterogeneity compared to adults, this challenge has so far resulted in a lack of val-idated outcome measures. Gait analysis is an emerging method to quantify subtle changes in walking patterns of adults with neurological disorders and can provide in-sight in the effects of a therapeutic intervention. Based on the results of a validation study in m.3243A>G carriers, we included gait quantification as the primary outcome measure for the adult randomised, placebo-controlled, cross-over, phase 2 trial performed in this population in our centre (the KHENERGY trial). We hypothesise that gait analysis is also a feasible and reliable outcome measure for intervention studies in ambulatory children with mi-tochondrial disease. Methods The aim of this study was to select the opti-mal protocol to quantify gait patterns with the Gaitrite in paediatric mitochondrial patients, comparing a normal walking protocol and a post-exercise protocol. Ambula-tory children with a genetically confirmed mitochondrial disease are asked to walk across the Gaitrite three times for each trial and two times for each condition to estimate test-retest variability. First, the normal walking condition is tested. Subsequently, a 3-minte walking test is performed, followed by a post-exercise protocol. After 10 min of rest, a recovery condition is tested. Secondly, the gait patterns of the mitochondrial patients are compared to 5 age-and gender matched healthy controls to gain more insight in which walking parameters were affected by mi-tochondrial disorders. Results and conclusion The results of this validation study will be presented.

Quantification of gait in mitochondrial m.3243A\u2009>\u2009G patients: a validation study

BackgroundMore than half of the patients harbouring the m.3243A > G mutation were found to have trouble maintaining balance when walking in a recent study by our group. Others demonstrated that these patients had an abnormal gait pattern, as quantified by gait analysis. Gait analysis is an emerging method to quantify subtle changes in walking pattern, also during therapeutic interventions. Therefore, we aimed to test the reliability and reproducibility of gait analysis and select the most suitable protocol for this group of patients using a GAITRite electronic walkway. Four different protocols were tested: normal walking, dual task, post exercise and after a ten minutes of rest.ResultsIn total 36 patients with the m.3243A > G mutation and 50 healthy controls were enrolled in this study. Overall high intra class correlation coefficients were found in all experimental conditions for both patients and healthy controls indicating good reproducibility. Marked differences in gait between patients and controls were observed and were in line with the only available exploratory study performed. There was a good correlation between both the overall NMDAS score, NMDAS subscale scores, both markers for disease severity, and specific gait parameters.ConclusionsThe observed reliability of the test makes GAITRite a suitable instrument for intervention studies in patients with mitochondrial disease.

New tool to assess walking patterns in the development of OA pain: kinetic weight bearing

Purpose: Osteoarthritis (OA), or degenerative joint disease, is a debilitating condition associated with pain that remains only partially controlled by available analgesics. Patients living with OA often exhibit abnormal movement patterns primarily due to altered joint kinematics. While some of these gait changes in OA are due to deterioration in joint congruency, compensatory movement to minimize joint loading and pain is also likely to play a part. Monitoring animal movement following arthritis induction could reveal some interesting insights into pain perception. Analyzing knee biomechanics during walking - the primary cyclic load-bearing activity - is therefore particularly relevant. Better understanding the differences in biomechanics between non-OA and OA individuals offers a unique basis to study the disease and improve prevention and treatment options. The current gap between basic science research and new analgesic development presents a serious challenge for the future of pain medicine. Therefore, a paradigm shift in translational pain research is necessary to transform the current strategy and to explain why animal behavioral testing does not assess subjective pain experience. Methods: We employed the OA model for the study of joint pain induced by the injection of monosodium iodoacetate (MIA) into the knee of rats. Behavioral changes resemble some of the symptoms reported by the patient population. Weight bearing deficits have been observed in MIA model. While most studies investigate the weight distribution on the two hind paws measured as the force exerted by each limb on a transducer plate in the floor over a given time period we used Kinetic Weight Bearing (KWB), a novel instrument developed by Bioseb (France) and designed to measure time and spatial distribution of a weight bearing by each paw in freely moving rodent. KWB quantifies over 20 parameters describing spontaneous movement patterns. We aimed at comparison of sensory system evaluation by joint hypersensitivity (Pressure Application Measurement, PAM) and gait analysis (KWB) to define their benefits for the study of OA-related pain and more accurate transition from bench to bedside. Results: PAM measurements showed biphasic development of pain behavior with acute response at day 2 and phase recognized as associated with cartilage degeneration starting at day 10-14 after MIA i.a. injection. KWB measurements presented similar pattern of response, where changes in walking pattern were more pronounced at the beginning and the end of experiment. The most abundant alternations were observed when rear left (RL) and rear right (RR) paws were compared in each of treatment groups, more robust in rats injected with 3mg MIA, rather than in the 1 mg MIA group. Changes in walking pattern were different in acute response to MIA injection and in the developed stages of OA. Changes between groups were pronounced only at the beginning of OA development and around day 21, however no significant differences could be seen. This suggests that dose of 1 mg of MIA used to induce OA is sufficient in the studies on pathophysiology of pain associated with that condition. Conclusions: Hereby we present results on KWB, as an alternative method generating quantitative data on footprints, with the main advantage of allowing to describe subtle changes in locomotor activity of a freely moving animal. Pain behavior measured by this test correlated with well-established PAM assessment, which increase credibility and utility of KWB measurements. Complex description of locomotor activity of rats in MIA model of OA allows to improve accurateness in rating in OA-associated pain. This might be of benefit in assessing effectiveness of novel treatments and better transitioning results from laboratory conditions to clinic. Supported by National Science Centre, Poland grants: OPUS UMO-2014/13/B/NZ7/02311, ETIUDA UMO-2015/16/T/NZ7/00052 and statutory funds.

Prolonged-release fampridine in multiple sclerosis: Improved ambulation effected by changes in walking pattern

Background: Prolonged-release fampridine (PR-fampridine, 4-aminopyridine) increases walking speed in the timed 25-foot walk test (T25FW) in some patients (timed-walk responders) with multiple sclerosis (MS). Objective: To explore the effects of PR-fampridine on different aspects of walking function and to identify associated gait modifications in subjects with MS. Methods: In this prospective, randomized, placebo-controlled, double-blind, phase II study (FAMPKIN; clinicaltrials.gov, NCT01576354), subjects received a 6-week course of oral placebo or PR-fampridine treatment (10 mg, twice daily) before crossing over. Using 3D-motion-analysis, kinematic and kinetic parameters were assessed during treadmill walking (primary endpoint). Clinical outcome measures included T25FW, 6-minute walk test (6MWT), and balance scales. Physical activity in everyday life was measured with an accelerometer device. Results: Data from 55 patients were suitable for analysis. Seventeen subjects were timed-walk responders under PR-fampridine. For the total study population and for responders, a significant increase in walking speed (T25FW) and distance (6MWT) was observed. Gait pattern changes were found at the single-subject level and correlated with improvements in the T25FW and 6MWT. Physical activity was increased in responders. Conclusion: PR-fampridine improves walking speed, endurance, and everyday physical activity in a subset of subjects with MS and leads to individual modifications of the gait pattern.

Kinematic and kinetic modifications in walking pattern of hip osteoarthritis patients induced by intra-articular injections of hyaluronic acid

BackgroundA growing body of evidence points to the efficacy of intra-articular injections of hyaluronic acid, in dealing with pain and function in hip osteoarthritis. To date, however, no data exist as to this treatment's effect on walking pattern. MethodsWe performed a prospective, open study in order to verify, in a group of 20 hip osteoarthritis patients (12 men, 8 women, mean age 60.5, range 47–73), the clinical effects of 3 intra-articular injections of 2ml of hyaluronic acid in the hip (1/week) in terms of pain and function at 1 (T1), 3 (T2) and 6-month (T3) follow-ups, as well as changes in the kinematics and kinetics of gait at 6-month follow-up. FindingsPain as measured with visual analog scale significantly dropped after this procedure (P<0.0001). A significant improvement was noted regarding stiffness (P=0.005) and disability (P=0.04), as measured by the Western Ontario and McMaster Universities osteoarthritis index. As regards gait analysis, patients at T3 walked with higher cadence (P=0.004) and stride length (P=0.02) compared to T0. Moreover, a significant increase for the pelvic tilt at heel contact (P=0.0004) and for hip flexion–extension moment at loading response sub-phases of gait cycle (P=0.02) was noted at T3. InterpretationIn line with current literature, our patients display clinical improvement 6months after intra-articular injections of hyaluronic acid, accompanied by changes in walking pattern, as measured by instrumental gait analysis. The kinematic and kinetic changes observed may be the consequence of the therapeutic effect of intra-articular injections of hyaluronic acid.

Short and Longer Term Changes in Amputee Walking Patterns Due to Increased Prosthesis Inertia

The purpose of this study was to quantify the time course of changes in walking patterns among unilateral, transtibial amputees whose prosthesis inertia properties were substantially altered to match with those of their intact limb. Four unilateral transtibial amputees completed three test sessions on days 1, 2, and 8 of an 8-day protocol. Walking kinetics were computed from overground trials; temporal characteristics were collected during treadmill walking. Assessments were initially performed on day 1 without additional mass on the prosthesis. Mass was then added to the distal aspect of the prosthesis such that the mass and moment of inertia of the prosthetic leg were matched with those of the intact shank and foot. This added mass remained attached to the prosthetic limb for the next 7 days. Gait assessments were completed immediately and after 5, 10, 15, 30, and 60 minutes of exposure to the altered inertia. Amputees returned to the laboratory on days 2 and 8 for additional assessments. Measures of gait symmetry between the intact and prosthetic legs changed within 5 minutes of exposure to altered prosthesis inertia and remained in this altered state until the load was removed on the eighth day, at which time symmetry indices returned to their original state. Matching the inertia properties between legs exacerbated stance time and swing time asymmetries but improved peak knee moment symmetry during swing termination. The increased joint kinetic symmetry, however, required greater muscular efforts, particularly on the prosthetic side. In conclusion, substantial alteration of the inertia properties of the prosthesis immediately altered temporal and joint kinetic symmetry between intact and prosthetic legs, both when mass was added to the prosthesis and when that mass was removed. Because of our small sample size, caution should be exercised when generalizing these outcomes to all lower limb amputees. (J Prosthet Orthot. 2011;23:114 –123.) KEY INDEXING TERMS: gait, rehabilitation, symmetry, prosthesis design, inertia manipulation

20대 남성의 낮은 조도의 평지 보행 시 보행 패턴 변화

This study examined the changes in the walking pattern during level walking under low illumination conditions. Fourteen male subjects (<TEX>$22.1{\pm}2.21$</TEX> years, <TEX>$174{\pm}3.74\;cm$</TEX>, <TEX>$68.86{\pm}10.81\;kg$</TEX>) with normal vision and no disabilities were enrolled in this study. All experiments were performed on a level walkway with three conditions: normal walking (preferred & low speed) and walking with low illumination. 3D motion capturing system was used for acquisition and analysis of the walking motion data with a sampling frequency of 120Hz. The walking speed, normalized jerk(NJ) at the center of mass(COM), wrist and heel, knee and elbow joint angle, ratio of the knee joint angle to elbow joint angle and the toe clearance on stance phase were used to compare the differences in walking pattern between the two illumination conditions, The results showed that the walking speed and joint angles decreased in low illumination, whereas the NJ and toe minimum clearance increased. In low illumination, most variables were similar to effects of low speed walking, but toe clearance was different from the effects of low speed. These results can be used as primary data for examining the changes in the level walking pattern of young adults under low illumination. Further study will be needed to compare these results in young adults with those in the elderly.

평지와 고르지 않은 지면 경사로 보행 시 고령자와 젊은 성인의 운동학적 요인 비교

The purpose of this study was to investigate the changes in walking pattern of the elderly during inclined walkway with uneven surfaces and level walking. 10 young(26.3±1.3 years, 174.3±5.3 cm, 69.5±9.5 kg) and 13 elderly(72.4±5.2 years, 164.5±5.4 cm, 66.1±9.6 kg) male subjects were participated in the experiment. Experiment consisted of 2 walking conditions: horizontal and inclined walkway with uneven surfaces. 3D motion capturing system were used to acquire and analyze walking motion data with sampling frequency of 120 Hz. To compare differences between conditions, kinematic variables(walking speed, stance-swing ratio, hip joint angle, knee joint angle, ankle joint angle, pelvic rotation angle) were used. Results showed that there were some changes of elderly walking pattern in inclined walkway with uneven surfaces: hip joint(adduction and rotation) and pelvic movement pattern. These changes by inclination and surface may affect gait pattern of young subjects as well as elderly subjects. However, in case of elderly it revealed more unstable gait than the young. Further study is necessary to clarify changes in walking pattern for elderly by considering various gait variables including head movement and various walkway conditions.

Increasing intensity during treadmill walking does not adversely affect walking pattern or quality in newly-ambulating stroke patients: an experimental study

Does walking on a treadmill at increasing intensities adversely affect walking pattern or reduce walking quality during treadmill walking? Are any changes influenced by walking ability? A within-participant, repeated measures experimental study. 18 individuals with a first stroke who were undergoing inpatient rehabilitation. Walking on a treadmill at intensities of 30%, 40%, 50% and 60% heart rate reserve in the one session. During treadmill walking practice, walking pattern was measured as linear and angular kinematics while walking quality was measured using the Rivermead Gait Analysis scale and a visual analogue scale. Walking on the treadmill at 60% heart rate reserve, step length of the paretic limb was 0.05 m (95% CI 0.01 to 0.10) longer, step length of the non-paretic limb was 0.09 m (95% CI 0.05 to 0.12) longer, and hip flexion at mid swing was 4 degrees (95% CI 1 to 6) greater than at 30% heart rate reserve. At 60% heart rate reserve, hip and knee extension at mid stance were respectively 3 and 4 degrees more flexed than at 30% heart rate reserve. Walking ability did not affect changes in walking pattern. Walking quality did not change with increasing treadmill intensity. Walking on a treadmill at increasing intensity did not adversely affect walking pattern or reduce walking quality in newly-ambulating stroke patients. This study adds some support for the inclusion of walking on a treadmill at higher intensities in rehabilitation for newly-ambulating stroke patients.