Differences In Spatiotemporal Gait Parameters Research Articles

Immediate effects of the honda walking assist on spatiotemporal gait characteristics in individuals after stroke

The use of unconstrained lower limb exoskeletons has become a promising approach to assist individuals with gait impairments. The Honda Walking Assist (HWA) is a hip-assistive exoskeleton functioning as a gait trainer and has been shown to improve several gait related outcomes after training. Studies investigating its immediate effects on spatiotemporal gait parameters other than walking speed in stroke survivors are lacking. The aim of this study was to investigate immediate differences in spatiotemporal gait parameters of stroke survivors between normal overground walking, walking with an unpowered, non-assisting HWA and walking with an optimally assisting HWA. Five ischemic stroke survivors (mean time since stroke 115 ​± ​213.6 days) walked 3 times 5 ​m in each condition. Differences in 14 spatiotemporal gait parameters between all 3 conditions were registered and reported in a descriptive manner. With optimal assistance, 4 patients walked faster (0.057–0.095 ​m/s) with longer strides of the paretic (0.055–0.069 ​m) and non-paretic (0.053–0.077 ​m) leg compared to normal walking. Compared to unpowered walking, all patients walked faster (0.020–0.063 ​m/s) in the optimal assist condition, with longer strides of the paretic (0.036–0.072 ​m) and non-paretic leg (0.045–0.082 ​m). During unpowered walking, gait velocity remained unchanged in 2 patients, increased (0.012–0.051 ​m/s) in 2 patients and decreased (−0.022 ​m/s) in 1 patient compared to normal walking. Changes in paretic stride lengths ranged from −0.066 to 0.029 ​m. The optimal individualized motor assistance provided by the HWA induces small, positive changes in gait parameters. This indicates that this light-weight hip-assistive exoskeleton can be of value in rehabilitation setting, where multiple training sessions with the device are possible.

Spatiotemporal, kinematic and kinetic assessment of the effects of a foot drop stimulator for home-based rehabilitation of patients with chronic stroke: a randomized clinical trial

BackgroundGait disability affects the daily lives of patients with stroke in both home and community settings. An abnormal foot–ankle position can cause instability on the supporting surface and negatively affect gait. Our research team explored the ability of a portable peroneal nerve-targeting electrical stimulator to improve gait ability by adjusting the foot–ankle position during walking in patients with chronic stroke undergoing home-based rehabilitation.MethodsThis was a double-blinded, parallel-group randomized controlled trial. Thirty-one patients with chronic stroke and ankle–foot motor impairment were randomized to receive 3 weeks of gait training, which involved using the transcutaneous peroneal nerve stimulator while walking (tPNS group; n = 16, mean age: 52.25 years), or conventional home and/or community gait training therapy (CT group; n = 15, mean age: 54.8 years). Functional assessments were performed before and after the 3-week intervention. The outcome measures included spatiotemporal gait parameters, three-dimensional kinematic and kinetic data on the ankle–foot joint, and a clinical motor and balance function assessment based on the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance scales (BBS). Additionally, 16 age-matched healthy adults served as a baseline control of three-dimensional gait data for both trial groups.ResultsThe FMA-LE and BBS scores improved in both the tPNS groups (p = 0.004 and 0.001, respectively) and CT groups (p = 0.034 and 0.028, respectively) from before to after training. Participants in the tPNS group exhibited significant differences in spatiotemporal gait parameters, including double feet support, stride length, and walking speed of affected side, and the unaffected foot off within a gait cycle after training (p = 0.043, 0.017, 0.001 and 0.010, respectively). Additionally, the tPNS group exhibited significant differences in kinematic parameters, such as the ankle angle at the transverse plane (p = 0.021) and foot progression angle at the frontal plane (p = 0.009) upon initial contact, and the peak ankle joint angle at the transverse plane (p = 0.023) and foot progression angle (FPA) at the frontal and transverse planes (p = 0.032 and 0.046, respectively) during gait cycles after 3 weeks of training.ConclusionsUse of a portable tPNS device during walking tasks appeared to improve spatiotemporal gait parameters and ankle and foot angles more effectively than conventional home rehabilitation in patients with chronic stroke. Although guidelines for home-based rehabilitation training services and an increasing variety of market devices are available, no evidence for improvement of motor function and balance was superior to conventional rehabilitation.Trial registration Chictr, ChiCTR2000040137. Registered 22 November 2020, https://www.chictr.org.cn/showproj.aspx?proj=64424

Clinical-Functional Evaluation and Test-Retest Reliability of the G-WALK Sensor in Subjects with Bimalleolar Ankle Fractures 6 Months after Surgery.

Ankle fractures can cause significant functional impairment in the short and long term. In recent years, gait analysis using inertial sensors has gained special relevance as a reliable measurement system. This study aimed to evaluate the differences in spatiotemporal gait parameters and clinical–functional measurements in patients with bimalleolar ankle fracture and healthy subjects, to study the correlation between the different variables, and to analyze the test–retest reliability of a single inertial sensor in our study population. Twenty-two subjects with bimalleolar ankle fracture six months after surgery and eleven healthy subjects were included in the study. Spatiotemporal parameters were analyzed with the G-WALK sensor. Functional scales and clinical measures were collected beforehand. In the ankle fracture group, the main differences were obtained in bilateral parameters (effect size: 0.61 ≤ d ≤ 0.80). Between-group differences were found in cadence, speed, stride length, and stride time (effect size: 1.61 ≤ d ≤ 1.82). Correlation was moderate (0.436 < r < 0.554) between spatiotemporal parameters and clinical–functional measures, explaining up to 46% of gait performance. Test–retest reliability scores were high to excellent (0.84 ≤ ICC ≤ 0.98), with the worst results in the gait phases. Our study population presents evident clinical–functional impairments 6 months after surgery. The G-WALK can be considered a reliable tool for clinical use in this population.

Lower-Extremity Intra-Joint Coordination and Its Variability between Fallers and Non-Fallers during Gait

Falling is one of the most common causes of hip fracture and death in older adults. A comparison of the biomechanics of the gait in fallers and non-fallers older adults, especially joint coordination and coordination variability, enables the understanding of mechanisms that underpin falling. Therefore, we compared lower-extremity intra-joint coordination and its variability between fallers and non-fallers older adults during gait. A total of 26 older adults, comprising 13 fallers, took part in this study. The participants walked barefoot at a self-selected speed on a 10-m walkway. Gait kinematics in the dominant leg during 10 cycles were captured with 10 motion tracking cameras at a sampling rate of 100 Hz. Spatiotemporal gait parameters, namely, cadence, walking speed, double support time, stride time, width, and length, as well as intra-joint coordination and coordination variability in the sagittal plane were compared between the two groups. Results showed that fallers walked with significant lower cadence, walking speed, and stride length but greater double support and stride time than non-fallers. Significant differences in the ankle-to-knee, knee-to-hip, and ankle-to-hip coordination patterns between fallers and non-fallers and less coordination variability in fallers compared to non-fallers in some instants of the gait cycles were observed. The differences in spatiotemporal gait parameters in fallers compared to non-fallers may indicate an adaptation resulting from decreased efficiency to decrease the risk of falling. Moreover, the differences in segment coordination and its variability may indicate an inconsistency in neuromuscular control. It may also indicate reduced ability to control the motion of the leg in preparation for foot contact with the ground and the knee and ankle motions during loading response. Finally, such differences may show less control in generating power during the push-off phase in fallers.

Do Differences in Spatiotemporal Gait Parameters Predict the Risk of Developing Depression in Later Life?

There is growing interest in the association between gait disturbance and depression in later life. The aim of this study is to clarify the longitudinal relationship between specific gait parameters and incident depression within a population-representative sample of older people. Longitudinal analysis of spatiotemporal gait parameters at baseline (wave 1) and incident depression at 2 and 4 years (waves 2/3). Logistic regression models were used to assess the relationship between tertiles of gait parameters and incident depression. The Irish Longitudinal Study on Aging. Over 3600 nondepressed community-dwelling people aged 50 years or older. A score of 9 or greater on the eight-item Center for Epidemiological Studies Depression Scale at wave 2 or 3 was indicative of incident depression. The GAITRite system was used to measure gait speed, step length, step width, and double support phase during usual speed walking and under dual task conditions. Participants with incident depression (344/3615) had slower gait speed (129.9 [95% confidence interval {CI} = 127.2-132.6] cm/s vs 134.1 [95% CI = 133.0-135.1] cm/s; F = 8.82; P = .003) and shorter step length (68.0 [95% CI = 66.9-69.2] cm vs 70.3 [95% CI = 69.9-70.7] cm; F = 13.99; P < .001) at baseline than those who did not develop depression. Logistic regression models demonstrated that those within the slowest tertile for gait speed and shortest tertile for step length had significantly increased likelihood of incident depression in fully adjusted models, with odds ratios of 1.54 (95% CI = 1.08-2.19) and 1.54 (95% CI = 1.01-2.35), respectively. Measures of step width and double support time were not associated with depression. This study demonstrates that older people with incident depression have significantly slower gait speed and shorter step length at initial assessment. These findings are clinically significant given the impact both conditions have on functional status in later life, as well as the possibility that gait problems may represent a potentially modifiable risk factor for depression. J Am Geriatr Soc 67:1050-1056, 2019.

Quantitative assessment of gait parameters in people with Parkinson's disease in laboratory and clinical setting: Are the measures interchangeable?

This study aimed to investigate possible differences in spatio-temporal gait parameters of people with Parkinson’s Disease (pwPD) when they are tested either in laboratory using 3D Gait Analysis or in a clinical setting using wearable accelerometers. The main spatio-temporal gait parameters (speed, cadence, stride length, stance, swing and double support duration) of 31 pwPD were acquired: i) using a wearable accelerometer in a clinical setting while wearing shoes (ISS); ii) same as condition 1, but barefoot (ISB); iii) using an optoelectronic system (OES) undressed and barefoot. While no significant differences were found for cadence, stance, swing and double support duration, the experimental setting affected speed and stride length that decreased (by 17% and 12% respectively, P<0.005) when passing from the clinical (ISS) to the laboratory (OES) setting. These results suggest that gait assessment should be always performed in the same conditions to avoid errors, which may lead to inaccurate patient’s evaluations.

A dance program to improve gait and balance in individuals with chronic stroke: a feasibility study

ABSTRACTBackground and Objective Despite gains made with rehabilitation, gait and balance remain limited post-stroke. Dance is a fun and motivating activity which has shown benefits in individuals with Parkinson’s disease. The purpose of this article is to investigate the feasibility of a dance program for individuals with chronic stroke.Methods Pre-post intervention feasibility study where twenty individuals with chronic stroke participated in a dance class twice a week for 10 weeks. Feasibility measures included interest, enrollment, attendance, adverse events, and participant satisfaction. Outcomes of interest were spatiotemporal gait parameters and balance assessed with the MiniBESTest before and after the dance program. Pre and post measures were compared with paired t-tests.Results Of the 33 individuals approached, 30 (90.9%) were interested in participating; however, scheduling conflicts were a common barrier. Ultimately, 22 individuals consented and 20 individuals completed the dance program without adverse events. The mean age was 62.3 (10.4) years, time post-stroke was 6.4 (6.0) years and National Institutes of Health Stroke Scale score was 3.1 (2.0). Average attendance was 92.5% with 10 classes missed across 8 participants and satisfaction ratings were high (e.g. 17/20 strongly agreed they enjoyed the program). No significant differences in spatiotemporal gait parameters were found; however, MiniBESTest scores significantly increased from 16.5 (6.0) to 18.6 (4.9) (p = 0.0005).Discussion and Conclusions A dance program is safe and feasible post-stroke. Attendance and satisfaction were high and participants perceived walking and balance benefits. Future work will include a randomized controlled trial.

Limbic and Basal Ganglia Neuroanatomical Correlates of Gait and Executive Function: Older Adults With Mild Cognitive Impairment and Intact Cognition.

This study aimed to examine differences in spatiotemporal gait parameters between older adults with amnestic mild cognitive impairment and normal cognition and to examine limbic and basal ganglia neural correlates of gait and executive function in older adults without dementia. This was a cross-sectional study of 46 community-dwelling older adults, ages 70-95 yrs, with amnestic mild cognitive impairment (n = 23) and normal cognition (n = 23). Structural magnetic resonance imaging was used to attain volumetric measures of limbic and basal ganglia structures. Quantitative motion analysis was used to measure spatiotemporal parameters of gait. The Trail Making Test was used to assess executive function. During fast-paced walking, older adults with amnestic mild cognitive impairment demonstrated significantly slower gait speed and shorter stride length compared with older adults with normal cognition. Stride length was positively correlated with hippocampal, anterior cingulate, and nucleus accumbens volumes (P < 0.05). Executive function was positively correlated with hippocampal, anterior cingulate, and posterior cingulate volumes (P < 0.05). Compared with older adults with normal cognition, those with amnestic mild cognitive impairment demonstrated slower gait speed and shorter stride length, during fast-paced walking, and lower executive function. Hippocampal and anterior cingulate volumes demonstrated moderate positive correlation with both gait and executive function, after adjusting for age. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) discuss gait performance and cognitive function in older adults with amnestic mild cognitive impairment versus normal cognition, (2) discuss neurocorrelates of gait and executive function in older adults without dementia, and (3) recognize the importance of assessing gait speed and cognitive function in the clinical management of older adults at risk for dementia. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Characterizing knee loading asymmetry in individuals following anterior cruciate ligament reconstruction using inertial sensors

Limitations in the ability to identify knee extensor loading deficits during gait in individuals following anterior cruciate ligament reconstruction (ACLr) may underlie their persistence. A recent study suggested that shank angular velocity, directly output from inertial sensors, differed during gait between individuals post-ACLr and controls. However, it is not clear if this kinematic variable relates to knee moments calculated using joint kinematics and ground reaction forces. Heel rocker mechanics during loading response of gait, characterized by rapid shank rotation, require knee extensor control. Measures of shank angular velocity may be reflective of knee moments. This study investigated the relationship between shank angular velocity and knee extensor moment during gait in individuals (n=19) 96.7±16.8days post-ACLr. Gait was assessed concurrently using inertial sensors and a marker-based motion system with force platforms. Peak shank angular velocity and knee extensor moment were strongly correlated (r=0.75, p<0.001) and between limb ratios of angular velocity predicted between limb ratios of extensor moment (r2=0.57, p<0.001) in the absence of between limb differences in spatiotemporal gait parameters. The strength of these relationships indicate that shank kinematic data offer meaningful information regarding knee loading and provide a potential alternative to full motion analysis systems for identification of altered knee loading following ACLr.

Explaining modified 2-min walk test outcomes in male Veterans with traumatic or nontraumatic lower-limb amputation.

Little evidence exists to support the presence of differences in spatiotemporal gait parameters and ambulation ability between those individuals with traumatic and nontraumatic lower-limb amputation (LLA). We conducted an exploratory study of 81 male Veterans with unilateral amputation to quantify differences in spatiotemporal gait parameters and ambulatory mobility between Veterans with traumatic and nontraumatic LLA. Furthermore, we identified variables that significantly contributed to the explanation of variability in modified 2-min walk test distance. All participants completed the modified 2-min walk test and a spatiotemporal gait analysis using an instrumented walkway during a routine physical therapy visit. Veterans with nontraumatic LLA walked significantly shorter mean distances during a modified 2-min walk test than Veterans with traumatic LLA. Variables identified as significant contributors to modified 2-min walk test variability were amputated limb stance time, amputated limb step length, and percentage of the gait cycle spent in double support. These findings demonstrate that differences in spatiotemporal gait parameters and ambulatory mobility exist between Veterans with traumatic and nontraumatic LLA and identify important spatiotemporal parameters of gait contributing to this decline. These parameters should be considered as targets for intervention and future investigation.

The effect of simulated elbow contracture on temporal and distance gait parameters

BackgroundElbow contractures can be functionally debilitating. Extensive research has been published on treatments to restore elbow motion, but few have discussed clinical implications beyond the affected extremity. Reciprocal arm swing in normal gait has been shown to increase stability and reduce energy expenditure. The importance of arm swing has been clinically demonstrated in patients with cerebral palsy, stroke and Parkinson's disease. We hypothesized that elbow contractures would result in an abnormal spatio-temporal gait parameters. MethodsForty volunteer subjects walked on the Gaitmat II which provided real-time analysis of temporal and distance gait parameters. Five conditions were tested: no brace (control 1), elbow brace unlocked (control 2) and brace locked in 30°, 90° or 120° flexion (simulating fixed elbow contractures). Condition order was randomized for each subject. Each condition consisted of five walking trials. ResultsAll three fixed elbow conditions (120°, 90° and 30°) demonstrated significantly decreased gait velocity (1.37, 1.39 and 1.39m/s) and stride length (1.45, 1.46 and 1.46m) compared to the control condition (1.42m/s and 1.48m, respectively). Single limb stance and double support times were decreased and increased, respectively, compared to control. There was no significant difference in cadence or limb asymmetry in the three fixed elbow conditions. ConclusionsDespite well-established functional limitations in elbow contracture patients and importance of arm swing in normal gait, the impact of elbow contractures on gait is unknown. This study demonstrates that simulated elbow contracture results in significant differences in spatio-temporal gait parameters suggesting that elbow contractures have a broader functional impact beyond the affected extremity. Level of evidenceII.

Comparison of Spatiotemporal Gait Parameters between Children with Normal Development and Children with Diplegic Cerebral Palsy.

[Purpose] The purpose of this study was to determine the differences in spatiotemporal gait parameters between children with spastic diplegic CP and children with normal development (ND). [Subjects and Methods] Sixteen children (eight children with spastic diplegic CP and eight ND children) were recruited for participation as volunteers in this study. The children with CP had a Gross Motor Function Classification (GMFC) System level of between I and II. [Results] Walking velocity, cadence, stride length, and step width of children with CP with a GMFC of between I and II were a level of 60%, 77%, 73%, and 160%, respectively, of those of ND children. The percentages of right and left double-limb support were 188% and 179% higher, respectively, and the proportion of single limb support was shorter by 83% and 82%. [Conclusion] Our results provide objective evidence of distinct differences in spatiotemporal gait parameters between children with spastic diplegic CP with a GMFC level I or II and ND children and would be helpful to persons involved in the care of these children.

No Difference in Gait Recovery After THA With Different Head Diameters: A Prospective Randomized Study

Larger femoral heads are commonly presumed to improve joint stability and hip biomechanics; some studies have suggested they may hasten recovery of a normal gait. To our knowledge, no gait analysis studies have compared different size head diameters in THA. We compared (1) spatiotemporal gait parameters, (2) kinematic and kinetic gait parameters, and (3) Harris hip scores in patients undergoing THA randomized to receive a 28-, 36-, or ≥ 42-mm bearing couple. We hypothesized a larger femoral head would restore an earlier, more physiologic gait pattern. This randomized, blinded study involved 60 patients who received the same cementless THA except for the size of the bearing. Inclusion criteria were primary hip arthritis, female sex, and age between 55 and 70 years. Exclusion criteria were other problems influencing walking ability. The patients were randomized into three groups of 20 each (28- and 36-mm ceramic-on-crosslinked polyethylene, ≥ 42-mm metal-on-metal). All patients underwent the same postoperative rehabilitation protocol. Gait evaluation using an optoelectronic system was performed preoperatively and at 2 and 4 months postoperatively. With the numbers available, no differences in spatiotemporal gait parameters, kinematic or kinetic gait parameters, or Harris hip scores emerged among the three groups. All variables assessed at 4 months postoperatively showed improvements across all groups, but the differences among them were not significant. The hypothesis that a larger femoral head results in improved early gait performance was not supported by this study.

Design and Performance of Plastic Modular Adaptors for External Transtibial Prostheses

There is a very large need for prosthetic components in developing countries, where such devices are imported and prohibitively expensive. The present work explores the possibility of developing and manufacturing prosthetic components locally in Venezuela, preserving high quality and function. We aimed to develop a kit of plastic modular adaptors for external transtibial prostheses. The project was divided in four stages that covered design, stress analyses, manufacture, and function assessment of the components. The design process is presented in detail, resulting in a prototype that comprises four adaptors of simple design. Their response was studied with stress analysis using the Finite Element Method applying static loads for different instants of gait during the stance phase. Then, five kits of adaptors were manufactured with thermoplastic material using conventional metal-working machines. The resulting components were lighter and cheaper than equivalent imported metallic ones. The kits were adapted to four patients and assessed via gait analysis. A very good function was observed with no significant differences in spatiotemporal gait parameters.

Characteristics of vertical climbing in African apes

The evolution of bipedalism is a key event in the transition from apes to early hominids. Vertical climbing has been proposed to be the critical locomotor behaviour preadaptive to habitual bipedalism, although quantitative data about vertical climbing in nonhuman primates are scarce. This study focuses on 3D-kinematics of vertical climbing in different hominoid species in zoos. Emphasis is laid on a sufficient number of individuals and trials to guarantee the reliability of the results. The climbing sequences were recorded simultaneously by four digital video cameras at a speed of 50 frames/second. As direct contact with apes in zoos is not feasible, markerless kinematic analysis with subsequent manual digitisation of the joint centres was applied. In this paper, the method is described and data from 97 climbing sequences of five western lowland gorillas (Gorilla gorilla gorilla) in the Zurich Zoo (CH) are compared with data from 127 climbing sequences of nine bonobos (Pan paniscus) in Apenheul Primate Park (NL). Although African apes are similar in their postcranial anatomy, substantial differences in spatio-temporal gait parameters and kinematics of vertical climbing can be observed between gorillas and bonobos. The climbing of bonobos is more diverse in speed and gait patterns compared to gorillas and the duty factor is generally lower. A better understanding of the relationship between morphology and function in living apes will help to reconstruct the locomotor habits of fossil hominoids and early humans.