Gait Cadence Research Articles

New Viscoelastic Hydrogel Hymovis MO.RE. Single Intra-articular Injection for the Treatment of Knee Osteoarthritis in Sportsmen: Safety and Efficacy Study Results.

Viscosupplementation by hyaluronic acid (HA) is recommended for non-surgical management of knee osteoarthritis (OA). This study investigated the efficacy and safety of a single i.a. (32 mg/4 ml) Hymovis MO.RE. injection, a new HA derivative hydrogel, for the treatment of adult regular sports players affected by knee OA arising from overuse injuries. Patients were prospectively enrolled if regularly practicing sports and diagnosed with Kellgren-Lawrence grade I-III OA. They received a single Hymovis MO.RE. intra-articular (i.a.) injection and were evaluated 30, 90, 180, and 360 days thereafter. The assessment involved measuring changes in knee function, pain, the activity of daily living (ADL), and quality of life (QOL) by using the Knee injury and Osteoarthritis Outcome Score (KOOS), GAIT analysis, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for knee pain (WOMAC A) and function (WOMAC C), and a visual analogue scale (VAS) pain score. The study involved thirty-one patients, 23 women and eight men, whose median age was 49. KOOS function subscore, as well as GAIT cadence and velocity, showed a statistically significant increase at each time-point after injection (p < 0.0001). WOMAC, KOOS pain, symptoms, ADL, and QOL scores also significantly improved at all control visits. No severe adverse events or treatment-related events were detected. A single Hymovis MO.RE. (32 mg/4 ml) intra-articular injection provides a rapid, lasting, and safe response in regular sports players affected by knee OA, possibly representing a viable therapeutic option for this demanding patient subgroup. Further investigations are necessary to confirm these findings.

Targeted verbal cues can immediately alter gait following stroke

ABSTRACT Background Physical therapists use verbal cueing extensively during gait rehabilitation. Nevertheless, little is known about the ability of individuals post-stroke to make immediate changes to targeted spatiotemporal gait parameters from verbal commands. Additionally, adequate muscle strength may be necessary to promote positive alterations in gait. Objectives To determine the influence of targeted verbal cues on spatiotemporal gait parameters for individuals with chronic stroke. Further, we assessed the potential of a relationship between cue-induced gait modifications and paretic lower limb strength. Methods Using a within-subjects design, twenty-seven adults with chronic stroke walked over a pressure mat with verbal cues to walk at (1) comfortable and (2) fast speeds, with increased (3) arm swing, (4) foot height, (5) step length, (6) push off, and (7) cadence. We also assessed lower extremity strength using a hand-held dynamometer. We measured gait speed, step length, stance time, and cadence for comparisons between conditions and performed correlational analyses to assess the influence of strength on gait alterations. Results Specific cues elicited increased walking speed, cadence, step lengths and paretic limb stance time. Only greater paretic hip and knee flexion strength was related to the ability to increase cadence when cued to do so (r > 0.41). Conclusion With targeted verbal cueing, clinicians can improve step length, gait speed, stance time and cadence for individuals with chronic stroke. Lower extremity strength does not appear to be related to the ability to alter gait with verbal cueing in individuals with chronic stroke.

A Classification Approach Based on Directed Acyclic Graph to Predict Locomotion Activities With One Inertial Sensor on the Thigh

Current state-of-the-art locomotion mode classifiers for controlling robotic lower-limb prostheses rely on multiple sensors to achieve high accuracy, prediction performance, and robustness to both speed changes and subject-specific gait patterns. However, multiple sensors placed on different body parts usually entail discomfort and poor usability for the user. This paper presents an intention detection method that relies on the features extracted from an inertial measurement unit worn on the thigh and an online phase estimator. The algorithm classifies the locomotion mode of the upcoming stride among the three modes of ground-level walking, stair ascent, and stair descent. A two-stage classification process first distinguishes between transient and steady-state strides and then classifies the locomotion mode of the impending stride based on directed acyclic graphs of binary classifiers. The classification is performed at 75% or 85% of the previous stride phase, respectively for steady-state and transient strides. Data were gathered from 10 healthy subjects and processed offline. Feature design and selection were based on the data of all subjects, while the classification performance was assessed by leave-one-subject-out cross-validation. Results presented a median recognition accuracy of 98.7% for steady-state strides and 95.6% for transitions, suggesting that the method was inherently robust to variations in gait cadence, since all of the features were phase-based and not dependent on fixed time intervals. These results inform the design of control strategies for active transfemoral prostheses able to predict the user’s locomotion intention during the next stride, using minimum sensors.

Strategies for increasing gait speed in patients with hip osteoarthritis: their clinical significance and effects on hip loading

BackgroundChanges in gait speed are required in various situations and can be achieved by changing stride length, cadence, or both. Differences in strategies for increasing gait speed may have different effects on hip joint and physical function. The purpose of this study was to determine the effects of strategies for increasing gait speed on hip pain, physical function, and changes in hip loading during gait in patients with hip osteoarthritis (OA). We hypothesized that patients who increase gait speed mainly by increasing cadence would have lesser hip pain, a higher physical function, and a lower rate of increase in hip moments with increasing gait speed.MethodsForty-seven patients with secondary hip OA (age, 48.3 ± 11.0 years) were included. Gait speed, stride length, cadence, and peak and impulse of the hip moments were measured during gait at self-selected normal and fast gait speeds. The patients were classified as types S (with mainly increasing stride length, n = 11 [23.4%]), C (with mainly increasing cadence, n = 23 [48.9%]), and SC (with increasing stride length and cadence, n = 13 [27.7%]) according to whether they used changes in stride length and/or cadence to transition from normal to fast gait. Hip pain, physical function, and hip moment changes during gait were compared between types.ResultsThe physical function was higher in types C (38.0 ± 8.8, P = 0.018) and SC (40.6 ± 8.5, P = 0.015) than in type S (28.2 ± 7.8), even after adjustment for age and minimum joint space width. Hip pain was not significantly different between types. The robustness of these results was confirmed with sensitivity analysis. The rates of increases in peak external hip adduction (P = 0.003) and internal rotation moments (P = 0.009) were lower in type C than in type SC.ConclusionsType C tended to suppress the increase in hip moments during fast gait. Types C and SC, which included increased cadence, maintained higher physical function levels than type S. Encouraging the use of cadence-increasing strategy may be useful for reducing hip loading and maintaining physical function in patients with hip OA.

BeatWalk: Personalized Music-Based Gait Rehabilitation in Parkinson's Disease.

Taking regular walks when living with Parkinson’s disease (PD) has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors (BeatWalk) and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application (30 min/day, 5 days/week). The music tempo was being aligned in real-time to patients’ gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% (±28.2) of the prescribed duration and enjoyed it throughout the program. The application was considered “easy to use” by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases “walk for exercise” duration thanks to high observance.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242.

Assessment of Selected Spatio-Temporal Gait Parameters on Subjects with Pronated Foot Posture on the Basis of Measurements Using OptoGait. A Case-Control Study.

Walking is part of daily life and in asymptomatic subjects it is relatively easy. The physiology of walking is complex and when this complex control system fails, the risk of falls increases. As a result, gait disorders have a major impact on the older adult population and have increased in frequency as a result of population aging. Therefore, the OptoGait sensor is intended to identify gait imbalances in pronating feet to try to prevent falling and injury by compensating for it with treatments that normalize such alteration. This study is intended to assess whether spatiotemporal alterations occur in the gait cycle in a young pronating population (cases) compared to a control group (non-pronating patients) analyzed with OptoGait. Method: a total of n = 142 participants consisting of n = 70 cases (pronators) and n = 72 healthy controls were studied by means of a 30 s treadmill program with a system of 96 OptoGait LED sensors. Results: Significant differences were found between the two groups and both feet in stride length and stride time, gait cycle duration and gait cadence (in all cases p < 0.05). Conclusions: pronating foot posture alters normal gait patterns measured by OptoGait; this finding presents imbalance in gait as an underlying factor. Prevention of this alteration could be considered in relation to its relationship to the risk of falling in future investigations.

Cadence-Insensitive Soft Exoskeleton Design With Adaptive Gait State Detection and Iterative Force Control

Soft exoskeletons have demonstrated the potential to save energy, but their efficiency is sensitive to variations in human gait cadence. This work aims to develop adaptive gait state detection and iterative force control methods for a soft exoskeleton to reduce human walking metabolic cost consistently, while the user may change walking cadence. The proposed approach is motivated by the rhythmicity of gait and applies an iterative learning concept to enhance the exoskeleton’s adaptability to varying walking conditions. The gait state detection method proposed for the designed exoskeleton combines two feature extraction algorithms, which can learn from the present and past body kinematic data, to provide accurate user gait state detection. Based on the state, the proposed force control method iteratively adjusts the commands to keep track of the desired profile. Experiments have been conducted on healthy subjects walking with varying cadence using the soft exoskeleton. Promising results were presented in separate validation tests. Moreover, metabolic costs of subjects walking under one unpowered and two powered conditions, where the assistance profiles were produced by classical methods and the proposed methods, showed that the proposed methods can effectively improve the exoskeleton’s ability to save human energy of walking with varying cadence. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —Lower limb exoskeletons have demonstrated the potential to save human energy in medical and industrial applications. The main purpose of this work is to solve the exoskeleton assistance efficiency loss problem for users walking with changing cadence. Constant cadence is unlikely maintained during natural human walking. Few existing exoskeletons could retain high efficiency under user cadence changes, limited by their control system capability. This work presents a new cable-driven cadence-insensitive soft exoskeleton, which is purposely designed with two adaptive methods to enable the device to offer consistent benefit to users walking with varying cadence. The proposed methods are inspired by the rhythmicity of human gait and can be iteratively reconfigured to perform accurate human gait state detection and assistive force tracking. The proposed methods have the potential to be integrated into other human-oriented robots to improve their adaptability. This work can greatly enhance the possibility of using the walking assist robotic devices in more practical applications.

Effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life for patients with Parkinson’s disease: A systematic review and meta-analysis

Objective: To conduct a systematic review evaluating the effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life among individuals with Parkinson’s disease. Data sources: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, and Physiotherapy Evidence Database was carried out to identify eligible papers published up to December 10, 2020. Review methods: Literature selection, data extraction, and methodological quality assessment were independently performed by two investigators. Publication bias was determined by funnel plot and Egger’s regression test. “Trim and fill” analysis was performed to adjust any potential publication bias. Results: Seventeen studies involving 598 participants were included in this meta-analysis. Music-based movement therapy significantly improved motor function (Unified Parkinson’s Disease Rating Scale motor subscale, MD = −5.44, P = 0.002; Timed Up and Go Test, MD = −1.02, P = 0.001), balance (Berg Balance Scale, MD = 2.02, P < 0.001; Mini-Balance Evaluation Systems Test, MD = 2.95, P = 0.001), freezing of gait (MD = −2.35, P = 0.039), walking velocity (MD = 0.18, P < 0.001), and mental health (SMD = −0.38, P = 0.003). However, no significant effects were observed on gait cadence, stride length, and quality of life. Conclusion: The findings of this study show that music-based movement therapy is an effective treatment approach for improving motor function, balance, freezing of gait, walking velocity, and mental health for patients with Parkinson’s disease.

Posture and gait in the early course of schizophrenia.

While correlations between postural stability deficits and schizophrenia are well documented, information on dynamic motor alterations in schizophrenia are still scarce, and no data on their onset are available yet. Therefore, the aim of this study was i) to measure gait pattern(s) in patients with schizophrenia; ii) to identify posture and gait alterations which could potentially be used as a predictive clinical tool of the onset of the disorder. Body composition, posture and gait parameters were assessed in a group of 30 patients with schizophrenia and compared to 25 healthy subjects. Sway area was significantly higher in the schizophrenia group compared to controls regardless of whether the participants were in eyes open or eyes closed condition. Gait cadence and speed were significantly lower in patients with schizophrenia, while stride length was similar. We concluded that the combination of an increased sway area (independent from eye closure) and a gait cadence reduction—in the presence of normal gait speed and stride length—might be considered peculiar postural and gait profile characteristic of early schizophrenia.

The Effects of Balance and Gait on the Treadmill Training in Patients with Hemiplegia Applying Kinesio-Taping and Lumbosacral Orthosis

Objective: This study was conducted to investigate the effect of balance and gait on the treadmill training in patients with hemiplegia applying kinesio-taping and lumbosacral orthosis. Method: Thirty patients with hemiplegia were randomly selected and divided into three groups.: treadmill training group, treadmill training applying kinesio-taping group, and treadmill training applying lumbosacral orthosis group and they were 30 minute and 6 week trainings. Results from the study are described as follows. Results: Treadmill group shows significant difference in the length of 10 m gait test, gait speed, gait cadence, and stride(p<.05). Treadmill Applying kinesio-taping group shows significant difference in the length of 10 m gait test, gait speed, gait cadence, and length of stride(p<.05). Treadmill applying lumbosacral orthosis group shows significant difference in BBS, TUG, 10 m gait test, gait speed, gait cadence, stride, and stance phase and swing phase of the affected side(p<.05). In the comparison with interventions, there was a significant difference in BBS, TUG, 10 m gait test, gait speed, gait and stance phase and swing phase of the affected side(p<.05). Conclusion: These findings demonstrate that there was a difference in the effect of kinesio-taping and lumbosacral orthosis on trunk stability of patients with hemiplegia during treadmill training and application of lumbosacral orthosis leads to a more effective result in balance and gait changes during treadmill training for patients with hemiplegia.

Effects of cadence-compatible melodic rhythmic auditory stimulation implementation on gait in patients with Parkinson’s disease

Purpose Progressive loss of dopaminergic neurons in basal ganglia is blamed as the main source of gait disturbance in Parkinson's disease (PD). It is known that the normal step pattern does not disappear in PD, but there is a problem in activating the correct step response. The aim of this study was to investigate the effect of Rhythmic Auditory Stimulation (RAS), which is an external stimulus, on gait in individuals with PD. Materials and methods Twenty-six individuals, 13 in the PD group and 13 in the control group, participated in the study. All individuals were asked to walk under four different RAS conditions configured with beat frequency and melodic variations. Time–distance parameters and gait performance of the individuals were evaluated. Results RAS significantly increased the gait speed of the individuals with PD compared to the control group. RAS set to 10% increase in the cadence of the patient with melody (10 M+) was found to be more effective than the RAS set to normal cadence of the patient without melody (0 M-) (p < 0.05). While all RAS implementations increased the stride length of the individuals with PD (p < 0.05), there was no change in the control group. RAS did not affect the return time in both groups. Conclusions Our study has shown that RAS implementation improves gait in individuals with PD both in terms of time–distance parameters and performance, especially when set to 10% more than the patient's gait cadence. It was concluded that cadence-compatible melodic RAS can be safely included in PD rehabilitation programs.

BeatPark: Personalized Music-Based Gait Rehabilitation in Parkinson's Disease

Background: Walking regularly in Parkinson’s disease has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation, such as music, can facilitate walking but patients vary significantly in their response to the stimulus. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, with beneficial effects on gait in Parkinson’s disease. We aim to evaluate the observance, safety, tolerance, usability and enjoyment of a new smartphone application coupled with wearable sensors (BeatPark) delivering individualized musical stimulation for gait auto-rehabilitation at home. Methods: Forty-five patients with Parkinson’s disease underwent a one month, outdoor, gait rehabilitation program, using the BeatPark application (30 min/day, 5 days/week). The music tempo was aligned in real time to patients’ gait cadence while fostering an increase of cadence up to +20% of the patient’s preferred cadence. Evaluation was based on BeatPark use measures, questionnaires and a six-minute walk test before and after the rehabilitation program. Findings: Patients used the application 78.8 % (±28.2) of the prescribed duration and mostly enjoyed it, across the whole program. 75 % of them rated the application as easy to use. While using BeatPark, patients increased their ‘walk for exercise’ duration and frequency, reduced their fear of falling, and improved their quality of life. After the program, they improved their gait parameters in the six-minute walk test. Interpretation BeatPark is an easy to use and enjoyable musical application for individualized gait rehabilitation in Parkinson’s disease increasing ‘walk for exercise’ duration, confidence in gait and quality of life. Trial Registration: NCT02647242 Funding: This research was supported by a European grant: BeatHealth: Health and Wellness on the Beat (EU FP7-ICT contract #610633). Declaration of Interests: None to declare. Ethics Approval Statement: The study was approved by the National Ethics Committee (CPP Sud Mediterannee III, Nimes, France, ID-RCB: 2015-A00531-48). All participants gave written informed consent before participating.

Wearable Haptics for Remote Social Walking.

Walking is an essential activity for a healthy life, which becomes less tiring and more enjoyable if done together. Common difficulties we have in performing sufficient physical exercise, for instance the lack of motivation, can be overcome by exploiting its social aspect. However, our lifestyle sometimes makes it very difficult to find time together with others who live far away from us to go for a walk. In this article, we propose a novel system enabling people to have a 'remote social walk' by streaming the gait cadence between two persons walking in different places, increasing the sense of mutual presence. Vibrations provided at the users' ankles display the partner's sensation perceived during the heel-strike. In order to achieve the aforementioned goal in a two users experiment, we envisaged a four-step incremental validation process: i) a single walker has to adapt the cadence with a virtual reference generated by a software; ii) a single user is tasked to follow a predefined time-varying gait cadence; iii) a leader-follower scenario in which the haptic actuation is mono-directional; iv) a peer-to-peer case with bi-directional haptic communication. Careful experimental validation was conducted involving a total of 50 participants, which confirmed the efficacy of our system in perceiving the partners' gait cadence in each of the proposed scenarios.

Concurrent validity of the ZeroWire® footswitch system for the measurement of temporal gait parameters

BackgroundIn contrast to wearable tools (like in-shoe) sensors, lab-based gait assessment (using pressure-sensitive mats or cameras) only acquire data over short distances in non-ecological environments. Research questionTo examine the concurrent validity of a wearable ZeroWire® footswitch system (Aurion Srl, Milan, Italy) vs. the GAITRite® walkway (CIR systems Inc., NJ, USA) for recording temporal gait parameters. MethodsWe included 40 healthy participants in a prospective, single-center study. Temporal gait parameters were recorded simultaneously with the ZeroWire® and GAITRite® systems while each participant walked at three different speeds (slow (60steps/min), comfortable and maximum). To measure the validity, we calculated the interclass correlation coefficient (ICC) and the coefficient of variation (CV) for each parameter (gait cadence, stride time, step time, stance time, and single-support and double-support times). We also performed a graphical analysis using the Bland and Altman method. ResultsThe footswitch system showed moderate-to-excellent concurrent validity vs. the GAITRite mat. The degree of agreement between the two assessments was greatest at the maximum gait velocity showed, with very good validity (ICC > 0.91) seen for most parameters, whereas agreement ranged from moderate to very good for the other speeds. Independently of the gait speed, the highest levels of agreement were recorded for gait velocity, cadence, stride time, step time, and stance time. According to the CVs, both systems showed the same accuracy and double-support time was the more variable parameter. SignificanceThe ZeroWire® footswitch system appears to be valid for assessing temporal gait parameters (and particularly gait cadence and stride, step and stance times in healthy participants). It is likely to be well suited to the assessment of gait parameters under ecological conditions and in dual-task gait paradigms.

Immediate Effects of Ankle Non-elastic Taping on Balance and Gait Ability in Patients With Chronic Stroke: A Randomized, Controlled Trial

ObjectiveThe purpose of this study was to determine the immediate effects of ankle non-elastic taping on balance and gait ability in patients with chronic stroke. MethodsThirty patients (inpatients and outpatients) with stroke were randomly assigned to 2 groups: the non-elastic taping group (n = 15) and the placebo-taping group (n = 15). Patients in the non-elastic taping group received Endura sports taping for their ankle joint, and patients in the placebo-taping group received Endura fix tape for their ankle joint. The Balance System SD assessed balance, and the GAITRite system assessed gait ability. We recorded measurements before and after intervention. ResultsThe non-elastic taping group showed a significant improvement in static and dynamic standing balance (P ≤ .001) after intervention; in addition, this group showed significant increases in the velocity, cadence, step length, and stride length of gait (P ≤ .001) after intervention. However, the placebo-taping group showed no significant improvements in standing balance and gait ability after intervention (P >.05). Furthermore, significant differences in static and dynamic standing balance, cadence, and velocity were observed between the 2 groups after intervention (P ≤ .001). ConclusionsOur results demonstrate that the application of ankle non-elastic taping is effective at improving balance and gait abilities in patients with stroke. Ankle non-elastic taping appears to be an effective method to facilitate active rehabilitation in patients with hemiplegia.

Effect of Comorbid Chronic Low Back Pain on Patient-Reported Outcome and Gait Parameters in Patients With Symptomatic Knee Osteoarthritis.

Knee osteoarthritis and chronic low back pain are common and often coexist. There are limited studies on the impact of coexisting musculoskeletal disorders on gait parameters and its association with self-assessed functional outcome. This study compared gait parameters, self-assessed functional outcome measurements, and quality-of-life scales between patients with knee osteoarthritis against those with coexisting knee osteoarthritis and chronic low back pain using gait analysis, Western Ontario and McMaster Osteoarthritis Index, and Short Form-36. Three hundred sixty-seven patients underwent gait analysis after the question-based functional outcome measurement. Pain, function, and quality of life were worse in the coexisting knee osteoarthritis and chronic low back pain group (n = 197) compared with the knee osteoarthritis only group (n = 170, P = 0.017, P = 0.004, P < 0.001, P = 0.004, respectively). The coexisting knee osteoarthritis and chronic low back pain group had significantly lower gait velocity and cadence than the knee osteoarthritis group (P = 0.028 and P = 0.003). The Western Ontario and McMaster Osteoarthritis Index Pain subscore was associated with gait velocity (P < 0.001) in the knee osteoarthritis group, whereas Short Form-36 physical composite was associated with gait velocity (P < 0.001) in the coexisting knee osteoarthritis and chronic low back pain group. Comorbid chronic low back pain in patients with knee osteoarthritis was associated with worse pain, function, quality of life, gait velocity, and cadence. Compared with the Western Ontario and McMaster Osteoarthritis Index, Short Form-36 may be a more suitable tool to track mobility outcome measure, such as gait velocity, in the management of the coexisting knee osteoarthritis and chronic low back pain.

Muscle torque production and kinematic properties in post-stroke patients: a pilot cross-sectional study

Stroke-related hemiplegia is an important factor influencing parameters of gait. So far, limited papers have assessed temporo- spatial capabilities and their correlations with gait parameters in the early post-stroke stage. This pilot study evaluated the temporospatial parameters of gait and assessed the maximal isometric and isokinetic torque production of the plantar flexor and dorsiflexor muscles. 15 patients with lower limb spasticity and 15 healthy controls were included. Stroke severity was assessed using the Modified Ashworth Scale and the Barthel Index. Gait cadence, gait speed, and gait cycle were assessed using inertial sensors during a Timed Up and Go test. Maximal isometric and isokinetic torque production of the ankle plantar flexor and dorsiflexor muscles were assessed using an isokinetic dynamometer device. Post-stroke patients had statistically significantly lower gait cadence than healthy participants (17%, p < 0.05). Statistically significantly lower values of vertical acceleration were also noted during a sit-to-stand movement task (42%, p < 0.05). Plantar flexion torque of the affected limb was significantly different during isometric (63%, p ≤ 0.01) and isokinetic work for 30o/s (49%, p = 0.04), 60o/s (58%, p = 0.01) and 20 °/s (53%, p = 0.01). Dorsiflexor muscles' torque production was significantly different in isometric activity (38%, p = 0.04). A statistically significant positive correlation occurred between the absolute peak torque of the dorsiflexor muscles in both static and speed phases of gait (Rs = 0.65, p = 0.04). Despite the low intensity of spasticity and early phase after stroke, differences in the muscle torque production and temporo-spatial parameters, as well as the correlations between them, were noticeable.

Four-week training involving self-ankle mobilization with movement versus calf muscle stretching in patients with chronic stroke: a randomized controlled study

ABSTRACTBackground: In self-ankle mobilization with movement (S-MWM) therapy, a strap can be utilized to stabilize the posterior glide of the talus during ankle dorsiflexion movements.Objectives: Our objective was to compare the effects of 4-week self-mobilization with movement (S-MWM) with those of calf muscle stretching (CMS) on ankle dorsiflexion passive range of motion (DF-PROM), gait parameters, and fall risk in patients with chronic stroke with limited ankle dorsiflexion.Methods: Participants were randomized into the S-MWM (n = 19) and CMS groups (n = 19). Both groups received conventional physiotherapy for 30 minutes per session. In addition, S-MWM and CMS techniques were performed 3 times per week for 4 weeks and were performed by the participants themselves. Ankle DF-PROM, gait parameters, and fall risk were measured after 4 weeks of training.Results: After 4 weeks of training, both groups showed significant improvement in all outcome measures (p < .05). Furthermore, ankle DF-PROM, gait parameters (gait speed, cadence, and stride lengths on both sides), and fall risk showed greater improvement in the S-MWM group than in the CMS group (p < .05).Conclusions: This study shows that S-MWM training combined with conventional physiotherapy improved ankle DF-PROM, gait parameters, and fall risk in patients with chronic stroke.

Plane-by-Plane Written, Low-Loss Polymer Optical Fiber Bragg Grating Arrays for Multiparameter Sensing in a Smart Walker

In this paper, we report the development of fiber Bragg gratings (FBGs) arrays in polymer optical fibers (POFs), specifically cyclic transparent optical polymer (CYTOP) fibers, using a femtosecond (fs) laser. The CYTOP is almost transparent to near-ultraviolet and visible light, thus femtosecond lasers appear to be a very promising technology for the development of gratings in such fibers. Bearing this in mind, we have applied the direct write, plane-by-plane inscription method to obtain `single-peak' FBGs in long arrays. Following this, we examine the performance of a 5-FBG array applied in a smart walker (SW) and characterized for four different functionalities of the proposed healthcare device. The polymer sensors were used to analyze 1) structural health monitoring (SHM) of the SW's mechanical structure; 2) detection of users' movement intention; 3) gait cadence estimation; and 4) detection of floor-induced vibrations for localization and mapping applications. The good results obtained in comparison to commercially available devices show the suitability of the proposed FBG-array on the instrumentation of healthcare devices, where multiple parameters can be measured using the same fiber, which leads to a compact and energy efficient system.

Simultaneous bilateral unicompartmental knee replacement improves gait parameters in patients with bilateral knee osteoarthritis

BackgroundUnicompartmental knee replacement (UKR) can provide reliable clinical and functional outcomes when performed simultaneously in both knees for treating bilateral osteoarthritis (OA). No studies to date have evaluated gait pattern after simultaneous bilateral UKR. The aim of this study was to evaluate changes in gait variables after bilateral single-stage UKR (B-UKR) and to compare them with the outcomes after unilateral UKR in two other groups of patients: one with bilateral knee OA (P-UKR) and one with the contralateral knee unaffected (H-UKR). MethodsThree-dimensional motion cohort data were prospectively collected before and six months after surgery; 37 were allocated to the B-UKR (n = 13), P-UKR (n = 12) or H-UKR (n = 12) group. Spatiotemporal variables (stride length, gait speed, gait cadence, stance phase, swing phase, and double support phase) and kinematic parameters (knee flexion and extension peak values, knee range of motion (ROM), and hip abduction peak value) were analyzed using mixed analysis of variance (ANOVA). The magnitude of effect for significant outcomes (ES) was determined using Cohen's d. ResultsPostoperative improvement in gait cadence (P < 0.01; ES = 1.20), walking speed (P < 0.05; ES = 0.58), stride length (P < 0.05; ES = 0.67), knee ROM (P < 0.05; ES = 0.89), knee flexion (P < 0.05; ES = 0.94), and hip abduction (P < 0.001; ES = 1.16) was noted for the B-UKR group, whereas only stride length improved (P < 0.05; ES = 0.48) for the H-UKR group, and no changes in any gait parameter were seen for the P-UKR group. ConclusionsPostoperative improvement in gait parameters was observed in the B-UKR patients with bilateral OA. Whenever possible, simultaneous bilateral UKR should be considered in such patients.