Gait Deficiencies Research Articles

Characterization of spatiotemporal and kinetic gait variables in dogs with hindlimb ataxia and bilateral hindlimb lameness

BackgroundDiscriminating the underlying cause of gait abnormalities can be challenging in a clinical setting, especially in the presence of bilateral disease. Pressure-sensitive walkways (PSWs) have been utilized to characterize the gait of dogs with various neurologic or orthopaedic conditions. The potential use of the PSW includes the discrimination of conditions that can be similar in clinical presentation, such as bilateral hindlimb lameness and hindlimb ataxia. The primary aim of this study was to describe the spatial, temporal, and kinetic gait parameters of dogs with hindlimb ataxia or bilateral hindlimb lameness and compare them to those of normal dogs. Forty-six dogs were prospectively recruited. The normal group included 20 dogs with normal neurologic and orthopaedic exams. The orthopaedic group included 15 dogs with bilateral hindlimb orthopaedic diseases with weight-bearing hindlimb lameness and normal neurologic exams. The neurologic group included 11 dogs with ambulatory paraparesis and normal orthopaedic exams. Each dog was walked across the PSW, and at least 3 valid trials were collected. The stride time, stance time, swing time, stride length, gait velocity, peak vertical force (PVF), vertical impulse (VI), and limb symmetry were recorded. The mean values of all parameters from the valid trials were calculated and used for data analysis. The outcomes were compared among all groups.ResultsCompared with the normal group, the orthopaedic group had a significantly greater percent body weight distribution (%BWD) and vertical impulse distribution (VID) in the forelimbs. When comparing the spatiotemporal parameters, the neurologic group showed an increase in forelimb stance time compared to that of the normal group. Compared with that in the normal group, the stride velocity in the forelimbs in the orthopaedic group was greater. There were no significant differences in the kinetic parameters between the neurologic group and the normal group, nor in stride time or stride length among the groups.ConclusionThe gait parameters obtained by PSW demonstrated that the orthopaedic and neurologic groups may have different compensatory mechanisms for their gait deficiencies. These parameters can potentially be used to construct a predictive model to evaluate PSW as a diagnostic tool in future studies.

The reliability and validity of the Lie‑To‑Sit‑To‑Stand‑To‑Walk transfer test in total knee arthroplasty.

Total knee arthroplasty (TKA) is the standard procedure for treating end-stage knee osteoarthritis. Nevertheless, some residual issues can persist, leading to various problems, including pain, compromised strength, impaired proprioception, postural instability, dynamic balance issues, and gait deficiencies. The Lie-to-Sit-to-Stand-to-Walk Transfer Test (LSSWT) implements a multi-faceted methodology to evaluate basic transfer abilities. The purpose of this study is to investigate the validity, reliability, and minimal clinically important difference of the LSSWT in TKA patients. Twenty-two patients with TKA were enrolled in this study. The patients were administered the LSSWT, the Timed Up and Go Test (TUG), and the Hospital for Special Surgery (HSS) knee score. Patients rested between the tests for an hour to prevent fatigue. The mean age was 68.1 ± 2.59 years and the mean HSS Knee Score was 85.43 ± 3.47 of the patients. The relative (ICC coefficient) and absolute (SEM and SRD95) reliability values were 0.88, 1.21, and 3.33 respectively. The Spearman correlation coefficient of the LSSWT with the TUG was 0.63. The LSSWT displays excellent reliability and high validity in assessing fall risk, complex dynamic balance, and mobility required for daily activities in patients post-TKA. The low MCID value (3.33) indicates its sensitivity and ability to identify minor changes in a patient's status over time or in response to rehabilitation applications. Therefore, it is recommended to use the LSSWT when evaluating fall risk, dynamic balance, and mobility for community living, discharge planning, or facility admission.

Gait Function and its Association with Functional Independence, Quality of Life, and Community Reintegration in Stroke Survivors.

Background and Aims: The major outcome of stroke rehabilitation is the recovery of the ability to walk. However, a large proportion of stroke survivors are discharged to the community with gait deficiency which impairs their functional independence, and quality of life increasing the burden of care on caregivers especially their lack of functioning in the community. This study assessed the gait functional performance in community-dwelling stroke survivors and explored its association with functional independence, quality of life, and community reintegration in community-dwelling stroke survivors. Materials and methods: This study involved 115(59 males and 56 females) community-dwelling stroke survivors. Their gait functional performance was assessed using the 10-meter walk test (10MWT) while their functional independence was assessed with the functional independence measure (FIM). Their quality of life (QoL) was assessed using the Stroke-specific QoL scale while community functioning and productivity were assessed using the community integration questionnaire (CIQ). Their scores on the assessments were compared with the normative data of their age and sex-matched healthy individuals. Data was analysed using Spearman’s correlation coefficient and Chi-Square at p<.05. Results: Participants’ ages ranged between 27 to 78 years (mean=60.48±37.84 years). More participants (56.7%) had right hemispheric lesions and 43.3% had lesions in the left hemisphere. Their gait function, functional independence performance, QoL, and community reintegration functions were significantly (p<0.05) lower than their age and sex-matched normative data. There was a significant (p<0.05) association and relationship between their gait functional performance and each of the functional independence performance, QoL, community reintegration, and productivity. Conclusion: Gait functional performance in community-dwelling stroke survivors is significantly lower than in age and sex-matched healthy individuals and it is significantly associated with low functional independence performance, low quality of life, poor community functioning, and lack of productivity in stroke survivors, Abnormal gait pattern is related to poor functional independence, poor quality of life and low productivity.

Effects of Head and Neck pattern of PNF combined with conventional balance training in older adults with balance impairment – A Randomized control Trial

BackgroundFalls are a prevalent and serious concern among individuals in their older life. Residual impairments, such as balance and gait deficiencies, reduced sensory processing, and diminished strength, are the common causes of falls. Balance and mobility deficits can last for years and are linked to a high rate of falls (>6 months). Proprioceptive Neuromuscular Facilitation is neuromuscular re-education in which sensory receptors are stimulated to provide information regarding body posture and movement. ObjectiveTo identify the effects of Head and Neck Pattern of PNF combined with Conventional Balance training in elderly. MethodsA total of 40 subjects were randomly assigned to the Experimental Group (Group A) and the Control Group (Group B) (Group B). The following were the criteria for inclusion: Subjects aged 60–80 years old, of both genders, who had experienced one or more episodes of loss of balance in the previous 12 months, were ambulating independently, had a Mini-mental scale score of 24 or higher, and were ready to participate. Subjects with heart or lung disease, chronic neurological diseases, mental illness, an acute orthopaedic ailment, or a head injury were excluded. ResultsGroup A showed greater improvement when compared to Group B (p < 0.05) Comparison of Pre and Post values of FAB and CBMS showed significant difference (p < 0.05). ConclusionsThe study provides evidence that PNF Pattern based Exercises when combined with Conventional Balance Training is effective in training individuals with balance impairment.

Alprazolam Reduces Freezing of Gait (FOG) and Improves FOG-Related Gait Deficiencies.

Freezing of gait (FOG) is an intractable motor symptom in Parkinson's disease (PD) that increases fall risk and impairs the quality of life. FOG has been associated with anxiety, with experimental support for the notion that anxiety itself provokes FOG. We investigated the effect of acute anxiety reduction via alprazolam on FOG in PD. In ten patients with PD, FOG, and normal cognition, we administered 0.25 mg alprazolam in one session and placebo in another, in counterbalanced order. At each session, on separate days, patients walked on a pressure-sensitive walkway. Using Oculus Rift virtual-reality goggles, patients walked along a plank that appeared to be (a) level with the floor, in the low-anxiety condition or (b) raised high above the ground, in the high-anxiety conditions. In this way, we assessed the impacts of anxiety and alprazolam (i.e., anxiety reduction) on FOG frequency and other gait parameters. FOG events appeared only in the high-anxiety conditions. Alprazolam significantly reduced subjective and objective measures of anxiety, as well as the prevalence of FOG (p = 0.05). Furthermore, alprazolam improved swing time (p < 0.05) and gait variability in all conditions, particularly during the elevated plank trials. Interpretation. Our results suggest that (1) anxiety induces FOG, and (2) alprazolam concomitantly reduces anxiety and FOG. Alprazolam further improved gait stability (i.e., swing time and gait variability). These findings reveal that anxiety triggers FOG in PD. Treating anxiety can reduce FOG and improve gait stability, potentially offering new therapeutic avenues for this intractable and disabling symptom in PD.

Neurophysiological and gait outcomes during a dual-task gait assessment in concussed adolescents

BackgroundGait deficits are common after concussion in adolescents. However, the neurophysiological underpinnings of these gait deficiencies are currently unknown. Thus, the goal of this study was to compare spatiotemporal gait metrics, prefrontal cortical activation, and neural efficiency between concussed adolescents several weeks from injury and uninjured adolescents during a dual-task gait assessment. MethodsFifteen concussed (mean age[SD]: 17.4[0.6], 13 female, days since injury: 26.3[9.9]) and 17 uninjured adolescents (18.0[0.7], 10 female) completed a gait assessment with three conditions repeated thrice: single-task walking, single-task subtraction, and dual-task, which involved walking while completing a subtraction task simultaneously. Gait metrics were measured using an inertial sensor system. Prefrontal cortical activation was captured via functional near-infrared spectroscopy. Neural efficiency was calculated by relating gait metrics to prefrontal cortical activity. Differences between groups and conditions were examined, with corrections for multiple comparisons. FindingsThere were no significant differences in gait metrics between groups. Compared to uninjured adolescents, concussed adolescents displayed significantly greater prefrontal cortical activation during the single-task subtraction (P = 0.01) and dual-task (P = 0.01) conditions with lower neural efficiency based on cadence (P = 0.02), gait cycle duration (P = 0.03), step duration (P = 0.03), and gait speed (P = 0.04) during the dual-task condition. InterpretationOur findings suggest that several weeks after injury concussed adolescents demonstrate lower neural efficiency and display a cost to gait performance when cognitive demand is high, e.g., while multitasking, suggesting that the concussed adolescent brain is less able to compensate when attention is divided between two concurrent tasks.

Simplified Markerless Stride Detection Pipeline (sMaSDP) for Surface EMG Segmentation.

To diagnose mobility impairments and select appropriate physiotherapy, gait assessment studies are often recommended. These studies are usually conducted in confined clinical settings, which may feel foreign to a subject and affect their motivation, coordination, and overall mobility. Conducting gait studies in unconstrained natural settings instead, such as the subject's Activities of Daily Life (ADL), could provide a more accurate assessment. To appropriately diagnose gait deficiencies, muscle activity should be recorded in parallel with typical kinematic studies. To achieve this, Electromyography (EMG) and kinematic are collected synchronously. Our protocol sMaSDP introduces a simplified markerless gait event detection pipeline for the segmentation of EMG signals via Inertial Measurement Unit (IMU) data, based on a publicly available dataset. This methodology intends to provide a simple, detailed sequence of processing steps for gait event detection via IMU and EMG, and serves as tutorial for beginners in unconstrained gait assessment studies. In an unconstrained gait experiment, 10 healthy subjects walk through a course designed to mimic everyday walking, with their kinematic and EMG data recorded, for a total of 20 trials. Five different walking modalities, such as level walking, ramp up/down, and staircase up/down are included. By segmenting and filtering the data, we generate an algorithm that detects heel-strike events, using a single IMU, and isolates EMG activity of gait cycles. Applicable to different datasets, sMaSDP was tested in healthy gait and gait data of Parkinson's Disease (PD) patients. Using sMaSDP, we extracted muscle activity in healthy walking and identified heel-strike events in PD patient data. The algorithm parameters, such as expected velocity and cadence, are adjustable and can further improve the detection accuracy, and our emphasis on the wearable technologies makes this solution ideal for ADL gait studies.

Lower Extremity Muscle Activity When Walking On A Non-motorized Treadmill

Effective interventions for increasing walking speed are important for improving health and quality of life in aging populations. Non-motorized treadmills (NMT) may enhance the ability to develop or improve motor control in gait by requiring the participant to produce and maintain speed as compared to use of a motorized treadmill (MT) which requires one to simply match speed. PURPOSE: The purpose of this project was to compare muscle activation patterns of lower extremity muscles between MT, NMT and overground (OG) walking. METHODS: Twenty healthy adults (24.4 ± 7.2 yrs, 1.75 ± 0.09 m, 75.4 ± 13.1 kg) completed one trial of walking at each of three speeds (2.5, 3.5, 4.5 mph) and three modes (OG, MT, NMT). Surface EMG of the Biceps Femoris (BF), Tibialis Anterior (TA), Gastrocnemius (GA), and Vastus Medialis (VM) was collected at 1000 Hz using electrodes placed longitudinally at the midpoint of the muscle belly. After removing DC bias, EMG RMS was computed using a moving window of 250 ms. Peak EMG RMS within a stride was averaged across 8 consecutive gait cycles identified using vertical acceleration measured with a triaxial accelerometer. Separate 3x3 repeated measures ANOVA’s were used to compare muscle activity across walking speed and mode for each muscle. RESULTS: For all muscles, there was no significant interaction between walking mode and speed. Muscle activity significantly increased with walking speed (p < 0.05). TA, VM, and GA activity was not different between walking modes (p > 0.05). At 2.5 mph, GA muscle activity, was significantly (p < 0.001) higher for NMT (0.44 ± 0.16 mV) than MT (0.33 ± 0.13 mV) and OG (0.31 ± 0.14 mV) but MT and OG were not different. At 3.5 mph, GA muscle activity, was significantly (p < 0.001) higher for NMT (0.49 ± 0.19 mV) than MT (0.36 ± 0.15 mV) and OG (0.36 ± 0.17 mV) but MT and OG were not different. At 4.5 mph, GA muscle activity, was significantly (p < 0.001) higher for NMT (0.58 ± 0.28 mV) than MT (0.47 ± 0.19 mV) and OG (0.44 ± 0.19 mV) but MT and OG were not different. CONCLUSIONS: These data suggest that use of NMT accentuates plantar flexor activity when walking. Given that reduced plantar flexor activity contributes to reduced gait speed in older adults, use of NMT has potential for clinical use in treatment of gait deficiencies in aging adults.

Modeling gain-of-function and loss-of-function components of SPAST-based hereditary spastic paraplegia using transgenic mice.

Hereditary spastic paraplegia (HSP) is a disease in which dieback degeneration of corticospinal tracts, accompanied by axonal swellings, leads to gait deficiencies. SPG4-HSP, the most common form of the disease, results from mutations of human spastin gene (SPAST), which is the gene that encodes spastin, a microtubule-severing protein. The lack of a vertebrate model that recapitulates both the etiology and symptoms of SPG4-HSP has stymied the development of effective therapies for the disease. hSPAST-C448Y mice, which express human mutant spastin at the ROSA26 locus, display corticospinal dieback and gait deficiencies but not axonal swellings. On the other hand, mouse spastin gene (Spast)-knockout (KO) mice display axonal swellings but not corticospinal dieback or gait deficiencies. One possibility is that reduced spastin function, resulting in axonal swellings, is not the cause of the disease but exacerbates the toxic effects of the mutant protein. To explore this idea, Spast-KO and hSPAST-C448Y mice were crossbred, and the offspring were compared with the parental lines via histological and behavioral analyses. The crossbred animals displayed axonal swellings as well as earlier onset, worsened gait deficiencies and corticospinal dieback compared with the hSPAST-C448Y mouse. These results, together with observations on changes in histone deacetylases 6 and tubulin modifications in the axon, indicate that each of these three transgenic mouse lines is valuable for investigating a different component of the disease pathology. Moreover, the crossbred mice are the best vertebrate model to date for testing potential therapies for SPG4-HSP.

Deep brain stimulation of midbrain locomotor circuits in the freely moving pig

BackgroundDeep brain stimulation (DBS) of the mesencephalic locomotor region (MLR) has been studied as a therapeutic target in rodent models of stroke, parkinsonism, and spinal cord injury. Clinical DBS trials have targeted the closely related pedunculopontine nucleus in patients with Parkinson’s disease as a therapy for gait dysfunction, with mixed reported outcomes. Recent studies suggest that optimizing the MLR target could improve its effectiveness. ObjectiveWe sought to determine if stereotaxic targeting and DBS in the midbrain of the pig, in a region anatomically similar to that previously identified as the MLR in other species, could initiate and modulate ongoing locomotion, as a step towards generating a large animal neuromodulation model of gait. MethodsWe implanted Medtronic 3389 electrodes into putative MLR structures in Yucatan micropigs to characterize the locomotor effects of acute DBS in this region, using EMG recordings, joint kinematics, and speed measurements on a manual treadmill. ResultsMLR DBS initiated and augmented locomotion in freely moving micropigs. Effective locomotor sites centered around the cuneiform nucleus and stimulation frequency controlled locomotor speed and stepping frequency. Off-target stimulation evoked defensive and aversive behaviors that precluded locomotion in the animals. ConclusionPigs appear to have an MLR and can be used to model neuromodulation of this gait-promoting center. These results indicate that the pig is a useful model to guide future clinical studies for optimizing MLR DBS in cases of gait deficiencies associated with such conditions as Parkinson’s disease, spinal cord injury, or stroke.

Motor and Cardiovascular Distinctions among genders in Hispanic-Latinx People Living with HIV

Background: HIV can lead to a plethora of health-related complications, such as cardiovascular and gait deficiencies. Some of the HIV obstacles are related among individuals; however, various facets come into play when considering and designing interventions for this population, like gender profile. This study aim to interpret the impact of HIV on distinct individuals; the present inquiry proposes to inspect the cardio-motor tendency on male versus female in Hispanics-Latinx living with HIV.Methods: Cardio-motor data was gathered from members' records enrolled in La Perla de Gran Precio HIV Community Center in Puerto Rico.Results: The data analyzed in this examination were compiled from 262 participants, further allocated into 190 for the males and 72 for the females. Both groups were similar in age and CD4 count. An ANOVA comparison indicated variations in the male group with an increase (P&lt;0.05) in heart rate frequency, SBP after the cardiovascular evaluation, and prolonged duration during the treadmill test distinguished the female group. The female group displayed distinct motor components with a considerable (P &lt; 0.05) reduction in gait velocity, and treadmill inclination pertained to the male counterpart.Conclusion: Hispanic Latino living with HIV displayed a distinctive cardio-motor profile applied to gender. Weencourage healthcare providers to incorporate the specific cardio-motor items alluded to in this investigation to identify the cardiovascular system and gait process that further alters the quality of life in those with HIV.

Dual Cognitive Tasks Provoke Temporo-Spatial Gait and Anticipatory Postural Adjustments in Healthy Young Adults

Usually, dual cognitive tasks require additional attention to maintain postural control during standing and walking. In certain pathologies or injuries, dual cognitive tasks, such as walking and speaking, can challenge the balance system, making certain gait deficiencies more apparent. The issue is identifying normal gait changes compared to gait impairments to understand better the impact cognitive tasks have on gait mechanics. Purpose: To identify changes in temporospatial gait parameters in healthy young adults while walking and performing a cognitive task. Methods: Thirty-four healthy young adults participated in this study. We collected gait parameters with six gyroscopes and accelerometers (distributed on all limbs and trunk) during the 7-meter walk test. Two trials were performed with just walking at a self-selected pace (single task). Then, the participant was asked to perform a cognitive task by counting backward by three from 100 while walking for 7m for two more trials (dual cognitive task). Results: Dual cognitive tasks provoked significant adaptations (p&lt;.05) in gait parameters, such as increased double limb support time and stance phase with a reduction in single limb support time and swing phase. Increase the length of the walking cycle by decreasing the cadence and speed of walking speed. In addition, an increase in mediolateral postural sway, first-step initiation time, and trunk range of motion was observed. Conclusion: Dual cognitive tasks can cause normal alterations in the gait's dynamic component and variations in walking initiation. We recommend studying neuromuscular modification, such as changes in muscle activation, during dual cognitive tasks.

Peripheral Neuropathy Impacts Gait Motor Components in Hispanic-Latinx living with HIV

HIV can cause numerous health-related complications that can lead to disabilities and affect the quality of life. Some problems added with HIV, like peripheral neuropathy (PN), may develop additional impediments in this population. Purpose: This study investigated PN’s impact on the cardio-motor profile of Hispanic Latino living with HIV. Methods: A submaximal cardiovascular test (Ross test) was conducted to obtain the study’s cardiomotor results. Cardiomotor data were compiled from records of members enrolled at La Perla de Gran Precio Community Centre on HIV in San Juan, Puerto Rico. Results: The motor profile included the speed and inclination of the treadmill. The cardiovascular data had blood pressure and heart rate at the time Ross’s test was terminated. Two hundred and ninety-one participants were further designated as 225 in the non-PN and 66 in the PN group. Both groups average comparable amounts of CD4 counts. An ANOVA was used to determine variations in the PN group with a considerable (P &lt; 0.05) increase in the time of HIV diagnosis and a reduction in gait velocity and treadmill inclination distinguished to counterpart. Conclusion: Hispanic Latino living with HIV and PN displayed distinctive motor gait deficiencies. Gait parameters, such as gait speed, were further impaired in those suffering from both conditions. We encourage healthcare providers to incorporate the specific cardio-motor items alluded to in this investigation to identify the process influencing gait that further alters the quality of life in those with HIV.

Functional assessment of outcome of surgery to correct patellofemoral instability in human patients

A case-control study with 6 months of patient follow up. This study sought to determine if surgery followed by rehabilitation for patellar instability could restore normal gait function. A previous study has established abnormalities in gait pattern and joint congruence in patients with a history of patellar instability. We hypothesised that surgery for patellofemoral instability would improve knee function. Eight human patients (mean age 29, range 17-42) who were awaiting patella stabilisation surgery (5 tibial tuberosity osteotomy, 2 medial patellofemoral ligament reconstruction, 1 trochleoplasty) were compared against eight normal Controls (mean age 28, range 19-31). Patients were assessed pre-operatively and six months after surgery by biomechanical gait analysis. Gait trials involved simultaneous collection of kinematic and force data. Patients were grouped into two subgroups pre-operatively based on knee joint net moment during stance, and their joint moments during stance pre- and post-operatively were compared against the Control subjects. In pre-operative gait analysis, four patients (P1) produced some extensor moment in early stance and four (P2) demonstrated a severe gait deficiency with failure to generate a knee extensor moment during stance. Normalisation in gait pattern was observed in all patients post-operatively. Those who had the most severe gait abnormality (P2) demonstrated the most improvement in their knee joint moments. Improvements were observed in the milder (P1) cases, but these were less dramatic. Patella stabilisation by surgery can restore normal gait function. Normalising the anatomy of the knee extensor mechanism is the objective of surgery. Normal anatomy facilitates the rehabilitation objectives of optimising extensor function during the weight-bearing phase of gait.

Temporo-spatial gait adaptations while walking on different surfaces in Latino-Hispanic adults with controlled type II diabetes

Those with Type 2 Diabetes with and without peripheral neuropathy (PN) display evident gait deficiencies, and kinematic alterations while stepping on various surfaces. Purpose: To verify if such modifications would emerge performing diverse tasks in the regulated stages of diabetes such as controlled type 2 diabetics without PN. Methods: We recruited and allocated 30 adult participants in two groups, 15 controlled diabetics (cDMII) and 15 controls (CoG). Gait temporospatial criteria were measured during even walkway and described concerning a ramp/slope surface, and a stair-step. Results: A Repeated measure ANOVA was employed to compare even surface gait parameters with slope and stair (ascending and descending) surfaces within each group. Our results highlight that cDMII shows distinct and initial traces of impaired gait parameters, notably on single-limb support time reduction with a double-limb time increment during ramp compared to even surface. Conclusion: Our conclusions suggest even at the early stages of diabetes, when glucose levels are regulated, adjustment while shifting and adapting to different, more challenging surfaces appear, notably in dynamic balance variables. Therefore, making this prompt detection of variations is clinically valuable for providing treatment interventions to diminish the risk of falls and trauma in those who have diabetes.

Rapid predictive simulations with complex musculoskeletal models suggest that diverse healthy and pathological human gaits can emerge from similar control strategies

Physics-based predictive simulations of human movement have the potential to support personalized medicine, but large computational costs and difficulties to model control strategies have limited their use. We have developed a computationally efficient optimal control framework to predict human gaits based on optimization of a performance criterion without relying on experimental data. The framework generates three-dimensional muscle-driven simulations in 36 min on average—more than 20 times faster than existing simulations—by using direct collocation, implicit differential equations and algorithmic differentiation. Using this framework, we identified a multi-objective performance criterion combining energy and effort considerations that produces physiologically realistic walking gaits. The same criterion also predicted the walk-to-run transition and clinical gait deficiencies caused by muscle weakness and prosthesis use, suggesting that diverse healthy and pathological gaits can emerge from the same control strategy. The ability to predict the mechanics and energetics of a broad range of gaits with complex three-dimensional musculoskeletal models will allow testing novel hypotheses about gait control and hasten the development of optimal treatments for neuro-musculoskeletal disorders.

Incidence and Risk Factors for Falls in Women With End-Stage Hip Osteoarthritis.

Fall-induced injuries and resulting deaths are a serious health problem among older adults. The most common risk factors for falls in older adults are muscle weakness, gait deficiencies, and balance deficits. Patients with end-stage hip osteoarthritis (OA) also have many hip dysfunctions, and these all have the potential to increase the risk of falls. However, the incidence and risk factors for falls in patients with end-stage hip OA remain unclear. The aim of this study was to determine the incidence of falls in women with end-stage hip OA and to identify risk factors for falls in this patient population. This study was a cross-sectional analysis. One hundred fifty-three women with end-stage hip OA (mean age = 64.0 years) and 112 age-matched healthy women (mean age = 64.1 years) were analyzed using available data. All participants were examined for the number and circumstances of falls in the past year. The circumstances of falls included the location, time, direction, cause, and injury. We examined the outcome of hip function, ambulatory ability, physical activity, and limping severity in women with end-stage hip OA. Multivariate logistic regression analysis was used to identify factors influencing falls in women with hip OA. The incidence of at least 1 fall in the past year was significantly higher in women with end-stage hip OA (30.1%) than in healthy women (12.5%) (P < .001). Falls in women with end-stage hip OA were most often caused by tripping and falling forward during the daytime. The majority of falls (65.2%) resulted in injuries and 13.0% resulted in fractures. The occurrence of a fall significantly correlated with limping (odds ratio = 3.26, 95% confidence interval = 1.49-7.14, P = .003) and knee extensor muscle strength (odds ratio = 0.22, 95% confidence interval = 0.05-0.85, P = .029). Women with end-stage hip OA have an increased risk of falls and fall-induced injuries. The prevention of falls in this vulnerable population should be a priority among health care practitioners. In particular, women who are limping and have reduced lower knee extensor strength should take care to avoid falls.

No difference in gait kinematics or kinetics between limbs in bilateral total hip replacement patients at long-term follow-up

BackgroundPrevious studies report that gait parameters of patients following total hip replacement improve from pre-operative levels, although in most cases do not reach those of normal subjects. However, studies are generally of unilateral total hip replacement patients at short-term follow-up. There have been no reports of 3D gait kinematics and kinetics in patients with bilateral total hip replacements at long-term follow-up. The aim of this study was to compare temporospatial parameters and 3D lower limb gait kinematics and kinetics at long-term follow-up between limbs and against controls for patients who have undergone staged bilateral total hip replacement. Methods3D gait analysis was performed on 13 patients who had undergone bilateral total hip replacement, at an average follow-up of 10.1 (first hip) and 9.3 years (second hip), and a normal elderly control group comprising 10 subjects. FindingsKnee flexion/extension range of motion was marginally greater in Hip 2 (p = 0.049) compared to Hip 1 by 3.2°. There were no other significant differences in temporospatial parameters or a range of lower limb kinematics or kinetics between the first and second operated hip. Multiple gait parameters were significantly worse for both hips compared to age-matched normal individuals. InterpretationAlthough symmetrical biomechanical recovery was achieved, significant gait deficiencies remain in both hips compared to normal controls. These deficits may provide targets for enhanced rehabilitation programs.

Measurement of attentional reserve and mental effort for cognitive workload assessment under various task demands during dual-task walking

Previous work focused on cognitive workload assessment suggests EEG spectral content and component amplitudes of the event-related potential (ERP) waveform may index mental effort and attentional reserve, respectively. Although few studies have assessed attentional reserve and mental effort during upper-extremity performance, none have employed a combined approach to measure cognitive workload during locomotion. Therefore, by systematically considering ERPs, spectral content and importantly their combination, this study aimed to examine whether concurrent changes in spectral content and ERPs could collectively serve as an index of cognitive workload during locomotion. Specifically, ERP and EEG biomarkers were assessed as participants performed a cognitive task under two levels of difficulty (easy or hard) and two conditions (seated or walking). Changes in attentional reserve and mental effort appeared to collectively index cognitive workload under varying demands due to changes in task difficulty or performance conditions. This work can inform cognitive workload assessment in patient populations with gait deficiencies for future applications.

Gait deficiencies associated with peripheral artery disease are different than chronic obstructive pulmonary disease

ObjectivePrevious studies have indicated that patients with peripheral artery disease (PAD), display significant differences in their kinetic and kinematic gait characteristics when compared to healthy, aged-matched controls. The ability of patients with chronic obstructive pulmonary disease (COPD) to ambulate is also limited. These limitations are likely due to pathology-driven muscle morphology and physiology alterations establish in PAD and COP, respectively. Gait changes in PAD were compared to gait changes due to COPD to further understand how altered limb muscle due to disease can alter walking patterns. Both groups were independently compared to healthy controls. It was hypothesized that both patients with PAD and COPD would demonstrate similar differences in gait when compared to healthy controls. MethodsPatients with PAD (n=25), patients with COPD (n=16), and healthy older control subjects (n=25) performed five walking trials at self-selected speeds. Sagittal plane joint kinematic and kinetic group means were compared. ResultsPeak values for hip flexion angle, braking impulse, and propulsive impulse were significantly reduced in patients with symptomatic PAD compared to patients with COPD. After adjusting for walking velocity, significant reductions (p<0.05) in the peak values for hip flexion angle, dorsiflexor moment, ankle power generation, propulsion force, braking impulse, and propulsive impulse were found in patients with PAD compared to healthy controls. No significant differences were observed between patients with COPD and controls. ConclusionsThe results of this study demonstrate that while gait patterns are impaired for patients with PAD, this is not apparent for patients with COPD (without PAD). PAD (without COPD) causes changes to the muscle function of the lower limbs that affects gait even when subjects walk from a fully rested state. Altered muscle function in patients with COPD does not have a similar effect.