Gait Stability Research Articles

A Stable Gait Recognition Algorithm Under Multiview and Multiwear Using Millimeter-Wave Radar

A Stable Gait Recognition Algorithm Under Multiview and Multiwear Using Millimeter-Wave Radar

Gait abnormalities and longitudinal fall risk in older patients with end-stage kidney disease and sarcopenia.

Sarcopenia, gait disturbance, and intradialytic hypotension are among the various factors that contribute to fall risk. This study aimed to investigate the relationship between risk of sarcopenia, hemodialysis (HD) session, and long-term fall risk in older end-stage kidney disease (ESKD) patients by analyzing their spatiotemporal gait characteristics. We recruited 22 non-demented patients aged ≥ 65 years who were undergoing maintenance HD. Participants were divided into two groups based on their SARC-F score (< 4 and ≥ 4) to identify those with higher and lower risk of sarcopenia. Demographics, comorbidities, and renal parameters were compared between groups. Inertial measurement unit-based technology equipped with triaxial accelerometry and gyroscope was used to evaluate gait characteristics. The gait task was assessed both before and after dialysis using the Timed-Up and Go (TUG) test and a 10-meter walking test at a regular pace. Essential gait parameters were thoroughly analyzed, including gait speed, stride time, stride length, double-support phase, stability, and symmetry. We investigated the interaction between the dialysis procedure and gait components. Outcome of interest was any occurrence of injurious fall during follow-up period. Logistic regression models were employed to examine the relationship between baseline gait markers and long-term fall risk. The SARC-F ≥ 4 group showed various gait abnormalities, including longer TUG time, slower gait speed, longer stride time, shorter stride length, and longer double support time compared to counterpart (SARC-F < 4). After HD sessions, the SARC-F ≥ 4 group showed a 2.0-second decrease in TUG task time, an 8.0cm/s increase in gait speed, an 11.6% lower stride time, and a 2.4% increase in gait symmetry with significant group-time interactions. Shorter stride length and longer double support time were associated with injurious falls during the two-year follow-up. Our study demonstrated the utility of triaxial accelerometers in extracting gait characteristics in older HD patients. High-risk sarcopenia (SARC-F ≥ 4) was associated with various gait abnormalities, some of which partially improved after HD sessions. These gait abnormalities were predictive of future falls, highlighting their prognostic significance.

Perceived Mobility Challenges in Rare Bone Diseases: How Real-world Gait Data Aligns

Rare bone diseases (RBD) are highly diverse and complex, and there is a lack of understanding of the correlation between perceived mobility challenges during everyday life and the physical abilities of people with RBD. This work aimed to elucidate perceived mobility challenges among people with RBDs and examine relationships with quantitative gait metrics captured in free-living environments to draw a link between physical abilities and everyday life challenges, which can be tracked with a smartphone. This study used a comprehensive approach involving a questionnaire including 70 daily mobility challenges across different areas of daily living and semi-supervised walks in an open-world setting using a smartphone on the thigh carried in the left jeans pocket. Gait analysis is conducted using standard (cadence, variance, covariance) and nonlinear variability calculations (Lyaopnov exponent and entropy) to assess stride characteristics and walking patterns, aligning with established methodologies for gait assessment in similar contexts. In summary, nine people with RBD and nine healthy controls completed the questionnaire and provided the smartphone data. People with RBD rated balance and walking-related mobility challenges significantly higher than healthy controls. Statistical analysis indicates a strong association between the sum score of relevant challenges and the dynamic gait stability (largest Lyapunov exponent), suggesting that gait irregularity correlates with perceived mobility challenges in people with RBD. Overall, the study draws a link between physical abilities and perceived mobility challenges using a smartphone and thus presents a way to track the progress of a disease remotely using a smartphone.

Several components of postural control are affected by benign paroxysmal positional vertigo but improve after particle-repositioning maneuvers: A systematic review and meta-analysis.

Benign Paroxysmal Positional Vertigo is a vestibular disorder causing vertigo and imbalance. This systematic review and meta-analysis aims to explore the impact of benign paroxysmal positioning vertigo and repositioning maneuvers on postural control. In September 2024, PubMed, Web of Science, Scopus and reference lists of included studies were systematically searched. Articles comparing measures of postural control between patients and controls, and/or pre- and posttreatment were considered relevant. Study selection, data extraction and identification of risk of bias were done by two researchers. If possible, meta-analysis was performed with Review Manager version 5.4.1 and standardized mean differences were calculated with a random-effects model. Twenty-one of the 37 included studies were useful for meta-analyses. Meta-analyses revealed that benign paroxysmal positional vertigo negatively affects perception of verticality (p < .001; SMD = 0.73; 95% CI = [0.39;1.08]) and sensory orientation (p < .001; SMD = -1.66; 95% CI = [-2.08, -1.23]). The perception of verticality (p < .001; SMD = 0.99; 95% CI = [0.76;1.21]) and sensory orientation (p < .001; SMD = -0.77; 95% CI = [-1.11, -0.44]) improved after treatment with repositioning maneuvers. Results of systematic review indicate stability in gait was impaired, vertigo but improve after repositioning maneuvers. Limits of stability were impaired in older patients, but did not improved after repositioning maneuvers. Benign paroxysmal positioning vertigo affects several underlying components of postural control. Repositioning maneuvers can significantly improve the related postural control impairments. This may partly explain the increased odds of falling in these patients, and the positive treatment effect of repositioning maneuvers on falls and fear of falling.

The relationship between walking speed, step parameters, and margins of stability in individuals after stroke

BackgroundIndividuals after stroke walk with different step parameters and consequently with different margins of stability compared to able-bodied peers. These differences might be a side effect of lower preferred walking speeds or primary limitations in regulating step parameters and margins of stability after stroke. MethodsTwenty-eight individuals after stroke (separated into more impaired and less impaired based on speed) and fourteen able-bodied peers completed five walking trials on an instrumented treadmill at 70 %, 85 %, 100 %, 115 %, and 130 % of their preferred speed. Center of pressure data were used to calculate stride frequency, stride length, step width and margins of stability in mediolateral and anteroposterior direction. Generalized estimation equations were used to analyze the (interaction) effects of group, speed, and most versus least affected leg on these parameters. FindingsWhen controlled for speed, all individuals after stroke walked with higher stride frequencies (P < 0.001) and shorter stride lengths (P < 0.001) than able-bodied peers. Less impaired individuals walked with larger step widths than able-bodied peers (P < 0.001). The interaction effect of group and speed suggested that individuals after stroke showed higher increases in stride length with increasing speed than able-bodied peers. When controlled for speed, mediolateral margins of stability were larger in less impaired individuals compared to able-bodied peers, but otherwise, margins of stability did not differ between groups. Only minor differences between the most and least affected leg were observed. InterpretationDifferences in step parameters between individuals after stroke and able-bodied peers seem independent of walking speed and function to enhance gait stability.

On the clinical interpretation of overground gait stability indices in children with cerebral palsy

Several indices have been devised to quantify a person’s stability from its gait pattern during overground walking. However, clinical interpretation of the indices is difficult because the link between being stable and adopting a mechanically stable gait pattern may not be straightforward. This is particularly true for one of these indices, the margin of stability, for which opposite interpretations are available in the literature. We collected overground walking data in two groups of 20 children, with unilateral cerebral palsy (CP) and typically developing (TD), for two conditions, on flat and on uneven grounds (UG). We postulated that TD children were more stable during gait than children with CP and that both groups were more stable on flat compared to UG. We explored the coherent association between several indices and the two postulates to clarify clinical interpretation. Our results showed that increased margin of stability, increased amplitude of the whole-body angular momentum, decreased duration of single limb support, increased variability (gait kinematics, step length, and step width) were associated with reduced stability for both postulates. However, results for the margin of stability were paradoxical between the sides in the CP group where small margin of stability was indicative of a fall forward strategy on the affected side rather than improved stability. Whole-body angular momentum and duration of single limb support appeared as the most sensitive indices. However, walking speed influenced these and would need to be considered when comparing groups of different walking speed.

Leather-Based Shoe Soles for Real-Time Gait Recognition and Automatic Remote Assistance Using Machine Learning.

Real-time monitoring of gait characteristics is crucial for applications in health monitoring, patient rehabilitation feedback, and telemedicine. However, the effective and stable acquisition and automatic analysis of gait information remain significant challenges. In this study, we present a flexible sensor based on a carbon nanotube/graphene composite conductive leather (CGL), which uses collagen fiber with a three-dimensional network structure as the flexible substrate. The CGL-based sensor demonstrates a high dynamic range, with notable pressure responses ranging from 0.6 to 14.5 kPa and high sensitivity (S = 0.2465 kPa-1). We further developed a device incorporating the CGL-based sensor to collect foot characteristic signals from human motion and designed smart sports shoes to facilitate effective human-computer interaction. Machine learning was employed to collect and process gait characteristic information in various states, including standing, sitting, walking, and falling. For real-time monitoring of falls, we optimized the K-Nearest Time Series Classifier (KNTC) algorithm, achieving an accuracy of 0.99 and a prediction time of only 13 ms, which highlights the system's excellent intelligent response capabilities. The system maintained a gait recognition accuracy of 90% across diverse populations, with low false-positive (3.3%) and false-negative (3.3%) rates. This work demonstrates stable gait recognition capabilities and provides valuable methods and insights for plantar behavior monitoring and data analysis, contributing to the development of advanced real-time gait monitoring systems.

Utilizing Inertial Measurement Units for Detecting Dynamic Stability Variations in a Multi-Condition Gait Experiment.

This study proposes a wearable gait assessment method using inertial measurement units (IMUs) to evaluate gait ability in daily environments. By focusing on the estimation of the margin of stability (MoS), a key kinematic stability parameter, a method using a convolutional neural network, was developed to estimate the MoS from IMU acceleration time-series data. The relationship between MoS and other stability indices, such as the Lyapunov exponent and the multi-site time-series (MSTS) index, using data from five IMU sensors placed on various body parts was also examined. To simulate diverse gait conditions, treadmill speed was varied, and a knee-ankle-foot orthosis was used to restrict left knee extension, inducing gait asymmetry. The model achieved over 90% accuracy in classifying MoS in both forward and lateral directions using three-axis acceleration data from the IMUs. However, the correlation between MoS and the Lyapunov exponent or MSTS index was weak, suggesting that these indices may capture different aspects of gait stability.

Perturbations During Gait on a Split-Belt Treadmill: A Scoping Review

Background: Humans encounter disturbances like slips, pushes, and trips while walking, mainly from external forces. Technological advances have improved methods to study these impacts on gait, with split-belt treadmills being particularly effective. This scoping review aims to examine the types of perturbations used during split-belt treadmill gait, explore the methods used to induce them, and consolidate current knowledge on the effects of split-belt treadmill-induced gait perturbations. Methods: The review included publications from January 2015 to May 2024, as searched via PubMed, EBSCO, and ScienceDirect. Results: The review examined 33 studies on split-belt treadmills, focusing on perturbations like slip-like, trip-like, lateral displacements, and tilts, with speed changes being the most common. Perturbations were mainly applied during initial contact. The results show that young, healthy adults adapt quickly to anticipatory and reactive adjustments, while older adults and those with neurological impairments use less efficient strategies like increased muscular co-contraction. Asymmetrical gait adaptations persist after perturbations, highlighting motor learning and the role of the central nervous system and sensory feedback. Conclusions: Despite their precision, split-belt and tilting treadmills may not fully replicate real-world walking complexities. The review highlights the strengths and limitations of split-belt treadmills, emphasizing the need to integrate diverse methods to enhance rehabilitation and improve gait stability.

Adaptive Vision-Based Gait Environment Classification for Soft Ankle Exoskeleton

Lower limb exoskeletons have been developed to improve functionality and assist with daily activities in various environments. Although these systems utilize sensors for gait phase detection, they lack anticipatory information about environmental changes, which limits their adaptability. This paper presents a vision-based intelligent gait environment detection algorithm for a lightweight ankle exosuit designed to enhance gait stability and safety for stroke patients, particularly during stair negotiation. The proposed system employs YOLOv8 for real-time environment classification, combined with a long short-term memory (LSTM) network for spatio-temporal feature extraction, enabling the precise detection of environmental transitions. An experimental study evaluated the classification algorithm and soft ankle exosuit performance through three conditions using kinematic analysis and muscle activation measurements. The algorithm achieved an overall accuracy of over 95% per class, which significantly enhanced the exosuit’s ability to detect environmental changes, and thereby improved its responsiveness to various conditions. Notably, the exosuit increased the ankle dorsiflexion angles and reduced the muscle activation during the stair ascent, which enhanced the foot clearance. The results of this study indicate that advanced spatio-temporal feature analysis and environment classification improve the exoskeleton’s gait assistance, improving adaptability in complex environments for stroke patients.

Assessing acute effects of two motor-cognitive training modalities on cognitive functions, postural control, and gait stability in older adults: a randomized crossover study.

The process of aging often accompanies a decline in cognitive function, postural control, and gait stability, consequently increasing the susceptibility to falls among older individuals. In response to these challenges, motor-cognitive training has emerged as a potential intervention to mitigate age-related declines. This study aims to assess the acute effects of two distinct motor-cognitive training modalities, treadmill dual-task training (TMDT) and interactive motor-cognitive training (IMCT), on cognitive function, postural control, walking ability, and dual-task performance in the elderly population. In this randomized crossover study, 35 healthy elderly individuals (aged 60-75) participated in three acute training sessions involving TMDT, IMCT, and a control reading condition. Assessments of executive function, postural control, gait performance, and cognitive accuracy were conducted both before and after each session. Both TMDT and IMCT improved executive functions. Notably, IMCT resulted in a significant enhancement in correct response rates and a reduction in reaction times in the Stroop task (p < 0.05) compared to TMDT and the control condition. IMCT also led to an increase in dual-task gait speed (p < 0.001) and showed a trend towards improved cognitive accuracy (p = 0.07). Conversely, TMDT increased postural sway with eyes open (p = 0.013), indicating a potential detriment to postural control. The findings suggest that IMCT holds greater immediate efficacy in enhancing cognitive function and gait stability among older adults compared to TMDT, with a lesser adverse impact on postural control. This underscores the potential of IMCT as a preferred approach for mitigating fall risk and enhancing both cognitive and physical functions in the elderly population.

A Recurrent Deep Network for Gait Phase Identification from EMG Signals During Exoskeleton-Assisted Walking

Lower limb exoskeletons represent a relevant tool for rehabilitating gait in patients with lower limb movement disorders. Partial assistance exoskeletons adaptively provide the joint torque needed, on top of that produced by the patient, for a correct and stable gait, helping the patient to recover an autonomous gait. Thus, the device needs to identify the different phases of the gait cycle to produce precisely timed commands that drive its joint motors appropriately. In this study, EMG signals have been used for gait phase detection considering that EMG activations lead limb kinematics by at least 120 ms. We propose a deep learning model based on bidirectional LSTM to identify stance and swing gait phases from EMG data. We built a dataset of EMG signals recorded at 1500 Hz from four muscles from the dominant leg in a population of 26 healthy subjects walking overground (WO) and walking on a treadmill (WT) using a lower limb exoskeleton. The data were labeled with the corresponding stance or swing gait phase based on limb kinematics provided by inertial motion sensors. The model was studied in three different scenarios, and we explored its generalization abilities and evaluated its applicability to the online processing of EMG data. The training was always conducted on 500-sample sequences from WO recordings of 23 subjects. Testing always involved WO and WT sequences from the remaining three subjects. First, the model was trained and tested on 500 Hz EMG data, obtaining an overall accuracy on the WO and WT test datasets of 92.43% and 91.16%, respectively. The simulation of online operation required 127 ms to preprocess and classify one sequence. Second, the trained model was evaluated against a test set built on 1500 Hz EMG data. The accuracies were lower, yet the processing times were 11 ms faster. Third, we partially retrained the model on a subset of the 1500 Hz training dataset, achieving 87.17% and 89.64% accuracy on the 1500 Hz WO and WT test sets, respectively. Overall, the proposed deep learning model appears to be a valuable candidate for entering the control pipeline of a lower limb rehabilitation exoskeleton in terms of both the achieved accuracy and processing times.

Stable Walking of a Biped Robot Controlled by Central Pattern Generator Using Multivariate Linear Mapping.

In order to improve the walking stability of a biped robot in multiple scenarios and reduce the complexity of the Central Pattern Generator (CPG) model, a new CPG walking controller based on multivariate linear mapping was proposed. At first, in order to establish a dynamics model, the lower limb mechanical structure of the biped robot was designed. According to the Lagrange and angular momentum conservation method, the hybrid dynamic model of the biped robot was established. The initial value of the robot's passive walking was found by means of Poincaré mapping and cell mapping methods. Then, a multivariate linear mapping model was established to form a new lightweight CPG model based on a Hopf oscillator. According to the parameter distribution of the new CPG model, a preliminary parameter-tuning idea was proposed. At last, the joint simulation of MATLAB and V-REP shows that the biped robot based on the new CPG control has a stable periodic gait in flat and uphill scenes. The proposed method could improve the stability and versatility of bipedal walking in various environments and can provide general CPG generation and a tuning method reference for robotics scholars.

The Relationship between Components of Postural Control and Locomotive Syndrome in Older Adults.

Locomotive Syndrome (LS), a condition related to impaired mobility, is influenced by balance control, which comprises six components. Deficiencies in these components can lead to reduced mobility and decreased quality of life. This study aimed to evaluate the relationship between the components of postural control and LS in older adults using the Brief-BESTest. Therefore, this cross-sectional study involved 122 elderly participants from Tha Sala District, Nakhon Si Thammarat Province, both with and without LS. Participants underwent assessments using the Instrumental Activities of Daily Living (IADL) assessment, the Thai Mental State Examination (TMSE), the Two-Step Test, and the Brief-BESTest. The Brief-BESTest covers six balance components: Biomechanical Constraints, Stability Limits, Anticipatory Postural Adjustments, Postural Responses, Sensory Orientation, and Stability in Gait. Descriptive statistics were used to summarize participant characteristics, and Chi-square tests were conducted to examine the relationship between each balance component and LS. Cramer's V was used to assess the strength of the relationships. The results showed the average age of the sample was 67.67 ± 6.01 years with 85.20 percent female and 14.80 percent male. There were significant relationships between LS and three balance components: Biomechanical Constraints (Chi-square = 5.35, p = 0.021, Cramer's V = 0.209), Stability Limits (Chi-square = 5.00, p = 0.025, Cramer's V = 0.204), and Anticipatory Postural Adjustments (left: Chi-square = 4.12, p = 0.042, Cramer's V = 0.213; right: Chi-square = 5.50, p = 0.019, Cramer's V = 0.213). No significant associations were found for Reactive Postural Response, Sensory Orientation, and Stability in Gait. These findings suggest that targeted interventions focusing on specific balance components consist of Biomechanical Constraints, Stability Limits, and Anticipatory Postural Adjustments could help reduce the risk of LS in older adults.

Gait stability improves following unilateral total ankle arthroplasty.

End-stage ankle arthritis is often treated surgically by total ankle arthroplasty (TAA) due to its potential to improve gait through increased joint range of motion and reduce pain. However, TAA's effect on gait stability is not well understood. This study explores the impact of TAA on gait stability, measured by Margin of Stability (MoS), in 148 patients with end-stage ankle arthritis. Kinematic data were collected pre-operatively, at 1-year post-op, and at 2-years post-op and the MoS was determined at heel strike and midstance for the anteroposterior (MoSAP) and mediolateral (MoSML) directions. A linear mixed effects model including gait speed as a factor was used to assess the effects of limb, session, and their interaction on outcome measures. A significant interaction (p < 0.002) between limb (surgical, nonsurgical) and session (pre-op, 1-year post-op, 2-years post-op) was identified for each MoS variable of interest. Cumulatively, our results suggest that the nonsurgical limb, MoSAP at heel strike and MoSML at midstance improved (increased) as time from surgery increased. These results suggest patients developed a compensatory movement pattern to navigate surgical limb single support. TAA reduces this compensation improving side-to-side symmetry, while not fully restoring symmetry by 2-years post-op. These results indicate that TAA could improve gait stability in patients with end-stage ankle arthritis, but further work is needed to understand the impact of TAA on altering fall risk.

Exploring the Influence of BMI on Gait Metrics: A Comprehensive Analysis of Spatiotemporal Parameters and Stability Indicators

Background: Gait analysis is a vital tool for evaluating overall health and predicting outcomes such as mortality and cognitive decline. This study explores how normal and obese BMI categories impact gait dynamics, addressing gaps in understanding the effect of body composition on specific gait parameters. Research Question: The primary objective is to investigate differences in spatiotemporal gait parameters—specifically, gait speed, step length, cadence, and double support time—between normal and obese BMI groups to understand the effects of obesity on gait. Methods: This observational case-control study analyzed spatiotemporal gait metrics from 163 participants, using inertial measurement units (IMUs) to collect data on various gait parameters. Statistical analyses explored the relationship between BMI categories and these metrics. Results: No significant differences were found in gait speed, cadence, stride duration, or double support time between the normal and obese groups. However, significant differences were identified in age, hypertension prevalence, balance problems, and the incidence of falls, emphasizing the complex effects of obesity on factors influencing gait stability. Significance: This study contributes to our understanding of obesity’s impact on gait by highlighting the need to consider associated health and stability parameters. These findings prompt a re-evaluation of how BMI is integrated into clinical gait assessments and emphasize the necessity for personalized healthcare strategies. This research highlights the importance of future studies with larger, more diverse populations and a wider array of biomechanical measures to dissect the relationship between BMI, body composition, and gait dynamics.

Functional performance comparison of long cane and secondary electronic travel aids for mobility enhancement

This study investigated the impact of secondary electronic travel aids (ETAs) on the mobility performance of individuals with profound visual impairment, specifically focusing on object detection and obstacle avoidance tasks. Seven experienced long-cane users were recruited for the study. The ETAs tested as secondary aids to the long cane included the MiniGuide, utilizing ultrasonic echo location, and the vOICe (Vision-to-Auditory Sensory Substitution Device), which translates visual information into auditory signals. Two software modes of the vOICe were examined: the standard contrast mode and a novel algorithm utilizing relative depth information. Notably, 30 min of familiarization was provided before the trials. Results indicated that while the use of the secondary ETAs led to increased awareness of the surrounding environment, it also resulted in longer processing times and more hesitations, compared with using the long cane alone. Participants demonstrated improved object detection and larger detection and safety ranges during obstacle avoidance. The study also introduced the concept of margin of stability (MoS) as a novel metric for evaluating gait stability while using ETAs. Both MiniGuide and vOICe users exhibited consistent and stable movements, suggesting that these additional aids did not negatively impact overall gait stability. The findings highlight the trade-offs between efficiency and effectiveness when using secondary mobility aids, with longer training periods potentially mitigating these issues. In addition, the study emphasizes the need for ongoing research to optimize the design and training programmes for new ETAs. Future studies may explore the impact of extended training periods on mobility performance. Overall, this research contributes to a deeper understanding of how ETAs can enhance the mobility of individuals with visual impairments while also highlighting some of the challenges associated with their use. Optimizing ETA design and training programmes is crucial for maximizing benefits for individuals with impaired vision.

Piezoelectric energy harvesting from walking motion of a passive biped robot model with flexible legs

Passive dynamic walking biped robots utilize the inherent dynamics of their structure to achieve walking motion without continuous actuation, enhancing energy efficiency and stability. Replacing conventional rigid legs with flexible elastic beams in the simplest passive walker will be associated with undesirable vibrations. Despite the positive effect of the damper in reducing vibrations, the current research has used the piezoelectric energy harvesting with the aim of reducing the wasted energy of the gait cycle and improving its stability range. For this purpose, the electromechanical Lagrange equations are determined by applying Hamilton's principle and the assumed mode method and then, the new definition of the step function is obtained through numerical methods, solving a boundary value problem to establish proper initial conditions for stable walking. Numerical simulations indicate that the piezoelectric energy harvester can create a stable period-one gait cycle by optimizing the length of the piezo layers attached to the undamped elastic legs despite the presence of small vibrations. Additional results are presented in bifurcation diagrams, investigating the effect of important physical and structural parameters such as slope angle, length and thickness of the piezo layer.

A continuum of balance performance between children with developmental coordination disorder, spastic cerebral palsy, and typical development.

Balance deficits are one of the most common impairments in developmental coordination disorder (DCD) and cerebral palsy (CP), with shared characteristics between both groups. However, balance deficits in DCD are very heterogeneous, but unlike in CP, they are poorly understood. To unravel the heterogeneity of balance performance in children with DCD by comparing them with CP and typical development (TD). Cross-sectional case-control study. Different outpatient settings and the community. Children aged 5-10.9 years with TD (N.=64, boys: 34, mean [SD] age: 8.1 [1.6]), DCD (N.=39, boys: 32, mean [SD] age: 8.1 [1.5], formal diagnosis [N.=27]), and CP (N.=24, boys: 14, mean [SD] age: 7.5 [1.4], GMFCS level I [N.=14]/II [N.=10], unilateral [N.=13]/bilateral [N.=11]). We evaluated balance performance with the extended version of the Kids-Balance Evaluation Systems Test (Kids-BESTest). Between-group differences in domain and total scores (%) were assessed via ANCOVA (covariate: age), with Tukey post-hoc analyses (P≤0.01). Children with DCD and CP performed poorer than TD children on total and domain scores with large effects (domains: η2=0.25-0.66 [P<0.001], total: η2=0.71 [P<0.001]). Still, post hoc comparisons revealed that DCD children scored significantly better than CP on the total score and four domains (P≤0.009), while performing similarly on tasks related to stability limits (P=0.999) and gait stability (P=0.012). There is a continuum of balance performance between children with TD, DCD and CP, but with great inter- and intra-individual heterogeneity in DCD and CP. DCD and CP children have difficulties with tasks requiring anticipatory postural adjustments, fast reactive responses, and with tasks that require complex sensory integration, suggesting an internal modeling deficit in both groups. This implies that these children must rely on slow conscious feedback-based control rather than fast feedforward control and fast automatic feedback. The performance of both DCD and CP children on their stability limits/verticality is similarly poor which further emphasizes a potential deficit in their sensory input and/or integration. Future research must focus on unraveling the control mechanisms, to further understand the heterogeneity of these balance deficits. The heterogeneous balance performances in both children with DCD and CP underscore the importance of comprehensively evaluating balance deficits in both groups. This comprehensive assessment contributes to a better understanding of individual balance deficits, thereby facilitating more tailored treatment programs.

Influence of Outsole Structures on Foot Loading and Gait Stability

As the downstream products most relevant to the leather industry, leather shoes perform well in the global market. Consumers have put forward high requirements for the comfort and safety of leather shoes in recent years, especially for high heels, whose unique outsole structure often causes foot overloading. The outsole structure varies in ground-contacted mode and heel base size, and plays a decisive role in its function, affecting gait patterns. This study aimed to investigate differences in foot loading and gait stability induced by different outsole structures, at two typical heel heights. Six pairs of customized high heels (3 outsole structures × 2 heel heights) were tested on eighteen healthy females while walking by the Novel Pedar-X in-shoe plantar pressure system. Taking the thick high heels for the intermediate control group, the main effects of the outsole structures and the heel heights, and their interactions on the plantar pressures were analyzed by Two-way repeated ANOVAs. The center of pressure displacements and velocities were calculated throughout the whole stance phase. The results indicated that the whole ground-contacted mode of the outsole displayed better stability in the medial-lateral direction in the early stance phase but may increase the risk of hallux valgus because of the elevated load there. On the contrary, the smaller heel base size exhibited poorer stability in the medial-lateral direction in the early stance phase and would increase forefoot loading. The response of gait characteristics to heel height change is more prominent, which could cause a more vulnerable gait posture. The results could be relevant to improving high-heel functional design, positively motivating the transformation and upgrading of the leather shoe industry.