Variability Of Gait Parameters Research Articles

Preliminary Evidence That Design Fluency Is Related to Dual-Task Treadmill Gait Variability in Healthy Adults.

Evidence supporting a link between gait and cognition is accumulating. However, the relation between executive functioning and spatiotemporal gait parameters has received little attention. This is surprising since these gait variables are related to falls. The goal of this preliminary study was to determine whether performance on measures of inhibition, reasoning, and fluency is related to variability in stride length and step width during dual-task treadmill walking in a sample of healthy adults. Nineteen healthy adults averaging 40 years of age were evaluated. Results indicated that processing speed was reduced, t(18) = 6.31, p = 0.0001, step width increased, t(18) = -8.00, p = 0.0001, and stride length decreased, t(18) = 3.06, p = 0.007, while dual tasking, but variability in gait parameters did not significantly change, consistent with a gait/posture-first approach. As hypothesized, better performance on a visual design fluency task which assesses cognitive flexibility was associated with less dual-task stride length variability, rs (17) = -0.43, p = 0.034, and step width variability, r = -0.56, p = 0.006. The results extend previous findings with older adults walking over ground and additionally suggest that cognitive flexibility may be important for gait maintenance while dual tasking.

Validation of a micro-doppler radar for measuring gait modifications during multidirectional visual perturbations

BackgroundChanges in spatio-temporal gait parameters and their variability during balance-challenging tasks are markers of motor performance linked to fall risk. Radio frequency (RF) sensors hold great promise towards achieving continuous remote monitoring of these parameters. Research questionsTo establish the concurrent validity of RF-based gait metrics extracted using micro-Doppler (µD) signatures and to determine whether these metrics are sensitive to gait modifications created by multidirectional visual perturbations. MethodsFifteen participants walked overground in a virtual environment (VE) and VE with medio-lateral (ML) and antero-posterior (AP) perturbations. An optoelectronic motion capture system and one RF sensor were used to extract the linear velocity of the trunk and estimate step time (ST), step velocity (SV), step length (SL), and their variability (STV, SVV, and SLV). Intra-class coefficient for consistency (ICC), mean and standard deviation of the differences (MD), 95 % limits of agreement, and Pearson correlation coefficients (r) were used to determine concurrent validity. One-way repeated-measures analysis of variance was used to analyze the main and interaction effects of visual conditions. ResultsAll outcomes showed good to excellent reliability (r>0.795, ICC>0.886). Average gait parameters showed good to excellent agreement, with values obtained with the RF sensor systematically smaller than the values obtained with the markers (MD of 0.001 s, 0.09 m/s, and 0.06 m). Gait variability parameters showed poor to moderate agreement, with values obtained with the RF sensor systematically larger than those obtained with the markers (MD of 1.9 %-3.9 %). Both measurement systems reported decreased SL and SV during ML perturbations, but the gait variability parameters extracted with the radar were not able to detect the higher STV and SLV during this condition. SignificanceThe radar µD signature is a valid and reliable method for the assessment of average spatio-temporal gait parameters but gait variability measures need to be viewed with caution because of the lower levels of agreement and sensitivity to ML visual perturbations. This work represents an initial investigation for the development of a low-cost system that will facilitate aging-in-place by providing remote monitoring of gait in natural settings.

Disentangling Cerebellar and Parietal Contributions to Gait and Body Schema: A Repetitive Transcranial Magnetic Stimulation Study

The overlap between motor and cognitive signs resulting from posterior parietal cortex (PPC) and cerebellar lesions can mask their relative contribution in the sensorimotor integration process. This study aimed to identify distinguishing motor and cognitive features to disentangle PPC and cerebellar involvement in two sensorimotor-related functions: gait and body schema representation. Thirty healthy volunteers were enrolled and randomly assigned to PPC or cerebellar stimulation. Sham stimulation and 1 Hz-repetitive-Transcranial-Magnetic-Stimulation were delivered over P3 or cerebellum before a balance and a walking distance estimation task. Each trial was repeated with eyes open (EO) and closed (EC). Eight inertial measurement units recorded spatiotemporal and kinematic variables of gait. Instability increased in both groups after real stimulation: PPC inhibition resulted in increased instability in EC conditions, as evidenced by increased ellipse area and range of movement in medio-lateral and anterior–posterior (ROMap) directions. Cerebellar inhibition affected both EC (increased ROMap) and EO stability (greater displacement of the center of mass). Inhibitory stimulation (EC vs. EO) affected also gait spatiotemporal variability, with a high variability of ankle and knee angles plus different patterns in the two groups (cerebellar vs parietal). Lastly, PPC group overestimates distances after real stimulation (EC condition) compared to the cerebellar group. Stability, gait variability, and distance estimation parameters may be useful clinical parameters to disentangle cerebellar and PPC sensorimotor integration deficits. Clinical differential diagnosis efficiency can benefit from this methodological approach.

Determining the characteristics of gait variability with a preferred walking speed in hypertensive and normotensive participants

IntroductionGait variability is a measure of the changes in a person's walking pattern over time. Gait variability may be a useful marker of balance and coordination in people with hypertension. The objective of this investigation was to assess and contrast the gait variability exhibited by hypertensive and normotensive individuals at their preferred walking speed. MethodsA total of fifty-six participants {hypertensive (N = 28) and normotensive (N = 28)} were selected for this cross-sectional study. Their anthropometric characteristics were as mean age: 40.64 ± 6.24years; height 174.87 ± 3.45 cm, body weight 73.76 ± 6.63 kg; body mass index 23.34 ± 4.24 kg/m2. The automatic blood pressure monitor was utilized for the measurement of blood pressure. Gait variability was measured using a Physilog inertial sensors from GaitUp that recorded the gait variability parameters. Each participant walked on a 15-m straight and zero-level hard surface at a self-preferred speed. Anthropometric data were analyzed using a t-test. Whereas the gait variability parameters were analyzed using Mann-Whitney U test. ResultSignificant differences were found for anthropometric characteristics, except for the height (p = .068). The significant differences between the hypertensive and normotensive participants have been shown as variability during the complete gait performance (z = 6.54,p = .000), Asymmetry between left and right foot (z = 6.54,p = .000), full speed during gait performance (z = 6.55,p = .000) was found. ConclusionsThis study demonstrates that hypertensive individuals have higher gait variability compared to normotensive individuals. These findings highlight the importance of monitoring gait variability in hypertensive individuals as it may be a useful marker for evaluating walking ability and cardiovascular health. The underlying mechanisms that lead to the greater gait variability in hypertensive people need to be further studied.

Cognitive impairment is associated with gait variability and fall risk in Amyotrophic Lateral Sclerosis.

In amyotrophic lateral sclerosis (ALS), gait abnormalities contribute to poor mobility and represent a relevant risk for falls. To date, gait studies in ALS patients focused on the motor dimension of the disease, underestimating the cognitive aspects. Using a wearable gait analysis device, we compared gait patterns in ambulatory ALS patients with Mild Cognitive Impairment (ALS MCI+; n=18), and without MCI (ALS MCI-; n=24), and healthy individuals (HS; n=16) under two conditions: (1) normal gait (single task), (2) walking while counting backward (dual task). Finally, we examined if the occurrence and number of falls in the three months following the baseline test were related to cognition. In the single task condition, ALS patients, regardless of cognition, displayed higher gait variability than HS, especially for stance and swing time (p< 0.001). The dual task condition revealed additional differences in gait variability parameters between ALS MCI+ and ALS MCI- for cadence (p=0.005), stance time (p=0.04), swing time (p=0.04) and stability index (p=0.02). Moreover, ALS MCI+ showed a higher occurrence (p=0.001) and number of falls (p<0.001) at the follow-up. Regression analyses demonstrated that MCI condition predicted the occurrence of future falls (β= 3.649 p= 0.01) and, together with executive dysfunction, was associated with the number of falls (cognitive impairment: β= 0.63; p < 0.001; executive dysfunction: β= 0.39; p= 0.03), regardless of motor impairment at clinical examination. In ALS, MCI is associated with exaggerated gait variability and predicts the occurrence and number of short-term falls. This article is protected by copyright. All rights reserved.

Characterizing gait and exploring neuro-morphometry in patients with PSP-Richardson's syndrome and vascular parkinsonism

Gait differentiation in progressive supranuclear palsy (PSP) and vascular parkinsonism (VaP) is sometimes difficult to detect with the naked eye. Here, we compared specific gait parameters, neuro-morphometric indices, and their associations between patients with PSP Richardson's syndrome (PSP-RS) and VaP. A total of 18 PSP-RS and 13 VaP patients were recruited. Spatio-temporal gait parameters (GAITRite®) and neuroanatomical morphometry (FreeSurfer pipeline) were assessed. The groups were compared using unpaired t-tests involving 10000 random permutations after statistically controlling for total UPDRS-III and H&Y scores. Statistically significant differences between the groups were decided at < 5% Benjamini-Hochberg False Discovery Rate (FDR) for multiple-comparison related corrections. Spearman's correlations were performed to assess the significant associations (p < 0.05) between the gait parameters and morphometry indices. Among all the spatio-temporal gait parameters, PSP-RS patients displayed greater stride time, step time, swing time, and stance time variabilities compared to VaP. Morphometric analyses showed that thalamus, and caudate volumes were significantly lower, but cerebellar cortex, hippocampus, amygdala, accumbens, and putamen volumes were higher in PSP-RS than VaP. Moreover, the bilateral insula was significantly thinner in VaP than in PSP-RS. Correlation analyses support the involvement of limbic structures besides cerebellum in postural control during self-paced walking of PSP-RS patients. Our findings underline the importance of examining individual brain regions to understand the association of cortical and subcortical morphometric estimates and gait variability parameters in PSP-RS and VaP. This study suggests the involvement of the limbic system in addition to the classical neural structures for motor control and gait.

Singular value decomposition-based gait characterization

BackgroundHuman gait varies based on personal characteristics, the existence of walking problems, or variability of gait parameters. Identifying the sources of variations is significant in detecting walking problems, designing orthotic/prosthetic products, etc. Research questionsWhat are the types of variations in joint angles and ground reaction forces? How do age, sex, height, weight, and walking speed affect the distribution of the modes? MethodsIn this study, temporal variations in the joint angles and ground reaction forces were obtained using singular value decomposition. Then, the relationships among age, sex, height, weight, walking speed, and the coefficients obtained by singular value decomposition were investigated using Pearson’s correlation coefficient matrix. ResultsThe first mode of joint angles and ground reaction forces represent the overall characteristics; the first six modes of joint angles and the first two modes of ground reaction forces express 99.9% of the gait parameter space. We concluded that the walking speed dramatically affects joint kinematics and ground reaction forces. In addition, the effects of age, gender, height, and weight on the joint kinematics and ground reaction forces were also found, but with less contribution. SignificanceThe temporal behavior of the joint angles and ground reaction forces was expressed using a few coefficients due to singular value decomposition. The effects of age, sex, weight, height, and walking speed on the modes were found. The proposed method can be applied to understand the progression of an abnormality, and design orthotic/prosthetic products etc. in future studies.

Efficacy of nGVS to improve postural stability in people with bilateral vestibulopathy: A systematic review and meta-analysis

ObjectiveNoisy galvanic vestibular stimulation (nGVS) has been used to boost vestibular afferent information to the central nervous system. This has the potential to improve postural control for people for whom vestibular signals are weak, such as in bilateral vestibulopathy (BVP). The aim of this systematic review and meta-analysis is to investigate the evidence for nGVS as a modality to improve postural control in people with BVP.MethodsA comprehensive systematic search was conducted of five databases up to July 2022 to find studies applying nGVS to people with BVP, with the aim of improving postural control. Two independent reviewers screened and identified eligible studies, completed a risk of bias evaluation (Cochrane) and extracted relevant data. The standardized mean difference (SMD) based on Hedges' g was calculated as a measure of effect size for the primary outcome measure that best identified postural control, and a forest plot generated.ResultsSeven studies met the eligibility criteria, with five being suitable for meta-analysis. Meta-analysis revealed a moderate effect in favor of nGVS improving postural control during standing and walking [pooled SMD = 0.47 95% CI (0.25, 0.7)]. nGVS-mediated improvements in postural control were most evident in observations of reduced sway velocity when standing on a firm surface with eyes closed, and in the reduced variability of gait parameters, particularly those measuring lateral stability.ConclusionsCoincident nGVS in people with BVP improves postural control during standing and walking. This improvement appears to be context specific, in that vestibular augmentation is most effective in situations where visual inputs are limited, and where reliable context specific proprioceptive cues are available. Further research is warranted investigating additional circumstances in which nGVS improves postural control, including investigating the residual, and sustained effects of nGVS.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=342147, identifier: 342147.

The use of functional near infrared spectroscopy and gait analysis to characterize cognitive and motor processing in early-stage patients with multiple sclerosis.

BackgroundDual-task paradigms are a known tool to evaluate possible impairments in the motor and cognitive function in patients with multiple sclerosis (MS). A technique to evaluate the cortical function during movement is functional near-infrared spectroscopy (fNIRS). The evaluation of the MS course or its treatment by associating fNIRS with gait measurements may be flexible and low-cost; however, there are no feasibility studies in the literature using these combined techniques in early-stage patients with MS.ObjectiveTo evaluate cortical hemodynamics using fNIRS and gait parameters in patients at early stages of MS and in healthy controls during a dual-task paradigm.MethodsParticipants performed cognitive tasks while walking to simulate daily activities. Cortical activation maps and gait variability were used to evaluate differences between 19 healthy controls and 20 patients with MS.Results and conclusionThe results suggest an enhanced cortical activation in the motor planning areas already at the early stages of MS when compared to controls. We have also shown that a systematic analysis of the spatiotemporal gait variability parameters indicates differences in the patient population. The association of cortical and gait parameters may reveal possible compensatory mechanisms related to gait during dual tasking at the early stages of the disease.

A Wearable Mixed Reality Platform to Augment Overground Walking: A Feasibility Study.

Humans routinely modify their walking speed to adapt to functional goals and physical demands. However, damage to the central nervous system (CNS) often results in abnormal modulation of walking speed and increased risk of falls. There is considerable interest in treatment modalities that can provide safe and salient training opportunities, feedback about walking performance, and that may augment less reliable sensory feedback within the CNS after injury or disease. Fully immersive virtual reality technologies show benefits in boosting training-related gains in walking performance; however, they lack views of the real world that may limit functional carryover. Augmented reality and mixed reality head-mount displays (MR-HMD) provide partially immersive environments to extend the virtual reality benefits of interacting with virtual objects but within an unobstructed view of the real world. Despite this potential advantage, the feasibility of using MR-HMD visual feedback to promote goal-directed changes in overground walking speed remains unclear. Thus, we developed and evaluated a novel mixed reality application using the Microsoft HoloLens MR-HMD that provided real-time walking speed targets and augmented visual feedback during overground walking. We tested the application in a group of adults not living with disability and examined if they could use the targets and visual feedback to walk at 85%, 100%, and 115% of each individual’s self-selected speed. We examined whether individuals were able to meet each target gait speed and explored differences in accuracy across repeated trials and at the different speeds. Additionally, given the importance of task-specificity to therapeutic interventions, we examined if walking speed adjustment strategies were consistent with those observed during usual overground walking, and if walking with the MR-HMD resulted in increased variability in gait parameters. Overall, participants matched their overground walking speed to the target speed of the MR-HMD visual feedback conditions (all p-values > 0.05). The percent inaccuracy was approximately 5% across all speed matching conditions and remained consistent across walking trials after the first overall walking trial. Walking with the MR-HMD did not result in more variability in walking speed, however, we observed more variability in stride length and time when walking with feedback from the MR-HMD compared to walking without feedback. The findings offer support for mixed reality-based visual feedback as a method to provoke goal-specific changes in overground walking behavior. Further studies are necessary to determine the clinical safety and efficacy of this MR-HMD technology to provide extrinsic sensory feedback in combination with traditional treatments in rehabilitation.

Probabilistic assessment of footbridge response to single walkers

Among the load scenarios considered for the serviceability assessment of human-induced footbridge vibration, is that of the transient action of a single pedestrian or a small group of pedestrians. Although such action is stochastic due to the variability of gait parameters, available Codes and Guidelines all assume it is deterministic and equal to that coming from the “worst pedestrian ever” for the given footbridge. This approach is sound from an engineering point of view but does not allow control of the probability of failure. The present work deals with a reliability-based procedure for the serviceability assessment of the footbridge peak characteristic accelerations due to pedestrian induced actions. Based on the results obtained incorporating the effects of the inter-subject variability of gait parameters and of the uncertainties in footbridge dynamic properties, a design response spectrum is proposed for both vertical and lateral vibrations. The proposed procedure lends itself for immediate Code implementation.

Short- and long-term effects of different exercise programs on the gait performance of older adults with subjective cognitive decline: A randomized controlled trial.

Older adults, especially those with cognitive decline, often have poor gait performance, which results in poor clinical outcomes due to falls or decreased daily physical activity. The effects of various exercises on gait performance have been studied, whereas the short-term and long-term effects of different exercise modalities remain unknown. To compare the short- and long-term effects of aerobic training (AT), resistance training (RT), and combined training (CT) on the gait performance of community-dwelling older adults with subjective cognitive decline (SCD). A four-arm, randomized controlled trial. 388 community-dwelling older adults with SCD (mean age, 72.3years). Participants attended an exercise or education class twice a week for 26weeks. 10 gait performance parameters were examined at baseline, post-intervention (Week 26), and after 26weeks of follow-up (Week 52) using an electronic walkway system. The mean adherence of exercise sessions was 82.5 to 85.9%. All exercise intervention induced an improvement in gait speed, stride time, cadence, stride length, and double-support time at Week 26 (p<.05), without significant intergroup differences among exercise interventions. However, only RT showed a significant effect on some spatiotemporal gait parameters at Week 52. The analyses for the gait variability parameters showed mild effects of all exercise interventions. All of the exercise programs examined had a positive short-term effect on spatiotemporal gait parameters of older adults with SCD, despite no effect on gait variability parameters. RT are most recommended when long-lasting effects are the primary aim.

Analysis of Gait Characteristics Using Hip-Knee Cyclograms in Patients with Hemiplegic Stroke

Gait disturbance is a common sequela of stroke. Conventional gait analysis has limitations in simultaneously assessing multiple joints. Therefore, we investigated the gait characteristics in stroke patients using hip-knee cyclograms, which have the advantage of simultaneously visualizing the gait kinematics of multiple joints. Stroke patients (n = 47) were categorized into two groups according to stroke severity, and healthy controls (n = 32) were recruited. An inertial measurement unit sensor-based gait analysis system, which requires placing seven sensors on the dorsum of both feet, the shafts of both tibias, the middle of both femurs, and the lower abdomen, was used for the gait analysis. Then, the hip-knee cyclogram parameters (range of motion, perimeter, and area) were obtained from the collected data. The coefficient of variance of the cyclogram parameters was obtained to evaluate gait variability. The cyclogram parameters differed between the stroke patients and healthy controls, and differences according to stroke severity were also observed. The gait variability parameters mainly differed in patients with more severe stroke, and specific visualized gait patterns of stroke patients were obtained through cyclograms. In conclusion, the hip-knee cyclograms, which show inter-joint coordination and visualized gait cycle in stroke patients, are clinically significant.

Falls in Post-Polio Patients: Prevalence and Risk Factors.

Simple SummaryPeople with post-polio syndrome (PPS) suffer frequent falls due to muscle weakness and problems with their balance. In order for a rehabilitation clinician to fit the patient with the optimal treatment plan to prevent imbalance and falls, we performed a simple 10-min walking test with 50 PPS patients. We also asked the patients how many falls they had experienced in the last year and they filled out a questionnaire regarding their balance confidence. We found that we can predict the occurrence of falls in PPS patients based on the consistency of their walking pattern. Since it is very easy to measure the walking pattern, our results may help rehabilitation clinicians to identify individuals at risk of fall and reduce the occurrence of falls in this population. Individuals with post-polio syndrome (PPS) suffer from falls and secondary damage. Aim: To (i) analyze the correlation between spatio-temporal gait data and fall measures (fear and frequency of falls) and to (ii) test whether the gait parameters are predictors of fall measures in PPS patients. Methods: Spatio-temporal gait data of 50 individuals with PPS (25 males; age 65.9 ± 8.0) were acquired during gait and while performing the Timed Up-and-Go test. Subjects filled the Activities-specific Balance Confidence Scale (ABC Scale) and reported number of falls during the past year. Results: ABC scores and number of falls correlated with the Timed Up-and-Go, and gait cadence and velocity. The number of falls also correlated with the swing duration symmetry index and the step length variability. Four gait variability parameters explained 33.2% of the variance of the report of falls (p = 0.006). The gait velocity was the best predictor of the ABC score and explained 24.8% of its variance (p = 0.001). Conclusion: Gait variability, easily measured by wearables or pressure-sensing mats, is an important predictor of falls in PPS population. Therefore, gait variability might be an efficient tool before devising a patient-specific fall prevention program for the PPS patient.

Evaluation of the Validity and Reliability of Connected Insoles to Measure Gait Parameters in Healthy Adults.

The continuous, accurate and reliable estimation of gait parameters as a measure of mobility is essential to assess the loss of functional capacity related to the progression of disease. Connected insoles are suitable wearable devices which allow precise, continuous, remote and passive gait assessment. The data of 25 healthy volunteers aged 20 to 77 years were analysed in the study to validate gait parameters (stride length, velocity, stance, swing, step and single support durations and cadence) measured by FeetMe® insoles against the GAITRite® mat reference. The mean values and the values of variability were calculated per subject for GAITRite® and insoles. A t-test and Levene’s test were used to compare the gait parameters for means and variances, respectively, obtained for both devices. Additionally, measures of bias, standard deviation of differences, Pearson’s correlation and intraclass correlation were analysed to explore overall agreement between the two devices. No significant differences in mean and variance between the two devices were detected. Pearson’s correlation coefficients of averaged gait estimates were higher than 0.98 and 0.8, respectively, for unipedal and bipedal gait parameters, supporting a high level of agreement between the two devices. The connected insoles are therefore a device equivalent to GAITRite® to estimate the mean and variability of gait parameters.

Assessment of gait in patients with fibromyalgia during motor and cognitive dual task walking: a cross-sectional study

BackgroundThe aim of the study was to assess gait pattern of patients diagnosed with fibromyalgia (FM) while performing demanding motor and/or cognitive dual tasks while walking. Further, idea was to explore possible correlations of dual task gait pattern alterations to patients’ functional status and presence or absence of clinical symptoms associated with FM.MethodsTwenty-four female FM patients and 24 healthy female subjects performed a basic walking task, a dual motor, a dual mental (cognitive) and a combined, dual motor and cognitive task simultaneously. Quantitative spatial (stride length) and temporal (cycle time, swing time and double support time) gait parameters were measured using GAITRite walkway system and their variability was assessed. Patients underwent clinical examination including assessment of functional status, pain and fatigue level, psychiatric and cognitive manifestations.ResultsThe motor, cognitive and combined dual tasks affect gait performance in FM patients. Difference in tasks between FM and healthy subjects was found as double support time prolongation. Comparison of tasks showing that cycle time in FM was longer than controls and stride length was shorter in patients for all conditions, while no changes were found in any of the gait parameters variability. Further, mental/cognitive dual tasks had a larger effect than motor tasks. Correlations were also found between depression and functional status of the patients and the gait parameters.ConclusionsGait is affected in FM patients while dual task walking. No changes in stride-to-stride variability point that patients preserve stability in complex walking situations. Analysis of gait may provide additional information for the FM identification based on presence of clinical features and cognitive status. Correlation of dual task gait alterations with occurrence of clinical symptoms and influence of cognitive changes on gait pattern could additionally define FM subgroups.

Temporal But Not Spatial Gait Parameters Associated With Lower Balance Capacity in Moderate-High Functioning Persons With Stroke.

Falls are a major health concern after stroke. Spatial and temporal gait asymmetry and variability can contribute to instability and increased fall risk in persons with stroke (PwS). We aimed to quantify gait spatiotemporal symmetry and variability parameters in PwS undergoing rehabilitation in the subacute stage of the disease, by comparison to healthy participants, and to examine the associations between these parameters and patients' reactive and proactive balance capacity. Twenty-two PwS and 12 healthy adults walked over a computerized treadmill system at their self-selected walking speed. Symmetry and variability of gait parameters (step length, swing time, and stance time) as well as upper extremity and lower extremity angular range of motion in the sagittal plane were extracted. In addition, the Berg Balance Scale (BBS) and the fall threshold in response to sudden surface translations at increasing intensities were assessed. PwS demonstrated significantly higher asymmetry in all gait parameters in comparison to controls. Also, PwS demonstrated increased stance time variability in comparison to healthy controls and increased swing time variability in the paretic lower extremity. Significant negative associations were found between fall threshold and stance time asymmetry in PwS (r = -0.48, P = 0.022), between the BBS and swing time asymmetry (r = -0.50, P = 0.018), and between the BBS and stance time variability of the paretic lower extremity (r = -0.56, P = 0.006). Findings highlight the importance of gait temporal symmetry and variability measures for dynamic balance control after stroke. These parameters should be considered when assessing gait recovery and safety in PwS.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A355).

Approach to Posture and Gait in Huntington's Disease.

Disturbances of gait occur in all stages of Huntington’s disease (HD) including the premanifest and prodromal stages. Individuals with HD demonstrate the slower speed of gait, shorter stride length, and increased variability of gait parameters as compared to controls; cognitive disturbances in HD often compound these differences. Abnormalities of gait and recurrent falls lead to decreased quality of life for individuals with HD throughout the disease. This scoping review aims to outline the cross-disciplinary approach to gait evaluation in HD and will highlight the utility of objective measures in defining gait abnormalities in this patient population.

Effects of barefoot vs. shod walking during indoor and outdoor conditions in younger and older adults

BackgroundGait stability and variability measures in barefoot and shod locomotion are frequently investigated in younger but rarely in older adults. Moreover, most studies examine gait measures in laboratory settings instead of real-life settings. Research questionsHow are gait stability and variability parameters affected by footwear compared to barefoot walking in younger and older adults as well as under indoor vs. outdoor conditions? MethodsHealthy younger (<35 years) and older adults (>65 years) participated in the randomised within-subject study design. Participants conducted consecutive 25 m walking trials barefoot and with standardised footwear inside and outside. Inertial measurement units were mounted on the participant’s foot and used to calculate local dynamic stability (LDS), velocity and minimal toe clearance (MTC), stride length and stride time, including variabilities for these parameters. Linear mixed models were calculated. ResultsData of 32 younger (17 female, 15 male, age: 30 ± 4 years) and 42 older participants (24 female, 18 male, age: 71 ± 4 years) were analysed. MTC variability was higher in shod conditions compared to barefoot (p = 0.048) and in outdoor conditions (p < 0.001). LDS was different between age groups (p < 0.001). Gait velocity and MTC were higher in shod and outdoor conditions (both p < 0.001). Stride length and time were higher in shod conditions (both p < 0.001) and different between outdoor vs. indoor (longer stride length and shorter stride time outdoor, both (p < 0.001) as well as age groups (shorter stride length (p < 0.021) and stride time in older adults (p < 0.001). SignificanceResults suggest that gait stability and variability in older and younger adults are acutely affected by footwear vs. barefoot and indoor vs. outdoor walking conditions, indicating a high adaptiveness of these parameters to different experimental conditions. Consequently, future studies should be careful with generalising results obtained under certain conditions. Findings stress the clinical potential of barefoot walking.

Gait variability is affected more by peripheral artery disease than by vascular occlusion.

BackgroundPatients with peripheral artery disease with intermittent claudication (PAD-IC) have altered gait variability from the first step they take, well before the onset of claudication pain. The mechanisms underlying these gait alterations are poorly understood.AimsTo determine the effect of reduced blood flow on gait variability by comparing healthy older controls and patients with PAD-IC. We also determined the diagnostic value of gait variability parameters to identify the presence of PAD.MethodsA cross-sectional cohort design was used. Thirty healthy older controls and thirty patients with PAD-IC walked on a treadmill at their self-selected speed in pain free walking (normal walking for healthy older controls; prior to claudication onset for PAD) and reduced blood flow (post vascular occlusion with thigh tourniquet for healthy older controls; pain for PAD) conditions. Gait variability was assessed using the largest Lyapunov exponent, approximate entropy, standard deviation, and coefficient of variation of ankle, knee, and hip joints range of motion. Receiver operating characteristics curve analyses of the pain free walking condition were performed to determine the optimal cut-off values for separating individuals with PAD-IC from those without PAD-IC.Results and discussionPatients with PAD-IC have increased amount of variability for knee and hip ranges of motion compared with the healthy older control group. Regarding the main effect of condition, reduced blood flow demonstrated increased amount of variability compared with pain free walking. Significant interactions between group and condition at the ankle show increased values for temporal structure of variability, but a similar amount of variability in the reduced blood flow condition. This demonstrates subtle interactions in the movement patterns remain distinct between PAD-IC versus healthy older controls during the reduced blood flow condition. A combination of gait variability parameters correctly identifies PAD-IC disease 70% of the time or more.ConclusionsGait variability is affected both by PAD and by the mechanical induction of reduced blood flow. Gait variability parameters have potential diagnostic ability, as some measures had 90.0% probability of correctly identifying patients with PAD-IC.