Self-selected Walking Research Articles

Between-limb difference in peak knee flexion angle can identify persons post-stroke with Stiff-Knee gait

BackgroundStiff-Knee gait affects 25–75 % of individuals with post-stroke gait impairment and is typically defined as reduced swing phase knee flexion. Different studies use various measures to identify Stiff-Knee gait, such as peak swing knee flexion angle, timing of peak knee flexion, knee range of motion, and ankle push-off acceleration, leading to inconsistent results. MethodsThis study used univariate cluster analysis to examine the independence, consistency, validity, and accuracy of different definitions in 50 post-stroke individuals (24 with and 26 without Stiff-Knee gait), as determined by a physiatrist. Spearman's rank correlation was used for correlation analysis, and five clustering techniques along with clinician evaluations were used for validity analysis. FindingsCorrelation analysis showed that peak knee flexion timing and knee hyperextension are poorly correlated with reduced swing-phase knee flexion angle (ρ = −0.09 and ρ = −0.26 respectively). Validity analysis indicated that the between-limb difference in peak swing knee flexion angle and peak swing knee flexion angle at self-selected gait speeds were the most valid differentiators. At the fastest comfortable gait speed, the between-limb difference of peak knee flexion angle had the highest sensitivity, lowest specificity, and highest F1 scores. InterpretationWe determined thresholds of less than 44.3° for peak swing knee flexion angle and greater than 17.0° for the between-limb difference of peak knee flexion angle identify Stiff-Knee gait during self-selected walking. We recommend using the difference in peak swing knee flexion angle between limbs to diagnose post-stroke Stiff-Knee gait due to its robustness to changes in gait speed.

Design and kinematic investigation of an actuated prosthetic ankle during walking

Due to the varied needs of persons who have lost a lower limb in their everyday lives, ankle-foot prosthetic technology is continually evolving. Numerous prosthetic ankles have been created in recent years to restore the ankle function of lower limb amputees. Most ankle foot prostheses, on the other hand, are passive, such as the solid ankle cushion heel and the energy storage and release foot (ESAR). The solid ankle foot can only provide steady vertical support during ambulation; however, the ESAR foot can store energy and gradually release it throughout human walking periods, hence increasing the walking pace of amputees. The aim of this work is to describe the design and manufacture of an actuated ankle-foot prosthesis. The main benefit of powered ankles is that they are capable of mimicking natural stride, particularly in steep or uneven terrain conditions. The primary objective is to establish two degrees of freedom of ankle rotation in two planes, plantar flexion and dorsiflexion in the sagittal plane, besides inversion and eversion in the frontal plane. As software can improve the gait stability, an automatic modifiable transmission arrangement was prepared for delivering the current design motions in the sagittal plane based on empirical collected biomechanical data related to passive prosthetic normal gait circumstances. However, the ankle rolling in the frontal plane was guided mechanically by means of mono leaf spring. The majority of the ankle mechanical components are made of 7075-T6 aluminum alloy and are integrated onto ESAR carbon fiber laminated foot. For a unilateral above-knee amputee, the ankle function at self-selected walking was assessed, achieving maximum results of 10° inversion, 10° eversion, 12° plantar flexion and 18° dorsiflexion ankle angles. Also, the patient gait experiment in a normal cadence showed an improvement in plantar flexion behavior for the powered ankle in contrast with the passive ankle

Are the spatiotemporal gait parameters at different walking speeds capable of predicting variations in cognitive status by the mini-mental state examination?

Background Several studies have reported the association between cognition and gait; however, most are limited to investigating gait in just one speed, usually the self-selected one, and commonly, only the general score of cognitive tests is used. Aims Investigate the relationship between the spatiotemporal gait parameters at different speeds (self-selected and fast walking speeds) and cognitive status in older adults. Methods Cross-sectional study. Two hundred and ninety-five older adults (70.9 ± 7.2 years; 82.3% women) were evaluated according to cognitive status (Mini-Mental State Examination, MMSE) and spatiotemporal gait parameters. Results Data analysis indicates that the spatiotemporal gait parameters (stride length, step time, and single support time) were able to predict cognitive status, assessed by the MMSE general score and its subdomain (temporal and spatial orientation) at both walking speeds. Conclusions The spatiotemporal gait parameters were associated with cognitive status, assessed by the MMSE (general score and temporal and spatial orientation), regardless of the walking conditions. The model’s variance was significant and with a large effect size. Stride length and step time were identified as the variables with the best explanatory factors. Therefore, it is concluded that greater cognitive performance is associated with longer stride lengths and faster step times.

Effects of age and knee osteoarthritis on the modular control of walking: A pilot study.

BackgroundOlder adults and individuals with knee osteoarthritis (KOA) often exhibit reduced locomotor function and altered muscle activity. Identifying age- and KOA-related changes to the modular control of gait may provide insight into the neurological mechanisms underlying reduced walking performance in these populations. The purpose of this pilot study was to determine if the modular control of walking differs between younger and older adults without KOA and adults with end-stage KOA.MethodsKinematic, kinetic, and electromyography data were collected from ten younger (23.5 ± 3.1 years) and ten older (63.5 ± 3.4 years) adults without KOA and ten adults with KOA (64.0 ± 4.0 years) walking at their self-selected speed. Separate non-negative matrix factorizations of 500 bootstrapped samples determined the number of modules required to reconstruct each participant’s electromyography. One-way Analysis of Variance tests assessed the effect of group on walking speed and the number of modules. Kendall rank correlations (τb) assessed the association between the number of modules and self-selected walking speed.ResultsThe number of modules required in the younger adults (3.2 ± 0.4) was greater than in the individuals with KOA (2.3 ± 0.7; p = 0.002), though neither cohorts’ required number of modules differed significantly from the unimpaired older adults (2.7 ± 0.5; p ≥ 0.113). A significant association between module number and walking speed was observed (τb = 0.350, p = 0.021) and individuals with KOA walked significantly slower (0.095 ± 0.21 m/s) than younger adults (1.24 ± 0.15 m/s; p = 0.005). Individuals with KOA also exhibited altered module activation patterns and composition (which muscles are associated with each module) compared to unimpaired adults.ConclusionThese findings suggest aging alone may not significantly alter modular control; however, the combined effects of knee osteoarthritis and aging may together impair the modular control of gait.

The effects of a secondary task on gait in axial spondyloarthritis

Studies on the effects of dual tasking in patients with chronic inflammatory rheumatic diseases are limited. The aim of this study was to assess dual tasking while walking in patients with axial spondyloarthritis (axSpA) in comparison to healthy controls. Thirty patients with axSpA and thirty healthy controls underwent a 10-m walk test at a self-selected comfortable walking speed in single- and dual-task conditions. Foot-worn inertial sensors were used to compute spatiotemporal gait parameters. Analysis of spatiotemporal gait parameters showed that the secondary manual task negatively affected walking performance in terms of significantly decreased mean speed (p < 0.001), stride length (p < 0.001) and swing time (p = 0.008) and increased double support (p = 0.002) and stance time (p = 0.008). No significant interaction of group and condition was observed. Both groups showed lower gait performance in dual task condition by reducing speed, swing time and stride length, and increasing double support and stance time. Patients with axSpA were not more affected by the dual task than matched healthy controls, suggesting that the secondary manual task did not require greater attention in patients with axSpA. Increasing the complexity of the walking and/or secondary task may increase the sensitivity of the dual-task design to axial spondyloarthritis.

Understanding patient preference in prosthetic ankle stiffness

BackgroundUser preference has the potential to facilitate the design, control, and prescription of prostheses, but we do not yet understand which physiological factors drive preference, or if preference is associated with clinical benefits.MethodsSubjects with unilateral below-knee amputation walked on a custom variable-stiffness prosthetic ankle and manipulated a dial to determine their preferred prosthetic ankle stiffness at three walking speeds. We evaluated anthropomorphic, metabolic, biomechanical, and performance-based descriptors at stiffness levels surrounding each subject’s preferred stiffness.ResultsSubjects preferred lower stiffness values at their self-selected treadmill walking speed, and elected to walk faster overground with ankle stiffness at or above their preferred stiffness. Preferred stiffness maximized the kinematic symmetry between prosthetic and unaffected joints, but was not significantly correlated with body mass or metabolic rate.ConclusionThese results imply that some physiological factors are weighted more heavily when determining preferred stiffness, and that preference may be associated with clinically relevant improvements in gait.

Dynamic Assessment of Femoroacetabular Impingement Syndrome Hips

The purpose of our study was to compare lower extremity rotational kinematics and kinetics (angles, torques, and powers) and hip muscle electromyography (EMG) activity between cam-type femoroacetabular impingement syndrome (FAIS) and age- and sex-matched controls during walking, fast walking, stair ascent, stair descent, and sit-to-stand. This study included 10 males with unilateral FAIS and 10 control males with no FAIS. We measured kinematics, kinetics, and electromyographic signals during stair ascent/descent, sit-to-stand, self-selected walk, and fast walk. Peak signal differences between groups were compared with independent t-tests with statistical significance when P < .05. FAIS hips showed significant differences compared to controls, including increased hip flexion during walking (+4.9°, P= .048) and stair ascent (+7.8°, P=.003); diminished trunk rotation during stair ascent (-3.4°; P= .015), increased knee flexion during self-selected walking (+5.1°, P= .009), stair ascent (+7.4°, P= .001), and descent (+5.3°, P= .038); and increased knee valgus during fast walking (+4.7°, P= .038). gMed and MedHam showed significantly decreased activation in FAIS during walking (gMed:-12.9%, P= .002; MedHam:-7.4%, P= .028) and stair ascent (gMed:-16.7%, P= .036; MedHam:-13.0%, P= .041); decreased gMed activation during sit-to-stand (-8.8%, P=.004) and decreased MedHam activation during stair descent (-8.0%, P= .039). Three-dimensional motion analysis and EMG evaluation of functional kinematics and kinetics in subjects with symptomatic unilateral cam-type FAIS across a spectrum of provocative tasks demonstrated significant differences compared to controls in hip flexion, trunk rotation, knee flexion, and valgus. FAIS hips had significantly decreased gMed and MedHam activity. These findings may explain altered torso-pelvic, hip, and knee mechanics in FAIS patients and suggest that evaluation of FAIS should include the patient's hip, knee, and torso-pelvic relationships and muscle function. The clinical and functional manifestation of FAIS hip pathomechanics is not entirely understood, and previous literature to date has not clearly described the alterations in gait and functional movements seen in patients with cam-type FAIS. The current study used 3D motion analysis and EMG evaluation of functional kinematics and kinetics to identify a number of differences between FAIS and control hips, which help us better understand the lower extremity kinematics and kinetics and muscle activation in FAIS.

Measuring Gait Velocity and Stride Length with an Ultrawide Bandwidth Local Positioning System and an Inertial Measurement Unit.

One possible modality to profile gait speed and stride length includes using wearable technologies. Wearable technology using global positioning system (GPS) receivers may not be a feasible means to measure gait speed. An alternative may include a local positioning system (LPS). Considering that LPS wearables are not good at determining gait events such as heel strikes, applying sensor fusion with an inertial measurement unit (IMU) may be beneficial. Speed and stride length determined from an ultrawide bandwidth LPS equipped with an IMU were compared to video motion capture (i.e., the “gold standard”) as the criterion standard. Ninety participants performed trials at three self-selected walk, run and sprint speeds. After processing location, speed and acceleration data from the measurement systems, speed between the last five meters and stride length in the last stride of the trial were analyzed. Small biases and strong positive intraclass correlations (0.9–1.0) between the LPS and “the gold standard” were found. The significance of the study is that the LPS can be a valid method to determine speed and stride length. Variability of speed and stride length can be reduced when exploring data processing methods that can better extract speed and stride length measurements.

A Comparison of PlayerLoadTM and Heart Rate during Backwards and Forwards Locomotion during Intermittent Exercise in Rugby League Players

Limited research has examined the demands of backward locomotion at various speeds using common load monitoring metrics in team sport athletes. Consequently, this study compared the external and internal loads between backward and forward locomotion during intermittent exercise in team sport athletes. Semi-professional, male rugby league players (n = 29) completed the same exercise protocol on two occasions in backward and forward directions. On each occasion, participants performed separate 20 m trials at self-selected walking, jogging, running, and sprinting speeds and then completed a 15 min modified Loughborough intermittent shuttle test (mLIST). Common external and internal load metrics were gathered across testing. Faster speeds (p < 0.001) were attained at all speeds during forward locomotion in the 20 m trials. Non-significant differences in accumulated PlayerLoadTM were found between directions across the mLIST; however, higher relative (per min) PlayerLoadTM (p < 0.001) was apparent during backward locomotion when walking and during forward locomotion when sprinting during the mLIST. RPE and mean heart rate were higher (p < 0.001) during backward locomotion across the mLIST. These data highlight the unique loading patterns experienced during backward locomotion and suggest practitioners should consider the discernment in loading imposed between backward and forward locomotion when measuring athlete demands using common metrics.

Effects of limb dominance on the symmetrical distribution of plantar loading during walking and running

The purpose of this study was to investigate the symmetry or asymmetry in the plantar pressure, foot axis angle and muscle mass of dominant and non-dominant legs. Sixty-eight able-bodied participants (age: 20 ± 1 years, height: 162 ± 8 cm, mass: 53 ± 7 kg, BMI: 20.63 ± 2 kg/m2) were recruited for the walking and running tests. All participants with right dominant feet, defined as the preferred leg when kicking a ball, were asked to perform four successful trials at their self-selected walking and running speeds after warm-up. FootScan force-measuring plate was utilized to collect plantar pressure and foot axis angle. The Tanita Segmental Body Composition Analyzer was used to measure the muscle mass of the lower limbs. The time-series parameters were checked using an open-source statistical parametric mapping 1d package. The result exhibited that the medial foot pressure of the dominant limb was higher than the non-dominant limb ( p &lt; 0.05). Foot balance index range showed asymmetry in both walking and running tasks (absolute symmetry index &lt;10%). There was no significant difference in muscle mass between the dominant and non-dominant lower limbs ( p = 0.79). The quantification of potential differences and asymmetries could provide implications for gait injury prevention and shoe design.

Biomechanics And Energetics Of Curved Treadmills

PURPOSE: This study aims to examine the biomechanical and energetic differences between the non-motorized curved treadmill and the motorized flat (i.e., traditional) treadmill (TM). We hypothesize that, when compared to TM, CT will result in significantly higher EE, percentage of VO2 max and trunk flexion under all testing conditions. METHODS: Data collection included two sessions. In session one, participants filled out an informed consent, health questionnaire, and anthropometric data was collected. After, the participants underwent a 20-minute resting energy expenditure test to gather baseline metabolic data and the session concluded with a Bruce VO2 max test. In session two, participants were connected to a metabolic cart to measure metabolic costs and outfitted with reflective markers to capture 3D kinematic data.). RESULTS: There was not a significant increase in the amount of trunk flexion under any of the conditions between treadmills. There was a significant increase in the amount of EE from the TM to the CT across all six speeds. At 15% above their self-selected jogging (SSJ) speed, EE was 10.00 ± 1.32 kcal/min and 8.74 ± 1.34 kcal/min for the CT and TM, respectively (p=.002). At 15% slower than SSJ speed, participants’ EE was 8.44 ± 1.16 kcal/min and 7.36 ± 1.05 kcal/min (p=.005) for the CT and TM, respectively. At SSJ speeds, participants EE was 8.94 ± 1.17 kcal/min and 7.47 ± 1.13 kcal/min for the CT and TM, respectively (p<0.001). At 15% above participants’ self-selected walking (SSW) speed, EE was 5.35 ± 1.18 kcal/min and 3.38 ± 0.68 kcal/min on the CT and TM, respectively (p<0.001). At 15% slower than SSW, participants EE was 4.34 ± 0.92 kcal/min and 2.93 ± .47 kcal/min on the CT and TM, respectively (p<0.001). At SSW speeds, participants EE was 4.66 ± 1.00 kcal/min and 3.18 ± 0.62 kcal/min on the CT and TM, respectively (p<0.001). CONCLUSIONS: Our findings suggest that female athletes may benefit from using CTs over TMs because of the increased EE utilization but further research needs to be conducted to assess the viability of CTs as a safe option with respect to musculoskeletal structures.

A spatio-temporal and kinematic description of self-selected walking in adults with Achondroplasia

BackgroundAchondroplasia is characterised by a shorter appendicular limb to torso ratio, compared to age matched individuals of average stature (controls). Despite the well documented shorter leg length of individuals with compared to controls, there are few complete descriptions of gait kinematics reported for the population. AimThe aim of this study was to report the spatio-temporal and kinematic characteristics of self-selected walking (SSW) in a group with Achondroplasia (N = 10) and age matched group without Achondroplasia (controls, N = 17). MethodWhole body 3D analysis of both groups was conducted using a 14 camera VICON system. Spatio-temporal and kinematic variables were determined through a Plug-in-Gait model. SSW was obtained from an average of three trials equating to a total of ∼120 m walking. ResultsThe group with Achondroplasia were 23 % slower (P < 0.001), had a 29 % shorter stride length (P < 0.001) and a 13 % higher stride frequency (P < 0.001) compared to controls. There were no differences in time normalised temporal measures of left toe off (P = 0.365), right heel contact (P = 0.442) or the duration of double support (P = 0.588) between groups. A number of discrete joint kinematic differences existed between groups, resulting in the group with Achondroplasia having more ‘flexed’ lower limbs than controls throughout the gait cycle. ConclusionDifferences in absolute spatio-temporal variables between groups is likely due to the shorter leg length of the group with Achondroplasia, while their more flexed position of the lower limbs may facilitate toe-clearance during the swing phase.

The effect of horizontal forces from a Smart Walker on gait and perceived exertion

ABSTRACT Increasingly, electric motors are being incorporated into wheeled walkers to implement various smart features to better assist their users physically. These modified walkers, known as Smart Walkers, use their electric motors to generate horizontal forces that can be used to reduce the physical load for walking, prevent falls and provide navigation support. However, these forces can also alter gait and may inadvertently increase the exertion of the users. This study aims to describe the effects of assistive and resistive horizontal forces (from −18.47 N to 27.70 N) from a Smart Walker on gait and perceived exertion of its users during steady-state walking. Self-selected comfortable walking speed, cadence, stride length, double support phase and ratings of perceived exertion (RPE) were significantly affected and different effects were found for resistive force, relatively low assistive force and high assistive force. With increasing force from −18.47 N to 0 N, RPE decreased and the users walked with lower double support time. From 0 N to 9.23 N, RPE continued to decrease to its lowest point while gait parameters remained constant. Further increasing force up to 27.70 N increased RPE and led to the users to choose to walk at higher speeds. This study demonstrates that users adapt their gait significantly to the forces applied and relatively high constant forces, whether assistive or resistive, will increase perceived exertion. Hence, these need to be carefully considered when developing Smart Walkers in order to provide safe and effective support to its users.

Design and Speed-Adaptive Control of a Powered Geared Five-Bar Prosthetic Knee Using BP Neural Network Gait Recognition.

To improve the multi-speed adaptability of the powered prosthetic knee, this paper presented a speed-adaptive neural network control based on a powered geared five-bar (GFB) prosthetic knee. The GFB prosthetic knee is actuated via a cylindrical cam-based nonlinear series elastic actuator that can provide the desired actuation for level-ground walking, and its attitude measurement is realized by two inertial sensors and one load cell on the prosthetic knee. To improve the performance of the control system, the motor control and the attitude measurement of the GFB prosthetic knee are run in parallel. The BP neural network uses input data from only the GFB prosthetic knee, and is trained by natural and artificially modified various gait patterns of different able-bodied subjects. To realize the speed-adaptive control, the prosthetic knee speed and gait cycle percentage are identified by the Gaussian mixture model-based gait classifier. Specific knee motion control instructions are generated by matching the neural network predicted gait percentage with the ideal walking gait. Habitual and variable speed level-ground walking experiments are conducted via an able-bodied subject, and the experimental results show that the neural network control system can handle both self-selected walking and variable speed walking with high adaptability.

Spatiotemporal Variables During Self-selected And Fastest-comfortable Walking Speeds In Individuals Following Acl Reconstruction

Spatiotemporal Variables During Self-selected And Fastest-comfortable Walking Speeds In Individuals Following Acl Reconstruction

A quantitative description of self-selected walking in adults with Achondroplasia using the gait profile score

BackgroundAchondroplasia is characterised by a shorter appendicular limb-to-torso ratio, compared to age matched individuals of average stature (controls). Previous work shows gait kinematics of individuals with Achondroplasia differing to controls, but no global quantification of gait has been made in adults with Achondroplasia. AimThe aim of this study was to quantify gait differences between a group of adult males with Achondroplasia and controls during self-selected walking (SSW) using the Gait Profile Score (GPS). DesignWhole body motion analysis of 10 adults with Achondroplasia (22 ± 3 yrs) who had not undergone leg lengthening and 17 adult controls (22 ± 2 yrs) was undertaken using a 14 camera VICON system (100 Hz). For each group, fifteen root mean squared Gait Variable Scores (GVS, units °) were computed from lower limb kinematic data and then summed to calculate GPS (°). ResultsThe group with Achondroplasia had higher GVSs than controls in 10 of the 15 measures (P < 0.05) with the largest differences found in ankle plantar/dorsiflexion (P < 0.001), knee flexion/extension (P < 0.001), and hip internal/external rotation (P < 0.001). The GPS value of the group with Achondroplasia was 64% higher than controls (11.4° (2.0) v 4.1° (1.8), P < 0.001). ConclusionGait is quantitatively different in adults with Achondroplasia compared to controls. The differences in GPS between groups are due to differences in joint kinematics, which are possibly manifested by maintaining toe-clearance during swing. Gait models derived from the anatomy of individuals with Achondroplasia may improve these data.

Estimates of individual muscle power production in normal adult walking

BackgroundThe purpose of this study was to determine the contribution of individual hip muscles to the net hip power in normal adult self-selected speed walking. A further goal was to examine each muscle’s role in propulsion or support of the body during that task.MethodsAn EMG-to-force processing (EFP) model was developed which scaled muscle-tendon unit (MTU) force output to gait EMG. Active muscle power was defined as the product of MTU forces (derived from EFP) and that muscle’s contraction velocity. Passive hip power was estimated from passive moments associates with hip position (angle of flexion (extension)) and the hip’s angular velocity. Net hip EFP power was determined by summing individual active hip muscle power plus the net passive hip power at each percent gait cycle interval. Net hip power was also calculated for these study participants via inverse dynamics (kinetics plus kinematics, KIN). The inverse dynamics technique – well accepted in the biomechanics literature – was used as a “gold standard” for validation of this EFP model. Closeness of fit of the power curves of the two methods was used to validate the model.ResultsThe correlation between the EFP and KIN methods was sufficiently close, suggesting validation of the model’s ability to provide reasonable estimates of power produced by individual hip muscles. Key findings were that (1) most muscles undergo a stretch-shorten cycle of muscle contraction, (2) greatest power was produced by the hip abductors, and (3) the hip adductors contribute to either hip adduction or hip extension (but not both).ConclusionsThe EMG-to-force processing approach provides reasonable estimates of individual hip muscle forces in self-selected speed walking in neurologically-intact adults.

Novel single marker approach to estimation of lower extremity movement.

Sacrum motion is used extensively in studying the biomechanical characteristics of walking. This study aimed at investigating the potential of sacrum motion to provide an estimation of important gait events in conjunction with predicting the motion of lower extremity segments. Three-dimensional trajectories of 37 reflective markers placed on anatomical landmarks of 14 healthy subjects were recorded while walking at self-selected normal walking speed on treadmill. Elevation angles of lower extremity segments in sagittal plane were estimated using the lower extremity markers. Regression analysis was used to estimate the ability of sacrum kinematic variables to predict lower extremity elevation angles. Prediction was performed at 10 different gait events extracted from three-dimensional sacrum trajectories. The coefficients of the predicting variables were analyzed at these events. The results indicated that heel strike and toe off event instances identified using trajectory of sacrum marker were close to the results of accurate kinematic methods. Additionally, the motion of this point was able to predict lower extremity angles with a suitable coefficient of determination at early single support and mid-swing events. A range of musculoskeletal disorders could be identified using the elevation angles at these events. This study could be considered as a step toward development of effective and simplified instrumentation in clinical diagnosis of gait disorders.

Relationships between walking velocity and distance and the symmetry of temporospatial parameters in chronic post-stroke subjects.

Subjects with post-stroke hemiparesis frequently present with asymmetric gait patterns. Symmetry, reflecting similarities in temporospatial, kinematic parameters, is an important measure of gait assessment. The study was designed to examine the relationships between asymmetry of temporal, spatial and kinematic gait parameters and walking velocity and distance. Temporospatial and kinematic gait parameters were examined in a group of 50 chronic post-stroke subjects and in a group of 25 healthy controls. Symmetry ratio was calculated for all the parameters. Gait velocity was measured during 10-metre test, the walking distance during 2-Minute Walk Test, and balance during Up and Go Test. The relationship between stance phase duration symmetry and gait speed was at a moderate level (r = -0.43, p = 0.0173). There was a moderate relationship between swing phase symmetry and walking velocity and distance. The findings did not show a significant correlation between step length symmetry versus gait speed and distance. There is a mild relationship between self-selected gait velocity and walking distance versus temporal parameters symmetry. The findings do not confirm a relationship between self-selected gait velocity and walking distance versus spatial and kinematic parameters as well as balance. Likewise, no evidence confirms that asymmetry of temporal, spatial, kinematic gait parameters changes with the age of post-stroke subjects or is related to the length of time from stroke onset. Given the above, gait symmetry may be recognized as an important indicator of the level of gait control in post-stroke patients because it enables unique gait assessment, independent from other parameters.

Relationships among exercise capacity, dynamic balance and gait characteristics of Nigerian patients with type-2 diabetes: an indication for fall prevention.

This study investigated the relationships among exercise capacity (EC), dynamic balance (DB), and gait characteristics (GCs) of patients with type-2 diabetes (T2D) and healthy controls (HCs). This observational controlled study involved 125 patients with T2D receiving treatment at a Nigerian university teaching hospital and 125 apparently healthy patients’ relatives and hospital staff recruited as controls. EC maximum oxygen consumption (VO2max) was estimated following a 6-min walk test. DB and GC were assessed using the Time Up to Go Test and an accelerometer (BTS G-Walk) assessing gait speed, step length, stride length, and cadence respectively during a self-selected walk. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. The mean ages of patients with T2D and HCs were 57.6±6.6 and 60.0±7.0 years, respectively. All physical characteristics were comparable (P>0.05). There were significant differences in the VO2max and DB between patients with T2D and HCs; 7.6±0.6 mL/kg/min vs. 9.6±0.6 mL/kg/min (t=−16.6, P=0.001) and 14.2±2.1 sec vs. 10.4±1.5 sec (t=−6.37, P=0.001), respectively. Furthermore, significant differences were found in GC between patients with T2D and HCs; gait speed: 0.7±0.1 m/sec vs. 1.2±0.1 m/sec (t=−16.60, P=0.001), step length: 0.6±0.2 m vs. 0.9±0.3 m (t=−7.56, P=0.001) and stride length: 0.9±0.1 m vs. 1.1±0.5 m (t=−6.09, P=0.001). There were significant correlations between EC and gait speed in both groups (T2D: r=−0.26, P=0.032 and HCs: r=0.51, P=0.003). In conclusion, patients with T2D demonstrated lower EC, unstable DB, and altered GCs compared with HCs. Exercise interventions to improve EC and gait balance are recommended.