Temporal-spatial Gait Parameters Research Articles

Influence of impaired selective motor control on gait in children with cerebral palsy.

PurposeSpastic cerebral palsy (CP) is characterized by four neuromuscular deficits: weakness, short muscle-tendon unit, muscle spasticity and impaired selective motor control (SMC). We examined the influence of impaired SMC on gait in children with bilateral spastic CP. Delineating the influence of neuromuscular deficits on gait abnormalities can guide surgical and therapeutic interventions to reduce long-term debilitating effects of CP.MethodsThe relationship between impaired SMC and gait was assessed using multivariate linear regression analysis of Selective Control Assessment of the Lower Extremity (SCALE) in relation to stance phase knee flexion and temporal-spatial gait parameters calculated using 3D kinematics for 57 children with bilateral spastic CP, ages seven to 11 years.ResultsMean SCALE values were 5.8 (0 to 10, sd 3.0) and 5.7 (0 to 10, sd 2.9) for right and left legs, respectively. Multivariate linear regression models, including right and left SCALE and height, significantly predicted right and left knee flexion at initial contact (R = 0.479, p = 0.003; R = 0.452, p = 0.007, respectively) and right and left knee flexion in midstance (R = 0.428, p = 0.013; R = 0.407, p = 0.022, respectively). The model significantly predicted right and left step length (R = 0.645, p = 0.000; R = 0.523, p = 0.001, respectively) and predicted gait velocity (R = 0.444, p = 0.008). The model including SCALE did not predict step width.ConclusionResults indicate impaired SMC predicts increased knee flexion at initial contact, and reduces step length and velocity. Understanding the influence of impaired SMC on gait can inform decisions regarding therapy and surgery, such as hamstring lengthening.Level of evidenceLevel II Retrospective Study

The effect of unilateral blood flow restriction on temporal and spatial gait parameters

Blood flow restriction walking (BFR-W) is becoming more frequently used in aerobic and strength training and it has been proposed that BFR-W can be used in clinical populations. BFR-W may change gait stability yet few studies have assessed gait changes during or following BFR-W. The aim of this study was to assess if spatial-temporal gait parameters change during and following BFR-W. Twenty-four participants completed two walking sessions (>48-hours apart); 1) Unilateral BFR-W applied at the dominant thigh, 2) walking without BFR. In each session participants performed a 5-min warmup, 15-min walking intervention and 10-min active recovery. The warmup and active recovery were performed without BFR on both days. Measurements were attained at baseline, during the intervention and post-intervention using the GAITRite®. Linear mixed models were applied to each measured variable. Fixed factors were timepoint (warmup, intervention, and active recovery), condition (BFR-W and control walking) and condition × timepoint. Random factors were subject and subject × condition. Participants took shorter (3.2-cm (mean difference), CI95%: 0.8–5.6-cm) and wider strides (1.4-cm, CI95%: 0.9–1.9-cm) during BFR-W. For single leg measures, participants took shorter steps (2.8-cm, CI95%: 1.7–4.0-cm) with a faster single support time (7.5-ms, CI95%: 2.9–12.0-ms) on the non-dominant (unoccluded) leg during BFR-W compared to the non-dominant leg during control walking. There were no differences in step length and single support time between the dominant (occluded) leg during BFR-W compared to the dominant leg during control walking. There were no significant changes in velocity, cadence or double support time between BFR-W and control walking (P > 0.05). BFR-W caused small transient changes to several gait parameters. These changes should be considered when using BFR-W in clinical populations.

Gradual increase of perturbation load induces a longer retention of locomotor adaptation in children with cerebral palsy

The goal of this study is to determine whether the size and the variability of error have an impact on the retention of locomotor adaptation in children with cerebral palsy (CP). Eleven children with CP, aged 7–16 years old, were recruited to participate in this study. Three types of force perturbations (i.e., abrupt, gradual and noisy loads) were applied to the right leg above the ankle starting from late stance to mid-swing in three test sessions while the subject walked on a treadmill. Spatial-temporal gait parameters were recorded using a custom designed 3D position sensor during treadmill walking. We observed that children with CP adapted to the resistance force perturbation and showed an aftereffect consisting of increased step length after load release. Further, we observed a longer retention of the aftereffect for the condition with a gradual load than that with an abrupt load. Results from this study suggested that the size of error might have an impact on the retention of motor adaptation in children with CP with a longer retention of motor adaptation for the condition with a small size of error than that with a large error. In addition, enhanced variability of error seems facilitate motor learning during treadmill training. Results from this study may be used for the development of force perturbation based training paradigms for improving walking function in children with CP.

Does flooring-type change the gait characteristics of the older adult? Analysis of balance and temporal-spatial gait parameters and ground reaction force

Does flooring-type change the gait characteristics of the older adult? Analysis of balance and temporal-spatial gait parameters and ground reaction force

Kinematic Parameters for Changing From Sitting to Standing Position and Gait in Poststroke Hemiparetic Patients

Hemiparetic individuals present changes that negatively affect the functional activities. The purpose of this article is to identify the kinematic parameters in poststroke hemiplegic patients for the duration of changing from the sitting to standing position and then to walking. Sociodemographic and clinical data were collected on the severity of stroke by using the National Institutes of Health Stroke Scale; functional mobility, by the Timed Up and Go test; and the kinematic parameters of changing from the sitting to standing position and then walking by means of the free Computation Vision Mobility software program. There was statistical difference in hip extension associated with ankle dorsiflexion in the final stage of support for walking and dorsiflexion in the beginning (P = .04) and while changing from the sitting to standing position (P = .01), speed (P < .01), cadence (P = .03), and step/stride length (P < .01) of gait. Significant correlations were found between cadence (r 2 = 0.72), speed (r 2 = 0.87), and step/stride length (r 2 = 0.71) and compromised functional mobility. Individuals with hemiparesis after stroke who presented greater ankle dorsiflexion when moving to standing performed a hip extension and dorsiflexion of the ankle in the final support of gait. Individuals who presented this position at this stage of walking had adequate temporal-spatial gait parameters, and these parameters showed significant correlations with impaired functional mobility.

Do Pain, Functional Disability, and Gait in End-stage Ankle Arthritis Worsen with Associated Varus Coronal Plane Deformity?

Category: Ankle Arthritis Introduction/Purpose: There is paucity of literature on quantitative gait changes in patients with increased coronal plane deformity along with end stage ankle arthritis. We aimed to study the difference in spatial temporal parameters of gait and patient reported functional measure in patients with end stage arthritis and no coronal plane deformity vs. varus deformity of >10? Methods: All patients diagnosed with end stage arthritis between April 2016 and December 2017 underwent an objective gait assessment using Tekscan system (BioSense Medicals, UK) as part of routine clinical practice. Of this cohort, patients with bilateral ankle arthritis, previous reconstructive surgery, inflammatory arthritis, hip and knee arthritis, spinal pathology and underlying neurological conditions were excluded. Patients with unilateral ankle arthritis for a diagnosis of osteoarthritis or post traumatic arthritis were included in this study. These patients were grouped into Group A (no coronal plane deformity) vs. Group B (varus deformity of more than 10?). In these patients differences were studied between the groups for temporal spatial parameters of gait and functional disability levels measured by MOX-FQ scores. Statistical tests included normality tests, student t’tests, chi square evaluation and analysis of variance tests with SPSS. Results: Of 33 patients, 22 were in Group A (N=22) and 10 in Group B (N=10). There was no difference in mean age between groups (61.5 vs. 65.07; p=0.335; diagnosis was predominantly OA in both groups MOX-FQ: - There were similar levels of pain (p=0.570), difficulty with walking / standing (p=0.492) and restriction in social activities (p=0.869) reported Quantitative gait measures: - For spatial parameters, there was no difference between groups; p>0.05. - For temporal parameters, there was decreased step time(s) (0.67 vs. 0.61) and mid stance times (0.38 s vs. 0.30 s) in Group B; borderline statistical significance (p=0.052). - There was increase in stride velocity measured in Group B (79.1 ± 22.7 m/s) compared to Group A (64.0 ± 18.1 m/s), (p=0.05). Conclusion: - Although there were no differences in functional levels of pain, difficulty with walking / standing and restriction in social activities, measured by MOX-FQ, there were differences observed in objective gait parameters. - Patients in both groups demonstrated antalgic gait patterns; this was slightly increased in varus group. - There is a trend for reduction in temporal parameters and stride velocity in patients with end stage ankle arthritis and coronal plane deformity >10?, when compared to patients with end stage arthritis and no coronal plane deformity - Larger clinical study with increased sample size is required to confirm these findings.

Functional impact of a new prosthetic foot design in transtibial amputation, a comparative study

Prosthetic feet designs are complex with energy storage and shock absorption characteristics. These feet store energy in the heel and the mid-foot during loading and release energy at push off. Device selection is based on subjective criteria because of a lack of quantitative methods. Studies have compared different prosthetic feet however, did not include functional outcome and rating for comfort. This study evaluated a new prosthetic foot (Pro-Flex XC TS and Pro-Flex LP TS) from Ossur. Prospective, comparative study that included 10 trans-tibial prosthetic users walking with current foot design vs. the Pro-Flex XC/LP TS outcomes included the Prostheses Evaluation Questionnaire, Socket Comfort Scale, 6 MWT Performance, L-Test, Activities-specific Balance Confidence Scale and temporal spatial parameters of gait measured with original prosthetic device and the test devices used for 4 weeks. With the Pro-Flex XC TS and Pro-Flex LP TS, most subjects demonstrated average 10% increase in walking velocity, improved scores in the PEQ and 15% increase walking capacity. Improved L test time and swing/stance ratio. Most had improvement in the ABC, with small non-significant decrease was reported in 4 subjects. The newly designed Pro-Flex XC TS and Pro-Flex LP TS foot produce improvement in walking and functional rating as well as benefits in self rated performance and stability. This new foot design should be considered as and excellent choice for patients with functional ambulatory category 2–4. Tests of function and satisfaction should be used in future prosthetic foot trials and included in foot prescription.

The effect of transverse prosthetic alignment changes on socket reaction moments during gait in individuals with transtibial amputation

BackgroundAlignment affects gait of individuals with transtibial prostheses. Sagittal and coronal alignment changes of the transtibial prostheses were demonstrated to affect socket reaction moments. However, the effects of transverse alignment changes on the socket reaction moments are not known. Research questionThe aim of this study was to investigate the effects of transverse alignment changes on the socket reaction moments and temporal-spatial parameters of gait in transtibial prostheses. MethodsThe effects of transverse prosthetic alignment changes (i.e. 10° and 5° of internal and external rotations: toe-in and toe-out of the foot relative to the socket from a baseline alignment) on the sagittal and coronal socket reaction moments and temporal-spatial parameters (gait speed, cadence and step width) while walking in 9 individuals with transtibial amputation were investigated using an instrumented prosthetic pyramid adaptor and a three-dimentional (3D) motion capture system. ResultsThe transverse alignment changes demonstrated significant effects on the socket reaction moments in the coronal plane at 5% (P = 0.04), 20% (P = 0.04) and 75% (P = 0.0001) of stance phase. No significant effects were found in the socket reaction moments in the sagittal plane and the temporal-spatial parameters. The internal and external rotations of the prosthetic feet may have opposite effect in early and mid- to late-stance potentially due to changes in the spatial position of the heel (rearfoot) and toe (forefoot) of the prosthetic foot relative to the socket. SignificanceTransverse alignment of the transtibial prostheses should be tuned not only considering the symmetry in toe-out angles of the feet, but also considering the potential effects of transverse alignment changes that may affect the coronal socket reaction moments.

A novel hinged ankle foot orthosis for gait performance in chronic hemiplegic stroke survivors: a feasibility study.

Stroke survivors with gait disturbances may use ankle foot orthoses (AFOs). However, most AFOs come in one-piece styles, which make it difficult for spasticity-affected stroke survivors to don. AFOs are also limited since they do not properly prevent ankle joint for foot drop by itself. Therefore, the present study developed a novel hinged AFO by adding a locking device to a hinged joint. We then tested its feasibility in 9 hemiplegic stroke survivors by investigating temporal-spatial gait parameters using the GAITRite in the following 3 conditions: no AFO, traditional AFO, and novel hinged AFO. There was no significant difference in spatiotemporal gait parameters among the different conditions. There were greater decreases in gait velocity, cadence, step length, and stride length in the novel hinged AFO group than in the no AFO and traditional AFO groups. This novel hinged AFO was developed to prevent foot drop. However, the AFO did not show significant differences in gait parameters because it consists of metal with extra weight and volume. Functionally, it prevented foot drop. It also improved convenience by its releasable design. Thus, further studies are needed to develop an AFO that improves gait and is convenient to use for hemiplegic stroke survivors.

Effects of backpack load on stair gait in young male adults

Backpack load has been found to be a potential risk factor for accidental falls during level walking. Stairs are considered one of the most hazardous locations in occupational settings, and falls often occur on stairs. However, how backpack load affects stair gait in young adults was still unknown. The objective of the present study was to reveal the effects of backpack load on stair gait in young male adults. Thirty male adults participated, and completed three ascent and three descent trials in the no load, low load, and high load conditions, respectively. Four categories of dependent measures were used to characterise stair gait, including lower limb and trunk kinematics, foot clearance measures, spatial-temporal gait parameters, and postural stability measures. We found that participants adjusted their postural control to compensate for the disturbance caused by backpack load and maintain their postural stability as in the no load condition. However, loaded participants may encounter increased risk of stair contact during ascent and increased risk of over-stepping during descent when passing over a step. These findings support that backpack load could be a risk factor for stair falls and imply that loaded people should pay more attention to the step when passing over it. Relevance to industryFindings from this study could aid in developing instructions for safe stair negotiation in occupational settings.

Increased double limb support times during walking in right limb dominant healthy older adults with low bone density

BackgroundOlder adults with low bone mineral density (BMD) may exhibit early markers for physical frailty; however, there is a lack of understanding of the dominant limb support patterns during walking. Research questionThe purpose of this study was to investigate limb support times during walking in healthy older adults with low BMD. MethodsSeventy-seven right limb dominant older adults (48 female subjects, 29 male subjects) participated in the study. Each participant's BMD (g/cm2) was measured by dual-energy x-ray absorptiometry (DEXA), and a motion capture system was utilized to measure temporal-spatial gait parameters (cadence, speed, stride length, and limb support times). The limb support times included initial double limb support (IDS), single limb support (SS), and terminal double limb support (TDS) in the stance phase. ResultsThose limb support times were significantly different (F = 44.28, p = 0.001) and demonstrated an interaction with dominance (F = 9.44, p = 0.003). In stance phase, the IDS was longer on the non-dominant limb (t = −3.07, p = 0.003); however, the TDS was significantly longer on the dominant limb (t = 3.07, p = 0.003). The stride length was longer on the dominant limb (t = 2.45, p = 0.02) and was positively associated with single limb support on the dominant limb (r = 0.34 p = 0.001) compared with the non-dominant limb (r = −0.29, p = 0.001). SignificanceThis longer stride length and single limb loading pattern on the dominant limb could increase asymmetrical balance in the stance phase. The gait modification strategies used to increase stride length on the non-dominant limb may allow for more functional symmetrical gait. Further investigation of asymmetric limb support patterns and gait modification strategies might be needed to enhance functional gait performance.

Dual-task Interference Disrupts Parkinson’s Gait Across Multiple Cognitive Domains

Gait dysfunction, a hallmark of Parkinson’s disease, contributes to a relatively high incidence of falling. Gait function is further diminished during the performance of a motor-cognitive task (i.e., dual-task). It is unclear if Parkinson’s disease-related dual-task deficits are related to a specific area of cognitive function or are the result of a more global decline in executive function. The aim of this project was to systematically evaluate gait performance to determine if gait dysfunction is restricted to certain types of executive function or a global phenomenon in individuals with Parkinson’s disease. Twenty-three individuals with mild-moderate Parkinson’s disease completed a series of dual-task conditions in which gait was paired with cognitive tasks requiring: working memory (0, 1, and 2-back), attention and problem solving (serial-7 subtraction), verbal memory (digit recall), semantic memory (Controlled Oral Word Association) and information processing speed (visual Stroop test). The results demonstrate that individuals with mild-moderate Parkinson’s disease have a generalized worsening of spatial–temporal gait parameters regardless of the specific cognitive demand being performed concurrently. Overall, gait velocity decreased (p < 0.01) and stride and stance time both increased (p < 0.01) across all cognitive conditions. The attention and problem solving task resulted in the greatest number of gait parameter decrements. Results indicated that performance on cognitive tasks remained unchanged from single-task to dual-task conditions. Diminished gait performance under dual-task conditions across different cognitive function domains suggests a global Parkinson’s disease-related deficit in information processing and regulation of gait.

The effects of an expected twofold perturbation on able-bodied gait: Trunk flexion and uneven ground surface

BackgroundAlthough alteration in trunk orientation and ground level potentially affects gait pattern individually, it is plausible to examine the interaction effects of such factors. ObjectiveThe interaction effects between trunk-flexed gait and uneven ground on able-bodied gait pattern. MethodsFor twelve able-bodied participants, we compared the adaptive mechanisms in kinematics, kinetics and spatial-temporal parameters of gait (STPG) with bent postures (30° and 50° of sagittal trunk flexion) across uneven surface (10-cm visible drop at the sight of the second ground contact) with that of upright posture on even ground surface. ResultsSignificant between-posture changes on the uneven surface included a decreased peak ankle dorsiflexion angle and vertical ground reaction force (GRF) 2nd peak as trunk flexion increased. Moreover, significant between-ground surface changes for each individual gait posture were a decreased peak ankle dorsiflexion angle and ankle range of motion irrespective of trunk posture and a reduced trailing step duration and vertical GRF 2nd peak in upright walking. The spatial parameters of gait remained unchanged across uneven surface, but at the expense of pronounced adjustments in temporal parameters, i.e., a more conservative gait strategy, indicating a distinct contribution from spatial and temporal strategies in trunk-flexed gaits. This was associated with greater peak flexion angles across lower limb joints regardless of trunk posture, alongside with an exertion of greater forces at faster rates earlier in stance and attenuated forces at lower rates at the end of the stance (i.e., early-skewed vertical GRF). When considering the main effect of posture, a more crouched gait was executed with reduced temporal parameters (except for cadence) and an early-skewed vertical GRF patterns with increasing trunk flexion. SignificanceThese results may have implications for understanding the nature of compensatory mechanisms in gait pattern of older adults and/or patients with altered trunk orientations while accommodating uneven ground.

The influence of motor ability rehabilitation on temporal-spatial parameters of gait in Huntington's disease patients on the basis of a three-dimensional motion analysis system: An experimental trial

ObjectiveThere is no existing standard, evidence-based, scientific model for motor ability improvement in Huntington's Disease (HD) patients aimed at maintaining independent gait for as long as possible, or performing activities of daily living, the effectiveness of which would be supported by the results of studies using objective research tools. Under these circumstances, the aim of this study was to analyze the influence of motor ability rehabilitation on the spatial-temporal parameters of gait in HD patients. DesignIt was an experimental trial. The studied group consisted of 30 patients (17 women and 13 men) with HD. In hospital conditions, the patients participated in the 3-week motor ability l rehabilitation programme tailored to individual needs. The study group was tested using the Vicon 250 three-dimensional gait analysis system before and after the physical exercise programme. ResultsWalking speed after therapy increased for the left lower limb from 1.06 (SD 0.24) [m/s] to 1.21 (SD 0.23) [m/s], and for the right lower limb from 1.07 (SD 0.25) [m/s] to 1.20 (SD 0.25) [m/s]. The cycle length increased after the applied therapy for the left lower limb from 1.17 (SD 0.20) [m] to 1.23 (SD 0.19) [m]. ConclusionThe three-week motor ability rehabilitation programme positively influences spatial-temporal gait parameters in HD patients.

Trunk rotation alters postural sway but not gait in female children and early adolescents: Results from a school-based screening for scoliosis

ObjectiveThe purpose of this study was to assess the influence of trunk rotation (TR) on postural sway and spatial-temporal parameters of gait in children and early adolescents screened at school for the presence of scoliosis. MethodsTwo hundred and fifty-five individuals aged 9–14 (141 boys, 114 girls) underwent trunk rotation (TR) assessment by means of angle of trunk rotation (ATR) measurements performed with Bunnell’s scoliometer. Participants with ATR ≥ 5° formed the TR group whose data were compared with those of a control group (CON) composed of individuals with ATR < 5° matched for age and anthropometric features. Postural sway was calculated on the basis of center of pressure (COP) time series acquired using a pressure plate. Spatial-temporal parameters of gait were derived from trunk accelerations collected by a single inertial sensor located in the low-back region. ResultsSway area, sway path, COP velocities in medio-lateral (ML) and antero-posterior (AP) directions and COP displacements in ML direction were found significantly higher in girls with TR, while no differences between the TR and CON groups were detected in boys. Both boys and girls with TR exhibited gait patterns similar to those of their CON schoolmates. ConclusionsThese findings suggest that even mild levels of TR may influence balance of female children and early adolescents screened for scoliosis, and thus early interventions including selective and task-oriented exercises appear advisable. In contrast, TR does not appear to influence gait, but further investigations are required to clarify whether different ATR cut-offs may reveal alterations of spatial-temporal parameters.

Improvement in Gait Pattern After Knee Arthroplasty Followed by Proprioceptive Neuromuscular Facilitation Physiotherapy.

The aim of the study was to assess the influence of a physiotherapy program based on proprioceptive neuromuscular facilitation (PNF) on kinematic gait pattern after total knee arthroplasty. This comparative study included two groups of patients qualified for total surgical knee joint replacement due to osteoarthritis: a study group and a control group, either consisting of 28 patients of a matched age range of 55-90years. Following surgery, 4days after standard postoperative rehabilitation, the study patients were subjected to a 3-week-long therapist-assisted rehabilitation based on PNF principles (10 sessions of 75min each), whereas control patients were discharged with instructions on how to exercise in the home setting. The outcome consisted of spatial-temporal gait parameters that were assessed at three time points: a day before surgery and then 1month and 6months after. The findings were that PNF caused substantial, sustained improvements in gait kinematics, shortening the stance phases, gait cycle duration, and double support phase and prolonging swing phase velocity, gait velocity, cadence, step length, and gait cycle length. Also, postsurgical pain was evidently less. We conclude that the individually tailored PNF rehabilitation program is superior compared to a standard recommendation of home-based physiotherapy in terms of improving gait kinematic pattern as well as psychological aspects related to pain perception in patients after knee arthroplasty.

Artificial Walking Technologies to Improve Gait in Cerebral Palsy: Multichannel Neuromuscular Stimulation.

Cerebral palsy (CP) is the most common childhood motor disability and often results in debilitating walking abnormalities, such as flexed-knee and stiff-knee gait. Current medical and surgical treatments are only partially effective in improving gait abnormalities and may cause significant muscle weakness. However, emerging artificial walking technologies, such as step-initiated, multichannel neuromuscular electrical stimulation (NMES), can substantially improve gait patterns and promote muscle strength in children with spastic CP. NMES may also be applied to specific lumbar-sacral sensory roots to reduce spasticity. Development of tablet computer-based multichannel NMES can leverage lightweight, wearable wireless stimulators, advanced control design, and surface electrodes to activate lower-limb muscles. Musculoskeletal models have been used to characterize muscle contributions to unimpaired gait and identify high muscle demands, which can help guide multichannel NMES-assisted gait protocols. In addition, patient-specific NMES-assisted gait protocols based on 3D gait analysis can facilitate the appropriate activation of lower-limb muscles to achieve a more functional gait: stance-phase hip and knee extension and swing-phase sequence of hip and knee flexion followed by rapid knee extension. NMES-assisted gait treatment can be conducted as either clinic-based or home-based programs. Rigorous testing of multichannel NMES-assisted gait training protocols will determine optimal treatment dosage for future clinical trials. Evidence-based outcome evaluation using 3D kinematics or temporal-spatial gait parameters will help determine immediate neuroprosthetic effects and longer term neurotherapeutic effects of step-initiated, multichannel NMES-assisted gait in children with spastic CP. Multichannel NMES is a promising assistive technology to help children with spastic CP achieve a more upright, functional gait.

P.223 - Postural and gait patterns assessed by 3D movement analysis in a late onset Pompe disease sibship

Late onset Pompe disease (LOPD) is characterized by significant motor disabilities, which affect in particular ambulation. Only one study reports on spatial-temporal parameters of gait assessed in a clinical heterogeneous group of unrelated patients. In this study spatiotemporal and kinematic gait patterns are described in a genetically homogenous group of LOPD patients using 3d movement analysis. 7 LOPD siblings, harbouring the same GAA mutations compound, were assessed with clinical scales and with 3d movement analysis to measure spatial-temporal and kinematic parameters during gait cycle and “sit to stand test”. Relevant abnormalities were observed either in spatial-temporal and kinematic parameters. The former consisted in a trend towards a decreased velocity and cadence, a prolonged time in double limb support, shorter step and stride length, and a widening of base of support; the latter in an increased anterior pelvic-tilt and posterior trunk-tilt during the whole gait cycle, a decreased pelvic obliquity, active hip extension and ankle dorsiflexion. This study shows, in homogenous group of LOPD patients, either spatial-temporal and kinematic deviations that may improve understanding of the musculoskeletal alterations, the evolution of disease and the answer to the enzyme replacement therapy.

Acute effects of anesthetic lumbar spine injections on temporal spatial parameters of gait in individuals with chronic low back pain: A pilot study

This study examined whether epidural injection-induced anesthesia acutely and positively affected temporal spatial parameters of gait in patients with chronic low back pain (LBP) due to lumbar spinal stenosis. Twenty-five patients (61.7±13.6years) who were obtaining lumbar epidural injections for stenosis-related LBP participated. Oswestry Disability Index (ODI) scores, Medical Outcomes Short Form (SF-36) scores, 11-point Numerical pain rating (NRSpain) scores, and temporal spatial parameters of walking gait were obtained prior to, and 11-point Numerical pain rating (NRSpain) scores, and temporal spatial parameters of walking gait were obtained after the injection. Gait parameters were measured using an instrumented gait mat. Patients received transforaminal epidural injections in the L1-S1 vertebral range (1% lidocaine, corticosteroid) under fluoroscopic guidance. Patients with post-injection NRSpain ratings of “0” or values greater than “0” were stratified into two groups: 1) full pain relief, or 2) partial pain relief, respectively. Post-injection, 48% (N=12) of patients reported full pain relief. ODI scores were higher in patients with full pain relief (55.3±21.4 versus 33.7 12.8; p=0.008). Post-injection, stride length and step length variability were significantly improved in the patients with full pain relief compared to those with partial pain relief. Effect sizes between full and partial pain relief for walking velocity, step length, swing time, stride and step length variability were medium to large (Cohen’s d>0.50). Patients with LBP can gain immediate gait improvements from complete pain relief from transforaminal epidural anesthetic injections for LBP, which could translate to better stability and lower fall risk.

Effect of Wii Fit™ exercise therapy on gait parameters in ankle sprain patients: A randomized controlled trial

Ankle sprains are the most common sport related injuries. An alternative to physical therapy in the treatment of ankle sprains is home based exercise therapy.This study aims to compare the effectiveness of Wii Fit™ exercise therapy in ankle sprain patients on temporal-spatial and kinematic gait parameters with a) conventional therapy and b) a control group not receiving exercise therapy.Ninety patients were randomly assigned to a Wii Fit™, physical therapy or control group. Temporal-spatial and kinematic gait parameters were assessed at baseline, 6 weeks and 6 months follow-up.All groups improved gait speed, cadence and step length between baseline and 6-week follow-up (P<0.036). Single support time improved only in the Wii Fit™ group (P<0.001). Symmetry index of the single support time improved in the Wii Fit™ group and physical therapy group (P<0.048). No between-group differences were found for temporal-spatial gait parameters (P>0.050). Maximum plantar flexion improved in the physical therapy and control group between baseline and 6-week follow-up (P<0.035). However, none of the groups improved dorsiflexion (P>0.050).In conclusion, an unsupervised home-based 6-week Wii Fit™ exercise therapy can be applied in ankle sprain patients. However, it was not more effective compared to physical therapy or no exercise therapy at all.