Spatiotemporal Gait Characteristics Research Articles

Reduced Short-Latency Afferent Inhibition in Parkinson's Disease Patients with L-dopa-Unresponsive Freezing of Gait.

Freezing of gait (FOG) in Parkinson's disease (PD), especially the "L-dopa-unresponsive" subtype, is associated with the dysfunction of non-dopaminergic circuits. We sought to determine whether cortical sensorimotor inhibition evaluated by short-latency afferent inhibition (SAI) related to cholinergic and gamma-aminobutyric acid (GABA)-ergic activities is impaired in PD patients with L-dopa-unresponsive FOG (ONOFF-FOG). SAI protocol was performed in 28 PD patients with ONOFF-FOG, 15 PD patients with "off" FOG (OFF-FOG), and 25 PD patients without FOG during medication "on" state. Additionally, 10 ONOFF-FOG patients underwent SAI testing during both "off" and "on" states. Twenty healthy controls participated in this study. Gait was measured objectively using a portable Inertial Measurement Unit system, and participants performed 5-meter Timed Up and Go single- and dual-task conditions. Spatiotemporal gait characteristics and their variability were determined. FOG manifestations and cognition were assessed with clinical scales. Compared to controls, PD patients without FOG and with OFF-FOG, ONOFF-FOG PD patients showed significantly reduced SAI. Further, dopaminergic therapy had no remarkable effect on this SAI alterations in ONOFF-FOG. Meanwhile, OFF-FOG patients presented decreased SAI only relative to controls. PD patients with ONOFF-FOG exhibited decreased gait speed, stride length, and increased gait variability relative to PD patients without FOG and controls under both walking conditions. For ONOFF-FOG patients, significant associations were found between SAI and FOG severity, gait characteristics and variability. Reduced SAI was associated with severe FOG manifestations, impaired gait characteristics and variability in PD patients with ONOFF-FOG, suggesting the impaired thalamocortical cholinergic-GABAergic SAI pathways underlying ONOFF-FOG.

OA-Pain-Sense: Machine Learning Prediction of Hip and Knee Osteoarthritis Pain from IMU Data

Joint pain is a prominent symptom of Hip and Knee Osteoarthritis (OA), impairing patients’ movements and affecting the joint mechanics of walking. Self-report questionnaires are currently the gold standard for Hip OA and Knee OA pain assessment, presenting several problems, including the fact that older individuals often fail to provide accurate self-pain reports. Passive methods to assess pain are desirable. This study aims to explore the feasibility of OA-Pain-Sense, a passive, automatic Machine Learning-based approach that predicts patients’ self-reported pain levels using SpatioTemporal Gait features extracted from the accelerometer signal gathered from an anterior-posterior wearable sensor. To mitigate inter-subject variability, we investigated two types of data rescaling: subject-level and dataset-level. We explored six different binary machine learning classification models for discriminating pain in patients with Hip OA or Knee OA from healthy controls. In rigorous evaluation, OA-Pain-Sense achieved an average accuracy of 86.79% using the Decision Tree and 83.57% using Support Vector Machine classifiers for distinguishing Hip OA and Knee OA patients from healthy subjects, respectively. Our results demonstrate that OA-Pain-Sense is feasible, paving the way for the development of a pain assessment algorithm that can support clinical decision-making and be used on any wearable device, such as smartphones.

Divided Attention Alters Trailing Limb Stepping activity– A Dual-task Study

<h3>Research Objectives</h3> To investigate the changes of lower extremity joint kinematics and gait characteristics of the trailing leg during the dual-task obstacle crossing task (OCT). <h3>Design</h3> Observational study from a healthy cohort. <h3>Setting</h3> Hospital and research institute setting. <h3>Participants</h3> Nine young healthy participants (4 females and 5 males; age:27.8±4.1 years old) were recruited from University of Kansas Medical Center following the volunteer sample selection procedure. Key eligibility criteria included: (1) be able to independently walk for 30 minutes; (2) no neurological disorders that cause postural instability; (3) no recent (< 6 months) lower extremity fracture. <h3>Interventions</h3> Participants were instructed to walk on the instrumented C-Mill VR treadmill (Motek, the Netherlands) and step over obstacle images projected on the treadmill belt using right legs as leading legs. During the dual-task OCT, an auditory Stroop test was administered concurrently. Eight-sensor APDM Moveo Explorer system (Portland, OR) was used to collect the trailing leg's joint kinematics and spatiotemporal gait characteristics. <h3>Main Outcome Measures</h3> The trailing leg's joint angles and spatiotemporal characteristics while stepping over the obstacle in a single- and dual- task condition were measured. We hypothesized that both joint angles and characteristics would be significantly altered in the dual-task setting. <h3>Results</h3> The maximal knee extension was significantly decreased. The double-support time was significantly extended while the stride length was significantly decreased. There has a trending that the height of foot elevation at mid-swing phase of stepping was decreased (ρ = 0.07). <h3>Conclusions</h3> Our hypothesis was supported through the decreased knee extension, stride length and increased double-support time. Future studies are warranted to identify trailing leg's stepping strategies among aging or neurodegenerative populations. <h3>Author(s) Disclosures</h3> No conflict of interests was disclosed in this study.

Brain activity response to cues during gait in Parkinson's disease: A study protocol.

Various cueing strategies (internal and external) have been used to alleviate gait deficits in Parkinson's disease (PD). However, it remains unclear which type of cueing strategy is most effective at different disease stages or with more severe walking impairment, such as freezing of gait (FOG). The underlying neural mechanisms of response to cueing are also unknown. This trial aims to: (i) determine brain activity response to cue stimulus (internal, visual, auditory or tactile) when walking in PD and; (ii) examine changes in brain activity to cues at different stages of PD. This ongoing single-site study uses an exploratory observational design, with laboratory application of cues for gait deficit. A total of 80 people with PD who meet the inclusion criteria will be enrolled. Participants are split into groups dependent on their disease stage (classified with the Hoehn and Yahr (H&amp;Y) scale); n = 20 H&amp;YI; n = 30 H&amp;YII; n = 30 H&amp;YIII. Within the H&amp;Y stage II and III groups, we will also ensure recruitment of a sub-group of 15 individuals with FOG within each group. Participants perform walking tasks under several conditions: baseline walking without cues; randomized cued walking conditions [internal and external (visual, auditory and tactile) cues]. A combined functional near-infrared spectroscopy and electroencephalography system quantifies cortical brain activity while walking. Inertial sensors are used to assess gait. Primary outcome measures are cue-related changes in cortical brain activity while walking, including the relative change in cortical HbO2 and the power spectral densities at alpha (8-13Hz), beta (13-30Hz), delta (0.5-4Hz), theta (4-8Hz) and gamma (30-40Hz) frequency bandwidths. Secondary outcome measures are cue-related changes in spatiotemporal gait characteristics. Findings will enhance our understanding about the cortical responses to different cueing strategies and how they are influenced by PD progression and FOG status. This trial is registered at clinicaltrials.gov (NCT04863560; April 28, 2021, https://clinicaltrials.gov/ct2/show/NCT04863560).

The Effect of Resist and Assist Torque of Hip Joint Motor-based Gait Assistance Robot on Gait Function in the Elderly

OBJECTIVES The purpose of this study was to investigate the effects of assist and resistance torque on the spatiotemporal gait characteristics, and the symmetry and asymmetry of gait using a Gait Enhancing and Motivating System (GEMS) in the elderly.METHODS A cross-sectional and repeated measure design was used. A total of 18 participants (9 males, 9 females; age: 63.5 ± 5.02 years; mass: 64.26 ± 6.87 kg; height: 164.06 ± 7.15 cm) were recruited from a local community, and spatiotemporal gait data were collected with OptoGait system and GEMS. Spatiotemporal gait variables and differences between the dominant and non-dominant legs of these variables were assessed (step length, step time, stance phase, swing phase, single support, load response, pre swing phase, stride time, stride length, double support, cadence, and gait speed). The effects of three modes including normal, assist, and resist modes using GEMS were investigated twice for each participant on a 9-meter walkway. A one-way repeated measure analysis of variance followed by Bonferroni post-hoc tests was conducted.RESULTS The assist mode increased step time, swing phase, stride time and reduced stance phase, pre-swing phase, double support, cadence, and gait speed as compared to normal mode. The resist mode increased stance phase, load response, pre-swing phase, double support, cadence, and reduced step time, swing phase, and stride time. In dominant leg, assist mode showed increased step time and reduced pre-swing phase than normal mode, and greater step time than resist mode (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). However, there was no effect of external torque on symmetry and asymmetry between both legs (&lt;i&gt;p&lt;/i&gt; &gt; 0.05).CONCLUSIONS The resistance and assist torque of GEMS alter spatiotemporal characteristics during the stance and swing phase of gait in the elderly. However, the resistance torque and assist torque of GEMS did not increase or decrease the gait asymmetry between the dominant and non-dominant legs.

Spatiotemporal characteristics of gait in partial foot amputation versus peripheral neuropathy

Background: Partial foot amputation (PFA) is defined as a surgical loss of part of either the forefoot or mid-foot. It is usually secondary to physiological foot dysfunctions such as peripheral neuropathy (PN). The effect of amputation on spatiotemporal characteristics of gait in patients with PFA secondary to PN is still not well established yet Purpose: The aim of the study was to evaluate the effect of PFA on characteristics of gait in patients with PFA secondary to PN compared to PN patients without amputation. Methods: Cadence, stance, swing, double limb support, stride time, step length, and stride length were assessed for 53 participants divided into two groups; (A) PFA group: 25 subjects with healed unilateral PFA and (B) PN Groups: 28 subjects with PN with neither ulcer nor amputation. The gait analysis was conducted at a self-selected speed using the STT three-dimensional motion analysis system. Results: The MANOVA main effect revealed no significant difference between the two groups (p = 0.102). The post hoc test revealed no significant difference between the two groups in all spatiotemporal variables (p &gt; 0.05). Conclusion: Both groups walked at a slow cadence, taking short steps with increased percentage of stance and double limb support.

Immediate effects of the honda walking assist on spatiotemporal gait characteristics in individuals after stroke

The use of unconstrained lower limb exoskeletons has become a promising approach to assist individuals with gait impairments. The Honda Walking Assist (HWA) is a hip-assistive exoskeleton functioning as a gait trainer and has been shown to improve several gait related outcomes after training. Studies investigating its immediate effects on spatiotemporal gait parameters other than walking speed in stroke survivors are lacking. The aim of this study was to investigate immediate differences in spatiotemporal gait parameters of stroke survivors between normal overground walking, walking with an unpowered, non-assisting HWA and walking with an optimally assisting HWA. Five ischemic stroke survivors (mean time since stroke 115 ​± ​213.6 days) walked 3 times 5 ​m in each condition. Differences in 14 spatiotemporal gait parameters between all 3 conditions were registered and reported in a descriptive manner. With optimal assistance, 4 patients walked faster (0.057–0.095 ​m/s) with longer strides of the paretic (0.055–0.069 ​m) and non-paretic (0.053–0.077 ​m) leg compared to normal walking. Compared to unpowered walking, all patients walked faster (0.020–0.063 ​m/s) in the optimal assist condition, with longer strides of the paretic (0.036–0.072 ​m) and non-paretic leg (0.045–0.082 ​m). During unpowered walking, gait velocity remained unchanged in 2 patients, increased (0.012–0.051 ​m/s) in 2 patients and decreased (−0.022 ​m/s) in 1 patient compared to normal walking. Changes in paretic stride lengths ranged from −0.066 to 0.029 ​m. The optimal individualized motor assistance provided by the HWA induces small, positive changes in gait parameters. This indicates that this light-weight hip-assistive exoskeleton can be of value in rehabilitation setting, where multiple training sessions with the device are possible.

Stable Sparse Classifiers predict cognitive impairment from gait patterns.

BackgroundAlthough gait patterns disturbances are known to be related to cognitive decline, there is no consensus on the possibility of predicting one from the other. It is necessary to find the optimal gait features, experimental protocols, and computational algorithms to achieve this purpose.PurposesTo assess the efficacy of the Stable Sparse Classifiers procedure (SSC) for discriminating young and healthy older adults (YA vs. HE), as well as healthy and cognitively impaired elderly groups (HE vs. MCI-E) from their gait patterns. To identify the walking tasks or combinations of tasks and specific spatio-temporal gait features (STGF) that allow the best prediction with SSC.MethodsA sample of 125 participants (40 young- and 85 older-adults) was studied. They underwent assessment with five neuropsychological tests that explore different cognitive domains. A summarized cognitive index (MDCog), based on the Mahalanobis distance from normative data, was calculated. The sample was divided into three groups (young adults, healthy and cognitively impaired elderly adults) using k-means clustering of MDCog in addition to Age. The participants executed four walking tasks (normal, fast, easy- and hard-dual tasks) and their gait patterns, measured with a body-fixed Inertial Measurement Unit, were used to calculate 16 STGF and dual-task costs. SSC was then employed to predict which group the participants belonged to. The classification's performance was assessed using the area under the receiver operating curves (AUC) and the stable biomarkers were identified.ResultsThe discrimination HE vs. MCI-E revealed that the combination of the easy dual-task and the fast walking task had the best prediction performance (AUC = 0.86, sensitivity: 90.1%, specificity: 96.9%, accuracy: 95.8%). The features related to gait variability and to the amplitude of vertical acceleration had the largest predictive power. SSC prediction accuracy was better than the accuracies obtained with linear discriminant analysis and support vector machine classifiers.ConclusionsThe study corroborated that the changes in gait patterns can be used to discriminate between young and healthy older adults and more importantly between healthy and cognitively impaired adults. A subset of gait tasks and STGF optimal for achieving this goal with SSC were identified, with the latter method superior to other classification techniques.

Coordination variability reduced for soccer players compared to non-athletes during the stance phase of gait.

Soccer is a unilateral sports activity that may alter the spatiotemporal characteristics of gait. This may alter motor control of gait in the dominant leg in soccer players and lead to a sport-specific gait pattern, which has not yet been considered. We aimed to determine whether soccer players exhibit differences in the lower extremity coupling variability during gait compared to healthy non-athletes. Hip, knee, and ankle joint angles from fourteen soccer players and sixteen controls were acquired during treadmill walking. Hip-knee coupling, knee-ankle coupling and coupling angle variability (CAV) of the right leg in the sagittal plane were assessed using a vector coding technique. Soccer players showed reduced hip-knee CAV during the mid-stance and terminal-stance phases of gait compared to the control group (P<inf>adj</inf> =0.04 and P<inf>adj</inf> <0.001, respectively). In addition, soccer players less often used an ankle coordination pattern, in which only the ankle joint but not the knee joint rotates (P<inf>adj</inf> =0.01). In summary, soccer players show altered gait dynamics during normal walking, possibly due to intense soccer training. These changes provide evidence of adaptive strategies of the motor control system to sports activities that can be used for gait rehabilitation. Clinicians should note that some sport, such as soccer, may result in sport-specific gait patterns However, further works are needed to confirm this finding.

Utilizing Spatio Temporal Gait Pattern and Quadratic SVM for Gait Recognition

This study aimed to develop a vision-based gait recognition system for person identification. Gait is the soft biometric trait recognizable from low-resolution surveillance videos, where the face and other hard biometrics are not even extractable. The gait is a cycle pattern of human body locomotion that consists of two sequential phases: swing and stance. The gait features of the complete gait cycle, referred to as gait signature, can be used for person identification. The proposed work utilizes gait dynamics for gait feature extraction. For this purpose, the spatio temporal power spectral gait features are utilized for gait dynamics captured through sub-pixel motion estimation, and they are less affected by the subject’s appearance. The spatio temporal power spectral gait features are utilized for a quadratic support vector machine classifier for gait recognition aiming for person identification. Spatio temporal power spectral preserves the spatiotemporal gait features and is adaptable for a quadratic support vector machine classifier-based gait recognition across different views and appearances. We have evaluated the gait features and support vector machine classifier-based gait recognition on a locally collected gait dataset that captures the effect of view variance in high scene depth videos. The proposed gait recognition technique achieves significant accuracy across all appearances and views.

Gait Characteristics and Cognitive Function in Middle-Aged Adults with and without Type 2 Diabetes Mellitus: Data from ENBIND.

Type 2 Diabetes Mellitus (T2DM) in midlife is associated with a greater risk of dementia in later life. Both gait speed and spatiotemporal gait characteristics have been associated with later cognitive decline in community-dwelling older adults. Thus, the assessment of gait characteristics in uncomplicated midlife T2DM may be important in selecting-out those with T2DM at greatest risk of later cognitive decline. We assessed the relationship between Inertial Motion Unit (IMUs)-derived gait characteristics and cognitive function assessed via Montreal Cognitive Assessment (MoCA)/detailed neuropsychological assessment battery (CANTAB) in middle-aged adults with and without uncomplicated T2DM using both multivariate linear regression and a neural network approach. Gait was assessed under (i) normal walking, (ii) fast (maximal) walking and (iii) cognitive dual-task walking (reciting alternate letters of the alphabet) conditions. Overall, 138 individuals were recruited (n = 94 with T2DM; 53% female, 52.8 ± 8.3 years; n = 44 healthy controls, 43% female, 51.9 ± 8.1 years). Midlife T2DM was associated with significantly slower gait velocity on both slow and fast walks (both p < 0.01) in addition to a longer stride time and greater gait complexity during normal walk (both p < 0.05). Findings persisted following covariate adjustment. In analyzing cognitive performance, the strongest association was observed between gait velocity and global cognitive function (MoCA). Significant associations were also observed between immediate/delayed memory performance and gait velocity. Analysis using a neural network approach did not outperform multivariate linear regression in predicting cognitive function (MoCA) from gait velocity. Our study demonstrates the impact of uncomplicated T2DM on gait speed and gait characteristics in midlife, in addition to the striking relationship between gait characteristics and global cognitive function/memory performance in midlife. Further studies are needed to evaluate the longitudinal relationship between midlife gait characteristics and later cognitive decline, which may aid in selecting-out those with T2DM at greatest-risk for preventative interventions.

Levodopa ONOFF-state freezing of gait: Defining the gait and non-motor phenotype.

Freezing in the levodopa-medicated-state (ON-state) is a debilitating feature of Parkinson's disease without treatment options. Studies detailing the distinguishing features between people with freezing of gait that improves with levodopa and those whose freezing continues even on levodopa are lacking. To characterize the gross motor, gait, and non-motor features of this phenotype. Instrumented continuous gait was collected in the levodopa-medicated-state in 105 patients: 43 non-freezers (no-FOG), 36 with freezing only OFF-levodopa (OFF-FOG) and 26 with freezing both ON- and OFF-levodopa (ONOFF-FOG). Evaluation of motor and non-motor disease features was undertaken using validated scales. A linear mixed model with age, sex, disease duration, and motor UPDRS scores as covariates was used to determine differences in spatiotemporal gait and non-motor disease features among the groups. Compared to OFF-FOG, the ONOFF-FOG group had greater disease severity (on the Unified Parkinson's disease Rating Scale) and worse cognition (on the Montreal Cognitive Assessment, Frontal Assessment Battery and Scales for Outcome in Parkinson's disease-Cognition scales) and quality of life (on the PDQ-39), but similar mood (on the Hamilton depression and anxiety scales) and sleep quality (on Epworth sleepiness scale and RBD questionnaire). For several gait features, differences between the ONOFF-OFF groups were at least as large and in the opposite direction as differences between OFF-no groups, controlling for disease severity. Variability in ONOFF-FOG was greater than in other groups. Using results from our study and others, a power analysis for a potential future study reveals sample sizes of at least 80 ONOFF and 80 OFF-FOG patients would be needed to detect clinically meaningful differences. Intra-patient variability in spatiotemporal gait features was much greater in ONOFF-FOG than in the other two groups. Our results suggest that multifactorial deficits may lead to ONOFF-FOG development.

Walking and Balance Outcomes Are Improved Following Brief Intensive Locomotor Skill Training but Are Not Augmented by Transcranial Direct Current Stimulation in Persons With Chronic Spinal Cord Injury.

Motor training to improve walking and balance function is a common aspect of rehabilitation following motor-incomplete spinal cord injury (MISCI). Evidence suggests that moderate- to high-intensity exercise facilitates neuroplastic mechanisms that support motor skill acquisition and learning. Furthermore, enhancing corticospinal drive via transcranial direct current stimulation (tDCS) may augment the effects of motor training. In this pilot study, we investigated whether a brief moderate-intensity locomotor-related motor skill training (MST) circuit, with and without tDCS, improved walking and balance outcomes in persons with MISCI. In addition, we examined potential differences between within-day (online) and between-day (offline) effects of MST. Twenty-six adults with chronic MISCI, who had some walking ability, were enrolled in a 5-day double-blind, randomized study with a 3-day intervention period. Participants were assigned to an intensive locomotor MST circuit and concurrent application of either sham tDCS (MST+tDCSsham) or active tDCS (MST+tDCS). The primary outcome was overground walking speed measured during the 10-meter walk test. Secondary outcomes included spatiotemporal gait characteristics (cadence and stride length), peak trailing limb angle (TLA), intralimb coordination (ACC), the Berg Balance Scale (BBS), and the Falls Efficacy Scale-International (FES-I) questionnaire. Analyses revealed a significant effect of the MST circuit, with improvements in walking speed, cadence, bilateral stride length, stronger limb TLA, weaker limb ACC, BBS, and FES-I observed in both the MST+tDCSsham and MST+tDCS groups. No differences in outcomes were observed between groups. Between-day change accounted for a greater percentage of the overall change in walking outcomes. In persons with MISCI, brief intensive MST involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes, and selected strength and balance outcomes; however, concurrent application of tDCS did not further enhance the effects of MST.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT03237234].

Prediction of Disorientation by Accelerometric and Gait Features in Young and Older Adults Navigating in a Virtually Enriched Environment

ObjectiveTo determine whether gait and accelerometric features can predict disorientation events in young and older adults.MethodsCognitively healthy younger (18–40 years, n = 25) and older (60–85 years, n = 28) participants navigated on a treadmill through a virtual representation of the city of Rostock featured within the Gait Real-Time Analysis Interactive Lab (GRAIL) system. We conducted Bayesian Poisson regression to determine the association of navigation performance with domain-specific cognitive functions. We determined associations of gait and accelerometric features with disorientation events in real-time data using Bayesian generalized mixed effect models. The accuracy of gait and accelerometric features to predict disorientation events was determined using cross-validated support vector machines (SVM) and Hidden Markov models (HMM).ResultsBayesian analysis revealed strong evidence for the effect of gait and accelerometric features on disorientation. The evidence supported a relationship between executive functions but not visuospatial abilities and perspective taking with navigation performance. Despite these effects, the cross-validated percentage of correctly assigned instances of disorientation was only 72% in the SVM and 63% in the HMM analysis using gait and accelerometric features as predictors.ConclusionDisorientation is reflected in spatiotemporal gait features and the accelerometric signal as a potentially more easily accessible surrogate for gait features. At the same time, such measurements probably need to be enriched with other parameters to be sufficiently accurate for individual prediction of disorientation events.

Gait‐Related Metabolic Covariance Networks at Rest in Parkinson's Disease

BackgroundGait impairments are characteristic motor manifestations and significant predictors of poor quality of life in Parkinson's disease (PD). Neuroimaging biomarkers for gait impairments in PD could facilitate effective interventions to improve these symptoms and are highly warranted.ObjectiveThe aim of this study was to identify neural networks of discrete gait impairments in PD.MethodsFifty‐five participants with early‐stage PD and 20 age‐matched healthy volunteers underwent quantitative gait assessment deriving 12 discrete spatiotemporal gait characteristics and [18F]‐2‐fluoro‐2‐deoxyglucose‐positron emission tomography measuring resting cerebral glucose metabolism. A multivariate spatial covariance approach was used to identify metabolic brain networks that were related to discrete gait characteristics in PD.ResultsIn PD, we identified two metabolic gait‐related covariance networks. The first correlated with mean step velocity and mean step length (pace gait network), which involved relatively increased and decreased metabolism in frontal cortices, including the dorsolateral prefrontal and orbital frontal, insula, supplementary motor area, ventrolateral thalamus, cerebellum, and cuneus. The second correlated with swing time variability and step time variability (temporal variability gait network), which included relatively increased and decreased metabolism in sensorimotor, superior parietal cortex, basal ganglia, insula, hippocampus, red nucleus, and mediodorsal thalamus. Expression of both networks was significantly elevated in participants with PD relative to healthy volunteers and were not related to levodopa dosage or motor severity.ConclusionsWe have identified two novel gait‐related brain networks of altered glucose metabolism at rest. These gait networks could serve as a potential neuroimaging biomarker of gait impairments in PD and facilitate development of therapeutic strategies for these disabling symptoms. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Study protocol of a randomised controlled trial for the effectiveness of a functional partial body weight support treadmill training (FPBWSTT) on motor and functional skills of children with ataxia

IntroductionA great heterogeneity characterises the paediatric population with ataxia, which has been studied poorly. The lack of postural control and coordination, in addition with features of the ‘ataxic’ gait are...

Effect of Treadmill Training Interventions on Spatiotemporal Gait Parameters in Older Adults with Neurological Disorders: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objective: Treadmill interventions have been shown to promote ‘normal’ walking patterns, as they facilitate the proper movement and timing of the lower limbs. However, prior reviews have not examined which intervention provides the most effective treatment of specific gait impairments in neurological populations. The objective of this systematic review was to review and quantify the changes in gait after treadmill interventions in adults with neurological disorders. Data Sources: A keyword search was performed in four databases: PubMed, CINAHL, Scopus, and Web of Science (January 2000–December 2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods. Study Selection: Studies were thoroughly screened using the following inclusion criteria: study design: Randomized Controlled Trial (RCT); adults ≥55 years old with a neurological disorder; treadmill intervention; spatiotemporal gait characteristics; and language: English. Data Extraction: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters including stride length, stride time, step length, step width, step time, stance time, swing time, single support time, double support time, or cadence. Data Synthesis: We found a total of 32 studies to be included in our systematic review through keyword search, out of which 19 studies included adults with stroke and 13 studies included adults with PD. We included 22 out of 32 studies in our meta-analysis that examined gait in adults with neurological disorders, which only yielded studies including Parkinson’s disease (PD) and stroke patients. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was >50% (denoted by I2), random plot analysis was used, otherwise, a fixed plot analysis was performed. All analyses used effect sizes and standard errors and a p < 0.05 threshold was considered statistically significant (denoted by *). Overall, the effect of treadmill intervention on cadence (z = 6.24 *, I2 = 11.5%) and step length (z = 2.25 *, I2 = 74.3%) in adults with stroke was significant. We also found a significant effect of treadmill intervention on paretic step length (z = 2.34 *, I2 = 0%) and stride length (z = 6.09 *, I2 = 45.5%). For the active control group, including adults with PD, we found that overground physical therapy training had the largest effect on step width (z = −3.75 *, I2 = 0%). Additionally, for PD adults in treadmill intervention studies, we found the largest significant effect was on step length (z = 2.73 *, I2 = 74.2%) and stride length (z = −2.54 *, I2 = 96.8%). Conclusion: Treadmill intervention with sensory stimulation and body weight support treadmill training were shown to have the largest effect on step length in adults with PD and stroke.

Ankle-Injury Patients Perform More Microadjustments during Walking: Evidence from Velocity Profiles in Gait Analysis.

Introduction We evaluated the velocity profiles of patients with lateral collateral ligament (LCL) injuries of the ankle with a goal of understanding the control mechanism involved in walking. Methods We tracked motions of patients' legs and feet in 30 gait cycles recorded from patients with LCL injuries of the ankle and compared them to 50 gait cycles taken from normal control subjects. Seventeen markers were placed on the foot following the Heidelberg foot measurement model. Velocity profiles and microadjustments of the knee, ankle, and foot were calculated during different gait phases and compared between the patient and control groups. Results Patients had a smaller first rocker percentage and larger second rocker percentage in the gait cycle compared to controls. Patients also displayed shorter stride length and slower strides and performed more microadjustments in the second rocker phase than in other rocker/swing phases. Patients' mean velocities of the knee, ankle, and foot in the second rocker phase were also significantly higher than that in control subjects. Discussion. Evidence from velocity profiles suggested that patients with ligament injury necessitated more musculoskeletal microadjustments to maintain body balance, but these may also be due to secondary injury. Precise descriptions of the spatiotemporal gait characteristics are therefore crucial for our understanding of movement control during locomotion.

Spatio-temporal gait differences in Facioscapulohumeral muscular dystrophy during single and dual task overground walking - A pilot study

Facioscapulohumeral muscular dystrophy (FSHD) is a rare genetic muscle disorder leading to progressive muscle loss over time. Research indicates that this progressive muscular atrophy can negatively impact spatio-temporal gait characteristics, but this is not always the case during early-onset or mild cases of the disease. In addition, the performance of a secondary task during overground walking may elucidate greater deficits in spatio-temporal characteristics of gait. However, such dual task effects on FSHD gait have not been studied thus far. The current study aimed to (a) quantify changes in spatio-temporal gait parameters in individuals with FSHD using the Tekscan Strideway gait mat system, (b) measure the dual task (DT) effects on cadence and gait velocity during single task (ST) and DT overground walking in FSHD and healthy controls and (c) investigate the correlation between the gait parameters and the methylation status in FSHD. Nine FSHD (M±SD=52.78±14.69 years) and nine nearly matched healthy controls (M±SD=50.11±16.18 years) performed five ST and five DT walking in a pseudo-randomized order. The DT included a serial 7's subtraction task from a random number between 50 and 100. Dependent variables: Cadence (steps/min) and gait velocity (cm/sec) were obtained from Tekscan Strideway (30 Hz, Boston, MA). The pairwise comparison indicated that cadence was significantly different for both ST (P<0.004) and DT (P<0.02) where FSHD showed lower cadence compared to controls. Gait velocity was also significantly lower for FSHD during ST (P<0.004) and DT (P<0.008). Multilevel modeling (MLM) approach revealed a group by task interaction for cadence (P<0.05) and gait velocity (P<0.001). The interaction showed a significant difference between ST and DT in controls for cadence and gait velocity. However, there was no difference between ST and DT in FSHD. Finally, a comparison of methylation percentage versus gait parameters revealed a significant negative correlation coefficient for cadence but not for gait velocity. These results indicate specific pairwise differences in both ST and DT walking, observed in the gait parameters as decreased cadence and gait velocity during ST and DT. In addition, the MLM showed that controls exhibited the DT cost as expected but FSHD did not for cadence and gait velocity. ST appears to be sufficiently challenging in FSHD and results in overall declines in spatio-temporal characteristics of gait. Further research is needed to test this paradigm with early-onset or mild cases to track disease progression and its effects on ambulation.

Spatiotemporal strategies adopted to walk at fast speed in high- and low-functioning individuals post-stroke: a cross-sectional study

ABSTRACT Background Walking at fast speed is a gait training strategy post-stroke. It is unknown how faster-than-preferred pace impacts spatiotemporal gait characteristics in survivors with different functional abilities. Objective To test the hypothesis that compared to high-functioning individuals, low-functioning individuals will be limited in modifying spatiotemporal gait parameters for walking at faster-than-preferred speed, and these limitations are associated with fear of falling. Methods Forty-two adults, 17.6 ± 14.6 months post-stroke, traversed an instrumented walkway at preferred and fast speeds. Participants were categorized to a low-functioning group (LFG) (n = 20; <0.45 m/s) and high-functioning group (HFG) (n = 22; ≥0.45 m/s). Cadence, step length, stance time and spatiotemporal asymmetry measures were calculated. The Modified Falls-efficacy Scale examined fear of falling. Multivariate and correlational analysis tested hypotheses. Results Increased speed from preferred to fast pace was significantly greater for HFG (0.27 ± 0.03 m/s) than LFG (0.10 ± 0.02 m/s) (p ≤ 0.001). Cadence gain from preferred to fast pace did not differ between groups. However, HFG exhibited greater change in paretic (∆6.1 ± 1.37 cm; p < .001) and non-paretic step lengths (∆4.5 ± 1.37 cm; p = .003) than LFG. Spatiotemporal asymmetry did not change for either group. Fear of falling had moderately positive correlation with ∆paretic step length (r = 0.43; p = .004) and ∆non-paretic step length (r = 0.32; p = .035). Conclusions While both low- and high-functioning individuals used a step-lengthening strategy to walk at faster-than-preferred speeds, the gain in step lengths was limited in low-functioning individuals and was partially explained by falls-efficacy.