Spatiotemporal Gait Research Articles

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

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

Evaluation of Smartphone Technology on Spatiotemporal Gait in Older and Diseased Adult Populations.

Objective: Advancements in smartphone technology provide availability to evaluate movement in a more practical and feasible manner, improving clinicians' ability to diagnose and treat adults at risk for mobility loss. The purpose of this study was to evaluate the validity and reliability of a smartphone application to measure spatiotemporal outcomes during level (primary) and uphill/downhill (secondary) walking with and without an assistive device for older adults (OAs), Parkinson's Disease (PD) and cerebrovascular accident (CVA) populations. Methods: A total of 50 adults (OA = 20; PD = 15; CVA = 15) underwent gait analysis at self-selected gait speeds under 0-degree, 5-degree uphill and 5-degree downhill environments. The validity and reliability of the smartphone outcomes were compared to a motion-capture laboratory. Bland-Altman analysis was used to evaluate limits of agreement between the two systems. Intraclass correlation coefficients (ICCs) were used to determine absolute agreement, and Pearson correlation coefficients (r) were used to assess the strength of the association between the two systems. Results: For level walking, Bland-Altman analysis revealed relatively equal estimations of spatiotemporal outcomes between systems for OAs without an assistive device and slight to mild under- and overestimations of outcomes between systems for PD and CVA with and without an assistive device. Moderate to very high correlations between systems (without an assistive device: OA r-range, 0.72-0.99; PD r-range, 0.87-0.97; CVA r-range, 0.56-0.99; with an assistive device: PD r-range, 0.35-0.98; CVA r-range, 0.50-0.99) were also observed. Poor to excellent ICCs for reliability between systems (without an assistive device: OA ICC range, 0.71-0.99; PD ICC range, 0.73-0.97; CVA ICC range, 0.56-0.99; with an assistive device: PD ICC range, 0.22-0.98; CVA ICC range, 0.44-0.99) were observed across all outcomes. Conclusions: This smartphone application can be clinically useful in detecting most spatiotemporal outcomes in various walking environments for older and diseased adults at risk for mobility loss.

Dual-task gait has prognostic value for cognitive decline in Parkinson’s disease

IntroductionCognitive decline frequently occurs in individuals with Parkinson’s disease (PD), but the clinical methods to predict the onset of cognitive changes are limited. Given preliminary evidence of the link between gait and cognition, the purpose of this study was to determine if dual task (DT) gait was related to declines in cognition over two years in PD. MethodsA retrospective two-year longitudinal study of 48 individuals with PD using data from the Parkinson’s Progression Markers Initiative of the Michael J. Fox Foundation. The following data were extracted at baseline: spatiotemporal gait (during single and DT), demographics (age, sex), PD disease duration (time since diagnosis), motor function (Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)), and cognition (Montreal Cognitive Assessment (MoCA)), with MoCA scores also extracted after two years. ResultsA binomial logistic regression was conducted, with all covariates (above) in block 1 and DT effect (DTE) of gait characteristics in block 2 entered in a stepwise fashion. The final model was statistically significant (χ2(6) = 23.20, p < 0.001) and correctly classified 78.7 % of participants by cognitive status after two years. Only DTE of arm swing asymmetry (ASA) (p = 0.030) was included in block 2 such that a 1 % decline in DTE resulted in 1.6 % increased odds of cognitive decline. ConclusionsIndividuals with greater change in arm swing asymmetry from single to DT gait may be more likely to experience a decline in cognition within two years. These results suggested that reduced automaticity or poor utilization of attentional resources may be indicative of subtle changes in cognition and indicate that DT paradigms may hold promise as a marker of future cognitive decline.

Dynamic Measures of Balance during Obstacle-Crossing in Self-Selected Gait in Individuals with Mild-to-Moderate Parkinson’s Disease

Individuals with Parkinson’s disease (PD) have postural instability and gait dysfunction that lead to falls and disability with disease progression. Increased fall risk is particularly seen during challenging gait tasks such as obstacle-crossing. The purpose of this study was to determine if there were differences in dynamic postural control during self-paced walking and obstacle-crossing between persons with mild-to-moderate PD and healthy controls. Participants included nine individuals with PD and nine age- and gender-matched controls (CON). This study examined margin of stability metrics using instrumented 3D motion analysis during the two-step sequence of the obstacle-crossing task. Dynamic balance variables and spatiotemporal (ST) parameters at distinct gait events related to the leading (step one) and trailing leg (step two) were compared for the PD and CON groups using a mixed-model ANOVA. No differences were found between groups for ST gait parameters during obstacle-crossing, except for a significantly reduced step length (p = 0.005) for the trailing limb for the PD group. The PD group demonstrated significantly larger mean values for mediolateral center of pressure–center of mass (COP–COM) distance at first double support (p = 0.004) and center of pressure–extrapolated center of mass (COP–XCOM) distance at second double support (p = 0.016) for the second step. Our results suggest that the margin of stability may be useful in discerning postural control adaptations during obstacle negotiation in persons with PD.

지역사회 거주하는 만성 뇌졸중 환자의 근육긴장도와 시공간적 보행의 상관관계: 사전연구

지역사회 거주하는 만성 뇌졸중 환자의 근육긴장도와 시공간적 보행의 상관관계: 사전연구

Effectiveness of Hospital-Based Systemic Rehabilitation in Improving Ankle Function after Surgery in Chronic Ankle Instability Patients

Category: Sports; Other Introduction/Purpose: We investigated the therapeutic effect of a postoperative hospital-based systemic rehabilitation protocol on ankle function in chronic ankle instability (CAI) patients. Methods: Thirty-five patients who underwent a modified Broström procedure for CAI were recruited in this prospective randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Education-based rehabilitation was conducted at home in the control group. The outcomes were evaluated at baseline (T0), 12 weeks (T1), and 16 weeks (T2). The primary outcome was the foot and ankle outcome score (FAOS). Ankle motor strength and spatiotemporal gait metrics were assessed as secondary outcomes. Results: There were time and group interaction effects on the pain, symptoms, activities of daily living, sports activities, and quality of life (QOL) domains of the FAOS (P &lt; 0.05, all). The patients in the intervention group showed larger improvements in all domains of the FAOS than did the control group at both T1 and T2 (P &lt; 0.05, all). The time and group interaction effects on invertor and evertor strength were also significant (P = 0.047 and P = 0.044). Invertor and evertor strength improved significantly more in the intervention group than in the control group at T1 and T2 (P &lt; 0.05, all). The preferred walking velocity, cadence, step length on the affected side, and double stance phase duration tended to improve over time. Conclusion: Postoperative hospital-based rehabilitation helped improve CAI pain, symptoms, independence in activities of daily living, sports activity levels, and QOL more effectively than did conventional rehabilitation at home.

Spatiotemporal gait changes in people with multiple sclerosis with different disease progression subtypes

BackgroundGait impairment is common in people with multiple sclerosis (MS), but less is known about gait differences between MS disease progression subtypes. The objective here was to examine differences in spatiotemporal gait in MS and between relapsing-remitting and progressive subtypes during the timed-25-ft-walk test. Our specific aims were to investigate (1) spatiotemporal, (2) spatiotemporal variability, and (3) gait modulation differences between healthy controls and MS subtypes at preferred and fast walking speed. MethodsThis study included 27 controls, 18 relapsing-remitting MS, and 13 progressive MS participants. Participants wore six inertial sensors and walked overground without walking aids at preferred and fast-as-possible speeds. FindingsBoth MS groups had significantly lower walking speed than controls, with a trend towards lower preferred gait speed in progressive compared to relapsing-remitting MS (ES = 0.502). Although most spatiotemporal gait parameters differed between controls and MS groups, differences were not significant between MS subtypes in these parameters and their variability, with low to moderate effect sizes during preferred and fast walking. Both MS groups showed reduced modulation in gait compared to controls and no significant differences between MS subtypes. InterpretationGait in MS is altered compared to controls. Although gait may change with progressive MS, the overall small differences in the gait parameters between the MS subtypes observed in this sample suggests that those with the progressive form of MS who are independently ambulatory and without further clinically meaningful changes in gait speed may not show gait decrements greater than the relapsing-remitting form of the disease.

Study of Gait and Posture Kinematic Indices for the Evaluation of Ankle-Foot Orthoses *

Motor disabilities resulting from pathologies such as brain injuries, strokes, spinal cord injuries and other neurological diseases usually lead to deficits in locomotion. One such problem is Drop Foot (DF), which can severely impair walking function. To cope with this pathology, ankle-foot orthoses (AFOs) can be used, which allow the patient to improve ankle dorsiflexion during the swing phase of the foot. The aim of this research work is to evaluate the impact of the use of a passive AFO orthosis on gait by studying the kinematic indices of gait in patients with DF. The study was conducted on a population of 19 patients at the IRCCS Istituti Clinici Maugeri in Bari. Ninteen subjects (12 males, 7 females), with unilateral DF syndrome, were involved in this research. The experimental data collection procedures consisted of gait analysis sessions performed with the Mobility Lab system by APDM (APDM Inc, Portland, OR, USA, http://apdm.com). In this test subjects wore 3 IMUs (low back and dorsal surface of the feet) and are instructed to stand quietly for 30 s and then asked to walk over a 7 meters walkway, turn around a pivot and walk back to the starting point. Each subject performed two sessions in two different gait conditions: (i) unconstrained gait (without any AFO); (ii) gait with an AFO attached to the participant’s affected limb. The median value of each parameter among the three selected trials was extracted and considered for the analysis. We focused on the following set of spatio-temporal parameters, which have clinical relevance in patients with DF: Elevation at Midswing ( cm ) (EMS), Gait Cycle Time ( s ) (GCT), Stride Length ( m ) (SL). These metrics were statistically analysed with two-way ANOVA test to explore the effects produced by the variables ‘Condition’ (With/Without AFO), ‘Limb’ (Affected/Contralateral) and the interaction between these two factors. Statistical analyses were performed using R version 4.0.3 (R Foundation, Vienna, Austria). Table 1 presents the results of the statistical test, reporting p-values when a significant difference was obtained (p−value < 0.05). Otherwise the absence of statistical significance is reported (ns). The level of statistical significance is specified by a different number of stars (∗): the higher number of stars, the lower α value threshold for the p − value. Fig. 1 shows the boxplots representing the distribution of the analysed data. This paper presented a clinical study regarding the impact of using a solid plastic AFO on spatio-temporal gait metrics of 19 patients with DF syndrome. Our analysis pointed out that EMS is generally higher in affected limb than in contralateral limb, as the patient compensates for difficulties in lifting the front part of the foot by increasing foot elevation during swing. However the use of the AFO has no significant effects on either foot. On the contrary, the GCT is reduced when the AFO is worn by the patient demonstrating higher confidence in step execution. The use of the AFO also tends to improve the stride length of both feet, however this difference is not statistically significant. In future studies, it would be better to evaluate changes in gait metrics on a longer walking trial, to carry out the assessment on a larger number of steps.

Centroidal Moment Pivot for ambulatory estimation of relative feet and CoM movement post stroke: Portable Gait Lab.

Measuring gait and balance recovery is necessary post stroke. In an earlier study, we developed a minimal three Inertial Measurement Units (IMUs) system called Portable Gait Lab (PGL). The PGL used the Centroidal Moment Pivot (CMP) assumption to estimate relative foot and centre of mass (CoM) positions, and thereby estimate gait parameters in healthy participants. In this study, we validate the feasibility of the PGL to track foot and CoM trajectory during gait in four persons with chronic stroke. Spatiotemporal gait and balance measures were estimated from the foot and CoM trajectories, and compared with the reference ForceShoes™. Each participant made at least 20 steps, and the PGL was able to track foot and CoM trajectories with a root mean square of the differences with the reference of 2.9 ± 0.2 cm and 4.6 ± 3.6 cm. The distances between either foot at the end of the walking task, and step lengths were estimated by PGL with an average error with the reference of 1.98 ± 2.2 cm and 7.8 ± 0.1 cm respectively across participants. We show that our approach was able to estimate spatiotemporal and balance parameters related to gait quality in a clinically useful manner. We recommend conducting further studies to study the feasibility of using the PGL system for variable gait patterns measured post stroke.

Understanding gait characteristics of Japanese elderly men through joint angle and angular velocity parameters

Studies investigating the walking patterns of elderly men are well documented, however, there has been no investigation of the gait parameters that specifically reflect the walking motion of elderly men. This study aimed to identify reliable gait parameters to represent the walking motion of elderly Japanese men. 33 elderly men (65 to 74.9 years old) and 20 very elderly men (≥ 75 years old) participated. A 3-dimensional motion analysis system was used to collect kinematic data and 52 gait parameters were analyzed namely; spatiotemporal gait, joint angle, and angular velocity parameters (peak value and peak timing at the hip, knee, and ankle joints. Our results showed that walking speed, cadence, walk ratio, gait cycle, peak joint angle timing, and angular velocity parameters significantly differ between elderly men and very elderly men. Delayed peak timing in the joint angle occurred during the terminal stance phase and pre-swing phase. The accurate parameters for walking motion in old Japanese men as they age may result from the peak timing of joint angle parameters and the peak value of angular velocity parameters.

Effects of a 6-Min Treadmill Walking Test on Dual-Task Gait Performance and Prefrontal Hemodynamics in People With Multiple Sclerosis.

Fatigue is one of the most limiting symptoms in people with multiple sclerosis (pwMS) and can be subdivided into trait and state fatigue. Activity-induced state fatigue describes the temporary decline in motor and/or cognitive performance (motor and cognitive performance fatigability, respectively) and/or the increase in the perception of fatigue (perceived fatigability) in response to motor or cognitive tasks. To the best of our knowledge, the effects of a 6-min walk test (6MWT), which was often used to assess motor performance fatigability in pwMS, on motor-cognitive dual-task performance (i.e., walking + arithmetic task) and prefrontal cortex (PFC) hemodynamics are not well-known. This is of importance, since daily activities are often performed as multitasks and a worse dual-task walking performance is associated with an increased risk of falling. Consequently, we investigated the effect of a fast 6MWT (comfort velocity + 15%) performed on a treadmill on motor-cognitive performance fatigability (spatio-temporal gait parameters/accuracy during the arithmetic task) and perceived fatigability measures (rating of perceived exhaustion; RPE) as well as PFC hemodynamics recorded during dual-task walking in pwMS and healthy controls (HCs). Twenty pwMS (48.3 ± 9.0 years; 13 females/7 males; expanded disability status scale 2.7 ± 1.0, first diagnosis 13.8 ± 8.8 years) and 24 HC with similar age and sex (48.6 ± 7.9 years; 17 females/7 males) were included. Only cognitive performance fatigability (increased error rate) during dual-task walking was found after the fast 6MWT on the treadmill in pwMS. However, the changes in gait parameters did not indicate motor performance fatigability, although both the groups reported perceived fatigability (increased RPE) after the fast 6MWT. Moreover, no change in the PFC activation was detected in both groups. Our results suggest that the intensity and/or duration of the fast 6MWT was not sufficient to induce motor performance fatigability in pwMS. These factors should be addressed by future studies on this topic, which should also consider further parameters, e.g., muscular oxygenation and/or myoelectrical activity, to verify that exercise intensity and/or duration was appropriate to induce motor performance fatigability in pwMS.Clinical Trial RegisterDRKS00021057.

Gait Performance of Friction-Based Prosthetic Knee Joint Swing-Phase Controllers in Under-Resourced Settings

Gait quality can influence walking ability and mobility outcomes making it an important part of prosthetic rehabilitation. Prosthetic knee joint designs can influence gait quality, and limited data exists to guide component selection in under-resourced settings. This study compared spatiotemporal and kinematic gait parameters for two common types of friction-based swing-phase controlled prosthetic knee joints. Two-dimensional optical gait analysis was conducted as part of a cross-over study design involving 17 individuals with unilateral transfemoral amputations. Two prosthetic knee joints were compared. One utilized constant-friction (CF) and the other a variable cadence controller (VCC) for swing-phase control. Gait was analyzed at normal and fast walking speeds. Primary gait parameters included swing-phase time, step length, and knee flexion. Swing-phase time and peak knee flexion angles, as well as their related symmetry indices, were lower for the VCC compared to the CF (p &lt; 0.01), by 11.1 to 94.1%. The VCC resulted in faster walking speeds by approximately 15% compared to the CF (p = 0.002). Friction-based swing-phase knee control mechanisms can facilitate an appropriate and cost-effective prosthetic knee joint solution in under-resourced settings. The findings suggest that friction-based mechanism can be designed to improve gait quality, and in turn overall walking performance.

Photobiomodulation Therapy Combined with Static Magnetic Field (PBMT-SMF) on Spatiotemporal and Kinematics Gait Parameters in Post-Stroke: A Pilot Study.

Background: Gait deficit is a major complaint in patients after stroke, restricting certain activities of daily living. Photobiomodulation therapy combined with a static magnetic field (PBMT-SMF) has been studied for several diseases, and the two therapies are beneficia. However, their combination has not yet been evaluated in stroke. Therefore, for PBMT–SMF to be used more often and become an adjunctive tool in the rehabilitation of stroke survivors at physical therapy rehabilitation centers and clinics, some important aspects need to be clarified. Purpose: This study aimed to test different doses of PBMT–SMF, to identify the ideal dose to cause immediate effects on the spatiotemporal and kinematic variables of gait in post-stroke patients. Methods: A randomized, triple-blinded, placebo-controlled crossover pilot study was performed. A total of 10 individuals with hemiparesis within 6 months to 5 years since the occurrence of stroke, aged 45–60 years, were included in the study. Participants were randomly assigned and treated with a single PBMT–SMF dose (sham, 10 J, 30 J, or 50 J) on a single application, with one dose per stage at 7-day intervals between stages. PBMT–SMF was applied with a cluster of 12 diodes (4 of 905 nm laser, 4 of 875 nm LEDs, and 4 of 640 nm LEDs, SMF of 35 mT) at 17 sites on both lower limbs after baseline evaluation: plantar flexors (2), knee extensors (9), and flexors (6). The primary outcome was self-selected walking speed, and the secondary outcomes were kinematic parameters. Gait analysis was performed using SMART-D 140® and SMART-D INTEGRATED WORKSTATION®. The outcomes were measured at the end of each stage after the single application of each PBMT–SMF dose tested. Results: No significant differences (p > 0.05) in spatiotemporal variables were observed between the different doses, compared with the baseline evaluation. However, differences (p < 0.05) were observed in the kinematic variable of the hip in the paretic and non-paretic limbs, specifically in the minimum flexion/extension angulation during the support phase (HMST–MIN) in doses 10 J, 30 J, and 50 J. Conclusions: A single application of PBMT–SMF at doses of 10 J, 30 J, and 50 J per site of the lower limbs did not demonstrate positive effects on the spatiotemporal variables, but it promoted immediate effects in the kinematic variables of the hip (maximum and minimum flexion/extension angulation during the support phase) in the paretic and non-paretic limbs in post-stroke people.

Overground versus treadmill walking in Parkinson’s disease: Relationship between speed and spatiotemporal gait metrics

BackgroundTreadmills provide a safe and convenient way to study the gait of people with Parkinson’s disease (PD), but outcome measures derived from treadmill gait may differ from overground walking. ObjectiveTo investigate how the relationships between gait metrics and walking speed vary between overground and treadmill walking in people with PD and healthy controls. MethodsWe compared 29 healthy controls to 27 people with PD in the OFF-medication state. Subjects first walked overground on an instrumented gait walkway, then on an instrumented treadmill at 85%, 100% and 115% of their overground walking speed. Average stride length and cadence were computed for each subject in both overground and treadmill walking. ResultsStride length and cadence both differed between overground and treadmill walking. Regressions of stride length and cadence on gait speed showed a log-log relationship for both overground and treadmill gait in both PD and control groups. The difference between the PD and control groups during overground gait was maintained for treadmill gait, not only when treadmill speed matched overground speed, but also with ± 15% variation in treadmill speed from that value. SignificanceThese results show that the impact of PD on stride length and cadence and their relationship to gait speed is preserved in treadmill as compared to overground walking. We conclude that a treadmill protocol is suitable for laboratory use in studies of PD gait therapeutics.

Spatiotemporal Gait Changes in People with Multiple Sclerosis with Different Disease Progression Subtypes

Spatiotemporal Gait Changes in People with Multiple Sclerosis with Different Disease Progression Subtypes

Real-Time Detection of Freezing Motions in Parkinson's Patients for Adaptive Gait Phase Synchronous Cueing.

Parkinson's disease is the second most common neurodegenerative disease worldwide reducing cognitive and motoric abilities of affected persons. Freezing of Gait (FoG) is one of the severe symptoms that is observed in the late stages of the disease and considerably impairs the mobility of the person and raises the risk of falls. Due to the pathology and heterogeneity of the Parkinsonian gait cycle, especially in the case of freezing episodes, the detection of the gait phases with wearables is challenging in Parkinson's disease. This is addressed by introducing a state-automaton-based algorithm for the detection of the foot's motion phases using a shoe-placed inertial sensor. Machine-learning-based methods are investigated to classify the actual motion phase as normal or FoG-affected and to predict the outcome for the next motion phase. For this purpose, spatio-temporal gait and signal parameters are determined from the segmented movement phases. In this context, inertial sensor fusion is applied to the foot's 3D acceleration and rate of turn. Support Vector Machine (SVM) and AdaBoost classifiers have been trained on the data of 16 Parkinson's patients who had shown FoG episodes during a clinical freezing-provoking assessment course. Two clinical experts rated the video-recorded trials and marked episodes with festination, shank trembling, shuffling, or akinesia. Motion phases inside such episodes were labeled as FoG-affected. The classifiers were evaluated using leave-one-patient-out cross-validation. No statistically significant differences could be observed between the different classifiers for FoG detection (p>0.05). An SVM model with 10 features of the actual and two preceding motion phases achieved the highest average performance with 88.5 ± 5.8% sensitivity, 83.3 ± 17.1% specificity, and 92.8 ± 5.9% Area Under the Curve (AUC). The performance of predicting the behavior of the next motion phase was significantly lower compared to the detection classifiers. No statistically significant differences were found between all prediction models. An SVM-predictor with features from the two preceding motion phases had with 81.6 ± 7.7% sensitivity, 70.3 ± 18.4% specificity, and 82.8 ± 7.1% AUC the best average performance. The developed methods enable motion-phase-based FoG detection and prediction and can be utilized for closed-loop systems that provide on-demand gait-phase-synchronous cueing to mitigate FoG symptoms and to prevent complete motoric blockades.

Supervised Exercise Training Improves 6 min Walking Distance and Modifies Gait Pattern during Pain-Free Walking Condition in Patients with Symptomatic Lower Extremity Peripheral Artery Disease.

This study aimed to investigate the effects of supervised exercise training (SET) on spatiotemporal gait and foot kinematics parameters in patients with symptomatic lower extremity peripheral artery disease (PAD) during a 6 min walk test. Symptomatic patients with chronic PAD (Fontaine stage II) following a 3 month SET program were included. Prior to and following SET, a 6 min walk test was performed to assess the 6 min walking distance (6MWD) of each patient. During this test, spatiotemporal gait and foot kinematics parameters were assessed during pain-free and painful walking conditions. Twenty-nine patients with PAD (65.4 ± 9.9 years.) were included. The 6MWD was significantly increased following SET (+10%; p ≤ 0.001). The walking speed (+8%) and stride frequency (+5%) were significantly increased after SET (p ≤ 0.026). The stride length was only significantly increased during the pain-free walking condition (+4%, p = 0.001), whereas no significant differences were observed during the condition of painful walking. Similarly, following SET, the relative duration of the loading response increased (+12%), the relative duration of the foot-flat phase decreased (−3%), and the toe-off pitch angle significantly increased (+3%) during the pain-free walking condition alone (p ≤ 0.05). A significant positive correlation was found between changes in the stride length (r = 0.497, p = 0.007) and stride frequency (r = 0.786, p ≤ 0.001) during pain-free walking condition and changes in the 6MWD. A significant negative correlation was found between changes in the foot-flat phase during pain-free walking condition and changes in the 6MWD (r = −0.567, p = 0.002). SET was found to modify the gait pattern of patients with symptomatic PAD, and many of these changes were found to occur during pain-free walking. The improvement in individuals’ functional 6 min walk test was related to changes in their gait pattern.

Spatiotemporal gait and centre of mass variables while performing different smartphone tasks and confronting obstacle among young adults

PurposeSmartphone is one of the essential tools but may be inappropriate during locomotion or transportation owing to cognitive distractions. The study aimed to investigate the main effects of smartphone tasks, obstacle conditions, and their interaction on the spatiotemporal gait and centre of mass (COM) variables among healthy young adults.MethodsThe study used a single group with repeated measures design. Overall, 20 participants completed 4 smartphone tasks (no task, texting, calling, and watching), combined with 2 conditions of obstacle confrontation (with and without). Spatiotemporal gait (step length, step time, cadence, and gait speed) and COM variables during gait (excursion and velocity in mediolateral and vertical directions) were collected.ResultsSignificant effects of smartphone tasks and obstacle conditions were found, while no interaction effect between smartphone tasks and obstacle was found. There were alterations of the spatiotemporal gait and COM variables during walking, both with and without obstacle. The obstacle condition significantly influenced the different tasks of mobile perturbation, all spatiotemporal gait and COM variables, except for the COM mediolateral velocity.ConclusionsConfronting smartphone tasks and obstacle conditions concurrently challenges young adults to adjust their movement and balance control systems to perform the tasks successfully.

Automated Loss-of-Balance Event Identification in Older Adults at Risk of Falls during Real-World Walking Using Wearable Inertial Measurement Units.

Loss-of-balance (LOB) events, such as trips and slips, are frequent among community-dwelling older adults and are an indicator of increased fall risk. In a preliminary study, eight community-dwelling older adults with a history of falls were asked to perform everyday tasks in the real world while donning a set of three inertial measurement sensors (IMUs) and report LOB events via a voice-recording device. Over 290 h of real-world kinematic data were collected and used to build and evaluate classification models to detect the occurrence of LOB events. Spatiotemporal gait metrics were calculated, and time stamps for when LOB events occurred were identified. Using these data and machine learning approaches, we built classifiers to detect LOB events. Through a leave-one-participant-out validation scheme, performance was assessed in terms of the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPR). The best model achieved an AUROC ≥0.87 for every held-out participant and an AUPR 4-20 times the incidence rate of LOB events. Such models could be used to filter large datasets prior to manual classification by a trained healthcare provider. In this context, the models filtered out at least 65.7% of the data, while detecting ≥87.0% of events on average. Based on the demonstrated discriminative ability to separate LOBs and normal walking segments, such models could be applied retrospectively to track the occurrence of LOBs over an extended period of time.

Instrumented Gait Analysis to Identify Persistent Deficits in Gait Stability in Adults With Chronic Vestibular Loss

Regaining the ability to walk safely is a high priority for adults with vestibular loss. Thus, practitioners need comprehensive knowledge of vestibulopathic gait to design, provide, and/or interpret outcomes of interventions. To date, few studies have characterized the effects of vestibular loss on gait. To investigate the use of an instrumented 2-minute walk test in adults with vestibular loss, to further characterize vestibulopathic gait, and to assess whether those with chronic vestibular loss have enduring gait deficits. This cross-sectional study, conducted between April 3, 2018, and June 27, 2019, recruited adults 20 to 79 years of age from an academic, tertiary, hospital-based, ambulatory care setting who were healthy or had confirmed unilateral or bilateral vestibular hypofunction. Of the 43 adults who were screened from convenience and referred samples, 2 declined, and 7 were excluded because of health conditions. The main exposure was the instrumented 2-minute walk test, which was conducted with participants using wearable inertial measurement units while they walked a 10-m path at their self-selected speed and turned 180° in their self-selected direction at either end. The primary measures were spatiotemporal gait metrics (eg, stride length [SL] and peak whole-body turning velocity). Multivariate analysis of variance was used to assess between-group differences. Validity was assessed using the area under the curve from receiver operator characteristic analyses. Data from 17 healthy adults (mean [SD] age, 39.27 [11.20] years; 13 [76%] female) and 13 adults with vestibular loss (mean [SD] age, 60.50 [10.81] years; 6 [46%] female) were analyzed. Very large between-group differences were found for SL (left) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.47 [0.04] m vs 1.31 [0.04] m; Cohen d, 1.35; 95% CI, 0.18-2.52), SL (right) (estimated marginal mean [SE] for healthy vs vestibular groups, 1.46 [0.04] m vs 1.29 [0.04] m; Cohen d, 1.44; 95% CI, 0.25-2.62), and peak turn velocity (estimated marginal mean [SE] for healthy vs vestibular groups, 240.17 [12.78]°/s vs 189.74 [14.70]°/s; Cohen d, 1.23; 95% CI, 0.07-2.40). The area under the curve was 0.79 (95% CI, 0.62-0.95) for SL (left), 0.81 (95% CI, 0.64-0.97) for SL (right), and 0.86 (95% CI, 0.72-0.99) for peak turn velocity. In this cross-sectional study, instrumented gait analysis had good discriminative validity and revealed persistent deficits in gait stability in those with chronic vestibular loss. The findings of this study suggest that these clinically and functionally meaningful deficits could be targets for vestibular rehabilitation.