Walking Step Research Articles

Exploring the impact of home-based Vojta therapy on gait performance in individuals with Down syndrome: a preliminary feasibility study

BackgroundVojta therapy (VT) enhances postural control and improves gait abilities. However, there is limited evidence regarding the impact of home-based VT on individuals with Down syndrome (DS).ObjectiveThis study aimed to assess the feasibility and preliminary effects of a two-week home-based VT program on spatiotemporal gait parameters in individuals with DS.MethodsSixteen individuals with DS (mean age = 17.88 ± 4.57 years, 8 females) participated in a two-week home-based VT program. Feasibility was measured through adherence rates and the occurrence of adverse events. Spatiotemporal gait parameters were evaluated before and after the intervention using the Vicon motion capture system.ResultsAll participants (100%) successfully completed the home-based VT program with no reported adverse events. Significant improvements were observed in walking speed, cadence, step time (left and right), stride time (left and right), step length (left and right), stride length (left and right), and single support (left and right) (p < 0.05).ConclusionThis preliminary study suggests that home-based VT is a feasible approach and can lead to meaningful improvements in spatiotemporal gait parameters for individuals with DS. Further research with larger sample sizes, more robust designs, and extended follow-up periods is recommended.

Smartphone-based gait analysis in the assessment of fatigue and fatigability in people with multiple sclerosis: a supervised cohort study

BackgroundGait impairments and fatigue are the most common and disabling symptoms in people with multiple sclerosis (PwMS). Objective 6-min walk test (6MWT) gait testing can be improved through body-worn accelerometers, but its association to subjective fatigue and objective fatigability is contradictory. This study aims to validate an algorithm using smartphone sensor data for spatial–temporal gait parameters in PwMS and healthy controls, and evaluate its accuracy in detecting fatigability, and quantify its association with fatigue in PwMS.MethodsWe recruited PwMS with mild to moderate disability (EDSS 0.0–6.5) and healthy controls in a supervised, lab-based cohort study. All participants performed the 6MWT while wearing a smartphone at the hip, which collected acceleration data of step count, cadence and walking speed. Algorithm validation included the mean absolute percentage error (MAPE) and Bland–Altman analysis. Fatigability and fatigue were measured in PwMS, with fatigability defined as a 10% decline in gait performance, and fatigue using the fatigue scale for motor and cognitive functions (FSMC). Further, correlations between gait parameters and FSMC were assessed.ResultsA total of 38 PwMS and 24 healthy controls were included. The algorithm demonstrated high validity for step count (MAPE < 3%) and cadence (MAPE < 10%). Gait analyses revealed fatigability in between 2.6 and 15.8% of PwMS, with large differences between the gait parameter assessed. Significant correlations were found especially between FSMC motor fatigue scores and step count (r = − 0.50), cadence (r = 0.51) and walking speed (r = 0.50).ConclusionSmartphone-based gait analysis provides an accessible and valid method for detecting steps and cadence. There are major differences in the assessment of fatigability, but an allover association to subjective motor fatigue.

Motor and functional characteristics in school-age survivors of congenital diaphragmatic hernia: a cross-sectional observational study

BackgroundChildren born with congenital diaphragmatic hernia (CDH) are at risk of poor developmental outcomes. This study aimed to clarify the motor and functional characteristics of school-age CDH survivors and identify...

Adaptation of functional gait parameters to a newly provided stiffness-optimized ankle-foot orthosis.

Adaptation of functional gait parameters to a newly provided stiffness-optimized ankle-foot orthosis.

Mobilization with movement is effective for improving ankle range of motion and walking ability in individuals after stroke: A systematic review with meta-analysis.

Mobilization with movement is effective for improving ankle range of motion and walking ability in individuals after stroke: A systematic review with meta-analysis.

Effect of Kinematic Analysis on the Gait of School-Going Children With Different Types of Foot Arches: An Observational Study Using Xsens 3D Motion Technology.

Background Gait mechanics can be influenced by foot structure, particularly in children with different types of arches, such as normal arches, flat feet, and high arches. Understanding how foot structure affects gait is essential for developing targeted interventions to improve walking efficiency and reduce injury risk. This observational study uses Xsens 3D motion technology (Xsens Technologies B.V., Netherlands) to analyze the impact of different foot arches on gait in school-going children. Objective The aim of the study is to investigate the effect of foot arch types on gait variables, such as speed, step length, cadence, and gait phases, in school-going children, using advanced kinematic analysis. Methods A total of 558 children were classified into three groups based on their foot arch type: normal arch, flat foot, and high arch. Kinematic data was collected using Xsens 3D motion technology to analyze gait variables. One-way ANOVA was used to compare continuous variables (age, height, weight, body mass index (BMI)) between the groups, while the chi-square test was used for categorical variables (gender). Gait variables were analyzed using one-way ANOVA and Tukey's post-hoc test. Results No significant differences were observed between the groups in terms of age, height, weight, BMI, or gender (p > 0.05). However, significant differences were found in all gait variables (p < 0.0001). Flat-footed individuals exhibited the highest walking speed (1.03 m/s), step count (34.01 steps/min), and step length (7.50 m), while high-arch participants demonstrated slower speeds (0.96 m/s) and wider step width (-0.16 m). High-arch individuals also spent more time in the double and single support phases, indicating a need for increased balance during gait. Conclusion Foot arch type significantly affects gait mechanics in school-going children. Children with flat feet exhibit faster gait speeds and longer step lengths, while those with high arches demonstrate slower, more cautious walking patterns. These results highlight the importance of individualized interventions, such as orthotics or gait training, to optimize walking efficiency and reduce the risk of gait-related issues in children with abnormal foot arches.

Gait changes induced by a 6-min walking exercise in individuals with myotonic dystrophy type 1: relationship with muscle strength.

Gait changes induced by a 6-min walking exercise in individuals with myotonic dystrophy type 1: relationship with muscle strength.

Assessing Caregiver Burden, Tasks, and Heart Rate Using Wearable Sensors: A Longitudinal Study of Informal Caregivers of Persons With Dementia and Older Adults.

Purpose In recent years, research on caregivers has highlighted the importance of integrating advanced technologies, such as wearable devices. Furthermore, when investigating the characteristics of persons with dementia (PWD), comparative analyses should be conducted based on the presence or absence of the condition. We aimed to elucidate the relationship between caregivers' subjective burdens, tasks, and heart rate (HR) using wearable sensors to objectively assess the health status of caregivers of PWDand older adults requiring long-term care. Methods The study recruited 21 caregivers of PWDs and older adults requiring long-term care between September 2022 and December 2024 from one hospital, two care plan centers, and visiting nursing stations in Fukuoka Prefecture, Japan. We collected the participants' sociodemographic data using a questionnaire survey for caregivers. We also measured the caregiver's HR, walking steps, and total sleep time using a wearable sensor. Results Data from 17 participants with no missing values were included in this analysis among the 21 caregivers who provided consent to participate in this study. The demographic variables of the caregivers and care recipients revealed that the caregivers were predominantly female (typical spouses). Most PWDs were diagnosed with atopic disease. No significant correlations were found between the short Japanese version of the Zarit Burden Interview (J-ZBI_8) and the following measures: caregiving years, activities of daily living (ADL), the 14-item Short-Memory Questionnaire (SMQ), caregiving time, the Caregiving Gratification Scale (CGS), total caregiving tasks, sleep time, walking steps, or conversation time. Caregiver burden was significantly associated with caregiving experience and continued caregiving. We observed no significant differences in the average HR for pre- and post-caregiving tasks. Significant differences were found in the maximum pre- and post-caregiving HR. While caregiver burden showed a high-scoring trend and positive perception showed a low-scoring trend, none of the variables differed according to the presence or absence of PWDs. Conclusions These results indicate that subjective appraisal of caregiver burden was not significantly associated with HR change during caregiving tasks. No differences were observed in the behaviors of caregivers with or without dementia. It is necessary to measure subjective and objective appraisals using wearable sensors to better understand caregivers' situations.

Treatment for Lateropulsion in Standard Clinical Practice: A Multicenter Randomized Controlled Trial

Background Post-stroke lateropulsion with pusher syndrome (LP) severely impacts postural control and daily activities. In Japan, while a knee-ankle-foot orthosis (KAFO) is recommended for LP treatment, a gait exercise assist robot (GEAR) is also used. Objective We investigated the effectiveness of gait training using a GEAR and KAFO in improving LP. Methods Thirty-six stroke patients with LP were randomly assigned to GEAR or KAFO groups, and received 50-min daily sessions for 2 weeks. Both the GEAR group, using robot assistance, and the KAFO group, with therapist assistance, engaged in gait training with a goal of 30 min per session. Primary outcomes were changes in Burke Lateropulsion Scale (BLS) and Scale for Contraversive Pushing (SCP) scores. Results Seventeen participants in each group completed their respective interventions. Both groups showed marked improvements in BLS and SCP scores (all p &lt; 0.001). Although the GEAR group achieved greater walking distances and step counts ( p &lt; 0.01 each), overall BLS and SCP improvements did not significantly differ between the groups ( p = 0.51 and 0.84, respectively). Both interventions demonstrated comparable LP improvement to previous studies. Conclusions We found no significant difference in the treatment effects between the two interventions, indicating both to be effective.

Association of Preoperative Walking Speed With 1-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Previous studies have identified demographic, radiographic, and intraoperative predictors of outcomes after hip arthroscopy for femoroacetabular impingement syndrome, yet few studies have identified whether preoperative gait metrics can predict outcomes. Increased preoperative step count, walking speed, step length, and gait symmetry will be associated with better outcomes after surgery. Retrospective cohort study. Level 4. Patients who underwent hip arthroscopy between 2019 and 2022 and downloaded the smartphone app rHip, allowing for retroactive access of gait metric data, were identified. Preoperative gait metrics, age, sex, body mass index (BMI), and exercise participation were analyzed via multivariate stepwise linear regression for a relationship with 1-year postoperative patient-reported outcomes (PROs), including Hip Outcome Scale-Activities of Daily Living (HOS-ADL); HOS-Sports Subscale (HOS-SS), and 12-item international Hip Outcome Tool (iHOT-12). Thresholds for preoperative gait metrics were analyzed via receiver operator characteristic curve. A subgroup analysis was performed to compare those who did and did not reach this threshold. A total of 43 patients (86% female; age, 33.1 ± 13.7 years; BMI, 23.9 ± 4.4 kg/m2) met inclusion criteria. Multivariate regression found that preoperative walking speed was significantly associated with postoperative HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .01). A preoperative walking speed threshold of 1.065 m/s was predictive of outcome achievement. Those who failed to achieve this threshold were significantly older, of greater BMI, and less active (P ≤ .04). They also showed significantly worse 1-year postoperative scores (P ≤ .02) and lower PASS achievement for HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .04). Preoperative walking speed is significantly associated with 1-year outcomes after hip arthroscopy. Patients who averaged <1.065 m/s show significantly worse outcomes after surgery. Assessment of preoperative walking speed may allow physicians to better counsel patients regarding expected outcomes after hip arthroscopy.

Ankle muscle strength and activation are associated with walking patterns in preschool and school-age children.

Walking patterns can differ between children and adults, both kinematically and kinetically. However, the detailed nature of the ankle pattern has not been clarified. We investigated musculature, biomechanics, and muscle activation strategies and their relevance to walking performance in preschool (PS) and school children (SC), with adults (AD) as reference. Twenty-six PS (3-5 yr), 20 SC (6-8 yr), and 17 AD (18-30 yr) participated. Tibialis anterior (TA) and medial gastrocnemius (MG) thicknesses, fascicle lengths, and maximal voluntary dorsi- and plantar flexion isometric torques were measured. Hip, knee, and ankle kinematics, ground reaction forces (GRFs), and TA and MG electromyographic activities were recorded during shod walking at each participant's preferred speed. Walking speed, step length, and cadence were correlated with age in PS. These walking performance measures were also correlated with muscle thickness and fascicle length, showing higher speed in individuals with thicker muscles and longer TA and MG fascicles (conversely, higher cadence with thinner muscles and shorter fascicles). AD demonstrated the largest values for muscle thickness (p<0.001), fascicle length (p<0.001), strength (p<0.001), and walking performance (speed p = 0.004; step length p<0.001; cadence p<0.001), followed by SC then PS. Both PS and SC exhibited higher TA activities than AD during the stance phase, resulting in a higher co-activation index. The GRFs relative to body weight were lower in both horizontal and vertical components in PS compared to SC and AD, while the relative lateral force during stance was greatest in PS followed by SC and then AD. Differences in preferred walking speed and step length were associated with age and muscle size. Children, particularly preschool-aged, employed a co-activation strategy of dorsi- and plantar flexors for stabilization, which resulted in sideways steps even at a preferred walking speed.

Foot orthosis design for children with Charcot-Marie-Tooth and impact on gait

Background: Charcot-Marie-Tooth (CMT) is a progressive disease resulting in distal sensory deficit and muscular weakness. As the disease progresses, most children develop a cavovarus foot deformity. Foot orthoses (FO) are widely prescribed in CMT to support the foot and improve gait, but there is a lack of guidelines for their conception. The aim of this pilot study was to report the methodology used for the design of FO (FOmax) based on an evaluation of foot deformities and to assess its effects on gait in children with CMT. Methods: This study included 11 children with CMT. Participants were provided with a classic pair of FO (FOclass) and a pair of FOmax. A full evaluation of foot deformities was performed, and a decision-making algorithm was used for the FOmax design. A gait analysis was performed with both FO after 3 months of wear. Results: Wearing FOmax compared with FOclass increased walking speed, step length, and single stance time. Hip flexion/extension range of motion during stance also increased. The pressure-time integral decreased on the lateral midfoot with FOmax. Conclusions: These results suggest that the FOmax, based on the algorithm, offers benefits for walking in children with CMT. The increased step length could be related to the increase of hip range of motion. The increase in walking speed and single support times could result from a better distribution of the plantar pressure that optimizes stability during walking. The present results need to be confirmed with a larger sample.

Effect of BMI on Endurance In Middle Aged Patients with Type 2 Diabetes: A Cross sectional study

Background: The prevalence of obesity and diabetes is rising. The aim of this study was to determine the association of endurance performance among normal, overweight and obese middle-aged patients with type 2 diabetes. Objectives: To find out endurance in Normal, Overweight and Obese middle age patient with type 2 diabetes. Methodology: After getting the ethical approval, patients were screened and informed consent form was taken from them. To accomplish the aim, 60 patients with diabetes were taken in which 20 patients were taken in each group of Body Mass Index (BMI) i.e. normal, overweight &amp; obese. The endurance was assessed by 6 min walk test and step test. Results: Distance covered is more in overweight as compared to normal and obese. Steps are decreased in obese followed by overweight and normal population. Conclusion: The study shows that there is no any correlation between the in the endurance test.

Association of Depression with Walking in People with Peripheral Artery Disease: A Post-Hoc Analysis of the BIP Trial.

This post-hoc analysis from the Behavioural Intervention by allied health professionals to promote Physical activity (BIP) trial examined the relationship between depression and step count and walking capacity over two years in people with peripheral artery disease (PAD). BIP included participants with walking impairment due to PAD followed up at 4, 12 and 24 months to measure step count over 7 days using an accelerometer and six-minute walking distance. The relationships between depression at entry with step count and walking distance during follow-up were assessed using linear mixed effects models. At entry, 29 (14.5%) of the 200 participants had depression being treated with anti-depressant medication. Participants diagnosed with depression were more likely to be female (13 of 29, 44.8%) than those not diagnosed with depression (43 of 171, 25.1%). Over 24 months follow-up, daily step count progressively decreased in participants with depression (mean [SD] 4406 (2266) at entry to 3888 (2555) at 24 months) as compared to no change in participants without depression (mean (SD) 5271 (2526) at entry compared to 5120 (2446) at 24 months), inter-group difference p = 0.010. No significant difference in change in six-minute walking distance over 2 years was found between participants with and those without depression. Depression is associated with greater decline in self-regulated walking in patients with PAD. Effective treatments for depression are needed which help promote physical activity in people with PAD.

Influence of treadmill speed selection on gait parameters compared to overground walking in subacute rehabilitation patients

[Purpose] Treadmill-based interventions are widely utilized in rehabilitation due to their advantages of providing controlled environments and enabling individualized training. However, the differences between overground and treadmill walking during the subacute rehabilitation phase remain incompletely understood. This study aimed to compare gait parameters between treadmill walking at varying speeds and overground walking in a subacute rehabilitation setting. [Participants and Methods] A total of 42 inpatients with cerebrovascular and orthopedic conditions were recruited from a convalescent rehabilitation ward. Gait parameters were measured using the Gait Real-time Analysis Interactive Lab (GRAIL) system during comfortable overground walking and treadmill walking at various speeds, including self-selected comfortable speeds and speeds matched to overground walking. Walking speed, stride length, cadence, and step width were calculated without markers and compared across conditions. [Results] The comfortable treadmill walking speed was significantly lower than the overground walking speed (mean [standard deviation]: 0.85 [0.23] m/s vs. 1.20 [0.20] m/s). Stride length was significantly shorter during treadmill walking at comfortable speeds compared to overground walking (0.86 [0.22] m vs. 1.21 [0.18] m), whereas step width was significantly wider (0.17 [0.04] m vs. 0.13 [0.03] m). [Conclusion] Maintaining cadence at reduced treadmill speeds promotes comfortable endurance training in subacute rehabilitation patients.

Effects of Motor Freezing on Balance, Activity-Specific Balance Confidence, and Quality of Life in Patients with Parkinson's Disease

Aim: The aim of this study is to evaluate the impact of motor freezing blocks on balance control, activity-specific balance confidence (ABC), and quality of life in patients with idiopathic Parkinson's disease (PD). Methods: The freezing of gait questionnaire (FOG) was employed to categorize the participants into groups according to the presence (group 1) or absence (group 2) of motor freezing blocks. The balance of the participants was evaluated using the Tinetti Balance and Walking, and the Tandem Stance and Walking test. Activity confidence was assessed using the ABC scale, while quality of life was evaluated using the Parkinson's Disease Questionnaire-8 (PDQ-8). Results: A total of 74 individuals with PD were included in the study, comprising groups 1 (n = 38) and 2 (n = 36). A comparison of the Tinetti balance and walking score, Tandem stance and step score, ABC-scale, and PDQ-8 scores of group 1 and group 2 revealed a significant difference between the groups (p

Completing the Asymptotic Classification of Mostly Symmetric Short Step Walks in an Orthant

Completing the Asymptotic Classification of Mostly Symmetric Short Step Walks in an Orthant

Relevance of patient-centered actigraphy measures in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: a qualitative interview study

BackgroundPulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are severe, progressive diseases characterized by key symptoms such as dyspnea and fatigue. These symptoms impair physical functioning, with patients struggling to perform their daily activities. One traditional measure of physical functioning and exercise capacity is the 6-minute walk test (6MWT). Actigraphy represents a promising tool to complement the 6MWT and provide a holistic picture of physical performance in patients with PAH or CTEPH. However, the current literature holds limited evidence on content validity of actigraphy in these populations, as reported by patients themselves. The primary objective of this study was to understand which physical functioning concepts are most meaningful to patients with PAH or CTEPH and identify relevant actigraphy variables and appropriate timeframes for their measurement.MethodsThis was a cross-sectional, qualitative study in adults with a confirmed diagnosis of PAH or CTEPH. Participants from the UK and USA were interviewed one-on-one via a web-based platform, with interviewers using a semi-structured discussion guide that included concept elicitation and cognitive debriefing sections. Data within the anonymized interview transcripts were coded and thematically analyzed.ResultsConcept elicitation identified the physical functioning concepts most meaningful to patients with PAH or CTEPH and generated a combined conceptual model of physical functioning, which strongly aligned with previous literature. During cognitive debriefing, of the four actigraphy variables debriefed in relation to these physical functioning concepts, study participants highly valued time spent in non-sedentary physical activity and time spent in moderate to vigorous activity, while step count and walking speed emerged as less relevant. Participants indicated four alternative variables as relevant: walking distance, walking up hills or inclines, duration of continuous walking bouts, and time spent walking. Regardless of the variable, participants suggested a timeframe of approximately 10 or 12 h/day over a minimum of 14 days for measuring physical functioning.ConclusionsBy demonstrating the content validity of actigraphy measures of physical functioning, this qualitative study begins to address the evidence gaps identified by the regulatory requirements for using actigraphy endpoints in future PAH and CTEPH clinical trials.

The Effect of Locomotor Training on Gait Parameters in Pediatric Patients with Cerebral Palsy: a Systematic Review and Meta-analysis

Background. Locomotor training is a relatively new approach in pediatric cerebral palsy, so there is still a lack of data on its effect of such training on walking function. Aim. To evaluate the effect of locomotor training on gait parameters in pediatric patients with cerebral palsy by reviewing the scientific literature. Methods. A systematic review with meta-analysis was conducted based on the results of the PubMed (MEDLINE) and the CINAHL Ultimate (EBSCOhost) searches for randomized clinical trials. Results. Fifteen eligible randomized clinical trials involving 375 pediatric patients with cerebral palsy were included. The results of the meta-analysis showed that locomotor training interventions, compared to standard treatment methods for cerebral palsy, have a small effect on walking speed (Cohen d = 0,16), cadence (Cohen d = 0,16) and step length (Cohen d = 0,18). Conclusions. There is evidence that supplementing standard treatment with locomotor training interventions has a small positive and lasting effect on walking speed, cadence and step length in pediatric patients with cerebral palsy. Keywords: cerebral palsy, children, locomotor training, spatiotemporal gait parameters.

Association of walking and activities of daily living with muscle thickness of the trunk and lower extremity muscles in children with down syndrome

ABSTRACT Purpose We examined the association of walking and activities of daily living(ADL) with trunk and lower extremity muscle thickness in children with Down syndrome (DS). Methods 27 children with DS participated in this study. Walking was assessed using measurements of the maximal walking speed and step length, while ADL was assessed using the Pediatric Evaluation of DisabilityInventory (PEDI). The thickness of the trunk and lower extremity muscles was measured using an ultrasound imaging device. Results The peroneus brevis muscle thickness was a significant and independent factor associated with step length. The tibialis posterior muscle thickness was significant and independent factor of self-care. The thickness of the soleus and tibialis posterior muscles were significant and independent factors of mobility. Finally, the soleus muscle thickness was a significant and independent factor of social function in PEDI. Conclusions The findings of this study indicate that future clinical work should focus on the function of the plantar flexor muscles in walking and ADL in children with DS.