Sustained Walking Research Articles

Multipedal DNA Walker: Engineering Strategy, Biosensing Application and Future Perspectives.

With the continuous development of DNA nanotechnology, DNA walkers have attracted increased attention because of their autonomous and progressive walking along predesigned tracks. Compared with the traditional DNA walkers, the emerged multipedal DNA walkers showed their special charm with sustainable walking capability, higher reaction efficiency, expanded walking region, and improved amplification capability. Consequently, multipedal DNA walkers have developed rapidly and shown potential in biosensing applications. Hence, in this review, we make a comprehensive representation of the engineering strategy of multipedal DNA walkers, which focused on the design of multiple walking strands as well as the construction of tracks and driving forces. Meanwhile, the application of multipedal DNA walkers in biosensors has been thoroughly described according to the type of biosensing signal readout. By illustrating some representative works, we also summarized the merits and challenges of multipedal DNA walker-based biosensors and offered a deep discussion of the latest progress and future.

Physiological Characteristics of Surgical Patients With Obesity in Response to the 6-Min Walk Test

ABSTRACT Background: Overall health and fitness contribute to surgical experience and recovery. The aim of this study was to describe an array of physiological characteristics in a presurgical patient cohort with obesity as a function of their sustained walking speed. Methods: We performed a prospective single-center cohort study in Wollongong Hospital, Australia from 2016 to 2018. Patients (N = 293) with severe obesity completed a 6-min walk test and were classified as either slow or fast walkers according to the cut point of 0.9 m·s−1 (2 mph). These groups were compared for anthropometry, comorbidities, respiratory and cardiovascular physiology, blood biomarkers, patient-centered outcomes, and perception of effort. Results: Slow walkers (n = 115; age 65 [63 to 67] years; mean [95% confidence interval]) and fast walkers (n = 178; age 54 [52 to 56]; P < 0.05) were not different in body weight but were different for body mass index (slow 43.2 [42.0 to 44.4] versus fast 41.1 [40.5 to 41.8]; P < 0.05). Cardiovascular disease and renal disease were more prevalent in slow walkers. Respiratory physiology reflective of restrictive lung disease (force vial capacity [L] slow 2.61 [2.45 to 2.77] versus fast 3.34 [3.19 to 3.47]; P < 0.05) was more common in slow walkers, who also reported higher dyspnea ratings. Resting cardiovascular characteristics were not different, although N-terminal pro-B-type natriuretic peptide levels were higher in the slow group (P < 0.05). Quality of recovery at postoperative day 30 was higher in the fast walking group. Conclusion: In this Australian cohort, patients with obesity undergoing nonbariatric surgery differed in their physiological profiles according to walking speed. This study supports the need to appreciate the physical fitness of patients beyond simplified body weight and classification of obesity in the perioperative period.

471 Using Computer Vision and Wearable Devices to Improve Care of Parkinson’s Disease

OBJECTIVES/GOALS: Inexpensive, accurate home monitoring is the standard-of-care in many diseases like hypertension or diabetes; however, it has yet to be widely used in neurodegenerative diseases. We used wearable activity monitors and computer-vision evaluated assessments to estimate Parkinson’s disease (PD)-related disease burden. METHODS/STUDY POPULATION: We recruited 22 people from the University of Iowa Movement Disorders Clinic. Each person completed a standardized set of 3 fine motor tasks using their hands. We recorded a video of this activity, which was evaluated using MediaPipe - an open-source pose classification program from Alphabet - as well as had an nurse-practitioner evaluate the performance on a validated scale (UPDRS). Participants wore a Fitbit Inspire 3 activity tracker at home for the next two weeks. We quantified disease burden using the Parkinson’s Disease Questionnaire 39 - a validated 39-item survey about the intensity of PD-related impairment. Using data from the videos and activity trackers, we estimated 1) the standardized UPDRS assessment of motor impairment and 2) the total PDQ-39 score. RESULTS/ANTICIPATED RESULTS: We found observationally recorded fastest sustained (at least 5 minutes) walking speed was a strong predictor of PDQ-39, explaining over one third of the variability in the measure. Range of motion in the videos was a significant predictor of UPDRS scores; however, was only weakly related to the overall PDQ-39 score. Further processing of the signals from the video, including wavelets and frequency domain analysis, may provide better predictive capabilities. PDQ-39 subscores (e.g., cognition, social support, mobility) will be the subject of further analysis. DISCUSSION/SIGNIFICANCE: Home monitoring has become the standard in other fields because of the better generalizability of home measurements. Improving the detection and evaluation of PD using home monitoring will lead to more timely and accurately changes in medication and less need for clinic visits - especially off levodopa.

Improving locomotive syndrome risk level through community‐led activities to establish walking habits

AbstractWe evaluated the effects of walking habits and mobility improvement on an aging population among 30 residents of a suburban residential complex with the aim of promoting sustainable health activities led by residents. The results showed a total of 911 person‐days of actual walking (Mean = 30.4, Standard Deviation = 15.7) with an average of 30 days per person or a frequency of almost daily intervals over 2 months. In total, 68.4% of early‐ and 54.5% of late‐elderly participants met the recommended criteria for healthy older adults. The results of the GLFS‐25 and 2‐step tests showed a significant improvement in the mobility function after the walking period compared to before the walking period. In addition to the improvements in physical mobility, there were improvements in social interactions and participation in community activities. The participants' post‐walking effect showed that 85% of them were in good health, 50% had positive social interactions, and 25% had positive statements regarding community and town planning. The results verified that resident‐led sustainable walking activities can establish walking habits and improve mobility.

Physical Activity and Its Prophylactic Effects on Cognition and Dementia

The dynamics of aging are not identical for all individuals, and certain lifestyle factors are likely to modulate its effects. Among these factors, the regular practice of physical activity is now the subject of increasing research. Many epidemiological, cross-sectional, and interventional studies present a convincing body of evidence in favor of the prophylactic effect of regular physical activity on brain and cognitive health in older adults. Various cognitive functions such as information processing speed, executive functions, or declarative memory appear to function more efficiently under the effect of a 6-month program combining 45 minutes of moderate-to-high-intensity aerobic physical exercise (sustained walking, jogging) and strength training three or more times a week.

Effects of smartphone use while walking on external knee abduction moment peak: A crossover randomized trial on an instrumented treadmill

IntroductionIn addition to its effects on cognitive awareness, smartphone use while walking may reduce the speed, regularity, and symmetry of walking. Although its effects on spatiotemporal gait parameters, such as walking speed and step width, have already been studied, little is currently known about the impact of smartphone dual tasking on lower limb kinetics. Research questionDoes smartphone use during walking alter gait patterns (i.e., walking speed and step width) and consequently external knee moments? MethodsIn a four-period crossover trial, external knee moment peaks, walking speed, and step width were assessed in 27 healthy adults during matched-speed walking, self-paced walking, self-paced walking with spoken calculation tasks, and self-paced walking with smartphone-entered calculation tasks. Differences between the smartphone use condition and all other conditions were determined using repeated measures ANOVA with predefined contrasts. ResultsDecreased walking speed and increased step width were observed during smartphone use. The mean external knee abduction moment peak (Nm/kg) differed significantly (p < 0.01) across the intervention condition, namely walking with smartphone-entered calculations (0.15; 95 % CI: 0.12, 0.18), and the control conditions, namely matched-speed walking (0.11; 95 % CI: 0.08, 0.13), self-paced walking (0.11; 95 % CI: 0.09, 0.14), and walking with spoken calculations (0.14; 95 % CI: 0.12, 0.16). After confounder adjustment for walking speed, step width, gender, and age, this primary outcome was significantly different between using the smartphone and self-paced walking (p < 0.01, r = 0.51). This effect size was reduced when comparing smartphone use with spoken calculations (p = 0.04, r = 0.32). ConclusionWhen using a smartphone while walking, walking speed is slowed down, step width is increased, and knee moments are adversely altered compared to walking without dual tasking. These altered knee moments are partially, but not entirely, attributable to the cognitive calculation task. These effects are age-independent, but women are more affected than men. Nevertheless, it remains unclear whether sustained walking while using a smartphone adversely affects the development of knee joint pathologies.

Planning for walkable cities in Africa: Co-producing knowledge on conditions, practices, and strategies

This study sought to unravel the conditions of the walking environment, and residents lived experiences of walking in two urban neighbourhoods in the Greater Accra Metropolitan Area (GAMA). Drawing on a participatory mapping exercise and a total of 70 community and institutional qualitative interviews, the results revealed that the study neighbourhoods have precarious walking conditions manifested by the absence of road markings, inadequate traffic lights and other road-calming infrastructure such as speed ramps. The results also show that previous and current national and local development plans do little to plan for the walking environment. This study demonstrates the impacts of the failure of planning and policy responses to the walking environment on urban residents. In an important stakeholder engagement workshop involving a total of 40 participants, our study brought academics, institutional representatives and residents from the two neighbourhoods together to discuss the findings and establish a stronger collaborative relationship for designing an equitable and sustainable walking environment. Based on the findings from the qualitative interviews and stakeholder engagement workshop, we therefore recommend a community-based participatory planning strategy for improving walkability conditions.

Repeated walking challenge campaign participation increases step averages among Mexican Americans living in an inactive U.S.-Mexico border community

Mexican Americans are among the least active race/ethnic groups in the United States, most notably during leisure time. We sought to ascertain the effect of repeated participation in community-based walking challenges on average steps as a potential strategy for improving physical activity engagement in a predominately Hispanic community in far west Texas. A total of 354 participants were recruited through a community-wide walking challenge campaign. Data were analyzed at baseline and 2 weeks post-challenge participation. We used step tracker data to determine quantifiable differences by previous challenge participation. Repeated challenge participation was associated with greater baseline step averages; however, there was no dose effect for the number of previous challenges. One previous challenge participation was no different from multiple challenges. Additionally, the type of challenge increased the likelihood of repeated challenge participation. Findings from this study provide evidence that regular community-level walking challenge campaigns contribute to sustained walking among Mexican Americans at the community level.

Natural ageing primarily affects the initial response to a sustained walking perturbation but not the ability to adapt over time.

The ability to flexibly respond and adapt the walking pattern over time to unexpected gait perturbations is pivotal for safe and efficient locomotion. However, these abilities might be affected by age due to age-related changes in sensorimotor functioning. In this cross-sectional lifespan study, we used a split-belt paradigm to determine how age affects the initial response (i.e., flexibility)-and the ability to adapt after prolonged exposure-to a sustained gait perturbation. Healthy adults (N = 75) of different ages (12-13 per decade) were included and walked on a split-belt treadmill, in which a sustained gait perturbation was imposed by increasing one of the belt speeds. Linear regression models, with the evoked spatiotemporal gait asymmetry during the early perturbation and late adaptation, were performed to determine the effects of age on the flexibility and adaptability to split-belt walking. Results showed that the flexibility to respond to an unexpected perturbation decreased across the lifespan, as evidenced by a greater step length asymmetry (SLA) during the early perturbation phase. Despite this reduced flexibility in step lengths, late adaptation levels in SLA were comparable across different ages. With increasing age, however, subjects needed more steps to reach a stable level in SLA. Finally, when the belts were set to symmetrical speeds again, the magnitude of SLA (i.e., the aftereffects) increased with age. Collectively, these findings suggest that natural ageing comes with a decrease in gait flexibility, while the ability to adapt to split-belt walking was not affected by age-only how adaptation was achieved.

The rate-limiting procedure of 3D DNA walkers and their applications in tandem technology.

DNA walkers, artificial dynamic DNA nanomachines, can mimic actin to move rapidly along a predefined nucleic acid track. They can generally be classified as one- (1D), two- (2D), and three-dimensional (3D) DNA walkers. In particular, 3D DNA walkers demonstrate amazing sustainable walking ability, strong enrichment ability, and fantastic signal amplification ability. In light of these, 3D DNA walkers have been widely used in fields such as biosensors, bioanalysis and cell imaging. Most notably, the strong compatibility of 3D DNA walkers allows their integration with a range of amplification strategies, effectively enhancing signal transduction and amplifying biosensor sensing signals. Herein, we first systematically expound the walking principle of the 3D walkers in this review. Then, by presenting representative examples, the research direction of 3D walkers in recent years is discussed. Furthermore, we also categorize and evaluate diverse tandem signal amplification strategies in 3D walkers. Finally, the challenges and development trends of 3D DNA walkers in the emerging field of analysis are carefully discussed. It is believed that this work can provide new ideas for researchers to quickly understand 3D DNA walkers and their applications in diverse biosensors.

The interplay between gastrocnemius medialis force-length and force-velocity potentials, cumulative EMG activity and energy cost at speeds above and below the walk to run transition speed.

What is the central question of the study? Are the changes in force potentials (at the muscle level) related with metabolic changes at speeds above and below the walk-to-run transition? What is the main finding and its importance? The force-length and force-velocity potentials of gastrocnemius medialis during human walking decrease as a function of speed; this decrease is associated with an increase in cumulative EMG activity and in the energy cost of locomotion. Switching from fast walking to running is associated to an increase in the force potentials, supporting the idea that the 'metabolic trigger' that determines the transition from walking to running is ultimately driven by a reduction of the muscle's contractile capacity. The aim of this study was to investigate the interplay between the force-length (F-L) and force-velocity (F-V) potentials of gastrocnemius medialis (GM) muscle fascicles, the cumulative muscle activity per distance travelled (CMAPD) of the lower limb muscles (GM, vastus lateralis, biceps femori, tibialis anterior) and net energy cost (Cnet ) during walking and running at speeds above and below the walk-to-run transition speed (walking: 2-8kmh-1 ; running: 6-10kmh-1 ). A strong association was observed between Cnet and CMAPD: both changed significantly with walking speed but were unaffected by speed in running. The F-L and F-V potentials decreased with speed in both gaits and, at 6-8kmh-1 , were significantly larger in running. At low to moderate walking speeds (2-6kmh-1 ), the changes in GM force potentials were not associated with substantial changes in CMAPD (and Cnet ), whereas at walking speeds of 7-8kmh-1 , even small changes in force potentials were associated with steep increases in CMAPD (and Cnet ). These data suggest that: (i) the walk to run transition could be explained by an abrupt increase in Cnet driven by an upregulation of the EMG activity (e.g., in CMAPD) at sustained walking speeds (>7kmh-1 ) and (ii) the reduction in the muscle's ability to produce force (e.g., in the F-L and F-V potentials) contributes to the increase in CMAPD (and Cnet ). Switching to running allows regaining of high force potentials, thus limiting the increase in CMAPD (and Cnet ) that would otherwise occur to sustain the increase in locomotion speed.

Changes in Gait Characteristics During and Immediately After the 6-Minute Walk Test in Persons With Multiple Sclerosis: A Systematic Review.

There is limited information about gait patterns during prolonged walking in people with multiple sclerosis (PwMS). The aim of this review was to report on gait metrics during and immediately after the 6-Minute Walk Test (6MWT) in PwMS with different levels of disability. The systematic search was performed in 3 databases (PubMed, Web of Science, and SCOPUS) using keywords related to multiple sclerosis and 6MWT. Studies that reported on quantitative gait outcomes before and after the 6MWT or multiple time points during the 6MWT were included. The Hedges g effect size (ES) was calculated to determine the magnitude of change in each gait parameter. Fourteen studies (n = 534 PwMS; n = 166 healthy controls) were eligible. Five studies investigated gait parameters prior to and immediately after the 6MWT. Nine studies collected gait measures during the 6MWT. Speed (ES = -0.43 to 0.19), cadence (ES = -0.46 to 0.16), step length (ES = -0.46 to 0.14), stability (ES = -0.35 to 0.33), and regularity (ES = -0.25 to -0.15) decreased in most studies. In the majority of included studies, step time (ES = 0 to 0.35), stance period (ES = 0.12 to 0.58), double support phase (ES = 0.03 to 0.62), variability (ES = -0.19 to 1.13), and asymmetry (ES = -0.79 to 0.62) increased following the 6MWT. The kinetic and kinematic (mainly in dorsiflexion angle [ES = -0.08 to -0.36]) features of gait were also negatively changed after 6minutes of walking. Walking speed, cadence, step length, stride length, and stride time after 6MWT at a comfortable speed all increased. Changes in the majority of spatiotemporal parameters were more pronounced in PwMS with moderate-to-severe disability compared with PwMS with mild disability. Most quantitative gait parameters deteriorated during the 6MWT, especially in PwMS with moderate-to-severe disability. The deterioration of gait patterns should be considered when designing therapeutic interventions to increase sustained walking capacity.

Tibial compression during sustained walking with body borne load

This study determined if sustained walking with body borne load increases tibial compression, and whether increases in tibial compression are related to vertical GRFs. Thirteen participants had tibial compression and vertical GRF measures quantified while walking at 1.3 m/s for 60 min with body borne load. Each tibial compression (maximum and impulse) and GRF measure (peak, impulse, impact peak and loading rate) were submitted to a RM ANOVA to test the main effect and interaction between load (0, 15, and 30 kg) and time (minute 0, 30 and 60), and correlation analyses determined the relation between tibial compression and vertical GRF measures for each load and time. Each tibial compression and GRF measure increased with the addition of body borne load (all: p < 0.001). Time impacted impact peak (p = 0.034) and loading rate (p = 0.017), but no other GRF or tibial compression measure (p > 0.05). Although both tibial compression and vertical GRFs increased with load, vertical GRF measures exhibited negligible to weak (r: −0.37 to 0.35), and weak to moderate (r: −0.62 to 0.59) relation with maximum and impulse of tibial compression with each body borne load. At each time point, GRF measures exhibited negligible to weak (r: −0.39 to 0.27), and weak to moderate (r: −0.53 to 0.65) relation with maximum and impulse of tibial compression, respectively. Walking with body borne load increased tibial compression, and may place compressive forces on the tibia that lead to stress fracture. But, increases in tibial compression may not stem from concurrent increases in vertical GRFs.

Assessing walkability in hot arid regions: the case of downtown Abu Dhabi

Regarded as critical infrastructure for a city’s planning and design, pedestrian facilities are considered to be crucial to the health and economic well-being of a city’s inhabitants. This study assesses the walkable environment of two urban neighborhoods in Abu Dhabi’s main island. The research aims at providing the primary data required to facilitate the development of policies, design strategies, and systems that will support sustainable walking environments throughout the Emirate. Specifically, the study examines the walking behavior of the users of two neighborhoods in Abu Dhabi. The following questions were explored: (1) What patterns of walking behavior are observable in the street, and what are their diurnal and seasonal rhythms? (2) What potential reasons could explain the observed walking behavior? (3) To what extent do the built environment and climate affect walking in Abu Dhabi? (4) What particular strategies could be adopted to encourage walking in Abu Dhabi? Data collection and analysis tools include the following: (1) Geographic Information Systems (GIS), (2) fieldwork, and (3) qualitative data assembled from a survey questionnaire. Survey results presented walking as a widely used form of non-motorized transportation for both leisure and utilitarian purposes among blue-collar employees working in the service and retail sectors. Transportation, entertainment, physical fitness, and health were reported as major reasons for walking. Although participants’ walking patterns were not significantly affected by climate, respondents reported that weather was the main source of discomfort while walking. Policy and design changes, infrastructure enhancement, and potential shading methods are proposed to enhance the walking experience.

Relationship between physical exercise and the most varied forms of dyskinesia

Abstract Aim: Dyskinesia is a hyperkinetic abnormal involuntary movement (AIM), like chorea, dystonia, athetosis, and ballism. AIM can occur in Levodopa-induced dyskinesia (LID) in Parkinson's disease (PD), tardive dyskinesia (TD) schizophrenia, and paroxysmal dyskinesias (PxDs). This review describes the effects of physical activity and exercise adaptation (e.g., rehabilitation) in the most varied forms of dyskinesias in an attempt to provide a comprehensive understanding of the role of physical exercise on this disorder. Methods: English-language articles available in the database PubMed electronics were examined. The following indexes were adopted with different combinations: LID and exercise; TD and exercise PED and exercise. Manual searches were performed in the references of the articles related to the chosen topic. Results. The relationship between many types of dyskinesia and exercise is poorly explored. The practice of physical activity showed antidyskinetic effects in Parkinson's LID, with well-described the biological mechanisms. Conclusion: Acute exercise does not modify the abnormal respiratory patterns in TD, and it reveals a normal response to progressive training and inspiratory time. Sustained walking or running may induce a type of paroxysmal dyskinesia in the healthy subjects, which was explored by us in this review.

Overground Locomotor Training In Parkinson's Disease: Effects On Walking Economy And Performance Fatigability

Walking economy (WE) is a measure of metabolic energy expenditure relative to walking speed, and, when elevated, may contribute to decreased capacity and performance relative to sustained walking in people with Parkinson’s Disease (PD). Coupled with performance fatigability (PF), these factors may increase disability in this population. Although sustained walking underlies many daily activities and impacts physical activity for many people with PD, responses to walking-specific interventions to develop optimal training methods have not been fully investigated in this population. PURPOSE: Determine changes in WE, PF, and physiologic response during sustained walking following a task-specific, performance-based overground locomotor training program (OLT) in people with mild/moderate PD. METHODS: 7 males and 2 females (68.9 ± 7.1 years old, H&Y scores 1-3) completed a 12-week program of 24 OLT sessions lasting 45 - 60 minutes each. Subjects were coached through multiplanar movement drills based on components of the gait cycle emphasizing power, stability and stepping under aerobically challenging conditions (ClinicalTrials.gov. - NCT03864393). Walking performance was measured during an overground 10-minute walk test (10MWT) by total distance (TD) and PF (Δ speed/total distance). During the final 5 minutes of the 10MWT, average heart rate (HR), oxygen consumption (V̇O2), and carbon dioxide production (V̇CO2) were recorded using a portable metabolic system. These values were divided by the average speed in the final 5 minutes of the 10MWT to assess WE and physiologic response. RESULTS: There were moderate to large, significant effects for TD (925.77 ± 175.67 vs 1018.37 ± 133.83, p=0.019, d=0.59), PFS (1.11 ± 0.19 vs 0.98 ± 0.13, p=0.013, d=0.79) and HR/speed (76.46 ± 7.69 vs 71.49 ± 6.71 bpm/m/s, p=0.05, d=0.69). There were small, non-significant effects for V̇O2/speed (12.14 ± 1.99 vs 11.47 ± 2.89 mL/min/kg/m/s, d=0.34) and V̇CO2/speed (790.56 ± 196.8 vs 778.93 ± 197.94 mL/min/m/s, d=0.06). CONCLUSIONS: OLT improved WE and PFS during sustained walking. Despite a moderate effect, HR changes in response to OLT are difficult to interpret without additional measures of cardiorespiratory function. Larger and more mechanistic studies can provide further insight into this potential adaptation.

A Development Plan for Walking Tour Route Led by Local Resident

The aim of this research is to investigate the idea of developing a walking tour route as a form of cultural experience in the capital area, the administration of which would be overseen by local residents. The targeted research area would be centered on the route of the Gyeonggi Yetgil(Old Road) Yeongnam-Gil, a route that provides access to various natural beauties, religious pilgrimage sites (Catholic, Reformed Christian as well as Buddhist sites), and numerous other places attractive to potential visitors. The period of research would be from June to July 2019. The methodology involves case studies of local resident authority over walking tour paths, analysis of the environmental conditions of the research target route, focus group interviews and, of course, relevant literature review. The expected results and implications of the research: First, the capital area walking tour paths, such as Dulegil and hiking trail, etc. are mainly for walking paths. Thus, they should be constructed in a way that addresses the diverse demands of people for an experience-oriented walking tour path. Second, it is necessary to develop various routes that range from easy to hard. And third, creating a walking tour path led by the local residents will bring positive effects on the quality of life of the residents, including, an improvement of the living environment and a steady source of job opportunities, etc. enabling the development of a sustainable walking tour path.

Deterioration of specific aspects of gait during the instrumented 6-min walk test among people with multiple sclerosis.

Prolonged walking is typically impaired among people with multiple sclerosis (pwMS), however, it is unclear what the contributing factors are or how to evaluate this deterioration. We aimed to determine which gait features become worse during sustained walking and to examine the clinical correlates of gait fatigability in pwMS. Fifty-eight pwMS performed the 6-min walk test while wearing body-fixed sensors. Multiple gait domains (e.g., pace, rhythm, variability, asymmetry and complexity) were compared across each minute of the test and between mild- and moderate-disability patient groups. Associations between the decline in gait performance (i.e., gait fatigability) and patient-reported gait disability, fatigue and falls were also determined. Cadence, stride time variability, stride regularity, step regularity and gait complexity significantly deteriorated during the test. In contrast, somewhat surprisingly, gait speed and swing time asymmetry did not change. As expected, subjects with moderate disability (n = 24) walked more poorly in most gait domains compared to the mild-disability group (n = 34). Interestingly, a group × fatigue interaction effect was observed for cadence and gait complexity; these measures decreased over time in the moderate-disability group, but not in the mild group. Gait fatigability rate was significantly correlated with physical fatigue, gait disability, and fall history. These findings suggest that sustained walking affects specific aspects of gait, which can be used as markers for fatigability in MS. This effect on gait depends on the degree of disability, and may increase fall risk in pwMS. To more fully understand and monitor correlates that reflect everyday walking in pwMS, multiple domains of gait should be quantified.

Putting the best foot forward: Relationships between indicators of step quality and cadence in three gait vulnerable populations.

Aging and neurological conditions like Multiple Sclerosis (MS) and Parkinson's disease (PD) make people vulnerable for gait impairments, limit function, and restrict sustained walking needed for health promotion. Walking to meet physical activity guidelines requires adequate cadence which is difficult to achieve for gait vulnerable populations. The objective of this study is to estimate, for seniors and people with MS or PD, the extent to which cadence is associated with heel-to-toe stepping pattern (good steps), angular velocity of ankle at heel-strike and its variability. A cross-sectional regression analysis was performed on data collected during walking tests using the Heel2Toe sensor. Health condition (MS = 57, PD = 27, seniors = 56) had an association with cadence, independent of age and sex. Only angular velocity showed a significant relationship with cadence such that every - 50° difference in angular velocity (more negative is better) was associated with a difference of ≈3.5 steps per minute. Adequate angular velocity occurs with an optimal heel-to-toe movement. This heel-to-toe gait can easily be targeted during therapy but technology would be an asset to sustain the relearned movement during everyday activities, Technology that provides real-time feedback for steps with adequate angular velocity at heel strike could be a valuable therapeutic adjunct.

Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults.

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for wandering behaviors. The benefits of a RTLS are objective and continuous measurements of activity. Self-report methods of activity, especially wandering, by health care staff are vulnerable to floor effects and recall bias, and continuous clinical or research observation over the long-term can be time-consuming and expensive. Health care staff also fail to recognize the onset and/or duration of wandering behaviors, which are associated with a variety of adverse health outcomes in this population but amenable to intervention. RTLS technologies can measure the walking activity of institutionalized residents with cognitive impairment over time with a high degree of accuracy. This is particularly useful for the study of wandering, defined as walking for at least 60 seconds with few (if any) breaks in activity. Wandering is associated with disease progression, hospitalizations, falls and death. Previous work suggests older adults with poor balance ability and high sustained walking activity may be particularly susceptible to poor health outcomes. RTLS's are used to assess cognitive impairment and factors associated with gait and balance; however, supplemental paper and pencil gait/balance tools may be used to further refine risk profiles. This project discusses the use of a RTLS to measure walking activity and also gait quality and balance ability measures on this population.