Walking In Shoes Research Articles

Dual-task effects on lower extremity gait coordination during barefoot & shod walking

Dual-task effects on lower extremity gait coordination during barefoot & shod walking

Midfoot Angle Changes During Running After an 8-week Foot Strengthening Program

Category: Other Introduction/Purpose: The arch has been referred to as the core of the foot. The arch’s structure, movement, and integrity during running gait largely depends on the function of intrinsic and extrinsic foot muscles. There are many injuries that can be associated with a dysfunctional medial longitudinal arch. Improving the strength of the foot muscles could help improve arch function during running. The purpose of this study was to compare changes in arch deformation after eight weeks in a foot strengthening exercise group (FS), a group walking in minimalist shoes (MSW), and a control group (C). Methods: 24 healthy runners (average of 15-30 miles/week, no experience with minimalist footwear) were randomly assigned to FS (n=9), MSW (n=7) or C (n=8). FS subjects followed a series of progressive exercises designed to strengthen the intrinsic and extrinsic foot muscles. MSW subjects walked in minimal footwear, increasing from 2,500 to 7,000 steps/day over an 8 wk period. All runners maintained their pre-study mileage in conventional running shoes throughout the 8-week study Three-dimensional motion analysis data was collected at the beginning of the study and after week 8. Passive-reflective markers were placed according to the Oxford Foot Model. Subjects ran at a self-selected pace on a treadmill while data were collected for at least 10 strides. Peak midfoot angles were extracted and averaged within each trial. Group means at week 0 and week 8 were compared using paired t-tests with alpha set at 0.05. Results: While all groups experienced a decrease in midfoot angle, only the FS group experienced a significant change (see table). These results suggest that the foot exercise intervention resulted in more arch control during running than the progressive walking in minimal shoes. Greater changes may have been found if the subjects progressively ran in the minimal shoes which would have placed greater demands on the arch musculature. Conclusion: Based on these data, it seems possible for patients to reduce the amount of arch deformation during running by using targeted foot exercises. This could help with patients who have overuse injuries associated with increased arch deformation. These results also suggest that foot strengthening may be an effective way to prepare for minimal footwear running.

A Comparison of Foot Strengthening versus Minimal Footwear Use on Intrinsic Muscle Size and Strength

Category: Other Introduction/Purpose: The intrinsic muscles of the arch have been classified as the core of the foot. Intrinsic foot muscles (IFM) work as local stabilizers and extrinsic foot muscles (EFM) work as global movers to help control the pronation of the foot. These muscles prevent excessive strain of the MLA. Previous research has shown that strengthening IFM may reduce pain and improve function in people with plantar fasciitis. Additionally, habitual use of minimal shoes that lack support of the arch require greater demand on the intrinsic muscles. The purpose of this study was to determine the effectiveness of two different strengthening interventions on IFM and EFM size and strength. Methods: 57 healthy runners (avg 15-30 mpw) were randomly assigned to a foot strengthening (FS, n=19), a minimal shoe walking (MSW, n=19), or a control group (C, n=19). Baseline cross-sectional areas of abductor hallucis, quadratus plantae, flexor digitorum brevis, and flexor digitorum longus, and thickness of the flexor hallucis brevis, tibialis posterior, and tibialis anterior were obtained with ultrasound using a 10 MHz linear probe. Doming, great toe flexion and lateral toes flexion strength were also measured using a custom-built dynamometer. The FS group then underwent an 8 wk foot and ankle strengthening program. The MSW group progressively walked in minimal footwear from 2,500-7,000 over the course of 8 wks. All groups, including C, maintained normal running mileage in conventional footwear throughout the 8 wks. Size and strength measures were then repeated. A repeated measures ANCOVA with a post-hoc test was used to determine differences in size and strength between groups. Results: All muscles measured in the FS and MSW groups increased significantly in size from weeks 0-8. There were no changes in muscle size in the C group. The FS group experienced significantly greater size changes for the flexor hallucis brevis than the MSW group. All other changes in muscle size were not significant between the FS and MSW groups. The FS and MSW groups showed significant increases in strength in all 3 tests from week 0-8. Strength of the control group did not change at any time. The increases in strength in the FS and MSW groups were not significantly different than each other. Conclusion: Exercises that target the intrinsic and extrinsic foot muscles are effective in increased strength and size of the muscles. However, similar increases in strength and size can be obtained by progressive walking in minimal footwear. Combining both these approaches may have an even greater effect. Stronger feet may offer greater protection against overuse injuries such as plantar fasciitis.

Effect of knee unloading shoes on regional plantar pressures in people with symptomatic knee osteoarthritis

Purpose: Knee ‘unloading’ footwear can reduce joint loading in people with knee osteoarthritis, yet effects of these shoes on regional plantar pressures are unknown. Measurement of regional plantar pressures permits an increased understanding of how unloading footwear changes regional plantar loading, and may yield important insights into why some people with knee osteoarthritis respond to unloading footwear, while others do not. We evaluated the effects of unloading shoes on in-shoe regional plantar pressures, and whether measures of foot posture and/or mobility moderate these effects in people with symptomatic knee osteoarthritis. Methods: Twenty-one participants with medial compartment knee osteoarthritis underwent in-shoe plantar pressure measurements (Novel Pedar) while wearing knee unloading shoes (ASICS GEL-Melbourne OA) and standard conventional walking shoes (ASICS) in random order. The knee unloading shoes were commercially available unloading walking shoes with triple-density midsoles (stiffer laterally than medially) and mild (5-degree) lateral wedge insoles attached to the underside of the sock liners. Peak total forces were compared across conditions for: entire foot, lateral heel, medial heel, lateral forefoot, and medial forefoot. Arch index, center of pressure position and medial-lateral heel peak force ratio were also evaluated. Foot posture (neutral or pronated) was assessed using the Foot Posture Index. Vertical and medial-lateral mobility of the midfoot was assessed with the foot mobility magnitude. Foot mobility was also assessed using the navicular drop test. Foot posture, foot mobility magnitude and navicular drop were separately added to the mixed linear model to investigate if these modified the effect of footwear on outcomes. Results: Patient characteristics are presented in Table 1. The effects of unloading shoes on in-shoe regional plantar pressures, relative to conventional shoes, are summarized in Table 2. Unloading shoes significantly increased total, lateral heel and lateral forefoot force (+6.4%, +12.9% and +20.2% respectively, all P < 0.001), with concurrent decreases in the medial heel (−8.9%, P = 0.001) and medial forefoot (−9.9%, P = 0.005). As a result of these changes, the medial-lateral heel force ratio also decreased significantly with unloading shoes (−20.0%, P < 0.001). Unloading shoes significantly shifted the center of pressure anteriorly (+4.7%, P < 0.001) and laterally (+5.6%, P = 0.034), but did not affect the arch index (−8.7%, P = 0.093). Whilst all but three participants demonstrated an increase in lateral heel force with unloading shoes relative to conventional shoes (Figure 1), there was a large degree of individual variation in response. Despite this, no significant interaction effect was observed for foot posture, foot mobility magnitude and navicular drop on the effect of footwear on regional plantar pressures. Conclusions: Compared to conventional shoes, unloading shoes cause a lateral shift in foot pressure and force patterns. These findings may explain why a small proportion of people with knee osteoarthritis experience foot problems when wearing unloading footwear. Foot posture/mobility did not moderate effects of footwear on plantar pressures.Table 1Characteristics of participants (n = 21)Age, years63.4 (7.0)Male, n (%)9 (43)Body mass index, kg/m229.8 (3.6)Mild radiographic disease (grade 2), n (%)16 (29)Moderate radiographic disease (grade 3), n (%)19 (43)Severe radiographic disease (grade 4), n (%)16 (29)Foot Posture Index Classification, n (%)(Highly) supinated (scores less than 0)0 (0)Normal (scores from 0 to +5)9 (43)(Highly) pronated (scores greater than +5)12 (57)Foot mobility magnitude, mm9.6 (3.8)Navicular drop, mm7.6 (3.1)Pain while walking (NRS)23.7 (3.0)Physical function (WOMAC)318.5 (13.2)Values are reported as mean (SD) unless otherwise indicated.1Using the Kellgren-Lawrencegrading system; NRS = numerical rating scale; WOMAC = Western Ontario and McMasterUniversities OsteoarthritisIndex. 2Ranges from 0 to 10 (higher scores indicate worse pain); 3Ranges from 0 to 68 (higher scores indicate worse function). Open table in a new tab Table 2The effect of unloading shoes on plantar forces relative to conventional shoes.Plantar force measurementsConventional shoes, Mean (SD)Unloading shoes, Mean (SD)Difference (95%CI)P valuePeak foot force, N806.8 (152.7)858.7 (155.8)52.0 (37.6 to 66.4)<0.001Peak lateral heel force, N233.0 (68.3)263.0 (69.6)30.0 (18.1 to 42.0)<0.001Peak medial heel force, N229.4 (62.5)208.9 (57.7)−20.5 (−32.3 to −8.7)0.001Peak lateral forefoot force, N204.1 (44.4)245.4 (52.3)41.3 (21.5 to 61.0)<0.001Peak medial forefoot force, N246.1 (74.8)221.8 (63.9)−24.3 (−41.2 to −7.4)0.005Arch index (midstance)0.23 (0.04)0.21 (0.03)−0.01 (−0.03 to 0.00)0.093CoP x-position [ML](25%stance), mm53.0 (5.0)55.5 (4.9)2.5 (1.4 to 3.6)<0.001CoP y-position [AP](25%stance), mm78.9 (15.5)83.3 (14.7)4.4 (0.3 to 8.5)0.034Medial - lateral heel peakforce ratio1.0 (0.3)0.8 (0.3)−0.2 (−0.3 to −0.1)<0.001CoP = center of pressure Open table in a new tab Values are reported as mean (SD) unless otherwise indicated.1Using the Kellgren-Lawrencegrading system; NRS = numerical rating scale; WOMAC = Western Ontario and McMasterUniversities OsteoarthritisIndex. 2Ranges from 0 to 10 (higher scores indicate worse pain); 3Ranges from 0 to 68 (higher scores indicate worse function). CoP = center of pressure

Lower limb muscle co-contraction and joint loading of flip-flops walking in male wearers.

Flip-flops may change walking gait pattern, increase muscle activity and joint loading, and predispose wearers to foot problems, despite that quantitative evidence is scarce. The purpose of this study was to examine the lower limb muscle co-contraction and joint contact force in flip-flops gait, and compare with those of barefoot and sports shoes walking. Ten healthy males were instructed to perform over-ground walking at self-selected speed under three footwear conditions: 1) barefoot, 2) sports shoes, and 3) thong-type flip-flops. Kinematic, kinetic and EMG data were collected and input to a musculoskeletal model to estimate muscle force and joint force. One-way repeated measures ANOVA was conducted to compare footwear conditions. It was hypothesized that flip-flops would induce muscle co-contraction and produce different gait kinematics and kinetics. Our results demonstrated that the musculoskeletal model estimation had a good temporal consistency with the measured EMG. Flip-flops produced significantly lower walking speed, higher ankle and subtalar joint range of motion, and higher shear ankle joint contact force than sports shoes (p < 0.05). There were no significant differences between flip-flops and barefoot conditions in terms of muscle co-contraction index, joint kinematics, and joint loading of the knee and ankle complex (p > 0.05). The variance in walking speed and footwear design may be the two major factors that resulted in the comparable joint biomechanics in flip-flops and barefoot walking. From this point of view, whether flip-flops gait is potentially harmful to foot health remains unclear. Given that shod walking is more common than barefoot walking on a daily basis, sports shoes with close-toe design may be a better footwear option than flip-flops for injury prevention due to its constraint on joint motion and loading.

In your shoes or mine? Shifting from other to self perspective is vital for emotional empathy.

Emotional empathy-feeling another person's affective states-entails simulating how one would feel in the same circumstance. Prior research has implicated the role of executive controls and shown a link between visuospatial perspective taking and personal disposition of empathy. No study has investigated how executive control processes involved in perspective shifting relate to emotional empathy. Incorporating a spatial perspective-taking task in a set switch paradigm, we investigated whether swiftly switching from the altercentric to the egocentric perspective is associated with heightened emotional empathy but not with accurate classification of low-level perceptual affective cues. Emotional empathy was measured by subjective ratings of arousal and the similarity of affective states with the target person when viewing photos of a person in an emotionally charged context. Cognitive empathy was measured by correct recognition of affective cues. Our results showed that executive controls in perspective shifting related to emotional empathy but not to cognitive empathy. Emotional empathy correlated negatively with the switch cost from the altercentric to the egocentric perspective and not vice versa. Faster switching from the altercentric to the egocentric perspective was associated with heightened emotional empathy. Moreover, the processing strategy did not moderate the association. Flexibility in perspective shifting, especially in regaining one's own perspective after taking another person's perspective, is critical for emotional empathy. To feel another person's affective states, one should regain self-perspective after walking in the other person's shoes. (PsycINFO Database Record

Use of high speed stereo radiography to assess the foot orthoses effectiveness in controlling midfoot posture during walking: A pilot study

BackgroundThe intent of this pilot study was to determine the feasibility of using high-speed stereo radiography (HSSR) to assess the effectiveness of footwear and foot orthoses in controlling the change in the position of the midfoot during walking in individuals with a flexible pes planus foot type. MethodsFour individuals (1 female; 3 male) with a mean age of 25 years (range 22–29) and a bilateral flexible pes planus foot type participated in the study. The HSSR system was used to measure 3-dimensional changes in the longitudinal arch angle (LAA) with each participant walking barefoot, shoe only and shoes with orthoses. ResultsThe HSSR system was found to be highly effective in measuring the change in the position of the midfoot, as measured using the LAA, when wearing footwear with or without foot orthoses. Based on an assessment of mean values, three out of the four participants demonstrated a change in the LAA as a result of using either shoes only or shoes with orthoses. The methodology used in this pilot study for assessing the effect of footwear and foot orthoses on the posture of the midfoot was highly effective with no side-effects noted by any of the study participants. ConclusionsFuture studies using the HSSR will require modifications to participant inclusion criteria as well as alterations to the data collection methodology. The HSSR system used in this study is feasible for use in larger cohort studies assessing footwear and foot orthosis effectiveness with the described modifications.

Independent factors associated with wearing different types of outdoor footwear in a representative inpatient population: a cross-sectional study

BackgroundFootwear can have both a positive and negative impact on lower limb health and mobility across the lifespan, influencing the risk of foot pain, ulceration, and falls in those at risk. Choice of footwear can be influenced by disease as well as sociocultural factors, yet few studies have investigated the types of footwear people wear and the profiles of those who wear them. The aim of this study was to investigate the prevalence and factors associated with outdoor footwear type worn most often in a representative inpatient population.MethodsThis study was a secondary data analysis of a cohort of 733 inpatients that is highly representative of developed nations’ hospitalised populations; 62 ± 19 years, 55.8% male, and 23.5% diabetes. Socio-demographic, medical history, peripheral arterial disease, peripheral neuropathy, foot deformity, foot ulcer history, amputation history and past foot treatment variables were collected. Participants selected the footwear type they mostly wore outside the house in the previous year from 16 types of footwear. Multivariate logistic regression identified independent factors associated with outdoor footwear types selected.ResultsThe most common outdoor footwear types were: running shoes (20%), thongs/flip flops (14%), walking shoes (14%), sandals (13%) and boots (11%). Several socio-demographic, medical history and foot-related factors were independently associated (Odds Ratio; 95% Confidence Interval)) with different types of footwear. Running shoes were associated with male sex (2.7; 1.8–4.1); thongs with younger age (0.95 for each year; 0.94–0.97), being female (2.0; 1.2–3.1) and socio-economic status (3.1; 1.2–7.6); walking shoes with arthritis (1.9; 1.2–3.0); sandals with female sex (3.8; 2.3–6.2); boots with male sex (9.7; 4.3–21.6) and inner regional (2.6; 1.3–5.1) and remote (3.4; 1.2–9.5) residence (all, p < 0.05).ConclusionsWe profiled the types of outdoor footwear worn most in a large diverse inpatient population and the factors associated with wearing them. Sex was the most consistent factor associated with outdoor footwear type. Females were more likely to wear thongs and sandals and males boots and running shoes. Overall, this data gives insights into the socio-demographic, medical and other health factors that are related to footwear choice in a large diverse population primarily of older age.

Design of Shoes Sole and Walking Analysis based on Tread Force Measurement

Design of Shoes Sole and Walking Analysis based on Tread Force Measurement

Effects of footwear and heel elevation on tensile load in the Achilles tendon during treadmill walking

This study used transmission-mode ultrasound (US) to evaluate the effect of footwear, with differing heel elevation, on Achilles tendon loading and basic gait parameters. Axial transmission velocity of US was measured in the right Achilles tendon of 20 healthy adults (10 male and 10 female; age: 31 ± 9 years; height: 1.72 ± 0.04 m; weight: 67.8 ± 14.2 kg) while walking barefoot (BF) and in four prototype athletic shoes (S1–S4) on an instrumented treadmill. Shoes were constructed from identical materials and differed only in heel elevation (S1: 0.4 mm; S2: 5 mm, S3: 9.9 mm, S4: 14.8 mm), which was achieved by varying the graded thickness of the midsole beneath the rearfoot. Temporospatial gait parameters, sagittal ankle movement, and vertical ground reaction force were simultaneously recorded at rate of 120 Hz. Shod walking conditions were characterized by a significantly lower cadence, longer stance duration, greater ankle dorsiflexion, larger peak vertical ground reaction force, and higher US transmission velocity in the Achilles tendon than BF walking (P < .05). Incremental heel elevation in footwear resulted in a progressive increase in peak vertical force, a reduction in peak external loading rate, and a small but progressive reduction in US transmission velocity in the Achilles tendon (P < .05). Simple regression modelling predicted that a shoe with 58 mm of heel elevation would effectively replicate values observed during BF walking. Peak US transmission velocity, and hence tensile load, in the Achilles tendon was higher during shod than BF walking and was partially countered by increasing the heel elevation of the shoe. These findings have important clinical implications for the use of footwear in performance applications and in the prevention and rehabilitation of Achilles tendon disorders.

Effects of lateral-offset sole shoes on knee adduction moment in women with medial compartment knee osteoarthritis.

This study aimed to determine the impact of wearing a lateral-offset sole shoe (LOSS) on knee adduction moment (KAM) in patients with medial knee osteoarthritis (OA). From December 2012 to November 2016, patients with medial knee OA were recruited. Ninety-three knees (50 left, 43 right) of 93 female patients were analyzed. The first peak KAMs were measured with patients (i) walking barefoot; (ii) walking in conventional shoes; and (iii) walking in LOSSs. The patients had grade 1 (n = 19), grade 2 (n = 49), grade 3 (n = 20), and grade 4 (n = 5) knee OA. First peak KAMs differed significantly in all three conditions (p = 0.031). In the post hoc analysis, first peak KAMs were significantly lower during LOSS walking than during conventional shoe walking (p = 0.001), but there were no differences in peak KAMs between barefoot and LOSS walking (p = 0.784). In the subgroup analysis, patients with grades 2 and 3 OA showed significantly lower first peak KAMs during LOSS walking than during conventional shoe walking (p = 0.029 and p = 0.011, respectively). Both the peak eversion ankle angle and moment of barefoot walking showed a significant increase compared with LOSS and conventional shoe walking, while there was no significant difference between LOSS and conventional shoe walking (p = 0.612 and p = 0.197, respectively). Our results suggest that LOSS wearing caused significant KAM reductions compared with conventional shoe wearing. Since LOSS wearing does not cause changes in the peak eversion ankle angle and moment during the load response, it may be an effective method to reduce the KAM in women with knee OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1694-1700, 2018.

Moderators and mediators of effects of unloading shoes on knee pain in people with knee osteoarthritis: an exploratory analysis of the SHARK randomised controlled trial.

To investigate moderators and biomechanical mediators of effects of unloading shoes on knee pain in people with knee osteoarthritis (OA). Exploratory analysis from 164 participants in a clinical trial comparing unloading (ASICS GEL-Melbourne OA) to conventional walking shoes. The primary outcome was 6-month change in knee pain (11-point numerical rating scale (NRS)). Moderators included baseline peak knee adduction moment (KAM), radiographic severity (Kellgren & Lawrence (KL) scale), body mass, foot posture, neuropathic pain and diffuse knee pain. Mediators included change in peak KAM and KAM impulse. Radiographic severity was the only moderator to interact with footwear group (P=0.02). Participants with KL=2 experienced greater pain reductions with conventional compared to unloading shoes (mean difference in change in pain-1.64 units, 95% CI-3.07,-0.21), while unloading shoes tended to result in greater pain reductions than conventional shoes in KL=3 (0.98, 95% CI-0.44, 2.39) and KL=4 (0.64, 95% CI-0.64, 1.93). No variable showed any significant mediating effect in the entire cohort. However, there was some evidence that unloading shoes may reduce pain through reductions in peak KAM (indirect effect-0.31, 95% CIs-0.65, 0.03; P=0.07) in people with KL≥3, compared to conventional shoes. Unloading shoes conferred additional symptomatic benefits over conventional shoes in people with moderate to severe knee OA. There was some evidence effects may be mediated by a reduction in peak KAM. However, we were underpowered for subgroup analyses. These patients may represent a subgroup to which biomechanical interventions designed to reduce the KAM may be more effectively targeted.

Influence of anterior load carriage on lumbar muscle activation while walking in stable and unstable shoes

Load carriage can be harmful for workers, and alternative interventions to reduce back pain while walking and carrying loads are necessary. Unstable shoes have been used to improve balance and reduce back pain, but it is unknown whether walking wearing unstable shoes while carrying loads anteriorly causes excessive trunk extensors muscle activation. The aim of this study was to investigate the effects of different shoe types and anterior load carriage on gait kinematics and lumbar electromyographic (EMG) activity. Fourteen adults that predominantly walk or stand during the work day were asked to walk with and without carrying 10% of body mass anteriorly while wearing regular walking shoes (REG) and unstable shoes (MBT). The effects of shoe type, load carriage, and shoe × load interactions on the longissimus thoracis (LT) and iliocostalis lumborum (IC) EMG, stride duration, and stride frequency were assessed. MBT shoes induced a significant increase in LT (44.4 ± 35%) and IC EMG (33.0 ± 32%, p < .005), while load carriage increased LT (58.5 ± 41%) and IC EMG (55.1 ± 32%, p < .001). No significant shoe × load interaction was found (p>.05). However, walking wearing MBT shoes while carrying loads induced a 46 ± 40% higher EMG activity compared to walking wearing MBT shoes without load carriage. No effects of shoes or load carriage were found on stride duration and stride frequency. It was concluded that walking wearing MBT shoes and carrying 10% of total body mass induced greater activation of trunk extensors muscle compared to these factors in isolation, such a combination may not influence gait patterns.

Validation of a smart shoe for estimating foot progression angle during walking gait

The foot progression angle is an important measurement related to knee loading, pain, and function for individuals with knee osteoarthritis, however current measurement methods require camera-based motion capture or floor-embedded force plates confining foot progression angle assessment to facilities with specialized equipment. This paper presents the validation of a customized smart shoe for estimating foot progression angle during walking. The smart shoe is composed of an electronic module with inertial and magnetometer sensing inserted into the sole of a standard walking shoe. The smart shoe charges wirelessly, and up to 160h of continuous data (sampled at 100Hz) can be stored locally on the shoe. For validation testing, fourteen healthy subjects were recruited and performed treadmill walking trials with small, medium, and large toe-in (internal foot rotation), small, medium, and large toe-out (external foot rotation) and normal foot progression angle at self-selected walking speeds. Foot progression angle calculations from the smart shoe were compared with measurements from a standard motion capture system. In general, foot progression angle values from the smart shoe closely followed motion capture values for all walking conditions with an overall average error of 0.1±1.9deg and an overall average absolute error of 1.7±1.0deg. There were no significant differences in foot progression angle accuracy across the seven different walking gait patterns. The presented smart shoe could potentially be used for knee osteoarthritis or other clinical applications requiring foot progression angle assessment in community settings or in clinics without specialized motion capture equipment.

Gait characteristics in women's safety shoes

Although workers in Japan are required to wear safety footwear, there is concern about occupational accidents that occur when wearing safety shoes. This study aimed to analyze the effect of wearing hardsoled safety shoes on both spatiotemporal gait characteristics and the muscle activity in the lower extremities.Seventeen young women participated in this study. A 5-m gait trial and a surface electromyography trial were conducted while the women walked in either safety shoes or sports shoes. Paired t-tests were performed to analyze the differences in gait characteristics when walking in the two different pairs of shoes. Walking in safety shoes was associated with a significant increase in vastus lateralis, biceps femoris and tibialis anterior activity. This increased muscle activity in the lower extremities is likely compensating for the lower flexibility of the safety shoes.

An Adaptive Neuromuscular Controller for Assistive Lower-Limb Exoskeletons: A Preliminary Study on Subjects with Spinal Cord Injury.

Versatility is important for a wearable exoskeleton controller to be responsive to both the user and the environment. These characteristics are especially important for subjects with spinal cord injury (SCI), where active recruitment of their own neuromuscular system could promote motor recovery. Here we demonstrate the capability of a novel, biologically-inspired neuromuscular controller (NMC) which uses dynamical models of lower limb muscles to assist the gait of SCI subjects. Advantages of this controller include robustness, modularity, and adaptability. The controller requires very few inputs (i.e., joint angles, stance, and swing detection), can be decomposed into relevant control modules (e.g., only knee or hip control), and can generate walking at different speeds and terrains in simulation. We performed a preliminary evaluation of this controller on a lower-limb knee and hip robotic gait trainer with seven subjects (N = 7, four with complete paraplegia, two incomplete, one healthy) to determine if the NMC could enable normal-like walking. During the experiment, SCI subjects walked with body weight support on a treadmill and could use the handrails. With controller assistance, subjects were able to walk at fast walking speeds for ambulatory SCI subjects—from 0.6 to 1.4 m/s. Measured joint angles and NMC-provided joint torques agreed reasonably well with kinematics and biological joint torques of a healthy subject in shod walking. Some differences were found between the torques, such as the lack of knee flexion near mid-stance, but joint angle trajectories did not seem greatly affected. The NMC also adjusted its torque output to provide more joint work at faster speeds and thus greater joint angles and step length. We also found that the optimal speed-step length curve observed in healthy humans emerged for most of the subjects, albeit with relatively longer step length at faster speeds. Therefore, with very few sensors and no predefined settings for multiple walking speeds or adjustments for subjects of differing anthropometry and walking ability, NMC enabled SCI subjects to walk at several speeds, including near healthy speeds, in a healthy-like manner. These preliminary results are promising for future implementation of neuromuscular controllers on wearable prototypes for real-world walking conditions.

Influence of Textured Insoles on Dynamic Postural Balance of Young Dancers.

Postural balance (PB) is a significant factor in dance performance and injury prevention. We aimed to determine whether the use of textured insoles inserted into casual walking shoes of dancers improved their dynamic PB and whether dancers with previous injury manifested different dynamic PB compared with non-injured dancers. In this crossover design study, 26 ballet dancers from the Australian Ballet School, aged 14-19 yrs, were divided into two groups matched by sex and class levels. Group 1 wore the textured insoles in their walking shoes for at least 2 hrs/day during weeks 1 to 4 of the study, and group 2 wore the textured insoles in their walking shoes during weeks 5 to 8. Reports from the school medical staff identified dancers who had previous injuries. All participants were tested pre-intervention and at 4 and 8 weeks by an accelerometer for dynamic PB (average acceleration magnitude, root mean square acceleration, range, and mean frequency) during single-leg fondu, flexing and extending of the knee. Interactions (group x time) were found in dynamic PB measured in the mediolateral direction, indicating significant differences between the groups at the three testing times. Furthermore, both previously injured and noninjured dancers manifested significant time effects from pre-intervention to 8 weeks, indicating a significant improvement in their PB after using the textured insoles. Textured insoles can improve the dynamic PB of ballet dancers and can also be useful as a routine intervention. PB was improved among both dancers with previous injury and non-injured dancers.

Juggling thoughts and feelings: How do female patients with borderline symptomology and substance use disorder experience change in mentalization-based treatment?

Objective: The aim of this study was to explore the experience of central psychological change processes for female patients with borderline symptomology and substance use disorder in mentalization-based treatment. Method: Semi-structured qualitative interviews on experiences from mentalization-based treatment with 13 participants were conducted. The interview material was analysed within a hermeneutical–phenomenological epistemology, with emphasis on researcher reflexivity. Results: The following themes regarding central psychological change processes were found: “by feeling the feeling,” “by thinking things through,” “by walking in your shoes to see myself” and “by stepping outside of own bad feelings in seeing you.” Two of these themes dealt with intra-psychic modes of how to relate to own mind-states. First, they had a shift from avoiding emotions into tolerating emotions. Second, they discovered the ability to think mental states through. Two themes dealt with mental stances for dealing with interpersonal situations, where one mode included a self-reflective stance in difficult encounters, and the other mode entailed an empathic reflective stance by exploring others’ intentionality. Conclusions: The findings are in line with theoretical assumptions that increasing mentalizing capacity is a central change process for these patients. Furthermore, the findings demonstrate the complex interaction between different modes of mentalizing.Clinical or methodological significance of this article: The article explores change processes in manualized psychotherapy for patients with comorbid borderline personality disorder and substance use disorder, a focus which is not researched in the clinical literature. We claim that putting attention to this patient group and investigating their potential in psychotherapy is of clinical significance. Methodologically, this article utilizes thematic analyses within an epistemology following a specific procedure that is step based and transparent, thus it is of interest for qualitative researchers who also utilize thematic analyses.

Walking in minimal shoes and standard hiking boots on smooth and rough surfaces

Walking in minimal shoes and standard hiking boots on smooth and rough surfaces

The reliability of the Adelaide in-shoe foot model

Understanding the biomechanics of the foot is essential for many areas of research and clinical practice such as orthotic interventions and footwear development. Despite the widespread attention paid to the biomechanics of the foot during gait, what largely remains unknown is how the foot moves inside the shoe. This study investigated the reliability of the Adelaide In-Shoe Foot Model, which was designed to quantify in-shoe foot kinematics and kinetics during walking. Intra-rater reliability was assessed in 30 participants over five walking trials whilst wearing shoes during two data collection sessions, separated by one week. Sufficient reliability for use was interpreted as a coefficient of multiple correlation and intra-class correlation coefficient of >0.61. Inter-rater reliability was investigated separately in a second sample of 10 adults by two researchers with experience in applying markers for the purpose of motion analysis. The results indicated good consistency in waveform estimation for most kinematic and kinetic data, as well as good inter-and intra-rater reliability. The exception is the peak medial ground reaction force, the minimum abduction angle and the peak abduction/adduction external hindfoot joint moments which resulted in less than acceptable repeatability. Based on our results, the Adelaide in-shoe foot model can be used with confidence for 24 commonly measured biomechanical variables during shod walking.