Walking Velocity Research Articles

Optimal Location of Exit Doors for Efficient Evacuation of Crowds at Gathering Places

This work deals with the optimal design for the location of the exit doors at meeting places (such as sports centers, public squares, street markets, transport stations, etc.) to guarantee a safer emergency evacuation in events of a sporting, social, entertainment or religious type. This problem is stated as an optimal control problem of nonlinear partial differential equations, where the state system is a reformulation of the Hughes model (coupling the eikonal equation for a density-weighted walking velocity of pedestrians and the continuity equation for conservation of the pedestrian density), the control is the location of the exit doors at the domain boundary (subject to several geometric constraints), and the cost function is related to the evacuation rate. We provide a full numerical algorithm for solving the problem (a finite element technique for the discretization and a gradient-free procedure for the optimization), and show several numerical results for a realistic case.

Anti-gravity treadmill training for children with cerebral palsy

Background: Walking dysfunction in children with cerebral palsy (CP) contributes to significant limitations in participating properly in daily living activities. Various types of treadmills have emerged to address this obstacle such as the antigravity treadmill (AGT) which aims towards reducing the effect of gravity on its users. Aim: This systematic review examines the literature on the effectiveness of (AGT) on walking abilities in children with CP. Methods: Protocol registration (CRD42020164202) in April 2020 was followed by six electronic database searches for randomized clinical trials (RCTs), examining the effectiveness of AGT on walking and balancing abilities in children with CP. The included studies were assessed for quality using the Physiotherapy Evidence Database (PEDro) scale. Results: Three studies of good quality met the inclusion criteria. AGT was significantly associated with improved walking velocity and cadence, while stride length showed insignificant difference between groups (SMD= 0.07, 95%CI 0.06 to 0.08, p< 0.00001),(SMD= 12.29, 95%CI 9.58 to 14.99, p< 0.00001) and (SMD= 0.07, 95%CI -0.08 to 0.23, p< 0.36).

Changes in cognitive-motor interference during rehabilitation of cane walking in patients with subacute stroke: A pilot study.

No previous research has examined cognitive-motor interference (CMI) repeatedly in patients with subacute stroke. This pilot study aimed to report on the changes over time in CMI in patients with stroke who have recently learned to walk with a cane. The assessment started as soon as the participants could walk independently with a quad cane, and was repeated up to six sessions as long as the cane was still used. The dual-tasking paradigm required participants to walk and perform continuous subtractions by 3s. Data were analyzed for 9 participants 33–127 days post-stroke. All 9 participants showed CMI in walking velocity at baseline and 8 of these showed improvement over time (Z = -2.547; p = 0.011). The improvement in CMI was associated with baseline dual-tasking performance (ρ = 0.600; p = 0.044), motor control ability (ρ = -0.695; p = 0.019), walking velocity (ρ = -0.767; p = 0.008), and functional mobility (ρ = 0.817; p = 0.004). All participants showed decrements in both tasks (mutual interference) at baseline, 1 evolved to decrements in walking velocity (cognitive-related motor interference), and 3 finally evolved to decrements in cognitive performance but increments in walking velocity (motor-priority tradeoff). In conclusion, during rehabilitation with cane walking in patients with subacute stroke, the dual-tasking paradigm revealed CMI and its improvements in the majority of participants. Greater improvement in CMI was moderately to strongly associated with worse baseline performance of many variables. The evolution of the CMI pattern over time provides novel information relevant to neurological recovery.

Biomechanical differences between self-paced and fixed-speed treadmill walking in persons after stroke.

Using self-paced treadmills for gait analysis requires less space compared to overground gait labs while a more natural walking pattern could be preserved compared to fixed-speed treadmill walking. Although self-paced treadmills have been used in stroke related intervention studies, studies comparing self-paced to fixed-speed treadmill walking in this population are scarce. Twenty-five persons after stroke (10 males/15 females; 53±12.05years; 40.72±42.94months post stroke) walked on a treadmill in a virtual environment (GRAIL, Motek) in two conditions (self-paced and fixed-speed). After familiarization, all participants completed two trials (3min) at comfortable walking velocity in randomized order. A paired-sample t-test or Wilcoxon Signed Rank test was used to calculate differences between both conditions for spatiotemporal parameters. Statistical Parametric mapping was conducted using the t-tests (SPM(t)), to statistically compare the kinematic and kinetic curves. The self-selected walking velocity on the treadmill was higher in the self-paced condition compared to the fixed-speed condition (p<0.001). However, most variability and symmetry measures were similar in both conditions. Only the standard deviation of the step length at the paretic side was significant higher (p=0.007) and step length symmetry was significantly better (p=0.032) in the self-paced condition. Detected kinematic and kinetic differences were small (< 3°, < 0.1Nm/kg) and stride to stride variability was comparable in both conditions. Based on the results of the current study, self-paced walking can be used as an equivalent to fixed-speed treadmill walking in persons after stroke. Accordingly, this justifies the use of this more functional mode in clinical gait assessment and rehabilitation trials.

Prediction of Whole-Body Velocity and Direction From Local Leg Joint Movements in Insect Walking via LSTM Neural Networks

Extracting motion information from videos is important for quantifying data from behavioral experiments to deepen the understanding of generation mechanisms of animal behavior. For insect walking, inter-leg coordination plays a crucial role, and the thorax-coxa (ThC) and femur-tibia (FTi) joint motions of six legs reflect the walking velocity and direction. This suggests that joint-motion information based on a continuous time series is beneficial for dynamic behavior prediction. Since pose estimation from markerless videos has been extensively studied, the joint angle can be calculated accurately from videos via deep-learning algorithms such as DeepLabCut. Herein, we propose a method for the single-step and multi-step prediction of whole-body velocity and direction using leg joint angles. The method constructs models using long short-term memory (LSTM) and Hammerstein LSTM (HLSTM), with joint data as input, to predict the whole-body velocity and direction of insect walking. We investigated motion prediction with ThC and FTi joint angles using LSTM and HLSTM. The trained models predicted single-step motion information with the accuracy in the range of 73.28%–92.12% for velocity and 66.66%–87.46% for direction. Multi-step prediction for the next 10 steps showed the accuracy in the range of 99.56%–99.99% for velocity and 99.43%–99.95% for direction.

FP.04 Three-year natural history study in Becker muscular dystrophy in The Netherlands

The slow and highly variable disease progression observed in BMD stresses the need to develop outcome measures for clinical trials. We evaluated the responsiveness of different assessments in a cohort of adult BMD patients followed for 3 years. We included 36 genetically confirmed BMD patients (median age at baseline 42.3 years, range 18.6-67.3) of whom 28 were ambulant at baseline (78%). We conducted ambulatory assessments (6WMT, NSAA, 10-meter walk velocity (TMWv), time to rise from floor velocity (TRFv)), PUL1.2 and bilateral maximal voluntary isometric contraction (grip, knee/hip/elbow flexion and extension). The median change and the standard response mean (SRM) at 1- and 3-year follow-up were calculated. Sample sizes (SS) were calculated assuming 50% reduction in disease progression over a 3 year clinical trial with 1:1 randomization. We observed a large variability across all measures, for example the median at baseline for the 6MWT was 439.10m (range 84.30 to 650.00), median change at 1 year follow-up -8.15 (-151.90 to 182.22) and at 3-years -14.50(-151.90 to 158.72). After 1-year follow-up, the SRM was below 0.8 for all considered outcomes. At 3-year follow-up, TMWv and TRFv showed a responsiveness with SRM above 0.8 (1.91, SS 17 and -0.90, SS 79 respectively). Three strength measurements showed SRM >0.8: right elbow flexion (SRM = -1.01, SS 62), left elbow flexion (SRM = -0.85, SS 88) and left hip flexion (SRM = -0.81, SS 96). Of the 29 patients who completed the PUL1.2 at 3rd year follow-up visit, 20 (69%) obtained the maximum score of 74 points. Only one patient lost ambulation during the study. BMD is hallmarked by large inter-individual variability at baseline and follow-up. A relatively stable disease course is common even with 3 years. The ceiling effect of the PUL1.2 illustrates the need for adequate outcome measures in non-ambulant patients.

Walking speed influences spatiotemporal but not symmetry measures of gait in children and adolescents with hemiplegia

BackgroundThe measurement of gait is likely influenced by walking speed in children with hemiplegia, but this relationship is not well characterized. Research questionWhat is the influence of walking speed on spatiotemporal and symmetry measures of gait in children with hemiplegia, with consideration of side and footwear condition? MethodsChildren with hemiparetic gait due to stroke were recruited for a small pilot intervention study. Participants walked at self-selected and fast speeds while barefoot and while wearing shoes. Data from baseline sessions were included in this analysis. The influence of walking speed on five spatiotemporal gait measures was determined using a generalized estimating equation to calculate the proportion of variability in the gait measures that was explained by walking speed. Differences between sides and footwear conditions, and the relationships between walking speed and two symmetry measures, are also reported. ResultsA total of 820 steps were analyzed from ten children (11.2 ± 4.1 years). Walking velocity significantly influenced all spatiotemporal measures of gait. As speed increased, step length increased and all temporal measures decreased, on both paretic and nonparetic sides. Wearing shoes increased step length and stance time for both paretic and nonparetic sides, and slowed step time on the nonparetic side. Regardless of footwear, the paretic side demonstrated slower step and swing times, and faster stance and single support times. We did not observe significant relationships between walking speed and gait symmetry. SignificanceOur observations suggest that walking speed alone influences the spatiotemporal measurement of gait in children with hemiplegia and should be considered in the interpretation of walking function. Yet, controlling for walking speed is often not feasible or not preferred in this population. We offer suggestions for clinicians and researchers who seek to measure gait during overground walking at freely-selected speeds.

Examining the Influence of Cognition on the Relationship Between Backward Walking and Falls in Persons With Multiple Sclerosis.

Multiple sclerosis (MS) causes motor, cognitive, and sensory impairments that result in injurious falls. Current fall risk measures in MS (ie, forward walking [FW] speed and balance) are limited in their sensitivity. Backward walking (BW) velocity is a sensitive marker of fall risk and correlates with information processing speed (IPS) and visuospatial memory (VSM) in persons with MS. Backward walking is a complex motor task that requires increased cognitive demands, which are negatively affected by MS; however, whether cognitive function modifies the sensitivity of BW as a fall risk assessment in MS remains unknown. This study examines the influence of cognition on the relationship between BW and falls in persons with MS. Measures of BW, FW, IPS, VSM, and retrospective falls were collected. Hierarchical regression tested moderation and included an interaction term predicting number of falls. Covariates for all analyses included age and disease severity. Thirty-eight persons with MS participated. Although BW, IPS, and covariates significantly predicted the number of falls (R 2 = 0.301; P = .016), there was no evidence of moderation. Backward walking, VSM, and covariates also significantly predicted number of falls (R 2 = 0.332, P = .008), but there was no evidence of moderation. The FW models generated comparable results. The relationship between BW velocity and falls was not conditional on IPS or VSM in this sample. Larger-scale studies examining additional cognitive domains commonly affected by MS and prospective falls are needed to characterize neurobiological processes relevant to BW and its clinical application in the assessment of fall risk.

The facilitation of trunk muscles by abdominal bracing during walking in chronic low back pain patients

Walking is known to be beneficial for chronic low back pain (LBP) patients and fast walking recruits more trunk muscles. Abdominal bracing has also been shown to improve LBP and facilitate several trunk muscles. We aimed to investigate the effects of walking velocity and abdominal bracing on the activation of trunk muscles in chronic LBP patients during walking. Forty-six volunteers with chronic LBP underwent walking exercise on the treadmill without (“non-braced walking”) and with abdominal bracing (“braced walking”) at speeds of 4, 5, and 6 km/h, with the surface electrodes placed on their trunk muscles to measure muscle activity. The root mean square values of the surface electromyography amplitude data were obtained at the multifidus of lower (ML) and upper lumbar (MU), erector spinae of lower lumbar (EL) and thoracic (ET), rectus abdominis (RA), and external oblique (EO). All muscles activated significantly more at faster walking. The “braced walking” facilitated the ET and RA significantly more than the “non-braced walking”. The interaction between the walking speed and abdominal bracing was significant at ML, MU, and RA. The increase in muscle activation observed at lower speed diminished as speed increased. Since “braced walking” seems to additionally facilitate the trunk muscles especially at slower gait speeds, patients who cannot walk fast may still be able to train their muscles by “braced walking.”

A Val66Met polymorphism is associated with weaker somatosensory cortical activity in individuals with cerebral palsy

BackgroundThe brain-derived neurotrophic factor (BDNF) protein plays a prominent role in the capacity for neuroplastic change. However, a single nucleotide polymorphism at codon 66 of the BDNF gene results in significant reductions in neuroplastic change. Potentially, this polymorphism also contributes to the weaker somatosensory cortical activity that has been extensively reported in the neuroimaging literature on cerebral palsy (CP). AimsThe primary objective of this study was to use magnetoencephalography (MEG) to probe if BDNF genotype affects the strength of the somatosensory-evoked cortical activity seen within individuals with CP. Methods and proceduresand Procedures: Twenty individuals with CP and eighteen neurotypical controls participated. Standardized low resolution brain electromagnetic tomography (sLORETA) was used to image the somatosensory cortical activity evoked by stimulation of the tibial nerve. BDNF genotypes were determined from saliva samples. Outcomes and resultsThe somatosensory cortical activity was weaker in individuals with CP compared to healthy controls (P = 0.04). The individuals with a Val66Met or Met66Met BDNF polymorphism also showed a reduced response compared to the individuals without the polymorphism (P = 0.03), had higher GMFCS levels (P = 0.04), and decreased walking velocity (P = 0.05). Conclusions and implicationsThese results convey that BDNF genotype influences the strength of the somatosensory activity and mobility in individuals with CP. What this paper addsPrevious literature has extensively documented altered sensorimotor cortical activity in individuals with CP, which ultimately contributes to the clinical deficits in sensorimotor processing documented in this population. While some individuals with CP see vast improvements in their sensorimotor functioning following therapeutic intervention, others are clear non-responders. The underlying basis for this discrepancy is not well understood. Our study is the first to identify that a polymorphism at the gene that codes for brain derived neurotrophic factor (BDNF), a protein well-known to be involved in the capacity for neuroplastic change, may influence the altered sensorimotor cortical activity within this population. Potentially, individuals with CP that have a polymorphism at the BDNF gene may reflect those that have difficulties in achieving beneficial outcomes following intervention. Thus, these individuals may require different therapeutic approaches in order to stimulate neuroplastic change and get similar benefits from therapy as their neurotypical peers.

Sarcopenia in patients with diabetes mellitus.

Diseases such as diabetes mellitus may be associated with adverse changes in body composition. Sarcopenia is characterized by a progressive and generalized loss of skeletal muscle mass and functionality. To investigate the relationship between type 2 diabetes mellitus (T2DM) and sarcopenia. In a retrospective, non-randomized study, 35 T2DM patients, aged 20-80 years, were assessed for sarcopenia prevalence compared to controls (n=16). Appendicular skeletal mass (ASM) (kg) was measured, and sarcopenia was defined as SMI <7.0 and <5.7 kg/m2, in males and females, respectively, using the European Working Group on Sarcopenia in Elderly (EWGOSP) definition. Low physical performance was defined as a walking speed of <0.8 m/s. Incidence of sarcopenia was significantly higher in T2DM patients vs. controls (27% vs. 20%, p=0.01) and elderly vs. young participants (40% vs. 12%, p<0.001), respectively. Walking velocity was significantly lower in T2DM patients compared to male and female controls (1.08±0.22 vs. 1.23±0.18 and 1.07±0.26 vs. 1.26±0.16, respectively, p<0.001,). A moderate prevalence of sarcopenia in patients with type 2 diabetes mellitus was observed, which appeared to increase significantly in older men. Finally, incidence of T2DM displayed decreased physical performance in both genders.

Modeling and simulation for designing a line walking chameleon-like legged robot

Legged robots have been developed to move on uneven terrains. They can move smoother and step over obstacles easily, and they are more versatile in various environmental scenarios. These features make them desirable for maintenance and/or search-and-rescue tasks where mobility is restricted on these complex terrains. A problem arises when legged robots are required to walk on the top of narrow support, e.g. thin beams or tubes. In this work, we present the design of a line walking legged robot for narrowed support. To achieve this goal, we get inspiration from the chameleon locomotion. From these observations, we simulate the robot, design an intelligent control strategy for self-balancing and walking, and we implement a robot prototype. The experimental results show that the balance controller provides a tilt angle of 2.24±2.21∘, while the robot walks in a straight line with a maximum offset of 3.0 cm and with a walking velocity of 0.2 cm/s. Our results demonstrate that the robot can move on narrowed support lines. We anticipate that the design of legged robots inspired by the chameleon locomotion might open wider possibilities for rescue and maintenance missions.

The Most Significant Factor Affecting Gait and Postural Balance in Patients' Activities of Daily Living Following Corrective Surgery for Deformity of the Adult Spine.

Background and Objectives: Gait ability and spinal postural balance affect ADL in patients who underwent adult spinal deformity (ASD) surgery. However, it is still unclear how to determine what the cause is. This study was done to investigate various factors affecting gait, postural balance and activities of daily living (ADL) in patients who were operated on for ASD over a period of one year, following corrective surgery. Materials and Method: A cohort of 42 (2 men, 40 women, mean age, 71.1 years) who were operated on for ASD were included in this study. According to Oswestry Disability Index (ODI), based on their ADL, patients were segregated into satisfied and unsatisfied groups. Gait and postural balance abilities were evaluated before and after the operative procedure. Radiographs of spine and pelvis as well as the rehabilitation data (static balance, standing on single-leg; dynamic postural adaptation, timed up and go test (TUG); Gait Capability, walk velocity for a distance of 10 m) were acquired 12 months after surgery and analyzed. Spinopelvic parameters such as (lumbar lordosis (LL), pelvic tilt (PT), sagittal vertical axis (SVA), pelvic incidence (PI)) were marked and noted. The factors which affect patients’ satisfaction with their ADL were evaluated. Results: The ADL satisfied group included 18 patients (1 man, 17 women, mean age 68.6 years) and the unsatisfied group included 24 patients (1 man, 23 women, mean age 73.1 years). One year after the surgery, the two groups were tested. TUG (8.5 s vs. 12.8 s), 10 m walk velocity (1.26 m/s vs. 1.01 m/s), and single leg standing test (25 s vs. 12.8 s) were regarded as notably different. According to logistic regression analysis, only TUG was extracted as a significant factor. The cut-off value was 9.7 s, with sensitivity 75%, specificity 83%, area under the curve 0.824, and a 95% confidence interval of 0.695–0.953. Conclusions: A significant factor among all evaluations in postoperative ASD patients was TUG, for which the cut-off value for ADL satisfaction was 9.7 s.

Effects of Walking Exercise at a Pace With Versus Without Ischemic Leg Symptoms on Functional Performance Measures in People With Lower Extremity Peripheral Artery Disease: The LITE Randomized Clinical Trial.

BackgroundIn people with peripheral artery disease, post hoc analyses of the LITE (Low Intensity Exercise Intervention in Peripheral Artery Disease) randomized trial were conducted to evaluate the effects of walking exercise at a pace inducing ischemic leg symptoms on walking velocity and the Short Physical Performance Battery, compared with walking exercise without ischemic leg symptoms and compared with a nonexercising control group.Methods and ResultsParticipants with peripheral artery disease were randomized to: home‐based walking exercise that induced ischemic leg symptoms; home‐based walking exercise conducted without ischemic leg symptoms; or a nonexercising control group for 12 months. Outcomes were change of walking velocity over 4 m and change of the Short Physical Performance Battery (0–12, with 12=best) at 6‐ and 12‐month follow‐up. A total of 264 participants (48% women, 61% Black race) were included. Compared with walking exercise without ischemic symptoms, walking exercise that induced ischemic symptoms improved change in usual‐paced walking velocity over 4 m at 6‐month (0.056 m/s [95% CI, 0.019–0.094 m/s]; P<0.01) and 12‐month follow‐up (0.084 m/s [95% CI, 0.049–0.120 m/s]; P<0.01), change in fast‐paced of walking velocity over 4 m at 6‐month follow‐up (P=0.03), and change in the Short Physical Performance Battery at 12‐month follow‐up (0.821 [95% CI, 0.309–1.334]; P<0.01). Compared with control, walking exercise at a pace inducing ischemic symptoms improved change in usual‐paced walking velocity over 4 m at 6‐month follow‐up (0.066 m/s [95% CI, 0.021–0.111 m/s]; P<0.01).ConclusionsIn people with peripheral artery disease, those who walked for exercise at a comfortable pace without ischemic leg symptoms slowed their walking speed during daily life and worsened the Short Physical Performance Battery score, a potentially harmful effect, compared with people who walked for exercise at a pace inducing ischemic leg symptoms. Compared with a control group who did not exercise, home‐based walking exercise at a pace inducing ischemic leg symptoms significantly improved change of walking velocity over 4 m at 6‐month follow‐up, but this benefit did not persist at 12‐month follow‐up.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT02538900.

An Experimental Demonstration of MIMO C-OOK Scheme Based on Deep Learning for Optical Camera Communication System

Currently, wireless communication systems that use radio frequency are commonly deployed, for example, mobile communication systems, satellite systems, and the Internet of Things (IoT) systems. Based on their easy installation, wireless communication systems have benefits over other wired communication systems. However, using high frequencies to transfer data via wireless communication can hold significant risks for human health. Several researchers have studied this topic using visible light instead of Radio Frequency (RF) waveforms in communication systems. Many potential approaches are relevant in this regard, i.e., visible light communication, light fidelity, free-space optical, and optical camera communication. Artificial intelligence is also influencing the future of industry and people and is used to solve complex problems, create intelligent solutions, and replace human intelligence as the driving force behind emerging technologies such as big data, smart factories, and the IoT. In this paper, we proposed the architecture of the MIMO C-OOK (Multiple-Input Multiple-Output Camera On–Off Keying) scheme, which uses a convolutional neural network for light-emitting diode detection and a deep learning neural network for threshold predictions considering long-distance communication and mobility support. Our suggested method aimed to improve the performance of the traditional camera on–off keying scheme by increasing data rate, communication distance, and low bit error rate. Our suggested technique may achieve a communication distance of up to 22 m with a low error rate when considering the mobility impact (2 m/s, i.e., walking velocity) by controlling the exposure time, focal length, and employing Forward Error Correction code.

Aberrant movement-related somatosensory cortical activity mediates the extent of the mobility impairments in persons with cerebral palsy.

There are numerous clinical reports showing that persons with cerebral palsy (CP) have proprioceptive, stereognosis, and tactile discrimination deficits. The current consensus is that these altered perceptions are attributable to aberrant somatosensory cortical activity. It has been inferred from these data that persons with CP do not adequately process ongoing sensory feedback during motor actions, which accentuates the extent of their mobility impairments. However, this hypothesis has yet to be directly tested. We used magnetoencephalographic brain imaging to address this knowledge gap by quantifying the somatosensory dynamics evoked by applying electrical stimulation to the tibial nerve in 22 persons with CP and 25 neurotypical controls at rest and during an ankle plantarflexion isometric force motor task. We also quantified the spatiotemporal gait biomechanics of participants outside the scanner. Consistent with the literature, our results confirmed that the strength of somatosensory cortical activity was weaker in the persons with CP compared to the neurotypical controls. Our results also showed that the strength of the somatosensory cortical responses were significantly weaker during the isometric ankle force task than at rest. Most importantly, our results showed that the strength of somatosensory cortical activity during the ankle plantarflexion force production task mediated the relationship between somatosensory cortical activity at rest and both walking velocity and step length. These results suggest that youth with CP have aberrant somatosensory cortical activity during isometric force generation, which ultimately contributes to the extent of mobility impairments seen in this patient population. KEY POINTS: Persons with cerebral palsy have reduced somatosensory cortical responses at rest and during movement. The somatosensory cortical responses during movement mediate the relationship between the somatosensory cortical responses at rest and mobility. Persons with cerebral palsy may have altered sensorimotor feedback that ultimately contributes to impaired mobility.

The first results of application of electrical stimulation of muscles during walking in patients with multiple sclerosis

On the basis of a course of functional electrical stimulation (FES) in 9 patients with multiple sclerosis (MS), the authors revealed peculiarities of the method of artificial cor-rection of movements in this cohort of patients. The authors found that the main features of the FES method, characteristic of other diseases, also remain in patients with MS. However, these patients have specific requirements for the method application, connect-ed with their increased fatigability. Authors suppose, that the following peculiarities may be assumed as the specific ones: short duration of the session (no more than 20 minutes), small number of sessions (8–9), modest quantity of the correctional influences (no more than 4 muscles), low intensity of contraction; session termination with the ap-pearance of minimal fatigue; necessity of complete rest for 1.5 hours before and after the session of FES. Following 76 sessions of FES in 9 patients with MS, the authors revealed the main correctional influences, necessary for this cohort of patients, peculiarities of the temporal and amplitude programs of FES, advantages of multichannel FES over the tradi-tional single-channel FES, usually applied in patients with MS. The example of a certain patient helped the authors to find out, that as long as these conditions can be ensured, considerable improvement of the biomechanical structure of walking is observed in this patient only after 6–7 sessions of FES. This is revealed in a remarkable increase of the mean walking ve-locity, cadence and double step length, in the growth of stability, the diminution of the temporal, kinematic and dynamic asymmetry, in a decrease of recurvation at the knee joint, in an increase of flexion angle at the knee and hip joints, in the appearance of a new element in the curve of knee angle – flexion at the knee joint in the stance phase, in a remarkable strengthening of heel-strike and push-off of the vertical component Rz of the ground reaction force.

Implanted Peroneal Nerve Stimulator Treatment for Drop Foot Caused by Central Nervous System Lesion: A Twelve-Month Follow-up of 21 Patients.

ObjectiveDrop foot is a common impairment following stroke or other causes of central pathology. We report data on patient self-perceived performance, satisfaction with performance, walking ability, and adverse effects after surgical implantation of the ActiGait® drop foot stimulator.DesignProspective case study with a 12-month follow-up.SubjectsTwenty-one participants with drop foot caused by central nervous system lesion.MethodsThe patients’ self-perceived performance and satisfaction with performance were evaluated using the Canadian Occupational Performance Measure (COPM). Walking ability was assessed using a 10-m walk test and a 6-min walk. Nerve conduction of the peroneal nerve was examined in 10 patients.ResultsAt follow-up, COPM self-percieved performance from 3.2 to 6.7 points, the median increase being 2.8 (interquartile range (IQR) 2.2–5.0), p < 0.001. Likewise, the COPM satisfaction with performance increased from 2.6 to 6.9 points, the median increase being 4.2 (IQR 2.8–5.8), p < 0.001. Walking velocity increased 0.1 m/s from a baseline measurement of 0.73 m/s (95% confidence interval (95% CI) 0.03–0.2), n = 21, p < 0.01, and walking distance increased by 33 m, from a baseline measurement of 236 m (95% CI 15–51), n = 21, p < 0.001.ConclusionStimulation of the peroneal nerve by an implantable stimulator increases self-perceived performance, satisfaction with performance, and ambulation in patients with long-lasting drop foot caused by a central nervous system lesion.LAY ABSTRACTDrop foot is a common impairment following stroke or other causes of disease in the nervous system. This study of 21 patients with drop foot caused by various diseases in the central nervous system reports data on patient self-perceived performance, satisfaction with performance, walking ability, and adverse effects after surgical implantation of the ActiGait® peroneal nerve stimulator. The patients’ self-perceived performance and satisfaction with performance were evaluated using the Canadian Occupational Performance Measure. Walking ability was assessed using a 10-m walk test and a 6-min walk test before implantation and at follow-up. At follow-up, patient self-perceived performance, satisfaction with performance, walking velocity, and walking distance increased. No changes in nerve function were demonstrated. In conclusion, implantable peroneal nerve stimulation increases self-perceived performance, satisfaction with performance, and ambulation in patients with long-lasting drop foot caused by central nervous system lesion.

The Effect of Fatigue on Lower Limb Joint Stiffness at Different Walking Speeds.

The aim of this study was to assess the stiffness of each lower limb joint in healthy persons walking at varying speeds when fatigued. The study included 24 subjects (all male; age: 28.16 ± 7.10 years; height: 1.75 ± 0.04 m; weight: 70.62 ± 4.70 kg). A Vicon three-dimensional analysis system and a force plate were used to collect lower extremity kinematic and kinetic data from the participants before and after walking training under various walking situations. Least-squares linear regression equations were utilized to evaluate joint stiffness during single-leg support. Three velocities significantly affected the stiffness of the knee and hip joint (p < 0.001), with a positive correlation. However, ankle joint stiffness was significantly lower only at maximum speed (p < 0.001). Hip stiffness was significantly higher after walking training than that before training (p < 0.001). In contrast, knee stiffness after training was significantly lower than pre-training stiffness in the same walking condition (p < 0.001). Ankle stiffness differed only at maximum speed, and it was significantly higher than pre-training stiffness (p < 0.001). Walking fatigue appeared to change the mechanical properties of the joint. Remarkably, at the maximum walking velocity in exhaustion, when the load on the hip joint was significantly increased, the knee joint’s stiffness decreased, possibly leading to joint instability that results in exercise injury.

Gait Classification and Physical Function Characteristics in Maintenance Hemodialysis Patients

Only walking velocity has been reported as a performance measure of gait in hemodialysis patients, and no kinematic or kinetic analysis has been reported. We evaluated basic information, physical function, aging, dialysis-related complications, and gait in 23 outpatients (≥60 years old) who could walk independently. Hierarchical cluster analysis was performed using joint angles, joint moments, and gait parameters during gait. The gait of hemodialysis patients was classified into two clusters: Cluster 1 and Cluster 2. Cluster 1 gait showed a longer hemodialysis duration, higher dialysis amyloidosis severity, knee joint pain, lower ankle plantarflexion weakness, and lower extremity joint dysfunction than Cluster 2. The gait of Cluster 1 patients consisted of flexion of the knee joint, ankle joint, and trunk, and excessive knee joint flexion was observed in the stance phase to escape posterior knee joint pain. Cluster 1 patients were also unable to kick out sufficiently, and their walking rate and walking velocity were decreased. Cluster 2 patients had a shorter hemodialysis duration than Cluster 1. External forces exerted on the knee joint in the hyperextension direction during gait could cause pain and inflammation of the posterior knee joint.