Walking Velocity Research Articles

Evaluating a Speech-Specific and a Computerized Step-Training-Specific Rhythmic Intervention in Parkinson's Disease: A Cross-Over, Multi-Arms Parallel Study.

Background:Recent studies suggest movements of speech and gait in patients with Parkinson's Disease (PD) are impaired by a common underlying rhythmic dysfunction. If this being the case, motor deficits in speech and gait should equally benefit from rhythmic interventions regardless of whether it is a speech-specific or step-training-specific approach.Objective:In this intervention trial, we studied the effects of two rhythmic interventions on speech and gait. These rhythmic intervention programs are similar in terms of intensity and frequency (i.e., 3x per week, 45 min-long sessions for 4 weeks in total), but differ regarding therapeutic approach (rhythmic speech vs. rhythmic balance-mobility training).Methods:This study is a cross-over, parallel multi-arms, single blind intervention trial, in which PD patients treated with rhythmic speech-language therapy (rSLT; N = 16), rhythmic balance-mobility training (rBMT; N = 10), or no therapy (NT; N = 18) were compared to healthy controls (HC; N = 17; matched by age, sex, and education: p > 0.82). Velocity and cadence in speech and gait were evaluated at baseline (BL), 4 weeks (4W-T1), and 6 months (6M-T2) and correlated.Results:Parameters in speech and gait (i.e., speaking and walking velocity, as well as speech rhythm with gait cadence) were positively correlated across groups (p < 0.01). Statistical analyses involved repeated measures ANOVA across groups and time, as well as independent and one-samples t-tests for within groups analyses. Statistical analyses were amplified using Reliable Change (RC) and Reliable Change Indexes (RCI) to calculate true clinically significant changes due to the treatment on a patient individual level. Rhythmic intervention groups improved across variables and time (total Mean Difference: 3.07 [SD 1.8]; 95% CI 0.2–11.36]) compared to the NT group, whose performance declined significantly at 6 months (p < 0.01). HC outperformed rBMT and NT groups across variables and time (p < 0.001); the rSLT performed similarly to HC at 4 weeks and 6 months in speech rhythm and respiration.Conclusions:Speech and gait deficits in PD may share a common mechanism in the underlying cortical circuits. Further, rSLT was more beneficial to dysrhythmic PD patients than rBMT, likely because of the nature of the rhythmic cue.

Association Between Balance Self-efficacy and Walking Ability in Those With New Lower Limb Amputations.

A relationship between walking ability and self-efficacy has been demonstrated in various rehabilitation patient populations. In experienced prosthetic ambulators, walking ability is related to self-efficacy of balance, however, this relationship has not been quantified for those with newly acquired lower limb amputations (LLA). To investigate the association between walking performance (objective) and self-reported walking abilities (subjective) on balance self-efficacy in those with LLA. Cross-sectional study of 27 people (17 men; mean age=63.57±9.33) at discharge from inpatient prosthetic rehabilitation for first major unilateral LLA. Individuals completed 6m straight path walking and the L-Test under single- and dual-task conditions. The Prosthesis Evaluation Questionnaire (PEQ) was administered, and the Ambulation subscale provided subjective measures of walking ability. A single PEQ question on satisfaction with walking (16B) was also used as a proxy for subjective walking ability. The Activities-specific Balance Confidence Scale measured balance self-efficacy. Multivariable linear regression was used to evaluate the strength of association between walking ability (objective and subjective) and balance self-efficacy (dependent variable). Walking velocity on the 6m straight path under single-task (p=0.011) and dual-task conditions (p=0.039), the single-task L-Test (p=0.035) and self-reported satisfaction with walking (p=0.019) were associated with self-efficacy of balance. Objective measures of walking ability that were independently associated with balance self-efficacy included straight path walking velocity under single and dual-task conditions and the single-task L-Test. Satisfaction with walking was also associated with balance self-efficacy. This highlights the interplay between physical and psychological factors during rehabilitation. More research in the area of self-efficacy and walking ability is needed to establish self-efficacy as a target during prosthetic rehabilitation for those with LLA.

Effect of Visual Cue Training on Gait and Walking Velocity in Chronic Stroke Patients- A Quasi-experimental Study

Introduction: Stroke is the major cause of disability and death in the world. More than 80% of stroke survivors face walking impairment due to muscle weakness, incoordination and spasticity. For physical rehabilitation of patients with neurological conditions combination of approaches are used. Visual cuing techniques are useful approaches for rehabilitation but the effect of visual cue training for gait and walking velocity is less explored for a patient with chronic stroke. Aim: To determine the effect of visual cue training on gait and walking velocity in subjects with chronic stroke. Materials and Methods: This was a quasi-experimental study in which 38 patients of chronic stroke were selected from various physiotherapy Outpatient Departments (OPD), of Surat, Gujarat from January 2019 to August 2020. Samples were randomly allocated into two groups, group A and group B; conventional and experimental group respectively. Group A was given conventional training and group B was given visual cue training along with conventional training for three days a week, 20 minutes/session. Both groups received conventional training five days a week, for four weeks. Dynamic Gait Index (DGI) and walking velocity were taken as an outcome measure and checked before intervention and after the end of four weeks of intervention. Statistical analysis was done using Statistical Package of the Social Sciences (SPSS) version 16.0. Paired t-test was carried out for within group comparison. Results: The results of the study indicates that there was significant difference in DGI and walking speed preintervention and postintervention in both the groups (p&lt;0.001). The mean difference of DGI in group A and B was 1.94±0.52 and 3. 26±0.99, respectively (p&lt;0.001). The result of the study suggests that there is greater improvement in visual cue training group. Conclusion: The present study results conclude that visual cue training along with conventional training shows greater improvements in gait and walking velocity than the conventional training alone.

Modelling of pedestrian-induced load in serviceability limit state analysis of footbridges

The last few decades new trends in the design of pedestrian bridges have resulted in lighter and more slender structures. This leads to a reduction in natural frequencies and increased flexibility, and thus a greater possibility for structures to become more exposed to excessive vibrations caused by pedestrians. The lager amplitudes of vibrations occur if the pace frequency of excitation load approaches one of natural frequency of footbridge. The vibration of high proportions may cause pedestrians to feel uncomfortable, sick or unsafe while crossing the bridge. In modern pedestrian bridge design, human-induced vibrations have become an important issue. Footbridge vibrations occur in vertical, lateral and longitudinal direction, and torsion of the bridge deck is also possible. The main types of pedestrian action on the bridge are walking and running, while jumping, bouncing, swaying are considered to be intentional, or sometimes even vandal excitation. Pedestrian-induced loads are difficult to model since pedestrians may have different weight, various number in the groups randomly distributed over the bridge deck. Also, the walking velocity may vary from a pedestrian to a pedestrian. The load models appropriately set up are of great importance for understanding the response of the bridge. Principles of modeling of the human-induced load and some characteristic models of pedestrian loads, described in proposals and codes, are presented in this paper. Some results of Serviceability Limit State analysis, in terms of human-induced vibration, of the pedestrian bridge over the Nisava River in Nis, are also presented.

New findings and pathophysiology in attitude control through vestibular interoception

Attitude control is associated with coordinated limb, body, head, and ocular movements through vestibular interoception. During straight walking, walking speed for velocities ranging from 1.2–1.8 m/s. Over this range of walking velocities, there is both translation and rotation of the head in the sagittal plane, reaching translational frequencies close to 2 Hz, peak vertical linear accelerations of 0.3–0.5 g, and peak pitch velocities of 15–22°/s. The magnitude and frequency of the pitch angular and vertical translational head movements are sufficient to activate both the angular and linear vestibulo-ocular (aVOR and lVOR) and vestibulo-collic (aVCR and lVCR) reflexes, which may play important roles in directing gaze and in stabilizing gait. In support of this, unilateral vestibular disease is associated with instability of gait, and astronauts, whose vestibular function has been adapted to microgravity, also experience difficulty when walking a curved path after flight. The purpose of this study was to infer a possible role for the vestibular interoception in producing head and eye movements in three dimensions as the body moves in space.

Development of Neuro-Degenerative Diseases’ Gait Classification Algorithm Using Convolutional Neural Network and Wavelet Coherence Spectrogram of Gait Synchronization

Objective: A neurodegenerative disease (NDD) detection algorithm using a convolutional neural network (CNN) and wavelet coherence spectrogram of gait synchronization was developed to classify NDD based on gait force signals. The main purpose of this research was to help physicians with screening for NDD for early diagnosis, efficient treatment planning, and monitoring of disease progression. Methods: The NDD detection algorithm was evaluated using the existing online database from Physionet by Hausdorff <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">et al.</i> , called gait in neurodegenerative disease database, comprised of windowing, feature transformation, and classification processes. Force pattern variations among healthy control (HC) and patients with ALS, HD, and PD were distinctly observed from feature-extracted wavelet coherence spectrogram images. Results: HC was balanced because their left and right feet supported each other when walking. In patients with ALS, the left-right foot correlation was weaker than that in HC. In patients with HD, walking velocity varied, which indicated that only one foot (right or left) was dominant and sustained the entire body’s balance during movement. The left and right feet of patients with PD were correlated and coordinated in terms of supporting lower-body movements. The right foot was always on the ground to support the entire body when walking. Conclusion: The proposed NDD detection algorithm effectively differentiates gait patterns on the basis of a time-frequency spectrogram of gait force signals between HC and NDD patients with an overall sensitivity of 94.34%, specificity of 96.98%, accuracy of 96.37%, and AUC value of 0.97 using 5-fold cross-validation.

Peculiarities of the biomechanical and innervative structure of walking of healthy children of the early age

Restoration of the locomotor function is one of the most essential problems of medicine. This problem becomes especially essential, when we deal with those children, who can’t walk from their birth. Term “abilitation” is used just in relation to such children, what means not retraining children the right stereotype of walking, but appearance of this skill and its further adequate development. Nowadays, more and more specialists, who occupy themselves with abilitation of children of the early age, realize necessity of the instrumental estimation of the locomotor function. This phenomenon is connected with the fact, that in contrast with the score system of estimation, instrumental estimation of walking is maximally concrete and exact, and complex investigation of the biomechanical and innervative structure of walking gives complete idea of the locomotor disturbances of the child. Authors of this article investigated biomechanical and innervative structure of walking of 4 healthy children at the age of 2–2.5 years. On the basis of these investigations, it has been revealed, that the following peculiarities of walking are characteristic of children at the age of 2: remarkable diminution of the mean walking velocity, increase of cadence and shortening of the step length, essential transformation of the temporal structure of walking (growth of duration of the stance and double-support phase and decrease of duration of the swing phase), flexion position of the lower extremities, displacement of all extreme values of the angular displacements to the right along the temporal axis, considerable prolongation of the maximums of activity, absence of the second maximum of activity in a number of muscles, severe disturbances in the resonance properties of the lower extremities. All these peculiarities point out to the immaturity of the process of locomotion in children at the age of 2. The received data are necessary first of all as the standard ones, because walking parameters of children with the locomotor disorders of the early age must be compared with the corresponding parameters of the healthy children of the same age.

The effect of a multi-modal boxing exercise program on cognitive locomotor tasks and gait in persons with Parkinson disease.

Parkinson disease (PD) is a progressive neurological disease resulting in motor impairments, postural instability, and gait alterations which may result in self-care limitations and loss of mobility reducing quality of life. This study's purpose was to determine the impact of a community-based boxing program on gait parameters, dual task and backwards walking in individuals with PD. This study included 26 community dwelling individuals with PD who participated in 12-week boxing classes (1 hour, 2 times a week). The focus was on upper/lower extremity exercises using punching bags, agility drills, and strengthening activities. Pre/post testing was performed for dual task and gait parameters and was analyzed using t-tests. Analysis of the scores indicated participants performed significantly better at post-test compared to pre-test on self-selected walking velocity (P = 0.041), cadence (P = 0.021); backwards walking velocity (P = 0.003), step length (P = 0.022); dual task walking velocity (P = 0.044), step length (P = 0.023), and gait variability index (P = 0.008). No significant differences for fast walking. Multi-modal boxing produced improvements in gait velocity, dual task velocity, step length, and gait variability, as well as backwards walking velocity and step length. These improvements may impact independence with functional mobility and may improve safety but require further studies.

One-Year Change in Walking Performance and Subsequent Mobility Loss and Mortality Rates in Peripheral Artery Disease: Longitudinal Data From the WALCS.

BackgroundAssociations of 1‐year change in functional performance measures with subsequent mobility loss and mortality in people with lower extremity peripheral artery disease are unknown.Methods and ResultsSix‐minute walk and 4‐meter walking velocity (usual and fastest pace) were measured at baseline and 1 year later in 612 people with peripheral artery disease (mean age 71±9 years, 37% women). Participants were categorized into tertiles, based on 1‐year changes in walking measures. Cox proportional hazards models were used to examine associations between 1‐year change in each walking measure and subsequent mobility loss and mortality, respectively, adjusting for potential confounders. Compared with the best tertile, the worst tertile (ie, greatest decline) in 1‐year change in each performance measure was associated with higher rates of mobility loss: 6‐minute walk (Tertile 1 [T1] cumulative incidence rate [IR], 72/160; Tertile 3 [T3] IR, 47/160; hazard ratio [HR], 2.35; 95% CI, 1.47–3.74), usual‐paced 4‐meter walking velocity (T1 IR, 54/162; T3 IR, 57/162; HR, 2.21; 95% CI, 1.41–3.47), and fast‐paced 4‐meter walking velocity (T1 IR, 61/162; T3 IR, 58/162; HR, 1.81; 95% CI, 1.16–2.84). Compared with the best tertile, the worst tertiles in 1‐year change in 6‐minute walk (T1 IR, 66/163; T3 IR, 54/163; HR, 1.61; 95% CI, 1.07–2.43) and fast‐paced 4‐meter walking velocity (T1 IR, 63/166; T3 IR, 44/166; HR, 1.75; 95% CI, 1.16, 2.64) were associated with higher mortality.ConclusionsIn people with peripheral artery disease, greater 1‐year decline in 6‐minute walk or 4‐meter walking velocity may help identify people with peripheral artery disease at highest risk for mobility loss and mortality.

Sensorimotor outcomes in adrenomyeloneuropathy show significant disease progression.

Current outcomes used to evaluate adrenomyeloneuropathy are limited by rater bias, not sensitive to preclinical changes, and require years to decades to detect disease progression. Quantitative outcomes are needed that detect meaningful change in a short time period over a broad range of disability. The study aim was to track sensorimotor outcomes in adults with adrenomyeloneuropathy and evaluate differences in progression between men and women. This prospective observational cohort study analyzes data collected annually in the Phase III study of adults with adrenomyeloneuropathy. Outcomes include postural sway in four static standing conditions, great-toe vibration, hip strength, walking velocity, timed up-and-go, and 6-minute walk distance. Linear mixed model analysis was used to detect change in the outcomes in 2 years, correcting for age, sex, disability, symptom duration, and treatment across the cohort. Modeling was repeated for each sex to evaluate differences. Power computations were carried out by sex and for the full dataset. Sixty-one men and 87 women participated. Average age, 46 ± 12 years; Expanded Disability Status Scale, 3 (1-6.5); symptom duration, 10.8 ± 9.4 years. The cohort showed significant worsening in all standing conditions (P < .001), sensation (P=.0223) and strength (P=.001); but more stability in walking with only velocity (P < .0337) significantly declining. For each sex, postural sway declines significantly in all conditions (P < .01) except for eyes closed feet together for women. Strength declines significantly by sex for hip flexion (P < .03). Sex-specific significant decline is seen in walking (velocity P=.0276; distance P=.0072) for men only. Quantitative measures of postural sway, sensation strength, and walking are effective measures of adrenomyeloneuropathy progression in 2 years.

Differences in walking-to-turning characteristics between older adult fallers and nonfallers: a prospective and observational study using wearable inertial sensors.

Wearable inertial sensors have gradually been used as an objective technology for biomechanical assessments of both healthy and pathological movement patterns. This paper used foot-worn sensors for characterizing the spatiotemporal characteristics of walking and turning between older fallers and nonfallers. Thirty community-dwelling older fallers and 30 older nonfallers performed 10-m straight walking, turned 180° around a cone, and then walked 10-m back to the starting point. Specific algorithms were used to measure spatiotemporal gait (double support phase of the gait cycle, swing width, and minimal toe clearance) and turning parameters (turn duration and turn steps) using two foot-worn Physiolog inertial sensor system. The researchers directly exported data as reported by the system. Our findings indicated that older fallers showed 26.58% longer time (P = 0.036) and 13.21% more steps (P = 0.038) compared to nonfallers during turning. However, both groups decreased their walking velocity (both P < 0.001), increased double support (both P = 0.001), and increased the swing width (both P = 0.001) during the transition from walking to turning. The older nonfallers additionally increased toe clearance (P = 0.001). Compared with the fallers, the older nonfallers showed a larger change in the swing width (P = 0.025) and toe clearance (P = 0.025) in walking to turning. Older fallers may adopt a cautionary strategy while turning to reduce the risk of falls. Wearable sensors can provide the temporospatial characteristics of turning and reveal significant differences by fall status, indicating the potential of turning measures as possible markers for identifying those at fall risk.

Survey of transfemoral amputee experience and priorities for the user-centered design of powered robotic transfemoral prostheses

BackgroundTransfemoral amputees experience a complex host of physical, psychological, and social challenges, compounded by the functional limitations of current transfemoral prostheses. However, the specific relationships between human factors and prosthesis design and performance characteristics have not yet been adequately investigated. The present study aims to address this knowledge gap.MethodsA comprehensive single-cohort survey of 114 unilateral transfemoral amputees addressed a broad range of demographic and clinical characteristics, functional autonomy, satisfaction and attitudes towards their current prostheses, and design priorities for an ideal transfemoral prosthesis, including the possibility of active assistance from a robotic knee unit. The survey was custom-developed based on several standard questionnaires used to assess motor abilities and autonomy in activities of daily living, prosthesis satisfaction, and quality of life in lower-limb amputees. Survey data were analyzed to compare the experience (including autonomy and satisfaction) and design priorities of users of transfemoral prostheses with versus without microprocessor-controlled knee units (MPKs and NMPKs, respectively), with a subsequent analyses of cross-category correlation, principal component analysis (PCA), cost-sensitivity segmentation, and unsupervised K-means clustering applied within the most cost-sensitive participants, to identify functional groupings of users with respect to their design priorities.ResultsThe cohort featured predominantly younger (< 50 years) traumatic male amputees with respect to the general transfemoral amputee population, with pronounced differences in age distribution and amputation etiology (traumatic vs. non-traumatic) between MPK and NMPK groups. These differences were further reflected in user experience, with MPK users reporting significantly greater overall functional autonomy, satisfaction, and sense of prosthesis ownership than those with NMPKs, in conjunction with a decreased incidence of instability and falls. Across all participants, the leading functional priorities for an ideal transfemoral prosthesis were overall stability, adaptability to variable walking velocity, and lifestyle-related functionality, while the highest-prioritized general characteristics were reliability, comfort, and weight, with highly variable prioritization of cost according to reimbursement status. PCA and user clustering analyses revealed the possibility for functionally relevant groupings of prosthesis features and users, based on their differential prioritization of these features—with implications towards prosthesis design tradeoffs.ConclusionsThis study’s findings support the understanding that when appropriately prescribed according to patient characteristics and needs in the context of a proactive rehabilitation program, advanced transfemoral prostheses promote patient mobility, autonomy, and overall health. Survey data indicate overall stability, modularity, and versatility as key design priorities for the continued development of transfemoral prosthesis technology. Finally, observed associations between prosthesis type, user experience, and attitudes concerning prosthesis ownership suggest both that prosthesis characteristics influence device acceptance and functional outcomes, and that psychosocial factors should be specifically and proactively addressed during the rehabilitation process.

Abstract 12807: Effects of Ischemic Pain Inducing Walking Exercise vs. Pain Free Walking Exercise on Walking Velocity and Functional Performance in Peripheral Artery Disease. Results From the Lite Randomized Clinical Trial

Introduction: The LITE randomized trial recently demonstrated that home-based pain free walking exercise did not improve 6-minute walk distance, compared to home-based ischemic pain inducing walking exercise, and compared to an attention control group, among people with lower extremity peripheral artery disease (PAD). This study examined effects of home-based pain free walking exercise and home-based ischemic pain inducing walking exercise on walking velocity, and the short physical performance battery (SPPB). Methods: 305 participants with PAD were randomized to home-based pain free walking exercise, home-based ischemic pain inducing walking exercise, or an attention control group in a multi-centered randomized trial, over 12 months. Participants in the pain free walking exercise group walked at a pace that did not cause ischemic leg symptoms. Participants in the ischemic pain inducing walking exercise group walked at a pace that caused ischemic leg symptoms. The attention control group received health education talks. Usual-paced 4-meter walking velocity (4MWV), fast-paced 4MWV, and SPPB (total score range: 0-12; 12=best) were measured at baseline and 12-month follow-up. Results: Of the 305 PAD participants randomized, 246 (mean age: 69 ± 9 years; 48% women; 60% black) with baseline or 12-month data on either usual-paced 4MWV, fast-paced 4MWV, or SPPB were included. The effects of the exercise interventions on each functional measure are shown in the table. Conclusion: These data suggest that ischemic pain inducing walking exercise improves walking speed and functional performance, while walking exercise at a comfortable pace may worsen walking velocity in PAD.

An Ergonomic Assessment of Different Postures and Children Risk during Evacuations.

Crawling is recommended for avoiding high heat and toxic fumes and for obtaining more breathable air during evacuations. Few studies have evaluated the effects of crawling on physical joints and velocity, especially in children. Based on motion capture technology, this study proposes a novel method of using wearable sensors to collect exposure (e.g., mean duration, frequency) on children’s joints to objectively quantify the impacts of different locomotion methods on physical characteristics. An on-site experiment was conducted in a kindergarten with 28 children (13 boys and 15 girls) of different ages (4–6 years old) who traveled up to 22 m in three different postures: upright walking (UW), stoop walking (SW), and knee and hand crawling (KHC). The results showed that: (1) The level of joint fatigue for KHC was heavier than bipedal walking (p < 0.05), which was evidenced by higher mean duration and frequency. There was no significant difference between UW and SW (p > 0.05). (2) The physical characteristics of the children in the different postures observed in this study were different (p < 0.05). The ankle was more fatigued than other joints during bipedal walking. Unlike infants, the wrists and hips of the children became fatigued while crawling. The key actions flexion/extension are more likely to induce joint fatigue vs. other actions. (3) Crawling velocity was significantly slower than the bipedal velocities, and UW was 10.6% faster than SW (p < 0.05). The bipedal walking velocity started to decrease after the children had travelled up to 13 m, while the KHC velocity started to decrease after traveling up to 11.6 m. (4) In a severe fire, the adoption of SW is suggested, as the evacuees can both evacuate quickly and avoid overworking their joints. (5) There were no significant differences in the age (p > 0.05) and gender (p > 0.05) of the children on the joints in any of the three postures. To conclude, KHC causes more damage to body joints compared to bipedal walking, as evidenced by higher exposure (mean duration, frequency), whereas UW and SW are similar in terms of the level of joint fatigue. The above findings are expected to provide a useful reference for future applications in the children’s risk assessment and in the prevention design of buildings.

Gait and Axial Spondyloarthritis: Comparative Gait Analysis Study Using Foot-Worn Inertial Sensors.

BackgroundAxial spondyloarthritis (axSpA) can lead to spinal mobility restrictions associated with restricted lower limb ranges of motion, thoracic kyphosis, spinopelvic ankylosis, or decrease in muscle strength. It is well known that these factors can have consequences on spatiotemporal gait parameters during walking. However, no study has assessed spatiotemporal gait parameters in patients with axSpA. Divergent results have been obtained in the studies assessing spatiotemporal gait parameters in ankylosing spondylitis, a subgroup of axSpA, which could be partly explained by self-reported pain intensity scores at time of assessment. Inertial measurement units (IMUs) are increasingly popular and may facilitate gait assessment in clinical practice.ObjectiveThis study compared spatiotemporal gait parameters assessed with foot-worn IMUs in patients with axSpA and matched healthy individuals without and with pain intensity score as a covariate.MethodsA total of 30 patients with axSpA and 30 age- and sex-matched healthy controls performed a 10-m walk test at comfortable speed. Various spatiotemporal gait parameters were computed from foot-worn inertial sensors including gait speed in ms–1 (mean walking velocity), cadence in steps/minute (number of steps in a minute), stride length in m (distance between 2 consecutive footprints of the same foot on the ground), swing time in percentage (portion of the cycle during which the foot is in the air), stance time in percentage (portion of the cycle during which part of the foot touches the ground), and double support time in percentage (portion of the cycle where both feet touch the ground).ResultsAge, height, and weight were not significantly different between groups. Self-reported pain intensity was significantly higher in patients with axSpA than healthy controls (P<.001). Independent sample t tests indicated that patients with axSpA presented lower gait speed (P<.001) and cadence (P=.004), shorter stride length (P<.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than healthy controls. When using pain intensity as a covariate, spatiotemporal gait parameters were still significant with patients with axSpA exhibiting lower gait speed (P<.001), shorter stride length (P=.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than matched healthy controls. Interestingly, there were no longer statistically significant between-group differences observed for the cadence (P=.17).ConclusionsGait was significantly altered in patients with axSpA with reduced speed, cadence, stride length, and swing time and increased double support and stance time. Taken together, these changes in spatiotemporal gait parameters could be interpreted as the adoption of a so-called cautious gait pattern in patients with axSpA. Among factors that may influence gait in patients with axSpA, patient self-reported pain intensity could play a role. Finally, IMUs allowed computation of spatiotemporal gait parameters and are usable to assess gait in patients with axSpA in clinical routine.Trial RegistrationClinicalTrials.gov NCT03761212; https://clinicaltrials.gov/ct2/show/NCT03761212International Registered Report Identifier (IRRID)RR2-10.1007/s00296-019-04396-4

The Incremental Shuttle Walk Test

The Incremental Shuttle Walk Test

Reuleaux Triangle–Based Two Degrees of Freedom Bipedal Robot

This paper presents the design, modeling, analysis, and experimental results of a novel bipedal robotic system that utilizes two interconnected single degree-of-freedom (DOF) leg mechanisms to produce stable forward locomotion and steering. The single DOF leg is actuated via a Reuleaux triangle cam-follower mechanism to produce a constant body height foot trajectory. Kinematic analysis and dimension selection of the Reuleaux triangle mechanism is conducted first to generate the desired step height and step length. Leg sequencing is then designed to allow the robot to maintain a constant body height and forward walking velocity. Dynamic simulations and experiments are conducted to evaluate the walking and steering performance. The results show that the robot is able to control its body orientation, maintain a constant body height, and achieve quasi-static locomotion stability.

Acute responses to locomotor tasks differ according to gait-asymmetry patterns in children with hemiplegic cerebral palsy: An exploratory analysis.

This study aimed at determining if differential responses to locomotor tasks in children with spastic hemiplegia occur on account of step-length asymmetry patterns [symmetrical step-length (S-SL); affected side short (AFFshort), and non-affected short (Non-AFFshort)] observed during on-ground walking. Thirty-two children (5-8years) were assessed for spatial/temporal measures of gait while walking on the ground with self-selected speed. Data from on-ground walking were compared against three locomotor tasks that were examined on a treadmill: self-imposed walking velocity with bodyweight support of 0% (BWS-0%), self-imposed walking velocity with a BWS of 20% (BWS-20%), and fastest walking velocity with a BWS of 20% and a manually-guided response of the non-affected leg (MGRnon-affected). The primary outcome measures were the spatial (step length) and temporal (single-limb support time) symmetry indices. The step-length asymmetry subgroups responded differently to the locomotor tasks. The MGRnon-affected produced spatial symmetry in the S-SL and Non-AFFshort groups and temporal symmetry in the AFFshort group. The BWS-0% and BWS-20% treadmill walking conditions were insufficient to remediate either spatial or temporal walking asymmetry. In conclusion, acute responses to locomotor tasks are not consistent among asymmetry subgroups, suggesting that they might need individual treatment plans. In spite of the differences in walking characteristics between asymmetry subgroups, the improvement in gait-symmetry arose out of changes in affected and non-affected sides together.

Effect of Cognitive Training on Lower Limb Muscular Activity in Older Adults With Balance Impairment During Walking

Purpose: The purpose of this study was to compare the effects of two different approaches of dual-task training and executive training on lower limb muscular activity in older adults with balance impairment. Methods: This was a quasi-experimental study performed with a pre-test and post-test method. Thirty old adults (Mean±SD age=73.8±4.6 y, height=1.65±0.06 m, weight=69.17±12.67 kg) were randomly assigned to one of the three groups: two experimental groups included Cognitive Dual-Task training (CDT; participants did exercises under the dual-task condition with cognitive tasks, such as forward counting, simple visual search task, etc.) and Executive Function training (EF; included a mixture of 20 tasks involving working memory tasks, inhibitory and speed of processing tasks), and a control group. The training session lasted 45 min and was held three times a week for eight weeks. Gait muscle activity under single-task and Dual-Task (DT) conditions was recorded before and after training. Results: during the stance phase of normal walking, the amplitude of Electromyography (EMG) activity of right Tibialis Anterior (TA) muscle in the post-test was about 32% lower than that in the pre-test in the CDT group (P=0.011), and no statistically significant change was between pre- and post-training in the EF and control groups (P&gt;0.05). During the swing phase of DT walking, the amplitude of EMG activity of the right Vastus Lateralis (VL) muscle in the post-test was about 15.5% higher than that in the pre-test in the CDT group (P=0.013), and in the right VL muscle during the post-test was lower than that in the pre-test in the EF group (P=0.01). In the CDT group, right ankle co-contraction during the stance phase in the post-test was statistically different from that in the pre-test. In all three groups, muscular EMG asymmetry demonstrated no statistically significant change between pre- and post-training measures (P&gt;0.05). Conclusion: Overall, both training groups showed similar muscular activity in the post-test than pre-test; however, in the EF training group, walking velocity improved more than that in the CDT group. Therefore, because of improvements in both walking velocity and muscle activities after EF training, this training mode is suggested for older adults.

Factors associated with walking activity in adults with cerebral palsy.

This prospective study used instrumented gait analysis, patient-reported outcomes, and portable accelerometers to examine walking activity in adults with cerebral palsy (CP). This study aimed to provide objective data and evaluate factors associated with walking activity in adults with CP. Participants with CP (ages 25-45 years) completed instrumented gait analysis and patient-reported outcomes, including the Patient Reported Outcome Measurement Information System (PROMIS) and Satisfaction with Life Score (SWLS), and wore a StepWatch for 8 days. Average strides per day, stratified by Gross Motor Function Classification System (GMFCS), were compared with nondisabled adults ages 30-39 years utilizing Welch's t-tests with Bonferroni corrections. Correlation coefficients and stepwise multiple linear regression analyses examined relationships between walking activity and GMFCS, gait deviation index (GDI), gait velocity, PROMIS physical function, SWLS, body mass index (BMI), and employment. Participants included 109 adults with CP, ages 29 ± 4 years, classified at GMFCS levels I/II (73 %) and III/IV (27 %). Compared with nondisabled adults, daily stride count was significantly lower in both groups of adults with CP (p < 0.00025), with a progressive decline according to GMFCS level. Walking activity correlated with PROMIS physical function (r = .42), GDI (r = .48), and gait velocity (r = .58). Association for employment was lower (r = 0.27) but significant, while age, SWLS, and BMI were not individually correlated with walking activity. Stepwise, multiple linear regression modeled with Akaike information criterion explained 40.9 % of the observed variability in walking activity in this cohort of adults with CP. Physical function, as classified by GMFCS or measured by PROMIS and self-selected walking velocity, has the strongest association with and is the most significant predictor of walking activity in adults with CP. After accounting for physical function, a small amount of the variation in walking activity can be explained by GDI, employment, and age.