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Honeine JL, Schieppati M, Gagey O, Do MC. By counteracting gravity, triceps surae sets both kinematics and kinetics of gait. Physiol Rep 2014. [PMID: 24744898 DOI: 10.1002/phy2.229phy2229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In the single-stance phase of gait, gravity acting on the center of mass (CoM) causes a disequilibrium torque, which generates propulsive force. Triceps surae activity resists gravity by restraining forward tibial rotation thereby tuning CoM momentum. We hypothesized that time and amplitude modulation of triceps surae activity determines the kinematics (step length and cadence) and kinetics of gait. Nineteen young subjects participated in two experiments. In the gait initiation (GI) protocol, subjects deliberately initiated walking at different velocities for the same step length. In the balance-recovery (BR) protocol, subjects executed steps of different length after being unexpectedly released from an inclined posture. Ground reaction force was recorded by a large force platform and electromyography of soleus, gastrocnemius medialis and lateralis, and tibialis anterior muscles was collected by wireless surface electrodes. In both protocols, the duration of triceps activity was highly correlated with single-stance duration (GI, R (2) = 0.68; BR, R (2) = 0.91). In turn, step length was highly correlated with single-stance duration (BR, R (2) = 0.70). Control of CoM momentum was obtained by decelerating the CoM fall via modulation of amplitude of triceps activity. By modulation of triceps activity, the central nervous system (CNS) varied the position of CoM with respect to the center of pressure (CoP). The CoM-CoP gap in the sagittal plane was determinant for setting the disequilibrium torque and thus walking velocity. Thus, by controlling the gap, CNS-modified walking velocity (GI, R (2) = 0.86; BR, R (2) = 0.92). This study is the first to highlight that by merely counteracting gravity, triceps activity sets the kinematics and kinetics of gait. It also provides evidence that the surge in triceps activity during fast walking is due to the increased requirement of braking the fall of CoM in late stance in order to perform a smoother step-to-step transition.
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Affiliation(s)
- Jean-Louis Honeine
- Complexité, Innovation et Activité Motrices et Sportive laboratory, Sport-Science Faculty, University Paris-Sud, Orsay, F-91405, France
| | - Marco Schieppati
- Complexité, Innovation et Activité Motrices et Sportive laboratory, Sport-Science Faculty, University Paris-Sud, Orsay, F-91405, France ; Centro Studi Attività Motorie laboratory, Salvatore Maugeri Foundation (IRCCS) and Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, I-27100, Italy
| | - Oliver Gagey
- Complexité, Innovation et Activité Motrices et Sportive laboratory, Sport-Science Faculty, University Paris-Sud, Orsay, F-91405, France ; Department of Orthopaedics, Faculty of Medicine, University Paris-Sud, Le Kremlin-Bicêtre, F-94276, France
| | - Manh-Cuong Do
- Complexité, Innovation et Activité Motrices et Sportive laboratory, Sport-Science Faculty, University Paris-Sud, Orsay, F-91405, France
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Barbe MT, Amarell M, Snijders AH, Florin E, Quatuor EL, Schönau E, Fink GR, Bloem BR, Timmermann L. Gait and upper limb variability in Parkinson’s disease patients with and without freezing of gait. J Neurol 2013; 261:330-42. [DOI: 10.1007/s00415-013-7199-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/08/2013] [Accepted: 11/20/2013] [Indexed: 12/16/2022]
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Nieuwboer A, Giladi N. Characterizing freezing of gait in Parkinson's disease: Models of an episodic phenomenon. Mov Disord 2013; 28:1509-19. [DOI: 10.1002/mds.25683] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alice Nieuwboer
- Department of Rehabilitation Sciences; KU Leuven Leuven Belgium
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology; Tel-Aviv Medical Center, Sackler School of Medicine; Sagol School of Neuroscience; Tel-Aviv University; Tel-Aviv Israel
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The how and why of arm swing during human walking. Gait Posture 2013; 38:555-62. [PMID: 23489950 DOI: 10.1016/j.gaitpost.2013.02.006] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 11/26/2012] [Accepted: 02/05/2013] [Indexed: 02/02/2023]
Abstract
Humans walk bipedally, and thus, it is unclear why they swing their arms. In this paper, we will review the mechanisms and functions of arm swinging in human gait. First, we discuss the potential advantages of having swinging arms. Second, we go into the detail on the debate whether arm swing is arising actively or passively, where we will conclude that while a large part of arm swinging is mechanically passive, there is an active contribution of muscles (i.e. an activity that is not merely caused by stretch reflexes). Third, we describe the possible function of the active muscular contribution to arm swinging in normal gait, and discuss the possibility that a Central Pattern Generator (CPG) generates this activity. Fourth, we discuss examples from pathological cases, in which arm swinging is affected. Moreover, using the ideas presented, we suggest ways in which arm swing may be used as a therapeutic aid. We conclude that (1) arm swing should be seen as an integral part of human bipedal gait, arising mostly from passive movements, which are stabilized by active muscle control, which mostly originates from locomotor circuits in the central nervous system (2) arm swinging during normal bipedal gait most likely serves to reduce energy expenditure and (3) arm swinging may be of therapeutic value.
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Williams AJ, Peterson DS, Earhart GM. Gait coordination in Parkinson disease: effects of step length and cadence manipulations. Gait Posture 2013; 38:340-4. [PMID: 23333356 PMCID: PMC3640640 DOI: 10.1016/j.gaitpost.2012.12.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 11/21/2012] [Accepted: 12/15/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait impairments are well documented in those with PD. Prior studies suggest that gait impairments may be worse and ongoing in those with PD who demonstrate FOG compared to those with PD who do not. PURPOSE Our aim was to determine the effects of manipulating step length and cadence individually, and together, on gait coordination in those with PD who experience FOG, those with PD who do not experience FOG, healthy older adults, and healthy young adults. METHODS Eleven participants with PD and FOG, 16 with PD and no FOG, 18 healthy older, and 19 healthy young adults walked across a GAITRite walkway under four conditions: Natural, Fast (+50% of preferred cadence), Small (-50% of preferred step length), and SmallFast (+50% cadence and -50% step length). Coordination (i.e. phase coordination index) was measured for each participant during each condition and analyzed using mixed model repeated measure ANOVAs. RESULTS FOG was not elicited. Decreasing step length alone or decreasing step length and increasing cadence together affected coordination. Small steps combined with fast cadence resulted in poorer coordination in both groups with PD compared to healthy young adults and in those with PD and FOG compared to healthy older adults. CONCLUSIONS Coordination deficits can be identified in those with PD by having them walk with small steps combined with fast cadence. Short steps produced at high rate elicit worse coordination than short steps or fast steps alone.
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Affiliation(s)
- April J. Williams
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO 63108
| | - Daniel S. Peterson
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO 63108
| | - Gammon M. Earhart
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO 63108
- Department of Anatomy and Neurobiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63105
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63105
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Split-belt locomotion in Parkinson’s disease with and without freezing of gait. Neuroscience 2013; 236:110-6. [DOI: 10.1016/j.neuroscience.2013.01.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/16/2013] [Accepted: 01/17/2013] [Indexed: 11/21/2022]
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Interlimb coordination is impaired during walking in persons with Parkinson's disease. Clin Biomech (Bristol, Avon) 2013; 28:93-7. [PMID: 23062816 PMCID: PMC3552037 DOI: 10.1016/j.clinbiomech.2012.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 09/17/2012] [Accepted: 09/17/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Coordination between the upper and lower extremities is important to providing dynamic stability during human gait. Though limited, previous research has suggested that interlimb coordination may be impaired in persons with Parkinson's disease. We extend this previous work using continuous analytical techniques to enhance our understanding of interlimb coordination during gait in persons with Parkinson's disease. METHODS Eighteen adults with Parkinson's disease and fifteen healthy older adults walked overground while undergoing three-dimensional motion capture. Ipsilateral and contralateral interlimb coordination between the sagittal shoulder and hip angles was assessed using cross-covariance techniques. Independent samples and paired samples t-tests compared measures of interlimb coordination between groups and between sides within the participants with Parkinson's disease, respectively. Pearson's correlations were applied to investigate associations between interlimb coordination measures and subscores of gait, posture, and bradykinesia on the Unified Parkinson's Disease Rating Scale. FINDINGS Ipsilateral and contralateral interlimb coordination was reduced in persons with Parkinson's disease compared to the healthy older adults. Ipsilateral coordination between the upper and lower extremities more affected by disease was found to be negatively associated with clinical scores of gait and posture. Interlimb coordination was not significantly associated with clinical measures of bradykinesia. INTERPRETATION Persons with Parkinson's disease exhibit reduced interlimb coordination during gait when compared to healthy older adults. These reductions in coordination are related to clinically-meaningful worsening of gait and posture in persons with PD and coordination of arm and leg movements should be considered in future research on gait therapy in this population.
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Meyns P, Van Gestel L, Bruijn SM, Desloovere K, Swinnen SP, Duysens J. Is interlimb coordination during walking preserved in children with cerebral palsy? RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1418-1428. [PMID: 22522200 DOI: 10.1016/j.ridd.2012.03.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 05/31/2023]
Abstract
Arm movements during gait in children with cerebral palsy (CP) are altered compared to typically developing children (TD). We investigated whether these changes in arm movements alter interlimb coordination in CP gait. 3D gait analysis was performed in CP (diplegia [DI]: N = 15 and hemiplegia [HE]: N = 11) and TD (N = 24) children at preferred and fast walking speeds. Mean Relative Phase (MRP, i.e. mean over the gait cycle of the Continuous Relative Phase or CRP) was calculated as a measure of coordination, standard deviation of CRP was used as a measure of coordinative stability, and the sign of MRP indicated which limb was leading (for all pair combinations of the four limbs). In HE, coordination was significantly altered, less stable and a different leading limb was found compared to TD whenever the most affected arm was included in the studied limb pair. In DI, coordination deteriorated significantly when any of the two legs was included in the studied limb pair, and coordinative stability was significantly affected when any of the two arms was included. In almost all limb pair combinations, a different limb was leading in DI compared to TD. Increasing walking speed significantly improved coordination and coordinative stability of several limb pairs in DI. Coordination and limb-leading deficits were mostly linked to the affected limb. The compensating (non-affected) arm primarily affected coordinative stability, which underlines the importance of active arm movements in HE. Increasing walking speed may be used to improve interlimb coordination in DI.
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Affiliation(s)
- Pieter Meyns
- Department of Kinesiology, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Heverlee, Belgium.
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Nanhoe-Mahabier W, Delval A, Snijders AH, Weerdesteyn V, Overeem S, Bloem BR. The possible price of auditory cueing: Influence on obstacle avoidance in Parkinson's disease. Mov Disord 2012; 27:574-8. [DOI: 10.1002/mds.24935] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/10/2011] [Indexed: 11/08/2022] Open
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Köse A, Cereatti A, Della Croce U. Bilateral step length estimation using a single inertial measurement unit attached to the pelvis. J Neuroeng Rehabil 2012; 9:9. [PMID: 22316235 PMCID: PMC3359258 DOI: 10.1186/1743-0003-9-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 02/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The estimation of the spatio-temporal gait parameters is of primary importance in both physical activity monitoring and clinical contexts. A method for estimating step length bilaterally, during level walking, using a single inertial measurement unit (IMU) attached to the pelvis is proposed. In contrast to previous studies, based either on a simplified representation of the human gait mechanics or on a general linear regressive model, the proposed method estimates the step length directly from the integration of the acceleration along the direction of progression. METHODS The IMU was placed at pelvis level fixed to the subject's belt on the right side. The method was validated using measurements from a stereo-photogrammetric system as a gold standard on nine subjects walking ten laps along a closed loop track of about 25 m, varying their speed. For each loop, only the IMU data recorded in a 4 m long portion of the track included in the calibrated volume of the SP system, were used for the analysis. The method takes advantage of the cyclic nature of gait and it requires an accurate determination of the foot contact instances. A combination of a Kalman filter and of an optimally filtered direct and reverse integration applied to the IMU signals formed a single novel method (Kalman and Optimally filtered Step length Estimation - KOSE method). A correction of the IMU displacement due to the pelvic rotation occurring in gait was implemented to estimate the step length and the traversed distance. RESULTS The step length was estimated for all subjects with less than 3% error. Traversed distance was assessed with less than 2% error. CONCLUSIONS The proposed method provided estimates of step length and traversed distance more accurate than any other method applied to measurements obtained from a single IMU that can be found in the literature. In healthy subjects, it is reasonable to expect that, errors in traversed distance estimation during daily monitoring activity would be of the same order of magnitude of those presented.
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Affiliation(s)
- Alper Köse
- Biomedical Sciences Department, University of Sassari, Sassari, Italy.
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Okada Y, Fukumoto T, Takatori K, Nagino K, Hiraoka K. Variable initial swing side and prolonged double limb support represent abnormalities of the first three steps of gait initiation in patients with Parkinson's disease with freezing of gait. Front Neurol 2011; 2:85. [PMID: 22232615 PMCID: PMC3247685 DOI: 10.3389/fneur.2011.00085] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 12/06/2011] [Indexed: 12/16/2022] Open
Abstract
This study investigated abnormalities of the first three steps of gait initiation in patients with Parkinson’s disease without freezing of gait (PD − FOG) and investigated which abnormalities are related to FOG. Seven PD − FOG and seven age-matched healthy controls performed self-generated or cue-triggered gait initiation. Data for PD patients with FOG (PD + FOG) were cited from a previous study using a procedure similar to that used in the present study. Gait initiation was abnormal, and external cue normalized some abnormalities in PD − FOG. The initial swing side was fairly consistent among the trials in both PD − FOG and in healthy controls, although the initial swing side was inconsistent in PD + FOG. The duration of the first double limb support (DLS) was the only parameter that depends on FOG severity and that was abnormal in PD + FOG but was not abnormal in PD − FOG. The variability of the initial swing side and prolonged first DLS are abnormalities specifically related to FOG.
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Affiliation(s)
- Yohei Okada
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University Osaka, Japan
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Abstract
Freezing of gait (FoG) is a unique and disabling clinical phenomenon characterised by brief episodes of inability to step or by extremely short steps that typically occur on initiating gait or on turning while walking. Patients with FoG, which is a feature of parkinsonian syndromes, show variability in gait metrics between FoG episodes and a substantial reduction in step length with frequent trembling of the legs during FoG episodes. Physiological, functional imaging, and clinical-pathological studies point to disturbances in frontal cortical regions, the basal ganglia, and the midbrain locomotor region as the probable origins of FoG. Medications, deep brain stimulation, and rehabilitation techniques can alleviate symptoms of FoG in some patients, but these treatments lack efficacy in patients with advanced FoG. A better understanding of the phenomenon is needed to aid the development of effective therapeutic strategies.
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Okada Y, Fukumoto T, Takatori K, Nagino K, Hiraoka K. Abnormalities of the first three steps of gait initiation in patients with Parkinson's disease with freezing of gait. PARKINSONS DISEASE 2011; 2011:202937. [PMID: 21785691 PMCID: PMC3140034 DOI: 10.4061/2011/202937] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 04/28/2011] [Accepted: 06/02/2011] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to investigate abnormalities of the first three steps of gait initiation in patients with Parkinson's disease (PD) with freezing of gait (FOG). Ten PD patients with FOG and 10 age-matched healthy controls performed self-generated gait initiation. The center of pressure (COP), heel contact positions, and spatiotemporal parameters were estimated from the vertical pressures on the surface of the force platform. The initial swing side of gait initiation was consistent among the trials in healthy controls but not among the trials in PD patients. The COP and the heel contact position deviated to the initial swing side during the first step, and the COP passed medial to each heel contact position during the first two steps in PD patients. Medial deviation of the COP from the first heel contact position had significant correlation with FOG questionnaire item 5. These findings indicate that weight shifting between the legs is abnormal and that medial deviation of the COP from the first heel contact position sensitively reflects the severity of FOG during the first three steps of gait initiation in PD patients with FOG.
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Affiliation(s)
- Yohei Okada
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka 583-8555, Japan
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