Advanced age and the mechanics of uphill walking: a joint-level, inverse dynamic analysis

Reconstruction of proximal hamstring ruptures restores joint biomechanics during various walking conditions

PURPOSE

We aimed to examine the functional outcome in different walking conditions in elderly adults who underwent surgical repair after a non-contact hamstring injury. Our objective was to compare lower limb kinematics and kinetics over the entire gait cycle between the injured and contralateral leg in overground and level and uphill treadmill walking.

METHODS

12 patients (mean ± SD, age: 65 ± 9 years; body mass index: 30 ± 6 kg/m2) walked at self-selected speed in overground (0% slope) and treadmill conditions (0% and 10% slope). We measured spatiotemporal parameters, joint angles (normalised to gait cycle) and joint moments (normalised to stance phase) of the hip, knee and ankle. Data between sides were compared using paired sample t-tests (p < 0.05) and continuous 95% confidence intervals of the paired difference between trajectories.

RESULTS

Patients walked at an average speed of 1.31 ± 0.26 m/second overground and 0.92 ± 0.31 m/second on the treadmill. Spatiotemporal parameters were comparable between the injured and contralateral leg (p > 0.05). Joint kinematic and joint kinetic trajectories were comparable between sides for all walking conditions.

CONCLUSIONS

Refixation of the proximal hamstring tendons resulted in comparable ambulatory mechanics at least 1 year after surgery in the injured leg and the contralateral leg, which were all within the range of normative values reported in the literature. These results complement our previous findings on hamstring repair in terms of clinical outcomes and muscle strength and support that surgical repair achieves good functional outcomes in terms of ambulation in an elderly population.

TRIAL REGISTRATION

clinicaltrials.gov (NCT04867746).

Effects of different slopes on hip and ankle biomechanics of replaced and non-replaced limbs of patients with total knee arthroplasty during incline ramp walking

Although knee biomechanics has been examined, hip and ankle biomechanics in incline ramp walking has not been explored for patients with total knee arthroplasty (TKA). The purpose of this study was to investigate the hip and ankle joint kinematic and kinetic biomechanics of different incline slopes for replaced limbs and non-replaced limbs in individuals with TKA compared to healthy controls. Twenty-five patients with TKR and ten healthy controls performed walking trials on four slope conditions of level (0°), 5°, 10° and 15° on a customized instrumented ramp system. A 3x4 (limb x slope) repeated analysis of variance was used to evaluate selected variables. The results showed a greater peak ankle dorsiflexion angle in the replaced limbs compared to healthy limbs. No significant interactions or limb main effect for other ankle and hip variables. The peak dorsiflexion angle, eversion angle and dorsiflexion moment were progressively higher in each comparison from level to 15°. The peak plantarflexion moment was also increased with each increase of slopes. Both the replaced and non-replaced limbs of patients with TKA had lower hip flexion moments than the healthy control limbs. Hip angle at contact and hip extension range of motion increased with each increase of slopes. Peak hip loading-response internal extension moment increased with each increase in slope and peak hip push-off internal flexion moment decreased with each increase of slope. Our results showed increased dorsiflexion in replaced limbs but no other compensations of hip and ankle joints of replaced limbs compared to non-replaced limbs and their healthy controls during incline walking, providing further support of using incline walking in rehabilitation for patients with TKA.

Aging Does Not Alter Ankle, Muscle, and Tendon Stiffness at Low Loads Relevant to Stance

Older adults have difficulty maintaining balance when faced with postural disturbances, a task that is influenced by the stiffness of the triceps surae and Achilles tendon. Age-related changes in Achilles tendon stiffness have been reported at matched levels of effort, but measures typically have not been made at matched loads, which is important due to age-dependent changes in strength. Moreover, there has been limited investigation into age-dependent changes in muscle stiffness. Here, we investigate how age alters muscle and tendon stiffness and their influence on ankle stiffness. We hypothesized that age-related changes in muscle and tendon contribute to reduced ankle stiffness in older adults and evaluated this hypothesis when either load or effort were matched. We used B-mode ultrasound with joint-level perturbations to quantify ankle, muscle, and tendon stiffness across a range of loads and efforts in seventeen healthy younger and older adults. At matched loads relevant to standing and the stance phase of walking, there was no significant difference in ankle, muscle, or tendon stiffness between groups (all p > 0.13). However, at matched effort, older adults exhibited a significant decrease in ankle (27%; p = 0.008), muscle (37%; p = 0.02), and tendon stiffness (22%; p = 0.03) at 30% of maximum effort. This is consistent with our finding that older adults were 36% weaker than younger adults in plantarflexion (p = 0.004). Together, these results indicate that, at the loads tested in this study, there are no age-dependent changes in the mechanical properties of muscle or tendon, only differences in strength that result in altered ankle, muscle, and tendon stiffness at matched levels of effort.

Perceptions and biomechanical effects of varying prosthetic ankle stiffness during uphill walking: A case series

BACKGROUND

Prosthetic foot stiffness, which is typically invariable for commercially available prosthetic feet, needs to be considered when prescribing a prosthetic foot. While a biological foot adapts its function according to the movement task, an individual with lower limb amputation may be limited during more functionally demanding gait tasks by their conventional energy storing and return prosthetic foot.

RESEARCH QUESTION

How do changes in prosthetic foot stiffness during incline walking affect biomechanical measures as well as perception of participants.

METHODS

Kinetic and kinematic data were collected during incline walking, for five participants with trans-tibial amputation. A mixed model analysis of variance was used to analyse the effects of changing the stiffness during incline walking, using a novel variable-stiffness unit built on a commercially available prosthetic foot. Biomechanical results were also analysed on an individual level alongside the participant feedback, for a better understanding of the various strategies and perceptions exhibited during incline walking.

RESULTS

Statistically significant effects were only observed on the biomechanical parameters directly related to prosthetic ankle kinematics and kinetics (i.e., peak prosthetic ankle dorsiflexion, peak prosthetic ankle power, dynamic joint stiffness during controlled dorsiflexion). Participant perception during walking was affected by changes in stiffness. Individual analyses revealed varied perceptions and varied biomechanical responses among participants.

SIGNIFICANCE

While changes in prosthesis mechanical properties influenced the amputee's experience, minimal immediate effects were found with the overall gait pattern. The reported inter-participant variability may be due to the person's physical characteristics or habitual gait pattern, which may influence prosthesis function. The ability to vary prosthetic foot stiffness during the assessment phase of setting up a prosthesis could provide useful information to guide selection of the appropriate prosthetic device for acceptable performance across a range of activities.

Gender differences on the age-related distal-to-proximal shift in joint kinetics during running

The increased running participation in women and men over 40 years has contributed to scientific interest on the age-related and gender differences in running performance and biomechanics over the last decade. Gender differences in running biomechanics have been studied extensively in young runners, with inconsistent results. Understanding how gender influences the age-related differences in running mechanics could help develop population-specific training interventions or footwear to address any potential different mechanical demands. The purpose of this study was to assess gender and age effects on lower limb joint mechanics while running. Middle-aged men (57 ± 5 years) and women (57 ± 8 years) and young men (28 ± 6 years) and women (30 ± 6 years) completed five overground running trials at a set speed of 2.7 m/s while lower limb kinematics and ground reaction forces were collected. Lower limb joint kinetics were computed, normalized to body mass and compared between age and gender groups using two-factor analyses of variance. Women reported slower average running paces than men and middle-aged runners reported slower running paces than young runners. We confirmed that young runners run with more ankle, but less hip positive work and peak positive power compared to middle-aged runners (i.e., age-related distal-to-proximal shift in joint kinetics). We also present a novel finding that women run with more ankle, but less hip peak positive power compared to men suggesting an ankle dominant strategy in women at a preferred and comfortable running pace. However, the age-related distal-to-proximal shift in joint kinetics was not different between genders.

Effects of backward-directed resistance on propulsive force generation during split-belt treadmill walking in non-impaired individuals

Introduction

Backward-directed resistance is the resistance applied in the opposite direction of the individual's walking motion. Progressive application of backward-directed resistance during walking at a target speed engages adaptive motor control to maintain that speed. During split-belt walking, a motor control strategy must be applied that allows the person to keep up with the two belts to maintain their position on the treadmill. This situation becomes more challenging when progressive resistance is applied since each limb needs to adapt to the greater resistance to maintain the position. We propose that strategies aimed at changing relative propulsion forces with each limb may explain the motor control strategy used. This study aimed to identify the changes in propulsive force dynamics that allow individuals to maintain their position while walking on an instrumented split-belt treadmill with progressively increasing backward-directed resistance.

Methods

We utilized an instrumented split-belt treadmill while users had to overcome a set of increasing backward-directed resistance through the center of mass. Eighteen non-impaired participants (mean age = 25.2 ± 2.51) walked against five levels of backward resistance (0, 5, 10, 15, and 20% of participant's body weight) in two different modalities: single-belt vs. split-belt treadmill. On the single-belt mode, the treadmill's pace was the participant's comfortable walking speed (CWS). In split-belt mode, the dominant limb's belt pace was half of the CWS, and the non-dominant limb's belt speed was at the CWS.

Results

We assessed differences between single-belt vs. split-belt conditions in the slope of the linear relationship between change in propulsive impulse relative to change of backward resistance amount. In split-belt conditions, the slower limb showed a significantly steeper increase in propulsion generation compared to the fast limb across resistance levels.

Discussion

As a possible explanation, the slow limb also exhibited a significantly increased slope of the change in trailing limb angle (TLA), which was strongly correlated to the propulsive impulse slope values. We conclude that the motor control strategy used to maintain position on a split-belt treadmill when challenged with backward-directed resistance is to increase the propulsive forces of the slow limb relative to the fast limb by progressively increasing the TLA.

Clinical trial registration

ClinicalTrials.gov, identifier NCT04877249.

Surface, but Not Age, Impacts Lower Limb Joint Work during Walking and Stair Ascent

Older adults often suffer an accidental fall when navigating challenging surfaces during common locomotor tasks, such as walking and ascending stairs. This study examined the effect of slick and uneven surfaces on lower limb joint work in older and younger adults while walking and ascending stairs. Fifteen young (18-25 years) and 12 older (>65 years) adults had stance phase positive limb and joint work quantified during walking and stair ascent tasks on a normal, slick, and uneven surface, which was then submitted to a two-way mixed model ANOVA for analysis. The stair ascent required greater limb, and hip, knee, and ankle work than walking (all p < 0.001), with participants producing greater hip and knee work during both the walk and stair ascent (both p < 0.001). Surface, but not age, impacted positive limb work. Participants increased limb (p < 0.001), hip (p = 0.010), and knee (p < 0.001) positive work when walking over the challenging surfaces, and increased hip (p = 0.015), knee (p < 0.001), and ankle (p = 0.010) work when ascending stairs with challenging surfaces. Traversing a challenging surface during both walking and stair ascent tasks required greater work production from the large proximal hip and knee musculature, which may increase the likelihood of an accidental fall in older adults.

Mechanics of the human foot during walking on different slopes

When humans walk on slopes, the ankle, knee, and hip joints modulate their mechanical work to accommodate the mechanical demands. Yet, it is unclear if the foot modulates its work output during uphill and downhill walking. Therefore, we quantified the mechanical work performed by the foot and its subsections of twelve adults walked on five randomized slopes (-10°, -5°, 0°, +5°, +10°). We estimated the work of distal-to-hindfoot and distal-to-forefoot structures using unified deformable segment analysis and the work of the midtarsal, ankle, knee, and hip joints using a six-degree-of-freedom model. Further, using a geometric model, we estimated the length of the plantar structures crossing the longitudinal arch while accounting for the first metatarsophalangeal wrapping length. We hypothesized that compared to level walking, downhill walking would increase negative and net-negative work magnitude, particularly at the early stance phase, and uphill walking would increase the positive work, particularly at the mid-to-late stance phase. We found that downhill walking increased the magnitude of the foot's negative and net-negative work, especially during early stance, highlighting its capacity to absorb impacts when locomotion demands excessive energy dissipation. Notably, the foot maintained its net dissipative behavior between slopes; however, the ankle, knee, and hip shifted from net energy dissipation to net energy generation when changing from downhill to uphill. Such results indicate that humans rely more on joints proximal to the foot to modulate the body's total mechanical energy. Uphill walking increased midtarsal's positive and distal-to-forefoot negative work in near-equal amounts. That coincided with the prolonged lengthening and delayed shortening of the plantar structures, resembling a spring-like function that possibly assists the energetic demands of locomotion during mid-to-late stance. These results broaden our understanding of the foot's mechanical function relative to the leg's joints and could inspire the design of wearable assistive devices that improve walking capacity.

A powered simple walking model explains the decline in propulsive force and hip flexion torque compensation in human gait

Excessive hip flexion torque to prioritize leg swings in the elderly is likely to be a factor that reduces their propulsive force and gait stability, but the mechanism is not clear. To understand the mechanism, we investigated how propulsive force, hip flexion torque, and margin of stability (MoS) change when only the hip spring stiffness is increased without changing the walking speed in the simple walking model, and verified whether the relationship holds in human walking. The results showed that at walking speeds between 0.50 and 1.75 m/s, increasing hip spring stiffness increased hip flexion torque and decreased the propulsive force and MoS in both the model and human walking. Furthermore, it was found that the increase in hip flexion torque was explained by the increase in spring stiffness, and the decreases in the propulsive force and MoS were explained by the increase in step frequency associated with the increase in spring stiffness. Therefore, the increase in hip flexion torque likely decreased the propulsive force and MoS, and this mechanism was explained by the intervening hip spring stiffness. Our findings may help in the control design of walking assistance devices, and in improving our understanding of elderly walking strategies.

Does ankle push-off correct for errors in anterior-posterior foot placement relative to center-of-mass states?

Understanding the mechanisms humans use to stabilize walking is vital for predicting falls in elderly. Modeling studies identified two potential mechanisms to stabilize gait in the anterior-posterior direction: foot placement control and ankle push-off control: foot placement depends on position and velocity of the center-of-mass (CoM) and push-off covaries with deviations between actual and predicted CoM trajectories. While both control mechanisms have been reported in humans, it is unknown whether especially the latter one is employed in unperturbed steady-state walking. Based on the finding of Wang and Srinivasan that foot placement deviates in the same direction as the CoM states in the preceding swing phase, and assuming that this covariance serves the role of stabilizing gait, the covariance between the CoM states and foot placement can be seen as a measure of foot placement accuracy. We subsequently interpreted the residual variance in foot placement from a linear regression model as "errors" that must be compensated, and investigated whether these foot placement errors were correlated to push-off kinetic time series of the subsequent double stance phase. We found ankle push-off torque to be correlated to the foot placement errors in 30 participants when walking at normal and slow speeds, with peak correlations over the double stance phase up to 0.39. Our study suggests that humans use a push-off strategy for correcting foot placement errors in steady-state walking.

Effects of Visual Input Absence on Balance Recovery Responses to Lateral Standing Surface Perturbations in Older and Younger Adults

Although the ability to recover balance in the lateral direction has important implications with regard to fall risk in older adults, the effect of visual input on balance recovery in response to lateral perturbation and the effect of age are not well studied. We investigated the effect of visual input on balance recovery response to unpredictable lateral surface perturbations and its age-related changes. Ten younger and 10 older healthy adults were compared during balance recovery trials performed with the eyes open and eyes closed (EC). Compared with younger adults, older adults showed increased electromyography (EMG) peak amplitude of the soleus and gluteus medius, reduced EMG burst duration of the gluteus maximus and medius, and increased body sway (SD of the body's center of mass acceleration) in EC. In addition, older adults exhibited a smaller % increase (EC-eyes open) of the ankle eversion angle, hip abduction torque, EMG burst duration of the fibularis longus, and a greater % increase of body sway. All kinematics, kinetics, and EMG variables were greater in EC compared with eyes open in both groups. In conclusion, the absence of visual input negatively affects the balance recovery mechanism more in older adults compared with younger adults.

Immediate improvements in post-stroke gait biomechanics are induced with both real-time limb position and propulsive force biofeedback

BACKGROUND

Paretic propulsion [measured as anteriorly-directed ground reaction forces (AGRF)] and trailing limb angle (TLA) show robust inter-relationships, and represent two key modifiable post-stroke gait variables that have biomechanical and clinical relevance. Our recent work demonstrated that real-time biofeedback is a feasible paradigm for modulating AGRF and TLA in able-bodied participants. However, the effects of TLA biofeedback on gait biomechanics of post-stroke individuals are poorly understood. Thus, our objective was to investigate the effects of unilateral, real-time, audiovisual TLA versus AGRF biofeedback on gait biomechanics in post-stroke individuals.

METHODS

Nine post-stroke individuals (6 males, age 63 ± 9.8 years, 44.9 months post-stroke) participated in a single session of gait analysis comprised of three types of walking trials: no biofeedback, AGRF biofeedback, and TLA biofeedback. Biofeedback unilaterally targeted deficits on the paretic limb. Dependent variables included peak AGRF, TLA, and ankle plantarflexor moment. One-way repeated measures ANOVA with Bonferroni-corrected post-hoc comparisons were conducted to detect the effect of biofeedback on gait biomechanics variables.

RESULTS

Compared to no-biofeedback, both AGRF and TLA biofeedback induced unilateral increases in paretic AGRF. TLA biofeedback induced significantly larger increases in paretic TLA than AGRF biofeedback. AGRF biofeedback increased ankle moment, and both feedback conditions increased non-paretic step length. Both types of biofeedback specifically targeted the paretic limb without inducing changes in the non-paretic limb.

CONCLUSIONS

By showing comparable increases in paretic limb gait biomechanics in response to both TLA and AGRF biofeedback, our novel findings provide the rationale and feasibility of paretic TLA as a gait biofeedback target for post-stroke individuals. Additionally, our results provide preliminary insights into divergent biomechanical mechanisms underlying improvements in post-stroke gait induced by these two biofeedback targets. We lay the groundwork for future investigations incorporating greater dosages and longer-term therapeutic effects of TLA biofeedback as a stroke gait rehabilitation strategy. Trial registration NCT03466372.

Age-related changes in gait biomechanics and their impact on the metabolic cost of walking: Report from a National Institute on Aging workshop

Changes in old age that contribute to the complex issue of an increased metabolic cost of walking (mass-specific energy cost per unit distance traveled) in older adults appear to center at least in part on changes in gait biomechanics. However, age-related changes in energy metabolism, neuromuscular function and connective tissue properties also likely contribute to this problem, of which the consequences are poor mobility and increased risk of inactivity-related disease and disability. The U.S. National Institute on Aging convened a workshop in September 2021 with an interdisciplinary group of scientists to address the gaps in research related to the mechanisms and consequences of changes in mobility in old age. The goal of the workshop was to identify promising ways to move the field forward toward improving gait performance, decreasing energy cost, and enhancing mobility for older adults. This report summarizes the workshop and brings multidisciplinary insight into the known and potential causes and consequences of age-related changes in gait biomechanics. We highlight how gait mechanics and energy cost change with aging, the potential neuromuscular mechanisms and role of connective tissue in these changes, and cutting-edge interventions and technologies that may be used to measure and improve gait and mobility in older adults. Key gaps in the literature that warrant targeted research in the future are identified and discussed.

Effects of exercise habituation and aging on the intersegmental coordination of lower limbs during walking with sinusoidal speed change

Background

The time courses of the joint elevation angles of the thigh, shank, and foot in one stride during walking can be well approximated by a “plane” in a triaxial space. This intersegmental coordination (IC) of the lower limb elevation angles is referred to as the planar covariation law. We examined the effects of exercise habituation and aging on the thickness of the IC plane of the lower limbs under sinusoidal speed changing conditions.

Methods

Seventeen sedentary young (SY), 16 active young (AY), and 16 active elderly (AE) adults walked on a treadmill in accordance with a sinusoidal speed changing protocol at 120, 60, and 30 s periods with an amplitude of ± 0.56 m·s⁻¹. Motion of the lower limbs from the sagittal direction was recorded to calculate the elevation angles of the lower limbs. When the best-fit IC plane was determined, the smallest standard deviation of the IC plane was considered as the anteroposterior gait variability of the lower limbs. The coefficient of variance of the step width was also quantified to evaluate the lateral step variability (CV_SW).

Results

The standard deviation of the IC plane was significantly greater in the order of SY, AY, and AE, regardless of the sinusoidal wave periods of the changing speed. The CV_SW was not significantly different among the three groups.

Conclusions

Exercise habituation influences anteroposterior gait variability of the lower limbs, but not lateral step variability, even in young adults. Given these, gait adaptability for sinusoidal speed changes does not always decline with aging.

Trial registration

UMIN000031456 (R000035911; registered February 23, 2018).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40101-022-00298-w.

The Effects of Incline Level on Optimized Lower-Limb Exoskeleton Assistance: a Case Series

For exoskeletons to be successful in real-world settings, they will need to be effective across a variety of terrains, including on inclines. While some single-joint exoskeletons have assisted incline walking, recent successes in level-ground assistance suggest that greater improvements may be possible by optimizing assistance of the whole leg. To understand how exoskeleton assistance should change with incline, we used human-in-the-loop optimization to find whole-leg exoskeleton assistance torques that minimized metabolic cost on a range of grades. We optimized assistance for three able-bodied, expert participants on 5 degree, 10 degree, and 15 degree inclines using a hip-knee-ankle exoskeleton emulator. For all assisted conditions, the cost of transport was reduced by at least 50% relative to walking in the device with no assistance, which is a large improvement to walking comparable to the benefits of whole-leg assistance on level-ground (N = 3). Optimized extension torque magnitudes and exoskeleton power increased with incline. Hip extension, knee extension and ankle plantarflexion often grew as large as allowed by comfort-based limits. Applied powers on steep inclines were double the powers applied during level-ground walking, indicating that greater exoskeleton power may be optimal in scenarios where biological powers and costs are higher. Future exoskeleton devices could deliver large improvements in walking performance across a range of inclines if they have sufficient torque and power capabilities.

Timing of propulsion-related biomechanical variables is impaired in individuals with post-stroke hemiparesis

BACKGROUND

In individuals with post-stroke hemiparesis, reduced paretic leg propulsion, measured through anterior ground reaction forces (AGRF), is a common and functionally-relevant gait impairment. Deficits in other biomechanical variables such as plantarflexor moment, ankle power, and ankle excursion contribute to reduced propulsion. While reduction in the magnitude of propulsion post-stroke is well studied, here, our objective was to compare the timing of propulsion-related biomechanical variables.

RESEARCH QUESTION

Are there differences in the timing of propulsion and propulsion-related biomechanical variables between able-bodied individuals, the paretic leg, and non-paretic leg of post-stroke individuals?

METHODS

Nine able-bodied and 13 post-stroke individuals completed a gait analysis session comprising treadmill walking trials at each participant's self-selected speed. Two planned independent sample t-tests were conducted to detect differences in the timing of dependent variables between the paretic versus non-paretic leg post-stroke and paretic leg versus the dominant leg of able-bodied individuals.

RESULTS

Post-stroke individuals demonstrated significantly earlier timing of peak AGRF of their paretic leg versus their non-paretic leg and able-bodied individuals. Post-stroke participants displayed earlier timing of peak power of their paretic leg versus their non-paretic leg and able-bodied individuals, and earlier timing of peak ankle moment of the paretic leg versus able-bodied. No significant differences were detected in the timing of peak ankle angle.

SIGNIFICANCE

The earlier onset of peak AGRF, peak ankle power, and peak ankle moment may be an important, under-studied biomechanical factor underlying stroke gait impairments, and a potential therapeutic target for stroke gait retraining. Future investigations can explore the use of interventions such as gait biofeedback to normalize the timing of these peaks, thereby improving propulsion and walking function post-stroke.

Effects of sensory manipulations on locomotor adaptation to split-belt treadmill walking in healthy younger and older adults

Locomotor adaptation relies on processes of both the peripheral and central nervous systems that may be compromised with advanced age (e.g., proprioception, sensorimotor integration). Age-related changes to these processes may result in reduced rates of locomotor adaptation under normal conditions and should cause older adults to be disproportionately more affected by sensory manipulations during adaptation compared to younger adults. 17 younger and 10 older adults completed five separate 5-minute split-belt walking trials: three under normal sensory conditions, one with 30% bodyweight support (meant to reduce proprioceptive input), and one with goggles that constrained the visual field (meant to reduce visual input). We fit step length symmetry data from each participant in each trial with a single exponential function and used the time constant to quantify locomotor adaption rate. Group by trial ANOVAs were used to test the effects of age, condition, and their interaction on adaptation rates. Contrary to our hypothesis, we found no evidence that sensory manipulations disproportionately affected older compared to younger adults, at least in our relatively small sample. In fact, in both groups, adaptation rates remained unaffected across all trials, including both normal and sensory manipulated trials. Our results provide evidence that both younger and older adults were able to adequately reweight sources of sensory information based on environmental constraints, indicative of well-functioning neural processes of motor adaptation.

Lower Limb Extension Power is Associated With Slope Walking Joint Loading Mechanics in Older Adults

Fall-related injuries are associated with muscle weakness and common during slope walking in older adults. However, no study has evaluated the relationship between muscle weakness, measured by maximal lower limb extension power, and older adults' ability to navigate slope walking for a better understanding of fall prevention. Therefore, the purpose of this study was to investigate the association between maximal lower limb extension power and joint mechanics during slope walking. Fifteen healthy older adults were tested. Lower limb extension power was measured using the Leg Extension Power Rig. Kinematic and kinetic analysis was performed during level (0°), incline (10°), and decline (10°) slope walking. Greater maximal lower limb extension power was significantly (p < .050; Cohen's f2 > 0.35) associated with multiple kinetic and kinematic joint mechanic variables across stance phase of the gait cycle during level, incline, and decline walking. These findings will allow clinicians to better educate patients and develop interventions focused on fall prevention and improving functional mobility in older adults.

Effect of Assistance Using a Bilateral Robotic Knee Exoskeleton on Tibiofemoral Force Using a Neuromuscular Model

Tibiofemoral compression forces present during locomotion can result in high stress and risk damage to the knee. Powered assistance using a knee exoskeleton may reduce the knee load by reducing the work required by the muscles. However, the exact effect of assistance on the tibiofemoral force is unknown. The goal of this study was to investigate the effect of knee extension assistance during the early stance phase on the tibiofemoral force. Nine able-bodied adults walked on an inclined treadmill with a bilateral knee exoskeleton with assistance and with no assistance. Using an EMG-informed neuromusculoskeletal model, muscle forces were estimated, then utilized to estimate the tibiofemoral contact force. Results showed a 28% reduction in the knee moment, which resulted in approximately a 15% decrease in knee extensor muscle activation and a 20% reduction in subsequent muscle force, leading to a significant 10% reduction in peak and 9% reduction in average tibiofemoral contact force during the early stance phase (p < 0.05). The results indicate the tibiofemoral force is highly dependent on the knee kinetics and quadricep muscle activation due to their influence on knee extensor muscle forces, the primary contributor to the knee load.

Neuromuscular Age-Related Adjustment of Gait When Moving Upwards and Downwards

Locomotor movements are accommodated to various surface conditions by means of specific locomotor adjustments. This study examined underlying age-related differences in neuromuscular control during level walking and on a positive or negative slope, and during stepping upstairs and downstairs. Ten elderly and eight young adults walked on a treadmill at two different speeds and at three different inclinations (0°, +6°, and −6°). They were also asked to ascend and descend stairs at self-selected speeds. Full body kinematics and surface electromyography of 12 lower-limb muscles were recorded. We compared the intersegmental coordination, muscle activity, and corresponding modifications of spinal motoneuronal output in young and older adults. Despite great similarity between the neuromuscular control of young and older adults, our findings highlight subtle age-related differences in all conditions, potentially reflecting systematic age-related adjustments of the neuromuscular control of locomotion across various support surfaces. The main distinctive feature of walking in older adults is a significantly wider and earlier activation of muscles innervated by the sacral segments. These changes in neuromuscular control are reflected in a reduction or lack of propulsion observed at the end of stance in older adults at different slopes, with the result of a delay in the timing of redirection of the centre-of-mass velocity and of an unanticipated step-to-step transition strategy.

Age-related differences in calf muscle recruitment strategies in the time-frequency domain during walking as a function of task demand

Activation of the plantar flexors is critical in governing ankle push-off power during walking, which decreases due to age. However, electromyographic (EMG) signal amplitude alone is unable to fully characterize motor unit recruitment during functional activity. Although not yet studied in walking, EMG frequency content may also vary due to age-related differences in muscle morphology and neural signaling. Our purpose was to quantify plantar flexor activation differences in the time-frequency domain between young and older adults during walking across a range of speeds and with and without horizontal aiding and impeding forces. Ten healthy young (24.0 ± 3.4 yr) and older adults (73.7 ± 3.9 yr) walked at three speeds and walked with horizontal aiding and impeding force while muscle activations of soleus (SOL) and gastrocnemius (GAS) were recorded. The EMG signals were decomposed in the time-frequency domain with wavelet transformation. Principal component analyses extracted principal components (PCs) and PC scores. Compared with young adults, we observed that GAS activation in older adults: 1) was lower across all frequency ranges during midstance and in slow to middle frequency ranges during push-off, independent of walking speed and 2) shifted to slower frequencies with earlier timing as walking speed increased. Our results implicate GAS time-frequency content, and its morphological and neural origins, as a potential determinant of hallmark ankle push-off deficits due to aging, particularly at faster walking speeds. Rehabilitation specialists may attempt to restore GAS intensity across all frequency ranges during mid-to-late stance while avoiding disproportionate increases in slower frequencies during early stance.NEW & NOTEWORTHY We use time-frequency analyses of calf muscle activation to quantify age-related differences in motor recruitment in walking. Gastrocnemius activation in older versus young adults was lower across all frequencies during midstance and in slow-to-middle frequencies during push-off, independent of speed, and shifted to slower frequencies with earlier timing as speed increased. Our results implicate gastrocnemius time-frequency content as a potential determinant of hallmark ankle push-off deficits due to aging, particularly at faster speeds.

Are Medial and Lateral Tibiofemoral Compressive Forces Different in Uphill Compared to Level Walking for Patients Following Total Knee Arthroplasty?

The purpose of this study was to determine how tibiofemoral joint compressive forces and knee joint-spanning muscle forces during uphill walking change compared to level walking in patients with total knee arthroplasty (TKA). A musculoskeletal model capable of resolving total (TCF), medial (MCF), and lateral (LCF) tibiofemoral compressive forces was used to determine compressive forces and muscle forces during level and uphill walking on a 10 deg incline for twenty-five post-TKA patients. A 2 × 2 (slope: level and 10 deg × limb: replaced and nonreplaced) repeated measures analysis of variance was used to detect differences in knee contact forces between slope and limb conditions and their interaction. Peak loading-response TCF, MCF, and LCF were greater during uphill walking than level walking for nonreplaced limbs. During uphill walking, peak loading-response TCF was smaller in replaced limbs compared to nonreplaced limbs with no change in MCF or LCF. Peak knee extension moment and knee extensor muscle force were smaller in replaced limbs compared to nonreplaced limbs during uphill walking. During level walking, replaced and nonreplaced limbs experienced rather equal joint loading; however, replaced limb experienced reduced joint loading during uphill walking. Differences in joint loading between replaced and nonreplaced limbs were not present during level walking, suggesting compensation from the replaced limb during the more difficult task. Uphill walking following TKA promotes more balanced loading of replaced limbs during stance; however, these benefits may come at the expense of increased loading on nonreplaced limbs.

Adapting Semi-Active Prostheses to Real-World Movements: Sensing and Controlling the Dynamic Mean Ankle Moment Arm with a Variable-Stiffness Foot on Ramps and Stairs

(1) Background: Semi-active prosthetic feet can provide adaptation in different circumstances, enabling greater function with less weight and complexity than fully powered prostheses. However, determining how to control semi-active devices is still a challenge. The dynamic mean ankle moment arm (DMAMA) provides a suitable biomechanical metric, as its simplicity matches that of a semi-active device. However, it is unknown how stiffness and locomotion modes affect DMAMA, which is necessary to create closed-loop controllers for semi-active devices. In this work, we develop a method to use only a prosthesis-embedded load sensor to measure DMAMA and classify locomotion modes, with the goal of achieving mode-dependent, closed-loop control of DMAMA using a variable-stiffness prosthesis. We study how stiffness and ground incline affect the DMAMA, and we establish the feasibility of classifying locomotion modes based exclusively on the load sensor. (2) Methods: Human subjects walked on level ground, ramps, and stairs while wearing a variable-stiffness prosthesis in low-, medium-, and high-stiffness settings. We computed DMAMA from sagittal load sensor data and prosthesis geometric measurements. We used linear mixed-effects models to determine subject-independent and subject-dependent sensitivity of DMAMA to incline and stiffness. We also used a machine learning model to classify locomotion modes using only the load sensor. (3) Results: We found a positive linear sensitivity of DMAMA to stiffness on ramps and level ground. Additionally, we found a positive linear sensitivity of DMAMA to ground slope in the low- and medium-stiffness conditions and a negative interaction effect between slope and stiffness. Considerable variability suggests that applications of DMAMA as a control input should look at the running average over several strides. To examine the efficacy of real-time DMAMA-based control systems, we used a machine learning model to classify locomotion modes using only the load sensor. The classifier achieved over 95% accuracy. (4) Conclusions: Based on these findings, DMAMA has potential for use as a closed-loop control input to adapt semi-active prostheses to different locomotion modes.

Age does not affect the relationship between muscle activation and joint work during incline and decline walking

Older compared with younger adults walk with different configurations of mechanical joint work and greater muscle activation but it is unclear if age, walking speed, and slope would each affect the relationship between muscle activation and net joint work. We hypothesized that a unit increase in positive but not negative net joint work requires greater muscle activation in older compared with younger adults. Healthy younger (age: 22.1 yrs, n = 19) and older adults (age: 69.8 yrs, n = 16) ascended and descended a 7° ramp at slow (~1.20 m/s) and moderate (~1.50 m/s) walking speeds while lower-extremity marker positions, electromyography, and ground reaction force data were collected. Compared to younger adults, older adults took 11% (incline) and 8% (decline) shorter strides, and performed 21% less positive ankle plantarflexor work (incline) and 19% less negative knee extensor work (decline) (all p < .05). However, age did not affect (all p > .05) the regression coefficients between the muscle activation integral and positive hip extensor or ankle plantarflexor work during ascent, nor between that and negative knee extensor or ankle dorsiflexor work during descent. With increased walking speed, muscle activation tended to increase in younger but changed little in older adults across ascent (10 ± 12% vs. -1.0 ± 10%) and descent (3.6 ± 10.2% vs. -2.6 ± 7.7%) (p = .006, r = 0.47). Age does not affect the relationship between muscle activation and net joint work during incline and decline walking at freely-chosen step lengths. The electromechanical cost of joint work production does not underlie the age-related reconfiguration of joint work during walking.

Biomechanical Comparison of Assistance Strategies Using a Bilateral Robotic Knee Exoskeleton

Despite there being studies that have investigated the effects of human augmentation using a knee exoskeleton, comparing different assistance schemes on a single knee exoskeleton has not been studied. Using a light-weight, low-profile bilateral knee exoskeleton system, this study examined and compared the biomechanical effects of three common assistance strategies (biological torque, impedance, and proportional myoelectric controllers) exhibiting different levels of flexibility for the user to control the assistance. Nine subjects walked on a 15% gradient incline surface at 1.1 m/s in the three powered conditions and with the exoskeleton unpowered. All the assistance strategies significantly reduced the metabolic cost of the users compared to the unpowered condition by 3.0% on average across strategies (p < 0.05), led by the significant reduction in the biological knee kinetic effort and knee extensor muscle activation (p < 0.05). Between assistance strategies, the metabolic cost and biomechanics displayed no statistically significant differences. The metabolic and biomechanical results indicate that powered extension assistance during early stance can improve performance compared to the unpowered condition. However, the user's ability to control the assistance may not be significant for human augmentation when walking on an inclined surface with a knee exoskeleton.

The metabolic and mechanical consequences of altered propulsive force generation in walking

Older adults walk with greater metabolic energy consumption than younger for reasons that are not well understood. We suspect that a distal-to-proximal redistribution of leg muscle demand, from muscles spanning the ankle to those spanning the hip, contributes to greater metabolic energy costs. Recently, we found that when younger adults using biofeedback target smaller than normal peak propulsive forces (F_P), they do so via a similar redistribution of leg muscle demand during walking. This alludes to an experimental paradigm that emulates characteristics of elderly gait independent of other age-related changes relevant to metabolic energy cost. Thus, our purpose was to quantify the metabolic and limb- and joint-level mechanical energy costs associated with modulating propulsive forces during walking in younger adults. Walking with larger F_P increased net metabolic power by 47% (main effect, p = 0.001), which was accompanied by small by relatively uniform increases in hip, knee, and ankle joint power and which correlated with total joint power (R² = 0.151, p = 0.019). Walking with smaller F_P increased net metabolic power by 58% (main effect, p < 0.001), which was accompanied by higher step frequencies and increased total joint power due to disproportionate increases in hip joint power. Increases in hip joint power when targeting smaller than normal F_P accounted for more than 65% of the variance in the measured changes in net metabolic power. Our findings suggest that walking with a diminished push-off exacts a metabolic penalty because of higher step frequencies and more total limb work due to an increased demand on proximal leg muscles.

Uphill walking at iso-efficiency speeds

Uphill walking gait has been extensively studied, but the optimal uphill speed able to enhance the metabolic demand without increasing fatigability has so far received little attention. Therefore, the aim of this study was to assess the metabolic/kinematic demand at constant speed (6 km·h^-1 G0 level, G2 2% uphill, G7 7% uphill) and at iso-efficiency speeds (G2IES 5.2 km·h^-1 2% uphill and G7IES 3.9 km·h^-1 7% uphill). For this aim, physically active women (n:24, Age 33.40 ± 4.97 years, BMI 21.62 ± 2.06 kg/m^-2) after an 8-min warm-up were studied on a treadmill for 10' for every walking condition with a 5' rest in between. Average heart rate (AVG-HR), rating of perceived exertion (RPE) and kinematic variables (stance time, swing time, stride length, stride cycle, stride-length variability, stride-cycle variability and internal work) were studied. Modifications in stance time, stride length and stride cycle (p<0.005), and lower internal-work values (p<0.001) occurred in G7IES in comparison to the other conditions. Swing time was significantly modified only in G7IES compared to G0 and G7 (p<0.001 and p<0.005, respectively). Stride-length variability and stride-cycle variability were higher in G7IES compared to the other conditions (p<0.001). G7 induced the highest AVG-HR (p<0.005) and RPE (p<0.001) compared to the other conditions. This study demonstrates that by applying the equation for uphill walking gait, it is possible to maintain a similar metabolic demand and RPE at iso-efficiency speeds during uphill compared to level walking, inducing at the same time a modification of the kinematic parameters of walking gait performed at the same slope condition.

Mechanics of walking and running up and downhill: A joint-level perspective to guide design of lower-limb exoskeletons

Lower-limb wearable robotic devices can improve clinical gait and reduce energetic demand in healthy populations. To help enable real-world use, we sought to examine how assistance should be applied in variable gait conditions and suggest an approach derived from knowledge of human locomotion mechanics to establish a 'roadmap' for wearable robot design. We characterized the changes in joint mechanics during walking and running across a range of incline/decline grades and then provide an analysis that informs the development of lower-limb exoskeletons capable of operating across a range of mechanical demands. We hypothesized that the distribution of limb-joint positive mechanical power would shift to the hip for incline walking and running and that the distribution of limb-joint negative mechanical power would shift to the knee for decline walking and running. Eight subjects (6M,2F) completed five walking (1.25 m s-1) trials at -8.53°, -5.71°, 0°, 5.71°, and 8.53° grade and five running (2.25 m s-1) trials at -5.71°, -2.86°, 0°, 2.86°, and 5.71° grade on a treadmill. We calculated time-varying joint moment and power output for the ankle, knee, and hip. For each gait, we examined how individual limb-joints contributed to total limb positive, negative and net power across grades. For both walking and running, changes in grade caused a redistribution of joint mechanical power generation and absorption. From level to incline walking, the ankle's contribution to limb positive power decreased from 44% on the level to 28% at 8.53° uphill grade (p < 0.0001) while the hip's contribution increased from 27% to 52% (p < 0.0001). In running, regardless of the surface gradient, the ankle was consistently the dominant source of lower-limb positive mechanical power (47-55%). In the context of our results, we outline three distinct use-modes that could be emphasized in future lower-limb exoskeleton designs 1) Energy injection: adding positive work into the gait cycle, 2) Energy extraction: removing negative work from the gait cycle, and 3) Energy transfer: extracting energy in one gait phase and then injecting it in another phase (i.e., regenerative braking).

Achilles tendon loading is lower in older adults than young adults across a broad range of walking speeds

The purpose of this study was to investigate age-related differences in Achilles tendon loading during gait. Fourteen young (7F/7M, 26 ± 5 years) and older (7F/7M, 67 ± 5 years) adults without current neurological or orthopaedic impairment participated. Shear wave tensiometry was used to measure tendon stress by tracking Achilles tendon wave speed. The wave speed-stress relationship was calibrated using simultaneously collected tensiometer and force plate measures during a standing sway task. Tendon stress was computed from the force plate measures using subject-specific ultrasound measures of tendon moment arm and cross-sectional area. All subjects exhibited a highly linear relationship between wave speed squared and tendon stress (mean R2 > 0.9), with no significant age-group differences in tensiometer calibration parameters. Tendon wave speed was monitored during treadmill walking at four speeds (0.75, 1.00, 1.25, and 1.50 m/s) and used to compute the stress experienced by the tendon. Relative to young adults, older adults exhibited 22% lower peak tendon wave speeds. Peak tendon stress during push-off in older adults (24.8 MPa) was 32% less than that in the young adults (36.7 MPa) (p = 0.01). There was a moderate increase (+11%) in peak tendon stress across both groups when increasing speed from 0.75 to 1.50 m/s (main effect of speed, p = 0.01). Peak tendon loading during late swing did not differ between age groups (mean 3.8 MPa in young and 4.2 MPa in older adults). These age-related alterations in tendon tissue loading may affect the mechanobiological stimuli underlying tissue remodeling and thereby alter the propensity for tendon injury and disease.

Steep (30°) uphill walking vs. running: COM movements, stride kinematics, and leg muscle excitations

PURPOSE

We sought to biomechanically distinguish steep uphill running from steep uphill walking and explore why athletes alternate between walking and running on steep inclines.

METHODS

We quantified vertical center of mass (COM) accelerations and basic stride parameters for both walking and running at a treadmill speed of 1.0 m/s on the level and up a 30° incline. We also investigated how electromyography (EMG) of the gluteus maximus (GMAX), vastus medialis (VM), medial gastrocnemius (MG), and soleus (SOL) muscles differ between gaits when ascending steep hills.

RESULTS

The vertical COM accelerations for steep uphill walking exhibited two peaks per step of magnitude 1.47 ± 0.23 g and 0.79 ± 0.10 g. In contrast, steep running exhibited a single peak per step pattern with a magnitude of 1.81 ± 0.15 g. Steep uphill running exhibited no aerial phase, 40% faster stride frequency, and 40% shorter foot-ground contact time compared to steep uphill walking but similar leg swing times. SOL showed 36% less iEMG per stride during steep uphill running versus steep uphill walking, but all other EMG comparisons between steep running and walking were not significantly different.

CONCLUSIONS

Multiple biomechanical variables clearly indicate that steep uphill running is a distinctly different gait from steep uphill walking and is more similar to level running. The competing desires to minimize the energetic cost of locomotion and to avoid exhaustion of the SOL may be a possible explanation for gait alternation on steep inclines.

The metabolic power required to support body weight and accelerate body mass changes during walking on uphill and downhill slopes

The metabolic cost of walking is due to muscle force generated to support body weight (BW), external work performed to redirect and accelerate the center of mass (CoM), and internal work performed to swing the limbs and maintain balance. We hypothesized that BW support would incur a greater and lower percentage of Net Metabolic Power (NMP) for uphill and downhill slopes, respectively, compared to level-ground walking. Additionally, we hypothesized that mass redirection would incur a greater and lower percentage of NMP for uphill and downhill slopes, respectively compared to level-ground walking. 10 subjects walked at 1.25 m/s on 0°, ±3°, and ±6° slopes with reduced/added weight and added mass while we measured metabolic rates. We calculated NMP per Newton of reduced BW at each slope and found that BW support required 58% and 64% of the NMP to walk at +3° and +6°, respectively, both greater than the 15% required for level-ground walking (p < 0.025). We calculated NMP per kg of added mass at each slope and found that mass redirection required 19% and 23% of the NMP to walk at +3° and +6°, respectively, both lower than the 35% required for level-ground walking (p < 0.025). We found no significant differences in the percentage of NMP for BW support or mass redirection during downhill compared to level ground walking (p > 0.05). Our findings elucidate that the percentage of NMP attributed to BW support and mass redirection is different for sloped compared to level-ground walking. These results inform biomimetic assistive device designs aimed at reducing metabolic cost.

Redistribution of joint moments and work in older women with and without hallux valgus at two walking speeds

BACKGROUND

Hallux valgus (HV) is a highly prevalent foot deformity in older women. Differences in lower extremity joint function of older women with and without HV during walking at slower and faster speeds are unknown.

RESEARCH QUESTION

Does walking speed affect lower extremity joint range of motion (ROM) and net extensor joint moment and associated work in older women with and without HV?

METHODS

Thirteen older women with HV and 13 controls completed five walking trials at 1.1 and 1.3 m·s^-1 as kinematic marker position and ground reaction force data were collected. Net ankle, knee, and hip joint moments were computed using inverse dynamics during the stance phase. Positive joint work was calculated by integrating hip power in early stance, knee power in mid stance, and ankle power in late stance.

RESULTS

Average ankle ROM and plantarflexor moment did not increase with walking speed in the HV group, while in the control group these variables were greater for the faster compared to the slower speed (p < 0.05). The magnitude of increase in ankle joint work with speed was 12 % lesser in the HV compared to the control group (p = 0.008). The hip ROM, extensor moment, and associated work was greater in the HV compared to the control group (p < 0.05). Knee and hip joint ROM, extensor moments, and work increased with walking speed in both groups (p < 0.05).

SIGNIFICANCE

Older women with HV compared to older women without HV demonstrate a distal-to-proximal redistribution by increasing hip motion and effort to compensate for reduced ankle contribution during walking.

How age and surface inclination affect joint moment strategies to accelerate and decelerate individual leg joints during walking

A joint moment also causes motion at other joints of the body. This joint coupling-perspective allows more insight into two age-related phenomena during gait. First, whether increased hip kinetic output compensates for decreased ankle kinetic output during positive joint work. Second, whether preserved joint kinetic patterns during negative joint work in older age have any functional implication. Therefore, we examined how age and surface inclination affect joint moment strategies to accelerate and/or decelerate individual leg joints during walking. Healthy young (age: 22.5 ± 4.1 years, n = 18) and older (age: 76.0 ± 5.7 years, n = 22) adults walked at 1.4 m/s on a split-belt instrumented treadmill at three grades (0%, 10%, -10%). Lower-extremity moment-induced angular accelerations were calculated for the hip (0% and 10%) and knee (0% and -10%) joints. During level and uphill walking, both age groups showed comparable ankle moment-induced ipsilateral (p = 0.774) and contralateral (p = 0.047) hip accelerations, although older adults generated lower ankle moments in late stance. However, ankle moment-induced contralateral hip accelerations were smaller (p = 0.001) in an older adult subgroup (n = 13) who showed larger hip extension moments in early stance than young adults. During level and downhill walking, leg joint moment-induced knee accelerations were unaffected by age (all p > 0.05). These findings suggest that during level and uphill walking increased hip flexor mechanical output in older adults does not arise from reduced ankle moments, contrary to increased hip extensor mechanical output. Additionally, results during level and downhill walking imply that preserved eccentric knee extensor function is important in maintaining knee stabilization in older age.

Increasing the Propulsive Demands of Walking to their Maximum Elucidates Functionally Limiting Impairments in Older Adult Gait

We elucidated functional limitations in older adult gait by increasing horizontal impeding forces and walking speed to their maximums compared to dynamometry and to data from their young counterparts. Specifically, we investigated which determinants of push-off intensity represent genuine functionally limiting impairments in older adult gait versus biomechanical changes that do not directly limit walking performance. We found that older adults walked at their preferred speed with hallmark deficits in push-off intensity. These subjects were fully capable of overcoming deficits in propulsive ground reaction force, trailing limb positive work, trailing leg and hip extension, and ankle power generation when the propulsive demands of walking were increased to maximum. Of the outcomes tested, age-related deficits in ankle moment emerged as the lone genuine functionally limiting impairment in older adults. Distinguishing genuine functional limitations from age-related differences masquerading as limitations represents a critical step toward the development and prescription of effective interventions.

Advanced Age Redistributes Positive but Not Negative Leg Joint Work during Walking

Supplemental digital content is available in the text.

Introduction

Advanced age brings a distal-to-proximal redistribution of positive joint work during walking that is relevant to walking performance and economy. It is unclear whether negative joint work is similarly redistributed in old age. Negative work can affect positive work through elastic energy return in gait. We determined the effects of age, walking speed, and grade on positive and negative joint work in young and older adults.

Methods

Bilateral ground reaction force and marker data were collected from healthy young (age = 22.5 yr, n = 18) and older (age = 76.0 yr, n = 22) adults walking on a split-belt instrumented treadmill at 1.1, 1.4, and 1.7 m·s⁻¹ at each of three grades (0%, 10%, and −10%). Subjects also performed maximal voluntary eccentric, isometric, and concentric contractions for the knee extensors (120°·s⁻¹, 90°·s⁻¹, and 0°·s⁻¹) and plantarflexors (90°·s⁻¹, 30°·s⁻¹, and 0°·s⁻¹).

Results

Compared with young adults, older adults exhibited a distal-to-proximal redistribution of positive leg joint work during level (P < 0.001) and uphill (P < 0.001) walking, with larger differences at faster walking speeds. However, the distribution of negative joint work was unaffected by age during level (P = 0.150) and downhill (P = 0.350) walking. Finally, the age-related loss of maximal voluntary knee extensor (P < 0.001) and plantarflexor (P = 0.001) strength was smaller during an eccentric contraction versus concentric contraction for the knee extensors (P < 0.001) but not for the plantarflexors (P = 0.320).

Conclusion

The distal-to-proximal redistribution of positive joint work during level and uphill walking is absent for negative joint work during level and downhill walking. Exercise prescription should focus on improving ankle muscle function while preserving knee muscle function in older adults trying to maintain their independence.

The timing of locomotor propulsion in healthy adults walking at multiple speeds

In computational models of human walking, both magnitude and timing of locomotor propulsion are important for mechanical and metabolic efficiency, suggesting that these are likely tightly controlled by the neuromuscular system. Studies of actual human walking have focused primarily on magnitude-related measures of propulsion, often ignoring its timing. The purpose of this study was to quantify the timing of onset and peak propulsion relative to contralateral heel strike (HS) in healthy, young adults walking at multiple speeds. Propulsion was quantified at the ground-level using the anterior component of the anteroposterior ground reaction force, the limb-level using individual limb power, and the joint-level using ankle power. Contrary to common computational models, most of our timing-related measures indicated that propulsion occurred after contralateral HS. Timing-related measures of propulsion also changed with walking speed - as speed increased, individuals initiated propulsion earlier in the support phase. Timing of locomotor propulsion is theoretically important for walking performance, especially metabolic efficiency, and could therefore provide important clinical information. This study provides a set of relatively simple metrics that can be used to quantify propulsion and benchmark data that can be used for future comparisons with individuals or populations with gait impairments.

Can shank acceleration provide a clinically feasible surrogate for individual limb propulsion during walking?

Aging and many pathologies that affect gait are associated with reduced ankle power output and thus trailing limb propulsion during walking. However, quantifying trailing limb propulsion requires sophisticated measurement equipment at significant expense that fundamentally limits clinical translation for diagnostics or gait rehabilitation. As a component of joint power, our purpose was to determine if shank acceleration estimated via accelerometers during push-off can serve as a clinically feasible surrogate for ankle power output and peak anterior ground reaction forces (GRF) during walking. As hypothesized, we found that young adults modulated walking speed via changes in peak anterior GRF and peak ankle power output that correlated with proportional changes in shank acceleration during push-off, both at the individual subject (R² ≥ 0.80, p < 0.01) and group average (R² ≥ 0.74, p < 0.01) levels. In addition, we found that unilateral deficits in trailing limb propulsion induced via a leg bracing elicited unilateral and relatively proportional reductions in peak anterior GRF, peak ankle power, and peak shank acceleration. These unilateral leg bracing effects on peak shank acceleration correlated with those in peak ankle power (braced leg: R² = 0.43, p = 0.028) but those effects in both peak shank acceleration and peak ankle power were disassociated from those in peak anterior GRF. In conclusion, our findings in young adults provide an early benchmark for the development of affordable and clinically feasible alternatives for assessing and monitoring trailing limb propulsion during walking.

Lower extremity joints and muscle groups in the human locomotor system alter mechanical functions to meet task demand

To facilitate movement through mechanically complex environments, terrestrial animals have evolved locomotor systems capable of flexibly altering internal mechanics to meet external demands. They do this by shifting imposed workloads between joints/muscle groups (central mechanical flexibility) and/or by altering the function of individual joints/muscle groups (local mechanical flexibility). In human locomotion research, central mechanical flexibility is well established and regularly reported. Local mechanical flexibility at major lower extremity joints and muscle groups, however, has received relatively less attention. We used an emerging biomechanical analysis known as functional indexing to test the hypothesis that lower extremity joints and muscle groups within the human locomotor system alter their mechanical function to meet altered locomotor demands. Thirteen healthy adults walked across a range of speeds (0.8, 1.2, 1.6, 2.0 m s^-1) and slopes (0 deg, +5 deg, +10 deg) to determine whether hip, knee and ankle joints and their extensors and flexors altered their mechanical function in response to increased speed and slope. As walking speed increased, the knee and its extensors altered their function to behave more like mechanical springs while the ankle and its extensors altered their function to behave more like motors. As slope increased, all three joints and their extensors decreased spring- and damper-like behavior and increased motor-like behavior. Our results indicate that humans - similarly to many other terrestrial animals - utilize local mechanical flexibility to meet the demands of the locomotor task at hand.

Compensatory sagittal plane ankle gait mechanics: Are they present in patients with a weak or stiff hip?

INTRODUCTION

Simulations suggest that subjects with reduced hip range of motion (ROM) and/or weakness can achieve more normal walking mechanics through compensations at the ankle. The aims of this study were to assess whether subjects with reduced hip ROM (Stiff hip) or hip flexor weakness (Weak hip) exhibit ankle compensations during walking and investigate redistribution of power in the lower extremity joints.

METHODS

Retrospective gait data were reviewed (IRB-approved hip registry). Preoperative kinematic/kinetic walking data were collected in patients with: adolescent hip dysplasia (AHD), femoral acetabular impingement (FAI), and Legg-Calvé Perthes disease (Perthes). AHD patients with significantly weak hip flexors on their affected side were included (Weak hip group). The Gait Profile Score (GPS) was calculated on the affected side of the FAI and Perthes groups to identify patients who had a Stiff hip. Patients who had undergone a hip arthrodesis (Fusion) were also included (Stiff hip group). Ankle kinematics/kinetics were compared to healthy participants (Control). The total positive work of sagittal plane hip, knee and ankle power were compared along with the distribution of power.

RESULTS

Patients in the Weak/Stiff hip groups did not walk with greater ankle plantarflexion, peak push-off power or positive ankle work on their affected sides compared to Control. Ankle work contribution (percentage of total positive work) on the affected or unaffected sides was greater in the Perthes and Hip Fusion patients compared to Control. Significant gait abnormalities on the unaffected side were observed.

CONCLUSIONS

Patients with a weak or stiff hip did exhibit altered ankle mechanics during walking. Greater percent ankle work contribution appeared to correspond with hip stiffness. In patients with hip pathology the redistribution of power among the lower extremity joints can highlight the importance of preserving ankle function.

Fore-aft resistance applied at the center of mass using a novel robotic interface proportionately increases propulsive force generation in healthy nonimpaired individuals walking at a constant speed

Background

Past studies have utilized external interfaces like resistive bands and motor-generated pulling systems to increase limb propulsion during walking on a motorized treadmill. However, assessing changes in limb propulsion against increasing resistance demands during self-controlled walking has not been undertaken.

Purpose

We assessed limb propulsion against increasing fore-aft loading demands by applying graded fore-aft (FA) resistance at the center of mass during walking in a novel, intent-driven treadmill environment that allowed participants to control their walking speeds. We hypothesized that to maintain a target speed against progressively increasing resistance, participants would proportionately increase their limb propulsion without increasing vertical force production, with accompanying increases in trailing limb angle and positive joint work.

Methods

Seventeen healthy-nonimpaired participants (mean age 52 yrs., SD = 11) walked at a target, self-controlled speed of 1.0 m/s against 10, 15, 20, and 25% (% body weight) FA resistance levels. We primarily assessed linear slope values across FA resistance levels for mean propulsive force and impulse and vertical impulse of the dominant limb using one-sample t-tests. We further assessed changes in trailing and leading limb angles and joint work using one-way ANOVAs.

Results

Participants maintained their target velocity within an a priori defined acceptable range of 1.0 m/s ± 0.2. They significantly increased propulsion proportional to FA resistance (propulsive force mean slope = 2.45, SD = 0.7, t (16) =14.44, p < 0.01; and propulsive impulse mean slope = 0.7, SD = 0.25, t (16) = 11.84, p < 0.01), but had no changes in vertical impulse (mean slope = − 0.04, SD =0.17, p > 0.05) across FA resistance levels. Mean trailing limb angle increased from 24.3° at 10% resistance to 27.4° at 25% (p < 0.05); leading limb angle decreased from − 18.4° to − 12.6° (p < 0.05). We also observed increases in total positive limb work (F (1.7, 26) = 16.88, p ≤ 0.001, η² = 0.5), primarily attributed to the hip and ankle joints.

Conclusions

FA resistance applied during self-driven walking resulted in increased propulsive-force output of healthy-nonimpaired individuals with accompanying biomechanical changes that facilitated greater limb propulsion. Future rehabilitation interventions for neurological populations may be able to utilize this principle to design task-specific interventions like progressive strength training and workload manipulation during aerobic training for improving walking function.

Electronic supplementary material

The online version of this article (10.1186/s12984-019-0577-x) contains supplementary material, which is available to authorized users.

Physiological Gait versus Gait in VR on Multidirectional Treadmill-Comparative Analysis

Background and objectives: Virtual reality (VR) is increasingly often finding applications in physiotherapy and health promotion. Recent years have seen the use of advanced technologies in the promotion of physical activity (PA) in society. New simulators, e.g., treadmills, enable the performance of PA (e.g., locomotive movements) in VR (artificially created virtual world). The question of how such movements are similar to natural forms of human locomotion (march, run) inspired the comparative analysis of physiological gait and gait in VR on a multidirectional Omni treadmill. Materials and Methods: The tests involved the use of the BTS Smart system for the triplanar analysis of motion. The test involved 10 healthy females aged 20–24 (weight: 52 ± 3.1 kg, height 162 ± 5.4 cm). Measurements were performed at two stages. The first stage involved the standard assessment of physiological gait, whereas the second was focused on gait forced by the Omni treadmill. The following gait parameters were analyzed: Flexion-extension in the ankle, knee joint and hip joint, rotation in the hip joint and knee joint, foot progression, adduction-abduction in the knee joint and hip joint, pelvic obliquity, pelvic tilt, pelvic rotation as well as energy expenditure and the movement of the body center of mass. Results: The analysis of the test results revealed the existence of differences in the kinematics of physical gait and gait on the treadmill. The greatest differences were recorded in relation to the dorsal-plantar flexion in the ankle, the foot progression, the rotation of the knee joint, pelvic tilt and rotation. In addition, the gait on the treadmill is characterized by the longer duration of the stance phase and reduced ranges of the following movements: Flexion-extension in the ankle, knee joint and hip joint, adduction-abduction in the hip joint as well as rotation in the ankle and hip joint. The values of potential, kinetic and total energy recorded in relation to forced gait are significantly lower than those of physiological gait. Conclusions: Because of the fact that the parameters of gait on the Omni platform vary significantly from the parameters of physical gait, the application of the Omni treadmill in the re-education of gait during rehabilitation should be treated with considerable care. Nonetheless, the treadmill has adequate potential to become a safe simulator enabling active motion in VR using locomotive movements.

Differential activation of lumbar and sacral motor pools during walking at different speeds and slopes

Organization of spinal motor output has become of interest for investigating differential activation of lumbar and sacral motor pools during locomotor tasks. Motor pools are associated with functional grouping of motoneurons of the lower limb muscles. Here we examined how the spatiotemporal organization of lumbar and sacral motor pool activity during walking is orchestrated with slope of terrain and speed of progression. Ten subjects walked on an instrumented treadmill at different slopes and imposed speeds. Kinetics, kinematics, and electromyography of 16 lower limb muscles were recorded. The spinal locomotor output was assessed by decomposing the coordinated muscle activation profiles into a small set of common factors and by mapping them onto the rostrocaudal location of the motoneuron pools. Our results show that lumbar and sacral motor pool activity depend on slope and speed. Compared with level walking, sacral motor pools decrease their activity at negative slopes and increase at positive slopes, whereas lumbar motor pools increase their engagement when both positive and negative slope increase. These findings are consistent with a differential involvement of the lumbar and the sacral motor pools in relation to changes in positive and negative center of body mass mechanical power production due to slope and speed.NEW & NOTEWORTHY In this study, the spatiotemporal maps of motoneuron activity in the spinal cord were assessed during walking at different slopes and speeds. We found differential involvement of lumbar and sacral motor pools in relation to changes in positive and negative center of body mass power production due to slope and speed. The results are consistent with recent findings about the specialization of neuronal networks located at different segments of the spinal cord for performing specific locomotor tasks.

Ankle power biofeedback attenuates the distal-to-proximal redistribution in older adults

BACKGROUND

Compared to young adults, older adults walk slower, with shorter strides, and with a characteristic decrease in ankle power output. Seemingly in response, older adults rely more than young on hip power output, a phenomenon known as a distal-to-proximal redistribution. Nevertheless, older adults can increase ankle power to walk faster or uphill, revealing a translationally important gap in our understanding.

RESEARCH QUESTION

Our purpose was to implement a novel ankle power biofeedback paradigm to encourage favorable biomechanical adaptations (i.e. reverse the distal-redistribution) during habitual speed walking in older adults.

METHODS

10 healthy older adults walked at their preferred speeds while real-time visual biofeedback provided target increases and decreases of 10 and 20% different from preferred ankle power. We evaluated the effect of changes in ankle power on joint kinetics, kinematics, and propulsive ground reaction forces. Pre and post overground walking speed assessments evaluated the effect of increased ankle power recall on walking speed.

RESULTS

Biofeedback systematically elicited changes in ankle power; increasing and decreasing ankle power by 14% and 17% when targeting ±20% different from preferred, respectively. We observed a significant negative correlation between ankle power and hip extensor work. Older adults relied more heavily on changes in ankle angular velocity than ankle moment to modulate ankle power. Lastly, older adults walked almost 11% faster when recalling increased ankle power overground.

SIGNIFICANCE

Older adults are capable of increasing ankle power through targeted ankle power biofeedback - effects that are accompanied by diminished hip power output and attenuation of the distal-to-proximal redistribution. The associated increase in preferred walking speed during recall suggests a functional benefit to increased ankle power output via transfer to overground walking. Further, our mechanistic insights allude to translational success using ankle angular velocity as a surrogate to modulate ankle power through biofeedback.

Inter-joint coordination patterns differ between younger and older runners

Older runners are at greater risk of certain running-related injuries. Previous work demonstrated that aging influences running biomechanics, and suggest a compensatory relation between changes in the proximal and distal joints. Previous comparisons of interjoint coordination strategies between young and older runners could potentially have missed relevant differences by averaging coordination measures across time.

OBJECTIVE

To compare coordination strategies between male runners under the age of 30 to those over the age of 60.

METHODS

Twelve young (22 ± 3 yrs, 1.80 ± 0.07 m, 78.0 ± 12.1 kg) and 12 older (63 ± 3 yrs, 1.78 ± 0.06 m, 73.2 ± 15.8 kg) male runners ran at 3.35 m/s on an instrumented treadmill. Ankle frontal plane, tibial transverse plane, knee sagittal plane, and hip frontal plane motion were measured. Inter-joint coordination was calculated using a modified vector coding technique. Coordination patterns and variability time series were compared between groups throughout stance using ANOVA for circular data.

RESULTS

At the ankle, older runners use in-phase propulsion (inversion, tibia external rotation) pattern following midstance (46-47% stance) while young runners are still in an in-phase collapse pattern (eversion, tibia external rotation). In coordination of the knee and hip, older runners maintained an in-phase collapse pattern (knee flexion, hip adduction) approaching midstance (35-37% stance), while younger runners use an out of phase strategy (knee extension, hip adduction). In coordination of the ankle and hip in the frontal plane, older runners again maintained an in phase collapse pattern up to midstance (34-39% stance), while younger runners used an out of phase strategy (ankle inversion, hip adduction). Variability was similar between age groups.

CONCLUSION

Older runners appear to display altered coordination patterns during mid-stance, which may indicate protective biomechanical adaptations. These changes may also have implications for performance in older runners.

Mobility related physical and functional losses due to aging and disease - a motivation for lower limb exoskeletons

BACKGROUND

Physical and functional losses due to aging and diseases decrease human mobility, independence, and quality of life. This study is aimed at summarizing and quantifying these losses in order to motivate solutions to overcome them with a special focus on the possibilities by using lower limb exoskeletons.

METHODS

A narrative literature review was performed to determine a broad range of mobility-related physical and functional measures that are affected by aging and selected cardiovascular, respiratory, musculoskeletal, and neurological diseases.

RESULTS

The study identified that decreases in limb maximum muscle force and power (33% and 49%, respectively, 25-75 yrs) and in maximum oxygen consumption (40%, 20-80 yrs) occur for older adults compared to young adults. Reaction times more than double (18-90 yrs) and losses in the visual, vestibular, and somatosensory systems were reported. Additionally, we found decreases in steps per day (75%, 60-85 yrs), maximum walking speed (24% 25-75 yrs), and maximum six-minute and self-selected walking speed (38% and 21%, respectively, 20-85 yrs), while we found increases in the number of falls relative to the number of steps per day (800%), injuries due to falls (472%, 30-90 yrs) and deaths caused by fall (4000%, 65-90 yrs). Measures were identified to be worse for individuals with impaired mobility. Additional detrimental effects identified for them were the loss of upright standing and locomotion, freezing in movement, joint stress, pain, and changes in gait patterns.

DISCUSSION

This review shows that aging and chronic conditions result in wide-ranging losses in physical and sensory capabilities. While the impact of these losses are relatively modest for level walking, they become limiting during more demanding tasks such as walking on inclined ground, climbing stairs, or walking over longer periods, and especially when coupled with a debilitating disease. As the physical and functional parameters are closely related, we believe that lost functional capabilities can be indirectly improved by training of the physical capabilities. However, assistive devices can supplement the lost functional capabilities directly by compensating for losses with propulsion, weight support, and balance support.

CONCLUSIONS

Exoskeletons are a new generation of assistive devices that have the potential to provide both, training capabilities and functional compensation, to enhance human mobility.

The Functional Utilization of Propulsive Capacity During Human Walking

Aging and many gait pathologies are characterized by reduced propulsive forces and ankle moment and power generation during trailing leg push-off in walking. Despite those changes, we posit that many individuals retain an underutilized reserve for enhancing push-off intensity during walking that may be missed using conventional dynamometry. By using a maximum ramped impeding force protocol and maximum speed walking, we gained mechanistic insight into the factors that govern push-off intensity and the available capacity thereof during walking in young subjects. We discovered in part that young subjects walking at their preferred speed retain a reserve capacity for exerting larger propulsive forces of 49%, peak ankle power of 43%, and peak ankle moment of 22% during push-off-the latter overlooked by maximum isometric dynamometry. We also provide evidence that these reserve capacities are governed at least in part by the neuromechanical behavior of the plantarflexor muscles, at least with regard to ankle moment generation. We envision that a similar paradigm used to quantify propulsive reserves in older adults or people with gait pathology would empower the more discriminate and personalized prescription of gait interventions seeking to improve push-off intensity and thus walking performance.