Using gait parameters to detect fatigue and responses to ice slurry during prolonged load carriage

Effect of Fatigue on Movement Patterns During a Loaded Ruck March

INTRODUCTION

Loaded ruck marching is a common training and operational task for many members of the military. It is known to cause fatigue, affect soldier readiness, and can lead to traumatic and overuse injuries. Quantifying the gait changes that occur over the course of a loaded ruck march may provide a better understanding of injury mechanisms and potentially allow for development of individualized injury-prevention training programs. This study examined the change in soldiers' gait patterns over the course of a loaded ruck march in order to examine the correlation between fatigue and kinematic parameters. Fatigue is a subjective term that may encompass factors such as energy expenditure, muscle exhaustion, and cognitive engagement. Since it can be difficult to quantify, the current study makes the broad assumption that fatigue increases in some (potentially nonlinear) fashion during a loaded ruck march.

METHOD

Three platoons of soldiers participated in a field training exercise with inertial measurement sensors placed on their chests and ankles to record gait parameters throughout a 7-mile ruck march. The effects of fatigue on stride length, stride width, ankle yaw, and torso lean (anterior-posterior [AP] and side-to-side [SS]) were compared using one-way repeated measure analyses of variance.

RESULTS

In comparing the first and last quarters of the ruck march, stride length decreased, stride width increased, stride width variability increased, AP torso lean variability increased, and SS torso lean variability increased.

CONCLUSION

Although they do not describe a direct relationship to injury, these results can inform enhanced approaches to quantify and predict soldier fatigue and more reliably prevent future injury.

Validation of In-Shoe Force Sensors during Loaded Walking in Military Personnel

The loadsol^® wireless in-shoe force sensors can be useful for in-field measurements. However, its accuracy is unknown in the military context, whereby soldiers have to carry heavy loads and walk in military boots. The purpose of this study was to establish the validity of the loadsol^® sensors in military personnel during loaded walking on flat, inclined and declined surfaces. Full-time Singapore Armed Forces (SAF) personnel (n = 8) walked on an instrumented treadmill on flat, 10° inclined, and 10° declined gradients while carrying heavy loads (25 kg and 35 kg). Normal ground reaction forces (GRF), perpendicular to the contact surface, were simultaneously measured using both the loadsol^® sensors inserted in the military boots and the Bertec instrumented treadmill as the gold standard. A total of eight variables of interest were compared between loadsol^® and treadmill, including four kinetic (impact peak force, active peak force, impulse, loading rate) and four spatiotemporal (stance time, stride time, cadence, step length) variables. Validity was assessed using Bland-Altman plots and 95% Limits of Agreement (LoA). Bias was calculated as the mean difference between the values obtained from loadsol^® and the instrumented treadmill. Results showed similar force-time profiles between loadsol^® sensors and the instrumented treadmill. The bias of most variables was generally low, with a narrow range of LoA. The high accuracy and good agreement with standard laboratory equipment suggest that the loadsol^® system is a valid tool for measuring normal GRF during walking in military boots under heavy load carriage.

A History of Heat Health Management Policies in the Singapore Military

Our paper, which is the first historical study about heat injuries in Singapore, seeks to situate the Singapore Armed Forces' (SAF) history of heat stress management policies within the national context. Firstly, we observe that since the late 1970s, a research-driven approach has been adopted by the SAF's military medical leaders to formulate a range of policies to address the Forces' high incidence of heat injuries. This has resulted in the introduction of SAF-wide training measures, and the assembling of local scientific research expertise, which has led to a sharp reduction in heat injury incidence from the 1980s to 2000s. Through this, the SAF sought to demonstrate that its heat stress mitigation measures made the Singapore military 'heat proof'. Secondly, the state shaped a soldier safety agenda in the late 2000s on the back of an increasing emphasis on safety and the transformation of the SAF into a highly-educated and technologically-sophisticated force. This meant a shift towards concern about the welfare of every soldier, particularly through the state's drive to eradicate all training-related deaths. Accordingly, the SAF medical military leaders responded to the state's safety agenda by introducing heat stress management research and policies that were oriented towards the target of eradicating deaths due to heat stress. This policy and research direction, as such, has been strongly guided by the state's safety agenda and utilised to demonstrate to the public that all efforts have been taken to comprehensively mitigate the risks of heat.

Effects of internal cooling on physical performance, physiological and perceptional parameters when exercising in the heat: A systematic review with meta-analyses

Background: An elevated core temperature (Tcore) increases the risk of performance impairments and heat-related illness. Internal cooling (IC) has the potential to lower Tcore when exercising in the heat. The aim of the review was to systematically analyze the effects of IC on performance, physiological, and perceptional parameters. Methods: A systematic literature search was performed in the PubMed database on 17 December 2021. Intervention studies were included assessing the effects of IC on performance, physiological, or perceptional outcomes. Data extraction and quality assessment were conducted for the included literature. The standardized mean differences (SMD) and 95% Confidence Intervals (CI) were calculated using the inverse-variance method and a random-effects model. Results: 47 intervention studies involving 486 active subjects (13.7% female; mean age 20-42 years) were included in the meta-analysis. IC resulted in significant positive effects on time to exhaustion [SMD (95% CI) 0.40 (0.13; 0.67), p < 0.01]. IC significantly reduced Tcore [-0.19 (22120.34; -0.05), p < 0.05], sweat rate [-0.20 (-0.34; -0.06), p < 0.01], thermal sensation [-0.17 (-0.33; -0.01), p < 0.05], whereas no effects were found on skin temperature, blood lactate, and thermal comfort (p > 0.05). IC resulted in a borderline significant reduction in time trial performance [0.31 (-0.60; -0.02), p = 0.06], heart rate [-0.13 (-0.27; 0.01), p = 0.06], rate of perceived exertion [-0.16 (-0.31; -0.00), p = 0.05] and borderline increased mean power output [0.22 (0.00; 0.44), p = 0.05]. Discussion: IC has the potential to affect endurance performance and selected physiological and perceptional parameters positively. However, its effectiveness depends on the method used and the time point of administration. Future research should confirm the laboratory-based results in the field setting and involve non-endurance activities and female athletes. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022336623.

Biomarkers for warfighter safety and performance in hot and cold environments

Exposure to extreme environmental heat or cold during military activities can impose severe thermal strain, leading to impairments in task performance and increasing the risk of exertional heat (including heat stroke) and cold injuries that can be life-threatening. Substantial individual variability in physiological tolerance to thermal stress necessitates an individualized approach to mitigate the deleterious effects of thermal stress, such as physiological monitoring of individual thermal strain. During heat exposure, measurements of deep-body (T_c) and skin temperatures and heart rate can provide some indication of thermal strain. Combining these physiological variables with biomechanical markers of gait (in)stability may provide further insight on central nervous system dysfunction - the key criterion of exertional heat stroke (EHS). Thermal strain in cold environments can be monitored with skin temperature (peripheral and proximal), shivering thermogenesis and T_c. Non-invasive methods for real-time estimation of T_c have been developed and some appear to be promising but require further validation. Decision-support tools provide useful information for planning activities and biomarkers can be used to improve their predictions, thus maximizing safety and performance during hot- and cold-weather operations. With better understanding on the etiology and pathophysiology of EHS, the microbiome and markers of the inflammatory responses have been identified as novel biomarkers of heat intolerance. This review aims to (i) discuss selected physiological and biomechanical markers of heat or cold strain, (ii) how biomarkers may be used to ensure operational readiness in hot and cold environments, and (iii) present novel molecular biomarkers (e.g., microbiome, inflammatory cytokines) for preventing EHS.

Gait balance control after fatigue: Effects of age and cognitive demand

BACKGROUND

Fatigue is a commonly mentioned symptom in older adults, and walking under the influence of fatigue frequently occurs in daily activities. Studies have reported individual effects from fatigue or cognitive demand on gait performance. However, the information on how fatigue and cognitive demand interact to affect gait balance control is still lacking.

RESEARCH QUESTION

How does fatigue affect walking balance control in young and older adults with and without performing a concurrent cognitive task?

METHODS

We collected and analyzed motion data from 17 young and 17 older adults, who performed over-ground walking with and without a concurrent working memory test, before and after been fatigued by performing repetitive sit-to-stand movements. Three-way ANOVAs were used for statistical analysis with Age (young and older adults), Fatigue (pre- and post-fatigue), and Task (single-task and dual-task) as factors.

RESULTS

From pre- to post-fatigue, an increased gait velocity was observed during dual-task walking regardless of age (p = .02). Only young adults demonstrated a significant increase in mediolateral center of mass displacement (M-L CoM) at post-fatigue (p = .019). Accuracies of the working memory test were not affected by Age, Task, or Fatigue.

SIGNIFICANCE

Our findings revealed that gait balance control, as measured by the M-L CoM, deteriorated post-fatigue in young adults. Older adults maintained their mediolateral body sway from pre-fatigue to post-fatigue. Fatigue effects were not further exacerbated during dual-task walking, and similar cognitive performance was maintained as performance fatigability increased.

Development of new 9-ball test protocols for assessing expertise in cue sports

Background

This study aimed to develop new test protocols for evaluating 9-ball expertise levels in cue sports players.

Methods

Thirty-one male 9-ball players at different playing levels were recruited (recreational group, n = 8; university team, n = 15; national team, n = 8). A 15-ball test was administered to indicate overall performance by counting the number of balls potted. Five skill tests (power control, cue alignment, angle, back spin, and top spin) were conducted to evaluate specific techniques by calculating error distances from pre-set targets using 2D video analysis.

Results

Intra-class correlation analyses revealed excellent intra-rater and inter-rater reliability in four out of five skill tests (ICC > 0.95). Significant between-group differences were found in 15-ball test performance (p <  0.001) and absolute error distances in the angle (p <  0.001), back spin (p = 0.006), and top spin tests (p = 0.045), with the recreational group performing worst while the national team performing best. Greater inter-trial variability was observed in recreational players than the more skilled players (p <  0.005).

Conclusions

In conclusion, the 9-ball test protocols were reliable and could successfully discriminate between different playing levels. Coaches and researchers may employ these protocols to identify errors, monitor training, and rank players.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00237-9.

EFFECTIVENESS OF FLOOR MARKINGS FOR CONTROLLING CUT WIDTH DURING SIDE CUTTING TASKS IN LABORATORY EXPERIMENTS

This study examined the effectiveness of floor markings for controlling cut width during the analysis of side cutting maneuvers. Eleven male basketball players performed two side cutting maneuvers of narrow (30[Formula: see text]cm) and wide (45[Formula: see text]cm) cut widths and were guided by floor markings. Ground reaction forces, together with ankle, knee, and hip joint ranges of motion (ROM), and respective joint moments were determined. Cut widths were verified by two approaches by calculating the actual foot-to-foot and foot-to-pelvis distances from motion data. Biomechanical lower extremity loading showed no significant differences in most kinetic and kinematic variables between narrow and wide cuts. The difference in foot-to-foot distance (15.1 [11.6, 18.7] cm, [Formula: see text] between conditions corresponded well with floor markings, however, the difference in foot-to-pelvis distance was much smaller (2.3 [0.3, 4.4] cm, [Formula: see text]. It is concluded that floor markings are not sufficient for controlling the actual anatomical cut width in laboratory experiments. Participants may adjust their body postures to maintain similar lower extremity loading when performing side cuts differing in foot placement width. Cut width should be represented by foot-to-pelvis distance and not foot-to-foot distance.

Wireless battery-free body sensor networks using near-field-enabled clothing

Networks of sensors placed on the skin can provide continuous measurement of human physiological signals for applications in clinical diagnostics, athletics and human-machine interfaces. Wireless and battery-free sensors are particularly desirable for reliable long-term monitoring, but current approaches for achieving this mode of operation rely on near-field technologies that require close proximity (at most a few centimetres) between each sensor and a wireless readout device. Here, we report near-field-enabled clothing capable of establishing wireless power and data connectivity between multiple distant points around the body to create a network of battery-free sensors interconnected by proximity to functional textile patterns. Using computer-controlled embroidery of conductive threads, we integrate clothing with near-field-responsive patterns that are completely fabric-based and free of fragile silicon components. We demonstrate the utility of the networked system for real-time, multi-node measurement of spinal posture as well as continuous sensing of temperature and gait during exercise.

Though wireless near-field communication (NFC) technologies that connect wearable sensors for health monitoring have been reported, the short range of NFC readers limits sensor functionality. Here, the authors report a wireless and battery-free body sensor network with near-field-enabled clothing.

The effects of unexpected mechanical perturbations during treadmill walking on spatiotemporal gait parameters, and the dynamic stability measures by which to quantify postural response

Most falls occur after a loss of balance following an unexpected perturbation such as a slip or a trip. Greater understanding of how humans control and maintain stability during perturbed walking may help to develop appropriate fall prevention programs. The aim of this study was to examine changes in spatiotemporal gait and stability parameters in response to sudden mechanical perturbations in medio-lateral (ML) and anterior-posterior (AP) direction during treadmill walking. Moreover, we aimed to evaluate which parameters are most representative to quantify postural recovery responses. Ten healthy adults (mean = 26.4, SD = 4.1 years) walked on a treadmill that provided unexpected discrete ML and AP surface horizontal perturbations. Participants walked under no perturbation (normal walking), and under left, right, forward, and backward sudden mechanical perturbation conditions. Gait parameters were computed including stride length (SL), step width (SW), and cadence, as well as dynamic stability in AP- (MoS-AP) and ML- (MoS-ML) directions. Gait and stability parameters were quantified by means, variability, and extreme values. Overall, participants walked with a shorter stride length, a wider step width, and a higher cadence during perturbed walking, but despite this, the effect of perturbations on means of SW and MoS-ML was not statistically significant. These effects were found to be significantly greater when the perturbations were applied toward the ML-direction. Variabilities, as well as extremes of gait-related parameters, showed strong responses to the perturbations. The higher variability as a response to perturbations might be an indicator of instability and fall risk, on the same note, an adaptation strategy and beneficial to recover balance. Parameters identified in this study may represent useful indicators of locomotor adaptation to successfully compensate sudden mechanical perturbation during walking. The potential association of the extracted parameters with fall risk needs to be determined in fall-prone populations.

Physiological and Biomechanical Responses to Prolonged Heavy Load Carriage During Level Treadmill Walking in Females

Heavy load carriage has been identified as a main contributing factor to the high incidence of overuse injuries in soldiers. Peak vertical ground reaction force (VGRFMAX) and maximal vertical loading rates (VLRMAX) may increase during heavy prolonged load carriage with the development of muscular fatigue and reduced shock attenuation capabilities. The objectives of the current study were (1) to examine physiological and biomechanical changes that occur during a prolonged heavy load carriage task, and (2) to examine if this task induces neuromuscular fatigue and changes in muscle architecture. Eight inexperienced female participants walked on an instrumented treadmill carrying operational loads for 60 minutes at 5.4 km·h–1. Oxygen consumption (), heart rate, rating of perceived exertion (RPE), trunk lean angle, and ground reaction forces were recorded continuously during task. Maximal force and in-vivo muscle architecture were assessed pre- and posttask. Significant increases were observed for VGRFMAX, VLRMAX, trunk lean angle,, heart rate, and RPE during the task. Increased vastus lateralis fascicle length and decreased maximal force production were also observed posttask. Prolonged heavy load carriage, in an inexperienced population carrying operational loads, results in progressive increases in ground reaction force parameters that have been associated with overuse injury.