Overground versus treadmill walking in Parkinson's disease: Relationship between speed and spatiotemporal gait metrics

Self-selected speed provides more accurate human gait kinematics and spatiotemporal parameters than overground simulated speed on a treadmill: a cross-sectional study

BACKGROUND

Walking speed, a key element of gait analysis, is essential for evaluating the biomechanics of the musculoskeletal system and is typically assessed on flat surfaces, such as walkways or treadmills. While many authors have compared the differences and similarities between treadmill and overground walking, no studies have yet investigated the differences between treadmill gait analysis at self-selected speed (SS) and overground simulated speed (OS). The hypothesis is that accurate kinematic measurements depend on selecting the correct gait speed; however, a mismatch between the perceived comfortable treadmill speed and actual overground speed may affect the accuracy of treadmill gait analyses. This study aimed to assess treadmill gait in healthy young adults by comparing the SS with the OS. The objectives were to determine whether participants could match SS with OS on a treadmill, examine sex differences in gait kinematics and spatiotemporal parameters (KSP) at different speeds, and identify which speed better reflects natural gait kinematics.

METHODS

A total of 60 healthy men and 70 healthy women, aged 22-35 years, participated in this cross-sectional study to investigate the gait kinematics and spatiotemporal differences between the SS and OS. Student's t-test, Bonferroni adjustment, Cohen's effect size, and quadratic regression were employed to analyse differences across walking speeds and groups.

RESULTS

A discrepancy between OS and SS was observed in 66.4% of the participants. Our findings revealed that the adjusted R² values for KSP at SS were consistently greater than those at OS, suggesting that SS offers a more robust and accurate representation of gait kinematics, whereas OS is less reliable.

CONCLUSIONS

These findings underscore the importance of individualized speed selection in gait analysis, as it significantly impacts the accuracy of kinematic and spatiotemporal measurements. This insight is pivotal for clinicians and researchers to develop more effective rehabilitation strategies and comprehensively understand gait dynamics.

Gait patterns during overground and virtual omnidirectional treadmill walking

BACKGROUND

Omnidirectional treadmills (ODTs) offer a promising solution to the virtual reality (VR) locomotion problem, which describes the mismatch between visual and somatosensory information and contributes to VR sickness. However, little is known about how walking on ODTs impacts the biomechanics of gait. This project aimed to compare overground and ODT walking and turning in healthy young adults.

METHODS

Fifteen young adults completed forward walk, 180° turn, and 360° turn tasks under three conditions: (1) overground, (2) on the Infinadeck ODT in a virtual environment without a handrail, and (3) on the ODT with a handrail. Kinematic data for all walking trials were gathered using 3D optical motion capture.

RESULTS

Overall, gait speed was slower during ODT walking than overground. When controlling for gait speed, ODT walking resulted in shorter steps and greater variability in step length. There were no significant differences in other spatiotemporal metrics between ODT and overground walking. Turning on the ODT required more steps and slower rotational speeds than overground turns. The addition of the stability handrail to the ODT resulted in decreased gait variability relative to the ODT gait without the handrail.

CONCLUSION

Walking on an ODT resembles natural gait patterns apart from slower gait speed and shorter step length. Slower walking and shorter step length are likely due to the novelty of physically navigating a virtual environment which may result in a more conservative approach to gait. Future work will evaluate how older adults and those with neurological disease respond to ODT walking.

Gait Variability at Different Walking Speeds

Gait variability (GV) is a crucial measure of inconsistency of muscular activities or body segmental movements during repeated tasks. Hence, GV might serve as a relevant and sensitive measure to quantify adjustments of walking control. However, it has not been clarified whether GV is associated with walking speed, a clarification needed to exploit effective better bilateral coordination level. For this aim, fourteen male students (age 22.4 ± 2.7 years, body mass 74.9 ± 6.8 kg, and body height 1.78 ± 0.05 m) took part in this study. After three days of walking 1 km each day at a self-selected speed (SS) on asphalt with an Apple Watch S. 7 (AppleTM, Cupertino, CA, USA), the participants were randomly evaluated on a treadmill at three different walking speed intensities for 10 min at each one, SS - 20%/SS + 20%/ SS, with 5 min of passive recovery in-between. Heart rate (HR) was monitored and normalized as %HRmax, while the rate of perceived exertion (RPE) (CR-10 scale) was asked after each trial. Kinematic analysis was performed, assessing the Contact Time (CT), Swing Time (ST), Stride Length (SL), Stride Cycle (SC), and Gait Variability as Phase Coordination Index (PCI). RPE and HR increased as the walking speed increased (p = 0.005 and p = 0.035, respectively). CT and SC decreased as the speed increased (p = 0.0001 and p = 0.013, respectively), while ST remained unchanged (p = 0.277). SL increased with higher walking speed (p = 0.0001). Conversely, PCI was 3.81 ± 0.88% (high variability) at 3.96 ± 0.47 km·h-1, 2.64 ± 0.75% (low variability) at SS (4.94 ± 0.58 km·h-1), and 3.36 ± 1.09% (high variability) at 5.94 ± 0.70 km·h-1 (p = 0.001). These results indicate that while the metabolic demand and kinematics variables change linearly with increasing speed, the most effective GV was observed at SS. Therefore, SS could be a new methodological approach to choose the individual walking speed, normalize the speed intensity, and avoid a gait pattern alteration.

Spatiotemporal Gait Parameters in Adults With Premanifest and Manifest Huntington's Disease: A Systematic Review

OBJECTIVE

To systematically review and critically evaluate literature on spatiotemporal gait deviations in individuals with premanifest and manifest Huntington's Disease (HD) in comparison with healthy cohorts.

METHODS

We conducted a systematic review, guided by the Joanna Briggs Institute's Manual for Evidence Synthesis and pre-registered with the International Prospective Register of Systematic Reviews. Eight electronic databases were searched. Studies comparing spatiotemporal footstep parameters in adults with premanifest and manifest HD to healthy controls were screened, included and critically appraised by independent reviewers. Data on spatiotemporal gait changes and variability were extracted and synthesised. Meta-analysis was performed on gait speed, cadence, stride length and stride length variability measures.

RESULTS

We screened 2,721 studies, identified 1,245 studies and included 25 studies (total 1,088 participants). Sample sizes ranged from 14 to 96. Overall, the quality of the studies was assessed as good, but reporting of confounding factors was often unclear. Meta-analysis found spatiotemporal gait deviations in participants with HD compared to healthy controls, commencing in the premanifest stage. Individuals with premanifest HD walk significantly slower (-0.17 m/s; 95% confidence interval [CI] [-0.22, -0.13]), with reduced cadence (-6.63 steps/min; 95% CI [-10.62, -2.65]) and stride length (-0.09 m; 95% CI [-0.13, -0.05]). Stride length variability was also increased in premanifest cohorts by 2.18% (95% CI [0.69, 3.68]), with these changes exacerbated in participants with manifest disease.

CONCLUSION

Findings suggest individuals with premanifest and manifest HD display significant spatiotemporal footstep deviations. Clinicians could monitor individuals in the premanifest stage of disease for gait changes to identify the onset of Huntington's symptoms.

Walking Endurance and Oxygen Uptake On-Kinetics in Individuals With Parkinson Disease Following Overground Locomotor Training

BACKGROUND AND PURPOSE

Poor walking endurance in Parkinson disease (PD) may be attributable to both bioenergetic and biomechanical factors, but locomotor training methods addressing both these factors simultaneously are understudied. Our objective was to examine the effects of overground locomotor training (OLT) on walking endurance in individuals with mild-to-moderate PD, and to further explore potential cardiorespiratory contributions.

METHODS

A single-arm, longitudinal design was used to examine the effects of 24 biweekly sessions of OLT in people with mild-to-moderate PD (n = 12). Walking endurance was measured as total distance walked during a 10-minute walk test (10minWT). Oxygen uptake (V˙ o2 ) on-kinetic profiles were determined using a monoexponential function. Perceived fatigability was assessed following the 10minWT using a self-report scale. Magnitude of change in primary outcomes was assessed using Cohen's d and adjusted for sample size (Cohen's d(unbiased) ).

RESULTS

Participants executed 3036 (297) steps and maintained 65.5% (8%) age-predicted heart rate maximum in a typical session lasting 56.9 (2.5) minutes. Medium effects in total distance walked-885.9 (157.2) versus 969.5 (140.9); Cohen's d(unbiased) = 0.54-and phase II time constant of the V˙ o2 on-kinetic profile-33.7 (12.3) versus 25.9 (15.3); Cohen's d(unbiased) = 0.54-were observed alongside trivial effects for perceived fatigability-4.7 (1.4) versus 4.8 (1.5); Cohen's d(unbiased) = 0.11-following OLT.

DISCUSSION AND CONCLUSIONS

These preliminary findings may demonstrate the potential for moderate-intensity OLT to improve walking endurance and enhance cardiorespiratory adjustments to walking activity in adults with mild-to-moderate PD.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A407 ).

Acclimatization of force production during walking in persons with Parkinson's disease

Individuals with Parkinson's disease walk slowly, with short strides resulting in decreased mobility. Treadmill walking assessments are utilized to understand gait impairment in persons with Parkinson's disease and treadmill-based interventions to mobility have become increasingly popular. While walking on a treadmill, there is a reported initial acclimatization period where individuals adjust to the speed and dynamics of the moving belt before producing consistent walking patterns. It is unknown how much walking time is required for individuals with Parkinson's disease to acclimate to the treadmill. We investigated how spatiotemporal parameters and ground reaction forces changed during treadmill acclimatization. Twenty individuals with idiopathic Parkinson's (15 Males, 5 Females) walked for a five-minute treadmill session on an instrumented treadmill while motion capture data were collected. The measures of interest included ground reaction force measures (peak propulsive force, peak braking force, propulsive impulse, and braking impulse) and spatiotemporal measures (stride length, stride time, or double support time). Analyses demonstrated significantly increased propulsive impulse (p <.001) after the first minute, with no significant difference for the remaining minutes (p ≥ 0.395). There were no significant changes in the spatiotemporal measures (P =.065). These results quantify the stabilization of ground reaction force during the treadmill acclimatization period. Based on our findings, if steady-state gait is desired, we recommend participants walk for at least two minutes before data collection. Future clinical investigations should consider ground reaction force as sensitive parameters for evaluating gait in persons with Parkinson's disease in treadmill-based assessments or interventional therapies.