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Duppen CP, Wrona H, Dayan E, Lewek MD. Evidence of Implicit and Explicit Motor Learning during Gait Training with Distorted Rhythmic Auditory Cues. J Mot Behav 2023; 56:42-51. [PMID: 37394515 DOI: 10.1080/00222895.2023.2231874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
Gait training with rhythmic auditory cues contains motor learning mechanisms that are weighted more explicitly than implicitly. However, various clinical populations may benefit from a shift to gait training with greater implicit motor learning mechanisms. To investigate the ability to incorporate more implicit-weighted motor learning processes during rhythmic auditory cueing, we attempted to induce error-based recalibration using a subtly varying metronome cue for naïve unimpaired young adults. We assessed the extent of implicit and explicit retention after both an isochronous metronome and subtly varying metronome frequency during treadmill and overground walking. Despite 90% of participants remaining unaware of the changing metronome frequency, participants adjusted their cadence and step length to the subtly changing metronome, both on a treadmill and overground (p < 0.05). However, despite evidence of both implicit and explicit processes involved with each metronome (i.e., isochronous and varying), there were no between-condition differences in implicit or explicit retention for cadence, step length, or gait speed, and thus no increased implicit learning advantage with the addition of error-based recalibration for young, unimpaired adults.
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Affiliation(s)
- Chelsea Parker Duppen
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hailey Wrona
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC and North Carolina State University, Raleigh, NC, USA
| | - Eran Dayan
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael D Lewek
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Physical Therapy, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Pimentel RE, Feldman JN, Lewek MD, Franz JR. Quantifying mechanical and metabolic interdependence between speed and propulsive force during walking. Front Sports Act Living 2022; 4:942498. [PMID: 36157906 PMCID: PMC9500214 DOI: 10.3389/fspor.2022.942498] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Walking speed is a useful surrogate for health status across the population. Walking speed appears to be governed in part by interlimb coordination between propulsive (FP) and braking (FB) forces generated during step-to-step transitions and is simultaneously optimized to minimize metabolic cost. Of those forces, FP generated during push-off has received significantly more attention as a contributor to walking performance. Our goal was to first establish empirical relations between FP and walking speed and then to quantify their effects on metabolic cost in young adults. To specifically address any link between FP and walking speed, we used a self-paced treadmill controller and real-time biofeedback to independently prescribe walking speed or FP across a range of condition intensities. Walking with larger and smaller FP led to instinctively faster and slower walking speeds, respectively, with ~80% of variance in walking speed explained by FP. We also found that comparable changes in either FP or walking speed elicited predictable and relatively uniform changes in metabolic cost, together explaining ~53% of the variance in net metabolic power and ~14% of the variance in cost of transport. These results provide empirical data in support of an interdependent relation between FP and walking speed, building confidence that interventions designed to increase FP will translate to improved walking speed. Repeating this protocol in other populations may identify other relations that could inform the time course of gait decline due to age and disease.
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Affiliation(s)
- Richard E. Pimentel
- Applied Biomechanics Laboratory, Joint Department of BME, UNC, and NCSU, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Human Movement Science Laboratory, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jordan N. Feldman
- Applied Biomechanics Laboratory, Joint Department of BME, UNC, and NCSU, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Human Movement Science Laboratory, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael D. Lewek
- Human Movement Science Laboratory, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason R. Franz
- Applied Biomechanics Laboratory, Joint Department of BME, UNC, and NCSU, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Human Movement Science Laboratory, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Jason R. Franz
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Backward vs. Forward Gait Symmetry Analysis Based on Plantar Pressure Mapping. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Symmetry is one of the factors analysed in normal and pathological gaits. Backward gait is an area of interest to scientists, in terms of its physiology and therapeutic possibilities. This study aimed to analyse the symmetry of the pressure parameters of backward gait in comparison to forward gait using different symmetry indices. Eighty-one healthy people aged between 19 and 84 years took part in the study. Foot pressure distribution was analysed during forward and backward gaits at self-selected speeds. Mean and maximum pressure values were calculated after dividing the foot into four or ten areas. Delta, Ratio Index, Robinson Index, Gait Asymmetry, and Symmetry Angle were calculated for each area, separately for both forward and backward gaits. Higher ratios of asymmetry were found during backward than during forward gait. Larger ratios of asymmetry were found within toes II–V, forefoot, metatarsals I, II, and III, medial and lateral heel areas. No significant correlation between symmetry indices and age or BMI was found. Results suggested that the lower symmetry of backward gait is caused by a higher number of corrective movements that allow for the maintenance of body balance and global symmetry of gait. This can be realised by increased cortical control of the backward gait, which was a new movement task for all participants.
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Tiwari A, Kujur A, Kumar J, Joshi D. Investigating the Effect of Real-Time Center of Pressure (CoP) Feedback Training on the Swing Phase of Lower Limb Kinematics in Transfemoral Prostheses with SACH foot. J Biomech Eng 2021; 144:1130976. [PMID: 34951460 DOI: 10.1115/1.4053364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Indexed: 11/08/2022]
Abstract
Transfemoral amputee often encounters reduced toe clearance resulting in trip-related falls. Swing phase joint angles have been shown to influence the toe clearance therefore, training intervention that targets shaping the swing phase joint angles can potentially enhance toe clearance. The focus of this study was to investigate the effect of the shift in the location of the center of pressure (CoP) during heel strike on modulation of the swing phase joint angles in able-bodied participants (n=6) and transfemoral amputees (n=3). We first developed a real-time CoP-based visual feedback system such that participants could shift the CoP during treadmill walking. Next, the kinematic data were collected during two different walking sessions- baseline (without feedback) and feedback (shifting the CoP anteriorly/posteriorly at heel strike to match the target CoP location). Primary swing phase joint angle adaptations were observed with feedback such that during the mid-swing phase, posterior CoP shift feedback significantly increases (p<0.05) the average hip and knee flexion angle by 11.55 degrees and 11.86 degrees respectively in amputees, whereas a significant increase (p<0.05) in ankle dorsiflexion, hip and knee flexion angle by 3.60 degrees, 3.22 degrees, and 1.27 degrees respectively compared to baseline was observed in able-bodied participants. Moreover, an opposite kinematic adaptation was seen during anterior CoP shift feedback. Overall, results confirm a direct correlation between the CoP shift and the modulation in the swing phase lower limb joint angles.
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Affiliation(s)
- Ashutosh Tiwari
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India; Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Abhijeet Kujur
- Department of Design, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Jyoti Kumar
- Department of Design, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Deepak Joshi
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India; Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, 110029, India
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Tiwari A, Joshi D. Design and Validation of a Real-Time Visual Feedback System to Improve Minimum Toe Clearance (mTC) in Transfemoral Amputees. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1711-1722. [PMID: 34398756 DOI: 10.1109/tnsre.2021.3105139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tripping is accompanied by reduced minimum toe clearance (mTC) during the swing phase of gait. The risk of fall due to tripping among transfemoral amputees is nearly 67% which is greater than the transtibial amputees. Therefore, intervention to improve mTC can potentially enhance the quality of life among transfemoral amputees. In this paper, we first develop a real-time visual feedback system with center of pressure (CoP) information. Next, we recruited six non-disabled and three transfemoral amputees to investigate the effect on mTC while participants were trained to shift the CoP anteriorly/posteriorly during heel strike. Finally, to assess the lasting effect of training on mTC, retention trials were conducted without feedback. During feedback, posterior shift in the CoP improved the mTC significantly from 4.68 ± 0.40 cm to 6.12 ± 0.68 cm (p < 0.025) in non-disabled participants. A similar significant improvement in mTC from 4.60 ± 0.55 cm to 5.62 ± 0.57 cm was observed in amputees during posterior shift of CoP. Besides mTC, maximal toe clearances, i.e., maxTC1 and maxTC2, also showed a significant increase (p < 0.025) during the posterior shift of CoP in both the participants. Moreover, during retention, mTC did not differ significantly (p > 0.05) from feedback condition in amputee, suggesting a positive effect of feedback training. The foot-to-ground angle (FGA) at mTC increased significantly (p < 0.025) during posterior shift feedback in non-disabled suggests active ankle dorsiflexion in increasing mTC. However, in amputees, FGA at mTC did not differ significantly during both anterior and posterior CoP shift feedback. The present findings suggest CoP feedback as a potential strategy during gait rehabilitation of transfemoral amputees.
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