Medial-lateral balance during stance phase of straight and circular walking of human subjects

Gait bradykinesia: difficulty in switching posture/gait measured by the anatomical y-axis vector of the sole in Parkinson's disease

This study in Parkinson's disease examined how spatiotemporal parameters in gait bradykinesia link to difficulty in terminating posture and initiating gait locomotion. 41 idiopathic Parkinson's disease patients and 15 age-matched healthy subjects participated in this study. After the patients fixated on a visual-fixation-target, gait was triggered by visual or vocal cue-stimulus. The LED instructed subjects to quickly achieve their own comfortable walking speed on a level floor. The posterior-anterior force of the y-axis vectors of sole relating to soleus and tibialis-anterior EMGs were examined. Step-gain was defined as the duration of the swing-phase relative that of the contralateral stance-phase. Dynamic-ratio was defined as the duration the fore-foot phase relative to that of the ipsilateral stance-phase as forward-oriented movement in each step. The pause in tonic soleus EMG was defined as the off-latency of posture (termination) and the onset of a tibialis-anterior EMG-burst as the on-latency of gait. In Parkinson's disease, soleus off-latencies were prolonged, whereas tibialis-anterior on-latencies were less prolonged. Unsynchronized off/on-latency differences correlated with spatiotemporal parameters of dynamic-ratios, step-gains, gait-initiation, and gait speed in gait bradykinesia. Delayed EMG off-latencies correlated with prolonged motor-latencies in gait bradykinesia as delayed initial backward body-shift. A delayed and deficient initial backward body-shift of y-axis vector was linked to each difficulty in terminating posture and initiating gait, changing to random gait akinesia. Gait bradykinesia in Parkinson's disease stemmed from unsynchronized off/on-latency EMG activities, linking to each difficulty in terminating posture and initiating gait synergic movement through an initial backward body-shift.

Infarct hemisphere and noninfarcted brain volumes affect locomotor performance following stroke

OBJECTIVE

Brain damage within the right middle cerebral artery (MCA) territory is particularly disruptive to mediolateral postural stabilization. The objective of this cross-sectional study was to test the hypothesis that chronic right MCA infarcts (as compared to left) are associated with slower and more bilaterally asymmetrical gait. We further hypothesized that in those with chronic right MCA infarct, locomotor performance is more dependent on gray matter (GM) volumes within noninfarcted regions of the brain that are involved in motor control yet lie outside of the MCA territory.

METHODS

Gait speed was assessed in 19 subjects with right MCA infarct, 20 with left MCA infarct, and 108 controls. Bilateral plantar pressure and temporal symmetry ratios were calculated in a subset of the cohort. GM volumes within 5 regions outside of the MCA territory (superior parietal lobe, precuneus, caudate, putamen, and cerebellum) were quantified from anatomic MRIs.

RESULTS

Right and left infarct groups had similar poststroke duration (7.6 ± 6.0 years), infarct size, and functional independence. The right infarct group demonstrated slower gait speed and greater asymmetry compared to the left infarct group and controls (p < 0.05). In the right infarct group only, those with larger GM volumes within the cerebellum (r(2) = 0.32, p = 0.02) and caudate (r(2) = 0.56, p < 0.001) exhibited faster gait speed.

CONCLUSION

Individuals with chronic lesions within the right MCA territory, as compared to the left MCA territory, exhibit slower, more asymmetrical gait. For these individuals, larger GM volumes within regions outside of the infarcted vascular territory may help preserve locomotor control.

Interventions to Improve Walking in Older Adults

Interventions to improve walking in older adults have historically been multifactorial (i.e. strengthening, endurance and flexibility programs) focusing on improving the underlying impairments. These impairment-based programs have resulted in only modest improvements in walking. In older adults, walking is slow, less stable, inefficient, and the timing and coordination of stepping with postures and phases of gait is poor. We argue the timing and coordination problems are evidence of the loss of motor skill in walking. Taking a lesson from the sports world and from neurorehabilitation, task-oriented motor learning exercise is an essential component of training to improve motor skill and may be a beneficial approach to improving walking in older adults. In this article we: 1) briefly review the current literature regarding impairment-based interventions for improving mobility, 2) discuss why the results have been only modest, and 3) suggest an alternative approach to intervention (i.e. task oriented motor learning).

Contributions of cognitive function to straight- and curved-path walking in older adults

OBJECTIVE

To determine whether the cognitive function contribution to straight- and curved-path walking differs for older adults.

DESIGN

Cross-sectional observational study.

SETTING

Ambulatory clinical research training center.

PARTICIPANTS

People (N=106) aged 65 to 92 years, able to walk household distances independently with or without an assistive device, and who scored 24 or greater on the Mini-Mental State Examination.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Cognitive function was assessed using the Digit Symbol Substitution Test (DSST) as a measure of psychomotor speed, and Trail Making Test Parts A and B (TMT-A and TMT-B) and the Trail Making Test difference score (TMT-B-A) as executive function measures of complex visual scanning and set shifting. Gait speed recorded over an instrumented walkway was used as the measure of straight-path walking. Curved-path walking was assessed using the Figure-of-8 Walk Test (F8W) and recorded as the total time and number of steps for completion.

RESULTS

Both DSST and TMT-A independently contributed to usual gait speed (P<.001). TMT-A performance contributed to F8W time (P<.001). Neither TMT-B nor TMT-B-A contributed to usual gait speed or time to complete the F8W. For the number of steps taken to complete the F8W, TMT-A, TMT-B, and TMT-B-A (all P<.001) were independent contributors, while DSST performance was not.

CONCLUSIONS

Curved-path walking, as measured by the F8W, involves different cognitive processes compared with straight-path walking. Cognitive flexibility and set-shifting processes uniquely contributed to how individuals navigated curved paths. The measure of curved-path walking provides different and meaningful information about daily life walking ability than usual gait speed alone.

The modified Gait Efficacy Scale: establishing the psychometric properties in older adults

BACKGROUND

Perceived ability or confidence plays an important role in determining function and behavior. The modified Gait Efficacy Scale (mGES) is a 10-item self-report measure used to assess walking confidence under challenging everyday circumstances.

OBJECTIVE

The purpose of this study was to determine the reliability, internal consistency, and validity of the mGES as a measure of gait in older adults.

DESIGN

This was a cross-sectional study.

METHODS

Participants were 102 community-dwelling older adults (mean [±SD] age=78.6±6.1 years) who were independent in ambulation with or without an assistive device. Participants were assessed using the mGES and measures of confidence and fear, measures of function and disability, and performance-based measures of mobility. In a subsample (n=26), the mGES was administered twice within a 1-month period to establish test-retest reliability through the intraclass correlation coefficient (ICC [2,1]). The standard error of measure (SEM) was determined from the ICC and standard deviation. The Cronbach α value was calculated to determine internal consistency. To establish the validity of the mGES, the Spearman rank order correlation coefficient was used to examine the association with measures of confidence, fear, gait, and physical function and disability.

RESULTS

The mGES demonstrated test-retest reliability within the 1-month period (ICC=.93, 95% confidence interval=.85, .97). The SEM of the mGES was 5.23. The mGES was internally consistent across the 10 items (Cronbach α=.94). The mGES was related to measures of confidence and fear (r=.54-.88), function and disability (Late-Life Function and Disability Instrument, r=.32-.88), and performance-based mobility (r=.38-.64).

LIMITATIONS

This study examined only community-dwelling older adults. The results, therefore, should not be generalized to other patient populations.

CONCLUSION

The mGES is a reliable and valid measure of confidence in walking among community-dwelling older adults.

Ambulatory estimation of foot placement during walking using inertial sensors

This study proposes a method to assess foot placement during walking using an ambulatory measurement system consisting of orthopaedic sandals equipped with force/moment sensors and inertial sensors (accelerometers and gyroscopes). Two parameters, lateral foot placement (LFP) and stride length (SL), were estimated for each foot separately during walking with eyes open (EO), and with eyes closed (EC) to analyze if the ambulatory system was able to discriminate between different walking conditions. For validation, the ambulatory measurement system was compared to a reference optical position measurement system (Optotrak). LFP and SL were obtained by integration of inertial sensor signals. To reduce the drift caused by integration, LFP and SL were defined with respect to an average walking path using a predefined number of strides. By varying this number of strides, it was shown that LFP and SL could be best estimated using three consecutive strides. LFP and SL estimated from the instrumented shoe signals and with the reference system showed good correspondence as indicated by the RMS difference between both measurement systems being 6.5 ± 1.0 mm (mean ± standard deviation) for LFP, and 34.1 ± 2.7 mm for SL. Additionally, a statistical analysis revealed that the ambulatory system was able to discriminate between the EO and EC condition, like the reference system. It is concluded that the ambulatory measurement system was able to reliably estimate foot placement during walking.

Walking skill can be assessed in older adults: validity of the Figure-of-8 Walk Test

BACKGROUND

The Figure-of-8 Walk Test (F8W) involves straight and curved paths and was designed to represent walking skill in everyday life.

OBJECTIVE

The purposes of this study were to validate the measure in older adults with walking difficulties and to explore correlates of the curved-path walking measure not represented by a straight-path walking measure.

DESIGN

Fifty-one community-dwelling older adults with mobility disability participated in 2 baseline visits as part of an intervention study.

METHODS

The F8W time, steps, and smoothness and measures of gait (gait speed, modified Gait Abnormality Rating Scale [GARS-M]), physical function (Late Life Function and Disabilities Index [LLFDI], Survey of Activities and Fear of Falling in the Elderly [SAFFE], Gait Efficacy Scale [GES], Physical Performance Test [PPT], and fall history), and movement control and planning (gait variability, Trail Making Test B [Trails B]) were recorded in each test session. Bivariate correlations for the F8W with each variable were conducted to examine concurrent and construct validity. Adjusted linear regression analyses were performed to explore the variance in mobility explained by F8W independent of gait speed.

RESULTS

Figure-of-8 Walk Test time correlated with gait (gait speed, r=-.570; GARS-M, r=.281), physical function (LLFDI function, r=-.469; SAFFE restriction subscale, r=.370; PPT, r=-.353), confidence in walking (GES, r=-.468), and movement control (step length coefficient of variation, r=.279; step width coefficient of variation, r=-.277; Trails B, r=.351). Figure-of-8 Walk Test steps correlated with step width variability (r=-.339) and was related to fear of falling (t=-2.50). All correlations were significant (P<.05).

LIMITATIONS

This pilot study had a small sample size, and further research is needed.

CONCLUSIONS

The F8W is a valid measure of walking skill among older adults with mobility disability and may provide information complementary to gait speed.

Maneuvers during legged locomotion

Maneuverability is essential for locomotion. For animals in the environment, maneuverability is directly related to survival. For humans, maneuvers such as turning are associated with increased risk for injury, either directly through tissue loading or indirectly through destabilization. Consequently, understanding the mechanics and motor control of maneuverability is a critical part of locomotion research. We briefly review the literature on maneuvering during locomotion with a focus on turning in bipeds. Walking turns can use one of several different strategies. Anticipation can be important to adjust kinematics and dynamics for smooth and stable maneuvers. During running, turns may be substantially constrained by the requirement for body orientation to match movement direction at the end of a turn. A simple mathematical model based on the requirement for rotation to match direction can describe leg forces used by bipeds (humans and ostriches). During running turns, both humans and ostriches control body rotation by generating fore-aft forces. However, whereas humans must generate large braking forces to prevent body over-rotation, ostriches do not. For ostriches, generating the lateral forces necessary to change movement direction results in appropriate body rotation. Although ostriches required smaller braking forces due in part to increased rotational inertia relative to body mass, other movement parameters also played a role. Turning performance resulted from the coordinated behavior of an integrated biomechanical system. Results from preliminary experiments on horizontal-plane stabilization support the hypothesis that controlling body rotation is an important aspect of stable maneuvers. In humans, body orientation relative to movement direction is rapidly stabilized during running turns within the minimum of two steps theoretically required to complete analogous maneuvers. During straight running and cutting turns, humans exhibit spring-mass behavior in the horizontal plane. Changes in the horizontal projection of leg length were linearly related to changes in horizontal-plane leg forces. Consequently, the passive dynamic stabilization associated with spring-mass behavior may contribute to stability during maneuvers in bipeds. Understanding the mechanics of maneuverability will be important for understanding the motor control of maneuvers and also potentially be useful for understanding stability.

Coordination of steering in a free-trotting quadruped

Typically, locomotion has been studied by restricting the animal's path and/or speed, focusing on stride and step kinematics. Here we incorporate measurements of the legs and trunk in the support and swing phases, during trotting with various speeds and curvatures. This paradigm releases the animal from the confines of the treadmill and runway into the open space. The diagonal step, a new unit of locomotion, is defined by regarding the line between the two supporting diagonal legs as a frame of reference for the description of the dynamics of the virtual line between the two swinging diagonal legs. This analysis reveals that during free trotting the mouse uses three types of steps: fixating, opening, and closing steps. During progression along a straight path, the mouse uses fixating steps, in which the swinging diagonal maintains a fixed direction, landing on the supporting foreleg; during progression along a curved path the mouse uses opening and closing steps alternately. If two steps of the same type are performed sequentially, they engender an abrupt change of direction. Our results reveal how steering with the swinging diagonal, while using a virtually bipedal gait, engenders the whole repertoire of free-trotting behavior.

Posterior-anterior body weight shift during stance period studied by measuring sole-floor reaction forces during healthy and hemiplegic human walking

Posterior-anterior body weight shift during stance phase of human overground locomotion was investigated by recording sole-floor reaction force from five anatomically discrete points with strain gauge transducers of 14 mm diameter attached firmly to the sole of bare foot. At first the subject was asked to walk straight on the laboratory floor at his/her preferred velocity. Then the subject was asked to walk curved path of about 1m radius. For kicking off the body at the end of stance phase, sole-floor reaction force from 3rd metatarsal was stronger than 1st metatarsal or 5th metatarsal during the straight walking, thus body weight shift is represented from heel to 3rd metatarsal line. When walking along a curved path, two types of strategies were recognized; a group of subjects walked leaning to inner leading foot during stance period as judged by stronger forces recorded from 5th metatarsal combined with stronger force from 1st metatarsal of outer trailing foot. Another group of subjects showed almost the same patterns either in the straight and curved walking, suggesting the subjects changed direction of the foot during the immediately previous swing phase to the tangent direction of the curve and placed the foot without leaning the body weight to either direction. Hemiplegic patients showed strikingly different distribution of sole-floor reaction forces from the five points; strongest forces were recorded from 3rd and 5th metatarsals combined with reduced reaction force from heel, therefore characteristic y-vector patterns were observed.