Classification of able-bodied gait using 3-D muscle powers

Running-Related Injury Incidence: Does It Correlate with Kinematic Sub-groups of Runners? A Scoping Review

BACKGROUND

Historically, kinematic measures have been compared across injured and non-injured groups of runners, failing to take into account variability in kinematic patterns that exist independent of injury, and resulting in false positives. Research led by gait patterns and not pre-defined injury status is called for, to better understand running-related injury (RRI) aetiology and within- and between-group variability.

OBJECTIVES

Synthesise evidence for the existence of distinct kinematic sub-groups across a population of injured and healthy runners and assess between-group variability in kinematics, demographics and injury incidence.

DATA SOURCES

Electronic database search: PubMed, Web of Science, Cochrane Central Register of Controlled Trials (Wiley), Embase, OVID, Scopus.

ELIGIBILITY CRITERIA

Original, peer-reviewed, research articles, published from database start to August 2022 and limited to English language were searched for quantitative and mixed-methods full-text studies that clustered injured runners according to kinematic variables.

RESULTS

Five studies (n = 690) were included in the review. All studies detected the presence of distinct kinematic sub-groups of runners through cluster analysis. Sub-groups were defined by multiple differences in hip, knee and foot kinematics. Sex, step rate and running speed also varied significantly between groups. Random injury dispersal across sub-groups suggests no strong evidence for an association between kinematic sub-groups and injury type or location.

CONCLUSION

Sub-groups containing homogeneous gait patterns exist across healthy and injured populations of runners. It is likely that a single injury may be represented by multiple movement patterns, and therefore kinematics may not predict injury risk. Research to better understand the underlying causes of kinematic variability, and their associations with RRI, is warranted.

Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis

Gait pattern classification in individuals with lower-limb amputation could help in developing personalized prosthetic prescriptions and tailored gait rehabilitation. However, systematic classifications of gait patterns in this population have been scarcely explored. This study aimed to determine whether the gait patterns in individuals with unilateral transfemoral amputation (UTFA) can be clustered into homogeneous subgroups using spatiotemporal parameters across a range of walking speeds. We examined spatiotemporal gait parameters, including step length and cadence, in 25 individuals with UTFA (functional level K3 or K4, all non-vascular amputations) while they walked on a split-belt instrumented treadmill at eight speeds. Hierarchical cluster analysis (HCA) was used to identify clusters with homogeneous gait patterns based on the relationships between step length and cadence. Furthermore, after cluster formation, post-hoc analyses were performed to compare the spatiotemporal parameters and demographic data among the clusters. HCA identified three homogeneous gait pattern clusters, suggesting that individuals with UTFA have several gait patterns. Further, we found significant differences in the participants' body height, sex ratio, and their prosthetic knee component among the clusters. Therefore, gait rehabilitation should be individualized based on body size and prosthetic prescription.

Characterization and Categorization of Various Human Lower Limb Movements Based on Kinematic Synergies

A proper movement categorization reduces the complexity of understanding or reproducing human movements in fields such as physiology, rehabilitation, and robotics, through partitioning a wide variety of human movements into representative sub-motion groups. However, how to establish a categorization (especially a quantitative categorization) for various human lower limb movements is rarely investigated in literature and remains challenging due to the diversity and complexity of the lower limb movements (diverse gait modes and interaction styles with the environment). Here we present a quantitative categorization for the various lower limb movements. To this end, a similarity measure between movements was first built based on limb kinematic synergies that provide a unified and physiologically meaningful framework for evaluating the similarities among different types of movements. Then, a categorization was established via hierarchical cluster analysis for thirty-four lower limb movements, including walking, running, hopping, sitting-down-standing-up, and turning in different environmental conditions. According to the movement similarities, the various movements could be divided into three distinct clusters (cluster 1: walking, running, and sitting-down-standing-up; cluster 2: hopping; cluster 3: turning). In each cluster, cluster-specific movement synergies were required. Besides the uniqueness of each cluster, similarities were also found among part of the synergies employed by these different clusters, perhaps related to common behavioral goals in these clusters. The mix of synergies shared across the clusters and synergies for specific clusters thus suggests the coexistence of the conservation and augmentation of the kinematic synergies underlying the construction of the diverse and complex motor behaviors. Overall, the categorization presented here yields a quantitative and hierarchical representation of the various lower limb movements, which can serve as a basis for the understanding of the formation mechanisms of human locomotion and motor function assessment and reproduction in related fields.

Healthy Knee Kinematic Phenotypes Identification Based on a Clustering Data Analysis

The purpose of this study is to identify healthy phenotypes in knee kinematics based on clustering data analysis. Our analysis uses the 3D knee kinematics curves, namely, flexion/extension, abduction/adduction, and tibial internal/external rotation, measured via a KneeKG™ system during a gait task. We investigated two data representation approaches that are based on the joint analysis of the three dimensions. The first is a global approach that is considered a concatenation of the kinematic data without any dimensionality reduction. The second is a local approach that is considered a set of 69 biomechanical parameters of interest extracted from the 3D kinematic curves. The data representations are followed by a clustering process, based on the BIRCH (balanced iterative reducing and clustering using hierarchies) discriminant model, to separate 3D knee kinematics into homogeneous groups or clusters. Phenotypes were obtained by averaging those groups. We validated the clusters using inter-cluster correlation and statistical hypothesis tests. The simulation results showed that the global approach is more efficient, and it allows the identification of three descriptive 3D kinematic phenotypes within a healthy knee population.

Similar Biomechanical Behavior in Gait Analysis between Ceramic-on-Ceramic and Ceramic-on-XLPE Total Hip Arthroplasties

In vitro measurements are widely used to implement gait kinematic and kinetic parameters to predict THA wear rate. Clinical tests of materials and designs are crucial to prove the accuracy and validate such measurements. This research aimed to examine the effect of CoC and CoXLPE kinematics and kinetics on wear during gait, the essential functional activity of humans, by comparing in vivo data to in vitro results. Our study hypothesis was that both implants would present the same hip joint kinematics and kinetics during gait. In total, 127 unilateral primary cementless total hip arthroplasties were included in the research. There were no statistically significant differences observed at mean peak abduction, flexion, and extension moments and THA kinematics between the two groups. THA gait kinematics and kinetics are crucial biomechanical inputs associated with implant wear. In vitro studies report less wear in CoC than CoXLPE when tested in a matched gait kinematic protocol. Our findings confirm that both implants behave identically in terms of kinematics in a clinical environment, thus strengthening CoC advantage in in vitro results. Correlated to all other significant factors that affect THA wear, it could address in a complete prism the wear on CoC and CoXLPE.

Effect of osteopathic manipulation on gait asymmetry

CONTEXT

Movement and loading asymmetry are associated with an increased risk of musculoskeletal injury, disease progression, and suboptimal recovery. Osteopathic structural screening can be utilized to determine areas of somatic dysfunction that could contribute to movement and loading asymmetry. Osteopathic manipulation treatments (OMTs) targeting identified somatic dysfunctions can correct structural asymmetries and malalignment, restoring the ability for proper compensation of stresses throughout the body. Little is currently known about the ability for OMTs to reduce gait asymmetries, thereby reducing the risk of injury, accelerated disease progression, and suboptimal recovery.

OBJECTIVES

To demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking.

METHODS

Forty-two healthy adults (20 males, 22 females) between the ages of 18 and 35 were recruited for this prospective intervention. Standardized osteopathic screening exams were completed by a single physician for each participant, and osteopathic manipulation was performed targeting somatic dysfunctions identified in the screening exam. Three-dimensional (3-D) biomechanical assessments, including the collection of motion capture and force plate data, were performed prior to and following osteopathic manipulation to quantify gait mechanics. Motion capture and loading data were processed utilizing Qualisys Track Manager and Visual 3D software, respectively. Asymmetry in the following temporal, kinetic, and kinematic measures was quantified utilizing a limb symmetry index (LSI): peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. A 2-way repeated-measures analysis of variance model was utilized to evaluate the effects of time (pre/post manipulation) and sex (male/female) on each measure of gait asymmetry.

RESULTS

Gait asymmetry in the peak vertical ground reaction force (-0.6%, p=0.025) and the impulse of the vertical ground reaction force (-0.3%, p=0.026) was reduced in males following osteopathic manipulation. There was no difference in gait asymmetry between time points in females. Osteopathic manipulation did not impact asymmetry in peak knee flexion angle, step length, stride length, or stance time. Among the participants, 59.5% (25) followed the common compensatory pattern, whereas 40.5% (17) followed the uncommon compensatory pattern. One third (33.3%, 14) of the participants showed decompensation at the occipitoatlantal (OA) junction, whereas 26.2% (11), one third (33.3%, 14), and 26.2% (11) showed decompensation at the cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) junctions, respectively. Somatic dysfunction at the sacrum, L5, right innominate, and left innominate occurred in 88.1% (37), 69.0% (29), 97.6% (41), and 97.6% (41) of the participants, respectively.

CONCLUSIONS

Correcting somatic dysfunction can influence gait asymmetry in males; the sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait, prevent injury and the progression of disease, and aid in recovery after surgery.

Comparison of four methods for determining the cut-off frequency of accelerometer signals in able-bodied individuals and ACL ruptured subjects

BACKGROUND

Selecting the appropriate cut-off frequency to filter triaxial accelerometric data is a challenging issue in gait analyses. It reduces soft tissues artifacts and the variability in the kinematic data waveform from able-bodied and physically impaired gaits.

RESEARCH QUESTION

Are cut-off frequencies estimated by four filtering methods similar along each axis of a triaxial accelerometer and for able-bodied subjects and those with an anterior cruciate ligament rupture (ACLR)?

METHODS

After walking on a treadmill, the cut-off frequency for the tibial accelerations was calculated using 95 and 99 per cent of the energy spectrum (E), residual analysis (RA) and, the method (Yu) proposed by Yu et al. [1]. The coefficient of variation was used to express the variability of the cut-off frequencies estimated by the four methods. t-Test and repeated measure ANOVA were applied to examine the effects of healthiness and acceleration axis on cut-off frequencies.

RESULTS

On average, E95 and E99 gave the lowest and the highest cut-off frequencies respectively. The results demonstrated the effect of ACL injury and axes on the cut-off frequencies, especially on the RA method. There was a significant difference in the cut-off frequencies between healthy and ACLR subjects for the vertical axis with the RA method and for the anterior-posterior (AP) axis with the Yu method. Similar cut-off frequencies were obtained for all axes with the E99 method for within groups' comparison. The E95 and E99 methods gave the least and most variable outputs respectively. Significant within group differences between cut off frequencies calculated by four methods, led to disappearing peaks in the more fluctuating portion of the acceleration data.

SIGNIFICANCE

A single cut-off frequency is not recommended for all individuals and axes. In cases where a single cut-off frequency is necessary for all individuals or axes, RA or E99 methods are suggested respectively.

The relative contributions of sagittal, frontal, and transverse joint works to self-paced incline and decline slope walking

Positive and negative work are generated at the lower limb joints in order to locomote over various terrains. Joint work quantifies the changes in energy that are necessary to adapt gait to environmental demands. The aim of this study was to quantify 3D joint work at the hip, knee, and ankle during slope walking. Work was calculated for ten males (23.9 ± 1.1 years) walking at a self-selected speed on inclines and declines (-20, -12, -6, 0, 6, 12, 20 degrees). Sagittal positive work significantly increased at the hip, knee, and ankle for incline walking (for example, hip positive work increased 153%, 280%, and 453% for 6, 12, and 20 degrees, respectively; knee and ankle positive work also increased) (p ≤ 0.05), in order to raise and propel the body forward. Sagittal negative work increased significantly at the hip, knee and ankle for decline walking (for example, knee negative work increased 193%, 355%, and 496% for -6, -12, and -20 degrees, respectively; hip and ankle negative work also increased) (p ≤ 0.05), in order to control body descent. These substantial changes in work will be especially challenging for people with compromised strength due to age and disease. Furthermore, changes in work were not limited to the sagittal plane: 46% of the total hip joint work occurred in the frontal and transverse planes for six degree decline walking. Thus, decline walking placed greater demands on the hip ab/adductors and rotators, and this may be related to the greater risk of falls observed for descent versus ascent.

Identification of specific gait patterns in patients with cerebellar ataxia, spastic paraplegia, and Parkinson's disease: A non-hierarchical cluster analysis

BACKGROUND

Patients with degenerative neurological diseases such as cerebellar ataxia, spastic paraplegia, and Parkinson's disease often display progressive gait function decline that inexorably impacts their autonomy and quality of life. Therefore, considering the related social and economic costs, one of the most important areas of intervention in neurorehabilitation should be the treatment of gait abnormalities. This study aims to determine whether an entire dataset of gait parameters recorded in patients with degenerative neurological diseases can be clustered into homogeneous groups distinct from each other and from healthy subjects. Patients affected by three different types of primary degenerative neurological diseases were studied. These diseases were: i) cerebellar ataxia (28 patients), ii) hereditary spastic paraplegia (31 patients), and iii) Parkinson's disease (70 patients). Sixty-five gender-age-matched healthy subjects were enrolled as a control group. An optoelectronic motion analysis system was used to measure time-distance parameters and lower limb joint kinematics during gait in both patients and healthy controls. When clustering single parameters, step width and ankle joint range of motion (RoM) in the sagittal plane differentiated cerebellar ataxia group from the other groups. When clustering sets of two, three, or four parameters, several pairs, triples, and quadruples of clusters differentiated the cerebellar ataxia group from the other groups. Interestingly, the ankle joint RoM parameter was present in 100% of the clusters and the step width in approximately 50% of clusters. In addition, in almost all clusters, patients with cerebellar ataxia showed the lowest ankle joint RoM and the largest step width values compared to healthy controls, patients with hereditary spastic paraplegia, and Parkinson's disease subjects. This study identified several clusters reflecting specific gait patterns in patients with degenerative neurological diseases. In particular, the specific gait pattern formed by the increased step width, reduced ankle joint RoM, and increased gait variability, can differentiate patients with cerebellar ataxia from healthy subjects and patients with spastic paraplegia or Parkinson's disease. These abnormal parameters may be adopted as sensitive tools for evaluating the effect of pharmacological and rehabilitative treatments.

Estimates of individual muscle power production in normal adult walking

Background

The purpose of this study was to determine the contribution of individual hip muscles to the net hip power in normal adult self-selected speed walking. A further goal was to examine each muscle’s role in propulsion or support of the body during that task.

Methods

An EMG-to-force processing (EFP) model was developed which scaled muscle-tendon unit (MTU) force output to gait EMG. Active muscle power was defined as the product of MTU forces (derived from EFP) and that muscle’s contraction velocity. Passive hip power was estimated from passive moments associates with hip position (angle of flexion (extension)) and the hip’s angular velocity. Net hip EFP power was determined by summing individual active hip muscle power plus the net passive hip power at each percent gait cycle interval. Net hip power was also calculated for these study participants via inverse dynamics (kinetics plus kinematics, KIN). The inverse dynamics technique – well accepted in the biomechanics literature – was used as a “gold standard” for validation of this EFP model. Closeness of fit of the power curves of the two methods was used to validate the model.

Results

The correlation between the EFP and KIN methods was sufficiently close, suggesting validation of the model’s ability to provide reasonable estimates of power produced by individual hip muscles. Key findings were that (1) most muscles undergo a stretch-shorten cycle of muscle contraction, (2) greatest power was produced by the hip abductors, and (3) the hip adductors contribute to either hip adduction or hip extension (but not both).

Conclusions

The EMG-to-force processing approach provides reasonable estimates of individual hip muscle forces in self-selected speed walking in neurologically-intact adults.

Analysis of Big Data in Gait Biomechanics: Current Trends and Future Directions

The increasing amount of data in biomechanics research has greatly increased the importance of developing advanced multivariate analysis and machine learning techniques, which are better able to handle “big data”. Consequently, advances in data science methods will expand the knowledge for testing new hypotheses about biomechanical risk factors associated with walking and running gait-related musculoskeletal injury. This paper begins with a brief introduction to an automated three-dimensional (3D) biomechanical gait data collection system: 3D GAIT, followed by how the studies in the field of gait biomechanics fit the quantities in the 5 V’s definition of big data: volume, velocity, variety, veracity, and value. Next, we provide a review of recent research and development in multivariate and machine learning methods-based gait analysis that can be applied to big data analytics. These modern biomechanical gait analysis methods include several main modules such as initial input features, dimensionality reduction (feature selection and extraction), and learning algorithms (classification and clustering). Finally, a promising big data exploration tool called “topological data analysis” and directions for future research are outlined and discussed.

Ankle plantarflexion strength in rearfoot and forefoot runners: a novel clusteranalytic approach

The purpose of the present study was to test for differences in ankle plantarflexion strengths of habitually rearfoot and forefoot runners. In order to approach this issue, we revisit the problem of classifying different footfall patterns in human runners. A dataset of 119 subjects running shod and barefoot (speed 3.5m/s) was analyzed. The footfall patterns were clustered by a novel statistical approach, which is motivated by advances in the statistical literature on functional data analysis. We explain the novel statistical approach in detail and compare it to the classically used strike index of Cavanagh and Lafortune (1980). The two groups found by the new cluster approach are well interpretable as a forefoot and a rearfoot footfall groups. The subsequent comparison study of the clustered subjects reveals that runners with a forefoot footfall pattern are capable of producing significantly higher joint moments in a maximum voluntary contraction (MVC) of their ankle plantarflexor muscles tendon units; difference in means: 0.28Nm/kg. This effect remains significant after controlling for an additional gender effect and for differences in training levels. Our analysis confirms the hypothesis that forefoot runners have a higher mean MVC plantarflexion strength than rearfoot runners. Furthermore, we demonstrate that our proposed stochastic cluster analysis provides a robust and useful framework for clustering foot strikes.

Effect of trunk sagittal attitude on shoulder, thorax and pelvis three-dimensional kinematics in able-bodied subjects during gait

It has been shown that an original attitude in forward or backward inclination of the trunk is maintained at gait initiation and during locomotion, and that this affects lower limb loading patterns. However, no studies have shown the extent to which shoulder, thorax and pelvis three-dimensional kinematics are modified during gait due to this sagittal inclination attitude. Thirty young healthy volunteers were analyzed during level walking with video-based motion analysis. Reflecting markers were mounted on anatomical landmarks to form a two-marker shoulder line segment, and a four-marker thorax and pelvis segments. Absolute and relative spatial rotations were calculated, for a total of 11 degrees of freedom. The subjects were divided into two groups of 15 according to the median of mean thorax inclination angle over the gait cycle. Preliminary MANOVA analysis assessed whether gender was an independent variable. Then two-factor nested ANOVA was used to test the possible effect of thorax inclination on body segments, planes of motion and gait periods, separately. There was no significant difference in all anthropometric and spatio-temporal parameters between the two groups, except for subject mass. The three-dimensional kinematics of the thorax and pelvis were not affected by gender. Nested ANOVA revealed group effect in all segment rotations apart those at the pelvis, in the sagittal and frontal planes, and at the push-off. Attitudes in sagittal thorax inclination altered trunk segments kinematics during gait. Subjects with a backward thorax showed less thorax-to-pelvis motion, but more shoulder-to-thorax and thorax-to-laboratory motion, less motion in flexion/extension and in lateral bending, and also less motion during push-off. This contributes to the understanding of forward propulsion and sideways load transfer mechanisms, fundamental for the maintenance of balance and the risk of falling.

Knee extensor and flexor dominant gait patterns increase the knee frontal plane moment during walking

High gait-induced knee frontal plane moment is linked with the development of knee osteoarthritis. Gait patterns across the normal population exhibit large inter-individual variabilities especially at the knee sagittal plane moment profile during loading response and terminal stance phase. However, the effects of different gait patterns on this moment remain unknown. Therefore, we examined whether different gait patterns are associated with atypically high knee frontal plane moments. Profiles of knee joint moments divided a sample of 24 subjects into three subgroups (11, 7, 6) through cluster analysis. Kinetics, kinematics, and spatio-temporal parameters were compared among clusters. Subjects who showed a typical sagittal plane moment pattern (n = 11) had 43% lower first peak of knee frontal plane moment compared to the cluster, which showed the dominance of the knee extensor moment during stance phase (n = 7, p < 0.01). In addition, a typical gait pattern cluster had 44% lower second peak knee frontal plane moment than the cluster, which showed the dominance of the knee flexor moment during the terminal stance phase (n = 6, p < 0.05). These findings indicate that different knee strategies driving gait considerably impact knee loading, suggesting that knee extensor and flexor dominant gait patterns demonstrate atypically high knee frontal plane moments. People in these subgroups may, therefore, be at higher risk of developing knee osteoarthritis.

IDENTIFICATION OF KNEE FRONTAL PLANE KINEMATIC PATTERNS IN NORMAL GAIT BY PRINCIPAL COMPONENT ANALYSIS

The purpose of this study was to identify meaningful gait patterns in knee frontal plane kinematics from a large population of asymptomatic individuals. The proposed method used principal component analysis (PCA). It first reduced the data dimensionality, without loss of relevant information, by projecting the original kinematic data onto a subspace of significant principal components (PCs). This was followed by a discriminant model to separate the individuals' gait into homogeneous groups. Four descriptive gait patterns were identified and validated by clustering silhouette width and statistical hypothesis testing. The first pattern was close to neutral during the stance phase and in adduction during the swing phase (Cluster 1). The second pattern was in abduction during the stance phase and tends into adduction during the swing phase (Cluster 2). The third pattern was close to neutral during the stance phase and in abduction during the swing phase (Cluster 3) and the fourth was in abduction during both the stance and the swing phase (Cluster 4).

Taxonomy of golf putting: do different golf putting techniques exist?

This study is a preliminary investigation into the use of cluster analysis to determine if different putting techniques existed in a group of club level golfers. Putting at a hole 4 m away, the performances of 34 experienced golfers (age 55.3 ± 17.8 years and handicap 15.3 ± 6.9, range 3-27) were analysed using putter head kinematic and centre of pressure data. Two distinct putting techniques were identified (named as Arm putting and Body putting), this being the first time different putting techniques have been reported in the research literature. These techniques were defined by parameters related solely to movement of the centre of pressure along the line of the putt. Some players (17 of 34) moved between techniques when performing their putting trials. Neither technique produced more accurate putt results (P = 0.783). Putting technique was further analysed after grouping players according to handicap (similar skill level) or accuracy (similar putting performance). The lack of significant findings when players were re-analysed according to handicap or accuracy highlights the importance of the correct methodological approach to detecting technique differences.

Trunk's natural inclination influences stance limb kinetics, but not body kinematics, during gait initiation in able men

The imposing mass of the trunk in relation to the whole body has an important impact on human motion. The objective of this study is to determine the influence of trunk's natural inclination--forward (FW) or backward (BW) with respect to the vertical--on body kinematics and stance limb kinetics during gait initiation.Twenty-five healthy males were divided based on their natural trunk inclination (FW or BW) during gait initiation. Instantaneous speed was calculated at the center of mass at the first heel strike. The antero-posterior impulse was calculated by integrating the antero-posterior ground reaction force in time. Ankle, knee, hip and thoraco-lumbar (L5) moments were calculated using inverse dynamics and only peaks of the joint moments were analyzed. Among all the investigated parameters, only joint moments present significant differences between the two groups. The knee extensor moment is 1.4 times higher (P<0.001) for the BW group, before the heel contact. At the hip, although the BW group displays a flexor moment 2.4 times higher (P<0.001) before the swing limb's heel-off, the FW group displays an extensor moment 3.1 times higher (P<0.01) during the swing phase. The three L5 extensor peaks after the toe-off are respectively 1.7 (P<0.001), 1.4 (P<0.001) and 1.7 (P<0.01) times higher for the FW group. The main results support the idea that the patterns described during steady-state gait are already observable during gait initiation. This study also provides reference data to further investigate stance limb kinetics in specific or pathologic populations during gait initiation. It will be of particular interest for elderly people, knowing that this population displays atypical trunk postures and present a high risk of falling during this forward stepping.

Clustering and classification of regional peak plantar pressures of diabetic feet

High plantar pressures have been associated with foot ulceration in people with diabetes, who can experience loss of protective sensation due to peripheral neuropathy. Therefore, characterization of elevated plantar pressure distributions can provide a means of identifying diabetic patients at potential risk of foot ulceration. Plantar pressure distribution classification can also be used to determine suitable preventive interventions, such as the provision of an appropriately designed insole. In the past, emphasis has primarily been placed on the identification of individual focal areas of elevated pressure. The goal of this study was to utilize k-means clustering analysis to identify typical regional peak plantar pressure distributions in a group of 819 diabetic feet. The number of clusters was varied from 2 to 10 to examine the effect on the differentiation and classification of regional peak plantar pressure distributions. As the number of groups increased, so too did the specificity of their pressure distributions: starting with overall low or overall high peak pressure groups and extending to clusters exhibiting several focal peak pressures in different regions of the foot. However, as the number of clusters increased, the ability to accurately classify a given regional peak plantar pressure distribution decreased. The balance between these opposing constraints can be adjusted when assessing patients with feet that are potentially "at risk" or while prescribing footwear to reduce high regional pressures. This analysis provides an understanding of the variability of the regional peak plantar pressure distributions seen within the diabetic population and serves as a guide for the preemptive assessment and prevention of diabetic foot ulcers.

The effects of walking sticks on gait kinematics and kinetics with chronic stroke survivors

BACKGROUND

There are robust clinical paradigms against the prescription of walking sticks for people with stroke. However, there is little information on the biomechanics of gait with and without these devices to guide clinical practice. Therefore, this study investigated how the use of walking sticks (canes or crutches) affected both the kinematics and kinetics of gait in people with chronic stroke after their walking had stabilized.

METHODS

Nineteen people with chronic stroke walked at both comfortable and fast speeds. A 3-D motion analysis system and one force platform were used to obtain kinematic and kinetic data of the paretic lower limb during four conditions: With and without walking sticks, and at comfortable and fast speeds. Outcomes included linear kinematics (walking speeds) and angular kinematics (maximum joint angles), power, and work of the paretic hip, knee and ankle joints in the saggital plane.

FINDINGS

The use of walking sticks resulted in increases in speed during both fast (P<0.001) and comfortable (P=0.001) walking, but did not result in changes in maximum joint angles. This also led to increases in ankle plantar flexion (P<0.01), knee extension (P<0.01), and hip flexion (P<0.001) power generation, but did not result in changes in work. There were no greater changes as a result of using walking sticks during fast versus comfortable walking for any outcome. INTERPRETATIN: The outcomes with the use of walking sticks were beneficial, which suggests that the prescription of these devices is not detrimental to walking that was stabilized in people with stroke.

Aging modifies joint power and work when gait speeds are matched

It is well known that ankle joint power generation (A2) is reduced in healthy older adults (OG) during gait. No general consensus exists, however, as to what fundamental compensatory actions are made at the knee and hip joints by the OG to compensate for this loss of power. The failure to control gait speed may account for this lack of agreement. This study investigated the effect of aging on lower limb joint power and work during gait. The gait patterns of eight old (OG: 66.8±5.4 yr) and 12 young adults (YG: 26.6±2.9 yr) were recorded for a range of matched speeds (1.0 m s(-1), 1.3 m s(-1), 1.6 m s(-1)). Speed did not differ between the groups. Combining speeds, the OG generated 17% less A2 power and 21% less A2 work (p<0.05). Compared to the YG, the OG generated 46% more H1 work, 30% more H2 peak power, 16% more H3 peak power, 30% more K3 peak power and 19% more K4 peak power (p<0.05). These actions by the OG were associated with less ankle plantar-flexion, more hip flexion and anterior pelvic tilt (p<0.05). The OG adopted a different gait pattern at the faster speeds by generating more H3 work than A2 work. This shows the OG rely on hip flexors to propel the leg into swing when ankle plantar-flexor function is reduced. This may partly explain how gait changes emerge with aging.

A new classification of diabetic gait pattern based on cluster analysis of biomechanical data

BACKGROUND

The diabetic foot, one of the most serious complications of diabetes mellitus and a major risk factor for plantar ulceration, is determined mainly by peripheral neuropathy. Neuropathic patients exhibit decreased stability while standing as well as during dynamic conditions. A new methodology for diabetic gait pattern classification based on cluster analysis has been proposed that aims to identify groups of subjects with similar patterns of gait and verify if three-dimensional gait data are able to distinguish diabetic gait patterns from one of the control subjects.

METHOD

The gait of 20 nondiabetic individuals and 46 diabetes patients with and without peripheral neuropathy was analyzed [mean age 59.0 (2.9) and 61.1(4.4) years, mean body mass index (BMI) 24.0 (2.8), and 26.3 (2.0)]. K-means cluster analysis was applied to classify the subjects' gait patterns through the analysis of their ground reaction forces, joints and segments (trunk, hip, knee, ankle) angles, and moments.

RESULTS

Cluster analysis classification led to definition of four well-separated clusters: one aggregating just neuropathic subjects, one aggregating both neuropathics and non-neuropathics, one including only diabetes patients, and one including either controls or diabetic and neuropathic subjects.

CONCLUSIONS

Cluster analysis was useful in grouping subjects with similar gait patterns and provided evidence that there were subgroups that might otherwise not be observed if a group ensemble was presented for any specific variable. In particular, we observed the presence of neuropathic subjects with a gait similar to the controls and diabetes patients with a long disease duration with a gait as altered as the neuropathic one.

Gait analysis after total hip replacement with hip resurfacing implant or Mallory-head Exeter prosthesis: a randomised controlled trial

A key to the analysis of function after total hip replacement (THR) is the ability to identify gait adaptations specific to design features and surgical procedures. In a randomised controlled design, we evaluated the mechanics of gait after THR with a hip resurfacing system or conventional prosthesis. We also investigated whether gait adaptations returned to normal postoperatively. Similar improvements in mechanics of gait were found, except for peak abductor moments, which improved more in the conventional group. Gait speed increased significantly, but with no differences between groups. The increase in walking speed was reflected as significant improvement within groups in most kinematic and kinetic variables. Significant differences between the operated and non-operated hip were seen in all patients, but with no difference between groups. Mean curves of joint angle profiles and moments in all anatomical planes during a gait cycle revealed that gait impairment persisted with no differences between the conventional prosthesis and the resurfacing system.

Determination of ankle muscle power in normal gait using an EMG-to-force processing approach

The purpose of this study was to determine the contribution of individual ankle muscles to the net ankle power and to examine each muscle's role in propulsion or support of the body during normal, self-selected-speed walking. An EMG-to-force processing (EFP) model was developed which scaled muscle tendon unit force output to gait EMG, with that muscle's power output being the product of muscle force and contraction velocity. Net EFP power was determined by summing individual ankle muscle power. Net ankle power was also calculated for these subjects via inverse dynamics. Closeness of fit of the power curves of the two methods was used to validate the model. The curves were highly correlated (r(2)=.91), thus the model was deconstructed to analyze the power contribution and role of each ankle muscle during normal gait. Key findings were that the plantar flexors control tibial rotation in single support, and act to propel the entire limb into swing phase. The dorsiflexors provide positive power for swing phase foot clearance, negative power to control early stance phase foot placement, and a second positive power burst to actively advance the tibia in the transition from double to single support. Co-contraction of agonists and antagonists was limited to only a small percentage of the gait cycle.

Effect of trunk inclination on lower limb joint and lumbar moments in able men during the stance phase of gait

BACKGROUND

Though the effect of imposed trunk posture affects walking patterns little is known about the effect of natural orientation of the trunk on gait. The objectives of this study are to test if the lower limb joint and thoraco-lumbar moments are similar in subjects who maintain an average natural forward or backward trunk inclination during gait and verify if the lower limbs are equally affected.

METHODS

Twenty-five young men were divided according to their natural backward or forward trunk inclination during level walking. Ankle, knee, hip and thoraco-lumbar moments were calculated by an inverse dynamic approach for the two limbs. A two-way ANOVA was performed on peak lower limb moments. A one-way ANOVA was performed on thoraco-lumbar peak moments.

FINDINGS

There was a main effect for both trunk inclinations and lower limb sides but no interaction. For the forward leaners, the duration of hip extension moment was longer (P<0.001) while the hip flexion moment was 1.3 times smaller (P<0.001). Differences between the lower limb sides were noted in all joints but at push-off of the stance phase only. The two thoraco-lumbar extension moments were, respectively, 1.4 times higher for the forward leaners while the two flexion moments were approximately 1.4 times higher for the backward leaners.

INTERPRETATIONS

The backward leaners propel themselves with a strong hip flexor activity at push-off while the forward leaners use their hip muscles throughout stance. These results support the idea that trunk inclinations and moment variations are associated with the type of walking patterns.

Hip and knee joints are more stabilized than driven during the stance phase of gait: an analysis of the 3D angle between joint moment and joint angular velocity

Joint power is commonly used in orthopaedics, ergonomics or sports analysis but its clinical interpretation remains controversial. Some basic principles on muscle actions and energy transfer have been proposed in 2D. The decomposition of power on 3 axes, although questionable, allows the same analysis in 3D. However, these basic principles have been widely criticized, mainly because bi-articular muscles must be considered. This requires a more complex computation in order to determine how the individual muscle force contributes to drive the joint. Conversely, with simple 3D inverse dynamics, the analysis of both joint moment and angular velocity directions is essential to clarify when the joint moment can contribute or not to drive the joint. The present study evaluates the 3D angle between the joint moment and the joint angular velocity and investigates when the hip, knee and ankle joints are predominantly driven (angle close to 0 degrees and 180 degrees ) or stabilized (angle close to 90 degrees ) during gait. The 3D angle curves show that the three joints are never fully but only partially driven and that the hip and knee joints are mainly stabilized during the stance phase. The notion of stabilization should be further investigated, especially for subjects with motion disorders or prostheses.

Effects of cadence on energy generation and absorption at lower extremity joints during gait

BACKGROUND

Information regarding kinetic changes associated with walking speed is important for identifying alterations in locomotor disorders caused by pathological processes, as opposed to those arising solely from altered speeds.

METHODS

Fourteen healthy subjects were assessed walking at both natural and imposed cadences of 60, 80, and 120 steps/min. A 3D motion analysis system, force platforms, and related software were used to obtain kinematic and kinetic data. Net joint powers were calculated across cycles and the area under the positive and negative phases of the power curves provided the mechanical work generated and absorbed at the hip, knee, and ankle. The relative contributions to the total positive and negative work across the four cadences were calculated for each joint. ANOVAs followed by planned contrasts were used to assess the effects of laterality, joint, and cadence.

FINDINGS

Power and mechanical work, as well as the contributions of individual joints to the total energy generated and absorbed, were shown to be influenced by walking cadence, independent of laterality. The ankle, knee, and hip contributions to the total limb generation and absorption at the lowest cadence were 53%, 21%, and 26%, and at the highest cadence, the corresponding values were 34%, 33%, and 33%, respectively.

INTERPRETATION

Power and mechanical work, as well as the contributions of individual joints to the total energy generated and absorbed, were shown to be influenced by the walking cadence, independent of laterality. These findings will be helpful for identifying walking strategies and adaptations in populations with gait disorders.

Gait pattern categorization of stroke participants with equinus deformity of the foot

Following stroke an equinus deformity of the foot may develop, which may affect the gait pattern of patients differently. Sub-categorization of gait patterns in these patients would be helpful in developing and delivering more targeted treatment. A hierarchical cluster analysis was used to classify the gait patterns of 23 chronic stroke patients with equinus deformity of the foot based on temporal distance parameters and joint kinematic and kinetic measures in the sagittal and coronal planes. Cluster analysis showed that gait patterns were not singularly homogenous and identified three subgroups that contained within group homogenous levels of function. Further analysis identified significant differences between the subgroups in some of the temporal distance and kinematic and kinetic measures examined. The results from this study can be used to categorise patients, facilitating appropriate development of targeted treatment.

Different centre of pressure patterns within the golf stroke I: Cluster analysis

Weight transfer research in the golf swing has produced conflicting and inconclusive results. A limitation of previous studies is the assumption that only one swing "style" exists within the golf swing. If different styles, or movement strategies, exist and if the different styles are analysed together in a single group, statistical errors will result. The aim of this study was to determine if different weight transfer styles exist in the golf swing by applying cluster analysis to centre of pressure (CP) patterns in the direction of hit (CPy) and to evaluate cluster analysis issues. Sixty-two professional to high handicap golfers performed simulated drives, hitting a golf ball into a net, while standing on two force plates. Centre of pressure position relative to the feet (CPy%) was quantified at eight swing events identified from 200-Hz video. Cluster analysis identified two major CPy% styles: a "Front Foot" style and a "Reverse" style. Both styles began with CPy% positioned evenly between the feet, moved to the back foot during backswing, and then forward during early downswing. Beyond early downswing, the Front Foot group continued to move CPy% to the Front Foot through to ball contact, while the Reverse group moved CPy% towards the back foot through ball contact and follow-through. Both weight transfer styles were evident across skill levels from professional to high handicap golfers, indicating that neither style was a technical error. Cluster analysis should include hierarchical and non-hierarchical clustering and use objective measures combined with theoretical assessment to determine the optimal number of clusters. Furthermore, a number of validation procedures should always be used to validate the solution.

Identification and classification of toe-walkers based on ankle kinematics, using a data-mining method

A database of 1,736 patients and 2,511 gait analyses was reviewed to identify for trials where the first rocker was absent. A fuzzy c-means algorithm was used to identify sagittal ankle kinematic patterns and three groups were identified. The first showed a progressive dorsiflexion during the stance phase, while the second had a short-lived dorsiflexion, followed by a progressive plantarflexion. The third group exhibited a double bump pattern, moving successively from a short-lived dorsiflexion to a short-lived plantarflexion and then returning to a further short-lived dorsiflexion before ending with plantarflexion until toe-off. The three patterns were linked to different neurological conditions. Myopathy, neuropathy and arthogryposis essentially revealed group 1 patterns, whereas idiopathic toe-walkers mainly displayed group 2 patterns. Cerebral palsy patients, however, were relatively homogeneously distributed amongst the three groups. Able-bodied subjects walking on their toes showed a high proportion of unclassifiable ankle patterns, due to a variable gait whilst toe walking. Despite the variety of neurological conditions included in this meta-analysis repeatable biomechanical patterns appeared that could influence therapeutic management.

Muscle force redistributes segmental power for body progression during walking

The ankle plantar flexors were previously shown to support the body in single-leg stance to ensure its forward progression [J. Biomech. 34 (2001) 1387]. The uni- (SOL) and biarticular (GAS) plantar flexors accelerated the trunk and leg forward, respectively, with each opposing the effect of the other. Around mid-stance their net effect on the trunk and the leg was negligible, consistent with the body acting as an inverted pendulum. In late stance, their net effect was to accelerate the leg and trunk forward, consistent with an active push-off. Because other muscles are active in the beginning and end of stance, we hypothesized that their active concentric and eccentric force generation also supports the body and redistributes segmental power to enable body forward progression. Muscle-actuated forward dynamical simulations that emulated observed walking kinematics and kinetics of young adult subjects were analyzed to quantify muscle contributions to the vertical and horizontal ground reaction force, and to the acceleration and mechanical power of the leg and trunk. The eccentric uniarticular knee extensors (vasti, VAS) and concentric uniarticular hip extensors (gluteus maximus, GMAX) were found to provide critical support to the body in the beginning of stance, before the plantar flexors became active. VAS also decelerated the forward motion of both the trunk and the leg. Afterwards when VAS shortens in mid-stance, it delivered the power produced to accelerate the trunk and also redistributed segmental power to the trunk by continuing to decelerate the leg. When present, rectus femoris (RF) activity in the beginning of stance had a minimal effect. But in late stance the lengthening RF accelerated the knee and hip into extension, which opposed swing initiation. Though RF was lengthening, it still accelerated the trunk forward by decelerating the leg and redistributing the leg segmental power to the trunk, as SOL does though it is shortening instead of lengthening. Force developed from highly stretched passive hip structures and active force produced by the uniarticular hip flexors assisted GAS in swing initiation. Hamstrings (HAM) decelerated the leg in late swing while lengthening and accelerated the leg in the beginning of stance while shortening. We conclude that the uniarticular knee and hip extensor muscles are critical to body support in the beginning of stance and redistribution of segmental power by muscles throughout the gait cycle is critical to forward progression of the trunk and legs.

Simultaneous, bilateral, and three-dimensional gait analysis of elderly people without impairments

OBJECTIVE

The main objectives of this study were to determine if the right and left lower limbs in the gait of elderly people developed similar muscle moment and power patterns and to determine whether their associated mechanical energies were different during two consecutive gait cycles.

DESIGN

A total of 18 able-bodied male subjects aged 71 +/- 6.8 yrs participated in this study. Data were collected using three Optotrak position sensors and two AMTI force platforms.

RESULTS

The peak muscle powers were very similar in the sagittal plane and reflected gait symmetry, except for greater and significant differences produced by the hip extensors. Differences in the frontal and transverse planes were mainly attributed to the actions taken by the muscles, leading the lower limbs to compensate and to dynamically balance and propel the body forward during two consecutive gait cycles. In terms of mechanical energy, 13% greater positive work was done in the left limb and was associated with asymmetrical behavior of the lower limbs to propel the body forward. The total negative work was similar for both limbs, and substantial work was done in the frontal plane by the hip, indicating the role of muscle activity in this plane to control the pelvis and trunk against gravitational forces.

CONCLUSIONS

In addition to the importance of a balance-control function in the gait of healthy, elderly subjects, muscle activity made an important contribution to propelling the body forward. Gait asymmetry in elderly subjects seems to be related to different degrees of energy generated by the lower limbs for the propulsion function, whereas both limbs contribute similarly to the balance-control function.

Use of cluster analysis for gait pattern classification of patients in the early and late recovery phases following stroke

The mixture of gait deviations seen in patients following a stroke is remarkably variable. An objective system for classification of gait patterns for this population could be used to guide treatment planning. Quantitated gait analysis was conducted for 47 individuals at admission to in-patient rehabilitation and again at 6 months post-stroke for 42 subjects. Non-hierarchical cluster analysis was used to classify the gait patterns of patients based on the temporal-spatial and kinematic parameters of walking. Four clusters of patients were identified at both assessment intervals. At the admission test walking velocity, peak knee extension in mid stance and peak dorsiflexion in swing were the three factors that best characterized the groups. At 6 months the explanatory variables were velocity, knee extension in terminal stance, and knee flexion in pre swing. Differences in muscle strength and muscle activation patterns during walking were identified between groups.

Continuous curve registration as an intertrial gait variability reduction technique

Timing in peak values shifts slightly between gait trials. When gait data are averaged, part of the standard deviation could be associated with this intertrial variability unless normalization is carried out beforehand. The objective of this study was to determine how continuous curve registration, an alignment technique, can reduce intersubject variability in gait data without altering the original curve characteristics. Gait data were obtained by means of a four-camera high-speed video system synchronized to a force plate. The data for 60 gait trials were collected from 20 young, healthy subjects. Curve registration was applied to hip angular displacement, net moment, and power curves generated in the sagittal plane. Following registration, the peak values increased by an average of 1.2% (0.11 +/- 0.26 degrees) for angular displacement, and by 11.2% (0.11 +/- 0.09 W/kg) for power, while there were no changes for moments. First and second derivatives of the unregistered and registered curves did not display significant differences, and the harmonics were barely affected. Continuous curve registration would thus be an appropriate technique for application prior to any statistical analysis using able-bodied gait patterns.

Contribution of accelerated body masses to able-bodied gait

OBJECTIVE

The objectives of this study were to demonstrate that data from a video-based system could be used to estimate the net effect of the external forces during gait, to determine the contribution of the trunk and upper and lower limbs using their accelerated body masses, and to test the hypothesis that the thigh mainly assumed lower limb propulsion during able-bodied locomotion.

METHODS

The gait of 16 able-bodied subjects was assessed using an eight-camera video-based system and two force plates. The right limb was the leading limb, and there were two trials per subject. Although data from all the body segments were used to answer the first two objectives, only right limb information was used to address the third objective.

RESULTS

Pearson's coefficients of correlation and root mean square errors were calculated to determine the difference between the curves obtained from the sum of the external forces and that of the accelerated masses. These were >0.85, and the mean root mean square error was <4 N. Analyses of variance were performed on the peak forces developed by the trunk and the upper and lower limbs along each axis. Tukey's posthoc tests (P < 0.05) revealed that the trunk was the principal contributor of external forces in the frontal and transverse planes, whereas the lower limbs were found to be more important in the plane of progression. Analyses of variance and Tukey's posthoc tests (P < 0.05) were performed on the peak forces developed by each segment of the right limb. In decreasing order, the thigh, shank, and foot displayed the highest mass-acceleration products in the right limb during gait.

CONCLUSIONS

A video-based system was able to determine the net effect of the external forces with the summation of the mass-acceleration products during able-bodied gait. The trunk and lower limbs were the dominant body segments responsible for the production of external forces during able-bodied gait, whereas the thighs contributed more to the ground reaction force than the foot and shank for forward progression in able-bodied gait.

[Postural strategies and falls in elderly and in parkinsonism]

OBJECTIVE

To use a posture analysis to show the evolution of postural pattern connected with falls.

MATERIAL AND METHOD

It is a prospective study on two groups of 16 persons of more than 60 years. A group concerns 16 small disability off drug parkinsonian patients, a group concerns 16 healthy witnesses. All the persons benefited from a posture recording by means of a force platform and were followed during 1 year.

RESULTS

Data analysis underlines three groups of persons corresponding to three postural patterns, independently of the presence of Parkinson disease. A group (n = 18) did not contain fallers, the second (n = 10 ) contained 20% of fallers, the third (n = 4) contained 100% of fallers. Differences between the groups were identified on 16 posturographic parameters.

DISCUSSION

A group has a good functional value and one does not record any fall. Its characteristics, which correspond to a category of persons who compensate well for the phenomena of ageing, are found in the literature. A group has an intermediate functional value and regrets 20% of fallers. Kinetic profile reveals a tendency to the stiffness of the posture. This group is going to operate rather ankle strategies. A group has an inferior functional value and regrets 100% of fallers. Kinetic profile seems disrupted and not to be able to adapt itself in a satisfactory way to the situation otherwise than by stereotypical reactions. This group is going to operate systematically much less stabilizing hip strategies.

CONCLUSION

A close determinism between physiological neuromotor ageing and Parkinson disease does exist. We showed with a prospective follow-up, the arisen of fall and showed the evolution of postural patterns related to fall. It appears as well that evolution mainly follows three stages leading from a small risk of fall gait pattern to a major risk of fall gait pattern.

Knee flexors/extensors in gait of elderly and young able-bodied men (II)

In this study the fundamental tasks of muscle activity at the knee during gait in elderly and young able-bodied subjects were identified using principal component analysis (PCA). Role discrepancies between the older and younger subjects for the actions executed by the knee flexors and extensors during the gait cycle were also investigated. The t-test for independent groups was applied to determine significant differences between spatio-temporal and peak muscle moment parameters (P<0.05). PCA as a multivariate classification and curve structure detection method was applied to the sagittal knee muscle moment curves of twenty elderly (72 +/-5.5 years) and twenty young (25 +/- 8.1 years) subjects. The first three principal components (PCs) which accounted for 80% (older) and 93% (younger) of the information were retained for further analysis. Providing stable locomotion was recognised as a major task of the knee in the older subjects, while for the younger subjects the knee contributed to both balance and propulsion. Supporting the body during single limb support should be considered the only common task at the knee level in elderly and young subjects' gait. The lack of muscle power for propulsion might be the reason for not identifying the knee extensor muscle roles in the first three major tasks during elderly gait. Functional asymmetry can be considered the result of a different ordering of the functional roles of the muscles acting at the knee level in elderly and young subjects.

Main functional roles of knee flexors/extensors in able-bodied gait using principal component analysis (I)

This study was undertaken to demonstrate how principal component analysis (PCA) can be used to detect the main functional structure of actions taken by knee flexors/extensors during able-bodied gait. PCA was applied as a classification and curve structure detection method for knee sagittal muscle moment developed during walking of 20 young, healthy male subjects. Over 90% of the information provided by the first three principal components (PCs) was chosen for further biomechanical interpretation. PCA was able to identify the three main functional contributions of knee sagittal muscle moment during able-bodied gait, namely control balance, foot clearance/limb preparation and shock absorption.

Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis

OBJECTIVE

To determine if compensatory actions take place at the pelvis and other joints of the affected lower limb in subjects who were in an early stage of hip osteoarthritis (OA).

DESIGN

Nonrandomized, case-control study.

SETTING

A gait laboratory.

PARTICIPANTS

Seventeen patients with OA of the hip (clinical group) matched with 17 healthy elderly subjects (nonclinical group).

INTERVENTIONS

Video data obtained while subjects walked a 10-meter walkway twice and stepped across a forceplate.

MAIN OUTCOME MEASURES

Four phasic and temporal gait parameters (walking speed, stance phase relative duration, stride length, cadence) 10 pelvic (pelvic tilt, obliquity, rotation at push-off maximum range of motion for all 3) and hip (3 hip angles at push-off, maximum hip flexion) kinematic parameters, 3 hip moments, and twenty-seven 3-dimensional peak muscle powers (labeled by joint, peak power, plane) developed in the lower limb joints during the gait cycle.

RESULTS

Subjects in the clinical group were characterized by a 12.4% slower walking speed. The pelvis was more upwardly tilted (2.5 times) at push-off in the clinical group than in the nonclinical group. Obliquity, measured in the frontal plane, revealed that the pelvis dropped more (2.4 times) on the unsupported limb of the clinical group at push-off. In the sagittal plane, subjects in the clinical group absorbed less energy in their second hip peak power for decelerating the thigh extension and generated less hip pull (third hip peak power) than the nonclinical group by 34% and 29%, respectively. In the sagittal plane, the clinical group had 57% lower second knee peak power to straighten the joint shortly after heel strike, and 43% less knee absorption (third peak power) at push-off. During the push-off phase, the clinical group developed more than twice their third peak knee power in the frontal plane and 5 times more their third peak knee power in the transversal plane than the peak knee power of the nonclinical group in an attempt to control knee adduction and to facilitate body-weight transfer by an internal rotation. At the end of the swing phase, the fourth peak power in the sagittal plane showed the absorption power required to decelerate the leg; it was reduced by 35% in the clinical group, representing a strategy to increase walking speed by lengthening the stride length.

CONCLUSIONS

Even at an early stage of hip OA, joint degeneration was compensated by an increase in pelvis motion and muscle power generation or absorption modifications in other lower limb joints.

Lower limb muscle power relationships in bilateral able-bodied gait

OBJECTIVE

The purpose of this study was to test the hypothesis that limb propulsion is mainly associated with the interaction of a number of muscle power bursts developed throughout the stance phase and that the control actions are mainly achieved by the contralateral limb through different power-burst interactions. We also hypothesized that the power activities of the propulsion limb would be related to those of the control limb.

DESIGN

Sixty gait trials of 20 subjects with dominant right hands and right legs were chosen for analysis. Each trial represents a performance of an able-bodied gait. Data were assessed using an eight-camera, high-speed, video-based system synchronized to two force plates. The muscle powers and their related mechanical energies were calculated at each joint and in each plane of the lower limbs by use of an inverse dynamic technique. The Pearson correlation method was used to determine the relationships within each limb by use of the data identified by principal component analysis, whereas a canonical correlation analysis was performed to illustrate the interaction between the limbs.

RESULTS

Gait propulsion was an activity initiated by the hip shortly after heel-strike and maintained throughout the stance phase. Control was the main task of the left limb as evidenced by the power absorption bursts at the hip and knee. The left limb power generations were generally secondary to control activities and were possibly involved in adjustments to correct the other limb's propulsion. Interlimb interaction further emphasized the functional relationship between forward progression and control tasks developed by each limb and highlighted the importance of the frontal and transverse plane actions during gait.

CONCLUSION

These results do not support the hypothesis that the ankle was a major contributor to forward progression.

Principal component analysis of the power developed in the flexion/extension muscles of the hip in able-bodied gait

This study was undertaken to demonstrate how principal component analysis (PCA) can be used: (a) to detect the main functional structure of actions taken by hip extensors and flexors during two consecutive gait cycles of able-bodied subjects, and (b) to determine whether or not symmetrical behaviour exists between right and left hip muscle power activity. Twenty young, healthy male subjects walked along a 13 m path at a freely-chosen speed. Applying curve structure detection methods such as PCA to walking patterns can provide insight into the functional tasks accomplished by the lower limbs of able-bodied and disabled subjects. PCA was applied as a classification and curve structure detection method to hip sagittal muscle power calculated for the right and left lower limbs. Over 70% of the information provided by the first four principal components (PCs) was chosen for further biomechanical interpretation. PC1 for both right and left sides mainly described the action taken by the hip extensors/flexors corresponding to the vertical component of ground force on the respective limbs during mid-stance. Propulsion and limb preparation were identified as the second and third tasks attributed to right hip muscle power, while between limb co-ordination was recognised as the second and third functional tasks of the left hip extensors/flexors. Balance was identified as the fourth main functional contribution of the hip extensors/flexors at the right limb while for the left limb, these muscles were mainly responsible for preparing the limb to enter into new gait cycle. PCA was able to identify the four main functional contributions of hip sagittal muscle power during able-bodied gait. PCA was also able to examine the existence of functional asymmetry in gait by highlighting different task priorities at the hip level for the right and left lower limbs.

Reduction of gait data variability using curve registration

Timing in peak gait values shifts slightly between gait trials. When averaged, the standard deviation (S.D.) in gait data may increase due to this inter-trial variability unless normalization is carried out beforehand. The objective of this study was to determine how curve registration, an alignment technique, can reduce inter-subject variability in gait data without perturbing the curve characteristics. Twenty young, healthy men participated in this study each providing a single gait trial. Gait was assessed by means of a four-camera high-speed video system synchronized to a force plate. A rigid body three-segment model was used in an inverse dynamic approach to calculate three-dimensional muscle powers at the hip, knee and ankle. Curve registration was applied to each of the 20 gait trials to align the peak powers. The mean registered peak powers increased by an average of 0.10 +/- 0.13 W/kg with the highest increases in the sagittal plane at push-off. After performing curve registration, the RMS values decreased by 13.6% and the greatest reduction occurred at the hip and knee, both in the sagittal plane. No important discontinuities were reported in the first and second derivatives of the unregistered and registered curves. Curve registration did not have much effect on the harmonic content. This would be an appropriate technique for application prior to any statistical analysis using able-bodied gait patterns.

Gait pattern classification of healthy elderly men based on biomechanical data

OBJECTIVES

To distinguish the gait patterns of young subjects from those of elderly men using three-dimensional (3D) gait data, to determine if elderly subjects displayed other than a typical gait pattern, and to identify which parameters best describe them.

DESIGN

Nonrandomized study in which video and force plate data were collected at the subject's own free walking speed and used in a 3D inverse dynamic model. Cluster analysis was chosen to identify the gait families, and analyses of variance were performed to determine which parameters were different.

SETTING

A gait laboratory.

PARTICIPANTS

The sample of convenience involved a single but mixed group consisting of 16 able-bodied elderly subjects (mean age, 62yrs) and 16 able-bodied young subjects aged between 20 and 35 years.

MAIN OUTCOME MEASURES

Phasic and temporal gait parameters, as well as the 3D muscle powers developed in the joints of the right lower limb during the gait cycle.

RESULTS

The walking patterns in elderly subjects were found to be different from those of the young adults. Three elderly gait families or groups forming a specific gait pattern were identified, and differences were found in the phasic and temporal parameters as well as in 6 peak muscle powers. Four of the peak powers occurred in the sagittal plane, and half of them were related to the hip.

CONCLUSIONS

Biomechanical parameters can be used to classify the gait patterns of young and elderly men using cluster analysis rather than age alone. The muscle powers in elderly subjects are perturbed throughout the gait cycle and not only at push-off. It appears that the plane in which the peak powers occurred was related to their occurrence in the gait cycle. Variability in the gait patterns of elderly subjects could reflect natural adaptations or compensations. These should not be indicative of a deficient gait or be misconstrued as some age-related pathology.