Reliability of three-dimensional kinematic gait data in adults with spinal cord injury

Reliability of Obstacle-Crossing Parameters during Overground Walking in Young Adults

We aimed to evaluate the intra-session relative and absolute reliability of obstacle-crossing parameters during overground walking in young adults, and to determine the number of trials required to ensure reliable assessment. We analysed data from 43 young male adults who were instructed to walk at a self-selected velocity on a pathway and to step over an obstacle (height = 15 cm; width = 80 cm, thickness = 2 cm) three times. Spatial-temporal gait parameters of the approaching and crossing phases (i.e., before and after the obstacle) and obstacle clearance parameters (i.e., vertical and horizontal distance between the foot and the obstacle during crossing) were computed using a three-dimensional motion analysis system. Intraclass correlation coefficients were used to compute the relative reliability, while standard error of measurement and minimal detectable change were used to assess the absolute reliability for all possible combinations between trials. Results showed that most spatial-temporal gait parameters and obstacle clearance parameters are reliable using the average of three trials. However, the mean of the second and third trials ensures the best relative and absolute reliabilities of most obstacle-crossing parameters. Further works are needed to generalize these results in more realistic conditions and in other populations.

Standard isometric contraction has higher reliability than maximum voluntary isometric contraction for normalizing electromyography during level walking among older adults with knee osteoarthritis

Introduction: Electromyography (EMG) normalization often relies on maximum voluntary isometric contraction (MVIC), which may not be suitable for knee osteoarthritis (KOA) patients due to difficulties in generating maximum joint torques caused by pain. This study aims to assess the reliability of standard isometric contraction (SIC) for EMG normalization in older adults with KOA, comparing it with MVIC. Methods: We recruited thirty-five older adults with KOA and collected root mean square EMG amplitudes from seven muscles in the affected limb during level walking, SIC, and MVIC tests. EMG data during level walking were normalized using both SIC and MVIC methods. This process was repeated after at least 1 week. We calculated intra-class correlation coefficients (ICCs) with 95% confidence intervals to evaluate between- and within-day reliabilities. Results: SIC tests showed higher between- (ICC: 0.75-0.86) and within-day (ICC: 0.84-0.95) ICCs across all seven muscles compared to MVIC tests. When normalized with SIC, all seven muscles exhibited higher between- (ICC: 0.67-0.85) and within-day (ICC: 0.88-0.99) ICCs compared to MVIC normalization. Conclusion: This study suggests that SIC may offer superior movement consistency and reliability compared to MVIC for EMG normalization during level walking in older adults with KOA.

Walking Ability Outcome Measures in Individuals with Spinal Cord Injury: A Systematic Review

Walking function recovery in spinal cord injury (SCI) is tackled through several therapeutic approaches in which precise evaluation is essential. A systematic review was performed to provide an updated qualitative review of walking ability outcome measures in SCI and to analyze their psychometric properties. PubMed, Cochrane, and PEDro databases were consulted until 1 April 2020. Seventeen articles written in English were included. Five of them studied the walking index for SCI, four studied the 10 meter walk test, and two studied the six-minute walk test, the timed Up and go test, and the Berg balance scale. The rest of the articles studied the following metrics: gait profile score, spinal cord injury functional ambulation profile, five times sit-to-stand test, spinal cord injury functional ambulation inventory, spinal cord independence measure (indoors and outdoors mobility items), locomotor stages in spinal cord injury, community balance and mobility scale, and activity-based balance level evaluation scale. The choice of a single or a set of metrics should be determined by the clinician. Based on the results obtained in this review, a combination of outcome measures is proposed to assess walking ability. Future work is required to integrate a more realistic environment for walking assessment.

Spatio-temporal gait parameters obtained from foot-worn inertial sensors are reliable in healthy adults in single- and dual-task conditions

Inertial measurement units (IMUs) are increasingly popular and may be usable in clinical routine to assess gait. However, assessing their intra-session reliability is crucial and has not been tested with foot-worn sensors in healthy participants. The aim of this study was to assess the intra-session reliability of foot-worn IMUs for measuring gait parameters in healthy adults. Twenty healthy participants were enrolled in the study and performed the 10-m walk test in single- and dual-task ('carrying a full cup of water') conditions, three trials per condition. IMUs were used to assess spatiotemporal gait parameters, gait symmetry parameters (symmetry index (SI) and symmetry ratio (SR)), and dual task effects parameters. The relative and the absolute reliability were calculated for each gait parameter. Results showed that spatiotemporal gait parameters measured with foot-worn inertial sensors were reliable; symmetry gait parameters relative reliability was low, and SR showed better absolute reliability than SI; dual task effects were poorly reliable, and taking the mean of the second and the third trials was the most reliable. Foot-worn IMUs are reliable to assess spatiotemporal and symmetry ratio gait parameters but symmetry index and DTE gait parameters reliabilities were low and need to be interpreted with cautious by clinicians and researchers.

Test-Retest Reliability of a Conventional Gait Model for Registering Joint Angles during Initial Contact and Toe-Off in Healthy Subjects

The aim of this study was to evaluate the test-retest reliability of a conventional gait model (CGM), the Plug-in Gait model, to calculate the angles of the hip, knee, and ankle during initial contact (IC) and toe-off (TO). Gait analysis was performed using the Vicon Motion System^® (Oxford Metrics, Oxford, UK). The study group consisted of 50 healthy subjects. To evaluate the test-retest reliability, the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the minimal detectable change (MDC), and the Bland-Altman analysis with 95% limits of agreement were calculated. The ICC for the joint angles of the hip, knee, and ankle was higher than 0.80. However, the ankle angle at IC had an ICC lower than 0.80. The SEM was <5° for all parameters. The MDC was large (>5°) for the hip angle at IC. The Bland-Altman analysis indicated that the magnitude of divergence was between ±5° and ±9° at IC and around ±7° at TO. In conclusion, the ICC for the plug-in gait model was good for the hip, knee, and ankle angles during IC and TO. The plots revealed a disagreement between measurements that should be considered in patients' clinical assessments.

Foot-Worn Inertial Sensors Are Reliable to Assess Spatiotemporal Gait Parameters in Axial Spondyloarthritis under Single and Dual Task Walking in Axial Spondyloarthritis

The aim of this study was (1) to evaluate the relative and absolute reliability of gait parameters during walking in single- and dual-task conditions in patients with axial spondyloarthritis (axSpA), (2) to evaluate the absolute and relative reliability of dual task effects (DTE) parameters, and (3) to determine the number of trials required to ensure reliable gait assessment, in patients with axSpA. Twenty patients with axSpa performed a 10-m walk test in single- and dual-task conditions, three times for each condition. Spatiotemporal, symmetry, and DTE gait parameters were calculated from foot-worn inertial sensors. The relative reliability (intraclass correlation coefficients-ICC) and absolute reliability (standard error of measurement-SEM and minimum detectable change-MDC) were calculated for these parameters in each condition. Spatiotemporal gait parameters showed good to excellent reliability in both conditions (0.59 < ICC < 0.90). The reliability of symmetry and DTE parameters was low. ICC, SEM, and MDC were better when using the mean of the second and the third trials. Spatiotemporal gait parameters obtained from foot-worn inertial sensors assessed in patients with axSpA in single- and dual-task conditions are reliable. However, symmetry and DTE parameters seem less reliable and need to be interpreted with caution. Finally, better reliability of gait parameters was found when using the mean of the 2nd and the 3rd trials.

Physical performance outcome measures used in exercise interventions for adults with childhood-onset disabilities: A scoping review

BACKGROUND

People with childhood-onset disabilities face unique physical and social challenges in adulthood. Exercise interventions may improve physical performance in children, but there is a lack of research on adults.

OBJECTIVE

To describe studies that investigate exercise interventions and to evaluate the quality of physical performance outcome measures for adults with childhood-onset disabilities.

METHODS

Eligible studies reported on exercise interventions for adults (ages 16+) with cerebral palsy, spina bifida, or acquired brain injuries. Only randomized controlled trials published in English from 2008 to 2019 were included. MEDLINE, CINAHL, PEDro, EMBASE, and Cochrane Central Register of Controlled Trials were searched. Two reviewers independently screened studies and abstracted data.

RESULTS

This scoping review included 4 trials reporting on cerebral palsy only. Three strength training programs found significant improvements in gait, and one mixed training program found significant improvements in strength and fitness. Only two outcome measures used are valid/reliable for adults (6 Minute Walk Test and Borg-20 Grades).

CONCLUSION

Certain interventions may improve physical performance, but there is a lack of research on appropriate exercise interventions and physical performance outcome measures for adults with childhood-onset disabilities. Different exercise interventions should be investigated using larger sample sizes and outcome measures should be standardized.

Test-Retest, Inter-Rater and Intra-Rater Reliability for Spatiotemporal Gait Parameters Using SANE (an eaSy gAit aNalysis systEm) as Measuring Instrument

Studies have demonstrated the validity of Kinect-based systems to measure spatiotemporal parameters of gait. However, few studies have addressed test-retest, inter-rater and intra-rater reliability for spatiotemporal gait parameters. This study aims to assess test-retest, inter-rater and intra-rater reliability of SANE (eaSy gAit aNalysis system) as a measuring instrument for spatiotemporal gait parameters. SANE comprises a depth sensor and a software that automatically estimates spatiotemporal gait parameters using distances between ankles without the need to manually indicate where each gait cycle begins and ends. Gait analysis was conducted by 2 evaluators for 12 healthy subjects during 4 sessions. The reliability was evaluated using Intraclass Correlation Coefficients (ICC). In addition, the Standard Error of the Measurement (SEM), and Smallest Detectable Change (SDC) was calculated. SANE showed from an acceptable to an excellent test-retest, inter-rater and intra-rater reliability; test-retest reliability ranged from 0.62 to 0.81, inter-rater reliability ranged from 0.70 to 0.95 and intra-rater ranged from 0.74 to 0.92. The subject behavior had a greater effect on the reliability of SANE than the evaluator performance. The reliability values of SANE were comparable with other similar studies. SANE, as a feasible and markerless system, has large potential for assessing spatiotemporal gait parameters.