Human treadmill walking needs attention

Selection of gait parameters during constrained walking

It is commonly thought that at prescribed speeds humans choose gait parameters that minimize the cost of transportation. However, it is unclear whether and how the relationship between step length and step frequency is affected by the additional physiological factors caused by constraints. We performed a series of experiments to understand the selection of gait parameters under different constraints from a probabilistic perspective. First, we show that the effect of constraining step length on step frequency (i.e., monotonically decrease, Experiment I) is different from the effect of constraining step frequency on step length (i.e., inverted-U, Experiment II). Using the results from Experiment I and II, we summarized the marginal distribution of step length and step frequency and built their joint distribution in a probabilistic model. The probabilistic model predicts the selection of gait parameters by achieving the maximum probability of joint distribution of step length and step frequency. In Experiment III, the probabilistic model could well predict gait parameters at prescribed speeds, and it is similar to minimizing the cost of transportation. Finally, we show that the distribution of step length and step frequency were completely different between constrained and non-constrained walking. We argue that constraints in walking are major factors determining how humans choose gait parameters due to their involvement of mediators, i.e., attention or active control. Using the probabilistic model to account for gait parameters has an advantage compared with fixed-parameter models in that it can still include the effect of hidden mechanical, neurophysiological, or psychological variables by grouping them into distribution curves.

Increased Attentional Focus on Walking by Older Adults Limits Maximum Speed and Is Related to Dynamic Stability

BACKGROUND AND PURPOSE

Older adults with lower balance confidence demonstrate a reduced willingness to experience instability as the task of walking becomes more challenging (i.e., walking with a faster speed). However, the specific reason why is not known. The purpose of this study was to investigate the extent to which capacity of increasing walking speeds relates to the attentional requirements (i.e., automaticity) of walking.

METHODS

Sixteen young (31 ± 5.85 years) and 15 older participants (69 ± 3.04 years) began walking on a treadmill at 0.4 m/s, and speed was increased by 0.2 m/s until the participant either chose to stop or reached a speed of 2.0 m/s. Sixty steps were collected at steady-state speed for each walking trial. Kinematic data were collected, and the margin of stability in the anterior direction (MOSAP) at heelstrike was quantified for each step. The timed up and go (TUG) and TUG dual (TUGdual) task were performed, from which an automaticity index (TUG/TUGdual × 100) was calculated. Older individuals were grouped based on whether they did or did not complete all walking speeds (i.e., completers [n = 9] or noncompleters [n = 6]). The fastest walking speed attempted (FSA), automaticity index, and MOSAP were compared, and correlations were assessed between the FSA/MOSAP and the automaticity index.

RESULTS

A significant difference was identified in an average MOSAP at heelstrike between older completer and noncompleter groups (p < 0.001). Further, older adults with lower automaticity index choose to stop walking at lower speeds (p = 0.001). The FSA was positively correlated with the automaticity index (ρ = 0.81, p < 0.001). Finally, the average MOSAP at FSA and the automaticity index were also negatively correlated (r = -0.85, p < 0.001).

CONCLUSION

Older adults with lower automaticity of walking choose to stop walking at speeds before they completed all walking speeds, which may relate with increased attentional demands required to maintain dynamic stability at higher walking speeds. Given that these were otherwise healthy adults, the combination of FSA and an automaticity of walking may help to identify individuals who should be considered for an assessment to identify walking problems.

Fuzzy controller for the treadmill speed adaptation system in mechatronic device for gait reeducation

Training with use of mechatronic devices is an innovative rehabilitation method for patients with various locomotor dysfunction. High efficiency of training is noted in systems that combine a treadmill or orthosis with a body weight support system. Speed control is a limitation of such rehabilitation systems. In commercially available devices, the treadmill speed is constant or set by the therapist. Even better training results should be obtained for devices in which the speed of the treadmill will be automatically adjusted to the patient walking pace. This study presents a mechatronic device for locomotor training that uses an algorithm to adjust the speed of the treadmill. This speed is controlled with use of a sensor that measures the rope inclination. The end of rope is fastened to the orthopaedic harness. Speed control is realized in such a way that ensures the smallest possible swing angle of the rope. A fuzzy controller was applied to adjust the treadmill speed. The drive system of the treadmill is equipped in a servodrive with PMSM motor and energy recovery module, which allows smooth speed control, limiting acceleration and minimizing electricity consumption. The presented solution was implemented in a real object and subjected to experimental tests.

Prescheduled Interleaving of Processing Reduces Interference in Motor-Cognitive Dual Tasks

Continuous motor tasks like walking have the potential to allow a dynamic allocation of processing resources when interrupted by intermittent cognitive tasks. The degree to which a successful interleaving of processing streams of both tasks is possible may depend on the temporal regularity of events. Fifteen subjects participated in an experiment where we systematically manipulated the regularity of stimulus onsets in a 2-back task relative to the step cycle. We tested three conditions where stimulus onset was always synchronous to a defined event in the stride (right heel strike, left heel strike, and midway between two heel strikes) and two conditions where the temporal location of the stimulus shifted from stride to stride. In order to test for potential effects of task difficulty, we also manipulated walking speed. We measured reaction times, accuracy of the reactions and several measures describing motor performance. There was no sign of task interference in these measures when stimuli always appeared at the same relative location within the step cycle. However, we observed prolonged reaction times when the stimulus came up earlier than expected. Surprisingly, in the other non-regular regime, where the stimulus appeared later than expected, reaction times were fastest. We interpret this result in the light of a prescheduled allocation of processing resources that is linked to the cyclic profile of processing requirements of the motor task.

Cognitive-Motor Dual Task Interference Effects on Declarative Memory: A Theory-Based Review

Bouts of exercise performed either prior to or immediately following study periods enhance encoding and learning. Empirical evidence supporting the benefits of interventions that simultaneously pair physical activity with material to be learned is not conclusive, however. A narrative, theory-based review of dual-task experiments evaluated studies in terms of arousal theories, attention theories, cognitive-energetic theories, and entrainment theories. The pattern of the results of these studies suggests that cognitive-motor interference can either impair or enhance memory of semantic information and the manner in which physical activity impacts working memory within executive processing appears to explain disparate outcomes. The integration and timing of physical movements in concert with the type of information to be encoded and remembered appears to be a critical requirement for learning. These observations have implications for the role of physical activity in education, rehabilitation, and gerontological settings.

Effects of a Dual-Task Paradigm and Gait Velocity on Dynamic Gait Stability during Stair Descent

Falls during stair negotiation have become one of the leading causes of accidental death. The effects of a concurrent cognitive or manual dual-task paradigm on dynamic gait stability remain uncertain. How much dynamic gait stability is influenced by gait velocity is also not clear. A total of 16 healthy young females descended a staircase under three different walking conditions: descend stairs only (single task), descend stairs while performing subtraction (cognitive dual-task), and descend stairs while carrying a glass of water (manual dual-task). An eight-camera Vicon motion analysis system and a Kistler force plate embedded into the third step of the staircase were used synchronously to collect kinematic and kinetic data. Gait velocity decreased and dynamic gait stability increased with both cognitive and manual dual-task conditions. The center of mass–center of pressure inclination angle increased with gait velocity but decreased with the manual dual-task condition compared to the single-task condition. Changes in gait velocity caused by the dual-task paradigm can partially explain the effects of dual-task dynamic gait stability. The influence of gait velocity should be considered in the assessment of dual-task effects.

Does squatting need attention?-A dual-task study on cognitive resources in resistance exercise

INTRODUCTION

Accumulating evidence shows that acute resistance exercises and long-term resistance training positively influence cognitive functions, but the underlying mechanisms have been rarely investigated. One explanatory approach assumes that the execution of resistance exercises requires higher cognitive processes which, in turn, lead to an 'indirect' training of higher cognitive functions. However, current knowledge on the engagement of higher cognitive functions during the execution of resistance exercises is relatively sparse. Hence, the purpose of this study was to examine to what extent cognitive resources are needed to perform a resistance exercise in the form of barbell back squatting.

METHODS

Twenty-four young adults performed a cognitive task (serial subtraction of 7's) during standing and during barbell back squatting on a Smith machine. The total number and the number of correct responses were analyzed and taken as indicators of the cognitive load imposed by the experimental condition (squatting) and the control condition (standing). Additionally, participants' perceived exertion, mean heart rate, and the number of squats they were able to perform were assessed.

RESULTS

While accuracy scores were found not to be significantly different between conditions, the numbers of total and of correct responses were significantly lower during squatting than during standing. Additionally, during squatting a higher number of total answers was given in the fifth set compared to the first set. We attribute this phenomenon to a learning effect. Furthermore, there was no statistically significant correlation between cognitive measures and perceived exertion.

CONCLUSION

Results suggest that perceived exertion cannot explain the higher dual-task costs observed during squatting. They rather reflect that more cognitive resources are needed to perform low-load barbell back squats than during standing. However, further research is necessary to confirm and generalize these findings.

Effects of Active Sitting on Reading and Typing Task Productivity

Increased sedentary behavior and reduced physical activity among children and adults has led to the advent of various active devices to combat these behaviors. Active sitting, consisting of modified chairs or stability balls, allows the body to stay dynamic while seated. While research has evaluated the health benefits of active sitting, minimal research has shown the effects of active sitting on productivity in adult populations. The purpose was to evaluate the effects of various chairs (active versus non-active) on typing and reading task productivity. Twenty adult participants performed typing and reading tasks for 10-minutes while sitting on each of the following: standard chair (SC), stability ball (SB), and active sitting chair (ST). Reading comprehension (RC), words per minute (WPM), accuracy, and errors were measured following each task. Additionally, perceived productivity was measured using a self-reported rating of difficulty scale (1-10). In terms of RC, there was no difference between the chairs (p = 0.16). However, perceived productivity was significantly greater on the SC as compared to SB (p < 0.01) and ST (p < 0.01). For the typing task, no differences were demonstrated for errors (p = 0.87) or accuracy (p = 0.91). However, WPM was significantly greater on SC (38.8 ± 10.5) compared to ST (35.9 ± 9.5) (p = 0.02). For perceived typing productivity, SC and SB demonstrated significantly greater values compared to ST (p < 0.01). Results suggest that various types of active sitting may have a minimal negative effect on workplace performance and perceived productivity.

Cognitive-motor interference in post-stroke individuals and healthy adults under different cognitive load and task prioritization conditions

[Purpose] We aimed to compare the effects of cognitive load and task prioritization on dual task strategies in patients with stroke and healthy adults in order to clarify the characteristics of cognitive-motor interference. [Participants and Methods] In total, 26 patients with stroke and 26 age-matched healthy adults (controls) performed the Timed Up and Go Test while performing a serial subtraction task from random numbers between 90 and 100. Dual task was measured under four conditions in which two difficulty levels of "3 subtraction" and "7 subtraction" were multiplied by two prioritizing tasks that involved "paying equal attention to both walking and subtraction tasks" (no priority) and "paying attention while mainly focusing on subtraction tasks" (cognitive priority). [Results] Increasing cognitive load and prioritizing cognitive tasks affected motor performance in terms of the amount of time and number of steps required to complete the Timed Up and Go Test in both the patients and controls. However, cognitive load and task prioritization did not affect cognitive performance. [Conclusion] When cognitive load increases and instructions are given to prioritize increases in cognitive load, patients with stroke use the "posture first" strategy to stabilize their gait as effectively as healthy adults do.

Towards the Neuromotor Control Processes of Steady-State and Speed-Matched Treadmill and Overground Walking

The neuromotor control of walking relies on a network of subcortical and cortical structures. While kinematic differences between treadmill and overground walking are extensively studied, the neuromotor control processes are still relatively unknown. Hence, this study aims to investigate cortical activation during steady-state treadmill and overground walking using functional near-infrared spectroscopy, inertial measurement units and a heart rate monitor. We observed a higher concentration of oxygenated hemoglobin in prefrontal cortices, premotor cortices and supplementary motor areas during treadmill walking. Therefore, our results suggest that treadmill walking requires higher demands on cortical neuromotor control.

The impact of age-related hearing loss and lateralized auditory attention on spatiotemporal parameters of gait during dual-tasking among community dwelling older adults

This investigation assessed the impact of hearing loss and lateralized auditory attention on spatiotemporal parameters of gait during overground dual-tasking by the use of the dichotic listening task. Seventy-eight right-handed, healthy older adults between 60 and 88 years were assigned to a Young-Old (<70 years) or an Old-Old (>71 years) group. Cognitive assessment and pure tone audiometry were conducted. Spatiotemporal parameters of gait quantified by mean (M), and coefficient of variations (CoV) were evaluated with the OptoGait system during 3 dichotic listening conditions: Non-Forced, Forced-Right and Forced-Left. Factorial analyses of variance and covariance were used to assess group differences and the moderating effects of hearing status, respectively. Results demonstrated that three of the gait parameters assessed were affected asymmetrically by the dual-task paradigm after controlling for hearing status. Asymmetries existed on step width, gait speed and variability of stride length. Finally, correlations between gait outcomes and dichotic listening results showed that M and CoVs in gait parameters during right-ear responses were longer compared with left-ear. Left-ear responses were related to increased variability on stride length, which indicates higher difficulty level. Hearing status varying from normal to mild levels of hearing loss modulates spatiotemporal gait outcomes measured during dichotic listening execution. Findings suggest that attending to left side stimuli relates to increased gait variability, while focusing on right-side assures a safe walk. Results demonstrated that attending to right-ear stimuli is an adaptive strategy for older adults that compensates for limited sensorimotor and cognitive resources during walking.

The effects of using an active workstation on executive function in Chinese college students

This study aimed to examine the effects of active workstation use on the executive function by measuring the three components of executive function (Inhibition, Updating, and Shifting) during sitting, standing, and walking at an active workstation with different speeds. Twenty-four college students completed a cognitive test battery while sitting, standing, walking on an active workstation with a self-selected speed (mean = 2.3 km/h) and a faster speed (mean = 3.5 km/h). The three components of executive function (Inhibition, Updating, and Shifting) were assessed by Stroop task, N-back task, More-odd shifting task, respectively. Performance of each task was determined by the response time and accuracy. Repeated measures ANOVAs were conducted with workstation condition and trial type as within-subjects factors. There were no significant main effects for workstation condition and no interaction between workstation condition × trial type in Stroop task and More-odd shifting task. There was a significant main effect for workstation condition (F (3, 69) = 4.029, p = 0.011) and interaction effect between workstation condition × trial type (F (6, 138) = 9.371, p < 0.001) in N-back task. Decomposition of the interaction showed that accuracy of 2-back task in self-paced walking was significantly lower than that in sitting condition (p = 0.017) and in standing condition (p < .001). But there was no difference in accuracy of 2-back task between self-paced walking condition and faster walking condition (p = 0.517). Our results suggest that using an active workstation may have a selective impact on three components of executive function, in which the Updating may be impaired to a certain extent while the Inhibition and Shifting remain unaffected.

Increasing cognitive load attenuates right arm swing in healthy human walking

Human arm swing looks and feels highly automated, yet it is increasingly apparent that higher centres, including the cortex, are involved in many aspects of locomotor control. The addition of a cognitive task increases arm swing asymmetry during walking, but the characteristics and mechanism of this asymmetry are unclear. We hypothesized that this effect is lateralized and a Stroop word-colour naming task-primarily involving left hemisphere structures-would reduce right arm swing only. We recorded gait in 83 healthy subjects aged 18-80 walking normally on a treadmill and while performing a congruent and incongruent Stroop task. The primary measure of arm swing asymmetry-an index based on both three-dimensional wrist trajectories in which positive values indicate proportionally smaller movements on the right-increased significantly under dual-task conditions in those aged 40-59 and further still in the over-60s, driven by reduced right arm flexion. Right arm swing attenuation appears to be the norm in humans performing a locomotor-cognitive dual-task, confirming a prominent role of the brain in locomotor behaviour. Women under 60 are surprisingly resistant to this effect, revealing unexpected gender differences atop the hierarchical chain of locomotor control.

Cellular Telephone Dialing Influences Kinematic and Spatiotemporal Gait Parameters in Healthy Adults

Gait speed is typically reduced when individuals simultaneously perform other tasks. However, the impact of dual tasking on kinetic and kinematic gait parameters is unclear because these vary with gait speed. The objective of this study was to identify whether dual tasking impacts gait in healthy adults when speed is constant. Twenty-two healthy adults dialed a cell phone during treadmill walking at a self-selected speed while kinetic, kinematic, and spatial parameters were recorded. Results indicated that dual tasking did not impact phone dialing speed, but increased stride width, peak knee flexion during stance, and peak plantarflexion, and decreased knee and ankle range of motion. Dual tasking appears to influence kinematic gait variables in a manner consistent with promotion of stability.

Development of a smartphone application to measure reaction times during walking

Dual-task methodology is useful to assess walking ability. We developed a smartphone application to measure reaction times (RTs) during walking. We can assess the attentional demands for a task from the RTs. In experiment 1, the accuracy and precision of the RT application were evaluated in two subjects. We investigated the agreement between the RTs calculated based on the external inertial sensor and the RT application; the application was installed in two smartphone models with different levels of performance. Additionally, in experiment 2, we investigated the RTs under 4 conditions: sitting, overground walking, treadmill walking, and auditory cued overground walking (n=19). The constant systematic error and low standard deviation of the difference between the two methods was demonstrated; this depended on the sampling interval of each sensor. The RTs in overground walking were increased compared with sitting and decreased compared with treadmill walking and auditory cued overground walking. Overall, the RTs were more decreased in the smartphone model with the shorter sampling interval. The RT application would be valid within a smartphone with a similar level of performance, because bias and precision are strongly dependent on the sampling interval. In field tests under different walking conditions, the RT application obtained results similar to those seen in previous studies and could identify even slight differences if there were many trials. The developed RT application will be a simple tool that is able to assess attentional demands during dual-task walking.

The effect of physical exhaustion on gait stability in young and older individuals

Fatigue directly affects key features of the sensorimotor system which disorganizes voluntary control of movement accuracy. Local dynamic stability of walking is considered a sensitive measure for neuromuscular performance. To gain greater insight in the role of fatigue in motor behaviour in older and young adults during walking, the current experiment analyses gait patterns of healthy young but maximal fatigued individuals and gait patterns in submaximal fatigued older adults. Ten young and 18 older subjects performed a bicycle incremental exercise test on a cycle ergometer. In young subjects, the incremental test was performed until total physical exhaustion. In older subjects, the test was performed until submaximal fatigue. Prior to and after the test, the participants walked for 2.5min on a treadmill. Based on linear acceleration data of the trunk, local dynamic stability was assessed. Student's t-test was used to check if differences are statistically significant. In young individuals, we found a significant decrease in the finite-time maximal Lyapunov exponents between unfatigued walking and maximal fatigued walking. In older participants, significant increases in the finite-time maximal Lyapunov between unfatigued walking and submaximal fatigued walking were observed. The results indicate that (1) young and sporty subjects become more stable after having passed a maximum cardiopulmonary exercise test on a cycle ergometer while (2) older individuals walk less locally stable in a submaximal fatigued condition. Older cohorts might show a higher fall risk when they are physically fatigued.

Treadmill Training Improves Forward and Backward Gait in Early Parkinson Disease

OBJECTIVE

The aim of this study was to examine effects of treadmill training (TT) and lasting duration of training effects on forward walking (FW) and backward walking (BW) gait in Parkinson disease (PD).

DESIGN

Twenty-six early PD patients undertook a 12-wk intensive TT program using FW. A repeated-measures design compared GAITRite-measured FW and BW gait before TT, within 1 wk, and at 4 and 12 wks after TT.

RESULTS

Twenty-three PD patients, after completing TT, walked forward and backward with increased velocity, enlarged stride length, prolonged swing phase, and decreased double support phase; improvements occurred within 1 wk and remained at 4 and 12 wks after training (P < 0.01 or < 0.001). In addition, trends toward reduced posttraining swing time variability and stride length variability occurred in both directions and sustained for 12 wks. Posttraining FW and BW gait improvements were comparable. BW deficits, regardless of training, constantly exceeded FW deficits. Cadence did not differ before and after training in FW (P = 0.195) and BW (P = 0.229) and between FW and BW irrespective of TT (P = 0.124).

CONCLUSIONS

A 12-wk TT program improves the 12-wk duration of FW and BW gait and can be considered a part of a rehabilitation strategy to overcome gait disturbances in early PD.

Reliability and Minimum Detectable Change of Temporal-Spatial, Kinematic, and Dynamic Stability Measures during Perturbed Gait

Temporal-spatial, kinematic variability, and dynamic stability measures collected during perturbation-based assessment paradigms are often used to identify dysfunction associated with gait instability. However, it remains unclear which measures are most reliable for detecting and tracking responses to perturbations. This study systematically determined the between-session reliability and minimum detectable change values of temporal-spatial, kinematic variability, and dynamic stability measures during three types of perturbed gait. Twenty young healthy adults completed two identical testing sessions two weeks apart, comprised of an unperturbed and three perturbed (cognitive, physical, and visual) walking conditions in a virtual reality environment. Within each session, perturbation responses were compared to unperturbed walking using paired t-tests. Between-session reliability and minimum detectable change values were also calculated for each measure and condition. All temporal-spatial, kinematic variability and dynamic stability measures demonstrated fair to excellent between-session reliability. Minimal detectable change values, normalized to mean values ranged from 1–50%. Step width mean and variability measures demonstrated the greatest response to perturbations with excellent between-session reliability and low minimum detectable change values. Orbital stability measures demonstrated specificity to perturbation direction and sensitivity with excellent between-session reliability and low minimum detectable change values. We observed substantially greater between-session reliability and lower minimum detectable change values for local stability measures than previously described which may be the result of averaging across trials within a session and using velocity versus acceleration data for reconstruction of state spaces. Across all perturbation types, temporal-spatial, orbital and local measures were the most reliable measures with the lowest minimum detectable change values, supporting their use for tracking changes over multiple testing sessions. The between-session reliability and minimum detectable change values reported here provide an objective means for interpreting changes in temporal-spatial, kinematic variability, and dynamic stability measures during perturbed walking which may assist in identifying instability.

Effects of walking on bilateral differences in spatial attention control: a cross-over design

Background

Walking requires a high attentional cost for balance control and interferes with the control of attention. However, it is unclear whether the performance of visual spatial attention control, which is one of the functions of attention control, is also decreased during walking. In addition, although previous studies have shown right-hemispheric dominance and lower ability of left side visual spatial attention control during sitting, it remains unknown whether walking accentuates bilateral differences in visual spatial attention control. We tested the hypothesis that walking interferes with visual spatial attention control on both sides and accentuates its bilateral differences.

Methods

Twenty healthy right-handed subjects (24.3 ± 2.0 years) participated in this study. Subjects performed a random stimulus–response compatibility (SRC) task during both sitting and walking situations. To evaluate the effects of walking, reaction time was measured on both sides for the two situations. In comparison to the both situations (sitting and walking), the amount of change of the SRC effect on both sides was used. In the comparing the bilateral difference (left and right), the difference of the SRC effect was evaluated in each situation. The paired t-test was applied to both comparisons for statistical analysis.

Results

The SRC effect on both sides during walking was significantly larger than during sitting (P < 0.05). In addition, walking significantly accentuated the bilateral differences in visual spatial attention control (P < 0.05).

Conclusions

These results suggest that walking affects the performance of visual spatial attention control on both sides and accentuates its bilateral differences. These results have implications for development of practice methods of gait disorder with higher brain dysfunction.

Using dual task walking as an aid to assess executive dysfunction ecologically in neurological populations: A narrative review

Within rehabilitation, clinical assessment plays a crucial role in diagnosis, prognostication and making decisions about return to function. The ecological validity of the assessment of executive dysfunction has become a particular focus in neuropsychology and is gaining interest in mobility research and neurological rehabilitation of acquired brain injury or degenerative neurological diseases. In this narrative review, we look at how the task of walking and the inseparable cognitive demands and interference of the surrounding environment are exploited in dual task walking (DTW) paradigms to expose executive dysfunction. While quite a number of studies and reviews have recently focused on the utility of DTW for gait assessment, particularly to assess fall risk, very little consideration has been given to the level of ecological validity required. This paper directly addresses this issue with discussion of evidence and lacunas related to task, personal and technological factors that should be addressed in order to exploit fully DTW paradigms as an ecological assessment tool.

Slow walking on a treadmill desk does not negatively affect executive abilities: an examination of cognitive control, conflict adaptation, response inhibition, and post-error slowing

An increasing trend in the workplace is for employees to walk on treadmills while working to attain known health benefits; however, the effect of walking on a treadmill during cognitive control and executive function tasks is not well known. We compared the cognitive control processes of conflict adaptation (i.e., congruency sequence effects—improved performance following high-conflict relative to low-conflict trials), post-error slowing (i.e., Rabbitt effect), and response inhibition during treadmill walking (1.5 mph) relative to sitting. Understanding the influence of treadmill desks on these cognitive processes may have implications for worker health and productivity. Sixty-nine individuals were randomized to either a sitting (n = 35) or treadmill-walking condition (n = 34). Groups did not differ in age or body mass index. All participants completed a computerized Eriksen flanker task and a response-inhibition go/no-go task in random order while either walking on a treadmill or seated. Response times (RTs) and accuracy were analyzed separately for each task using mixed model analysis of variance. Separate ANOVAs for RTs and accuracy showed the expected conflict adaptation effects, post-error slowing, and response inhibition effects when collapsed across sitting and treadmill groups (all Fs > 78.77, Ps < 0.001). There were no main effects or interactions as a function of group for any analyses (Fs < 0.79, Ps > 0.38), suggesting no decrements or enhancements in conflict-related control and adjustment processes or response inhibition for those walking on a treadmill versus sitting. We conclude that cognitive control performance remains relatively unaffected during slow treadmill walking relative to sitting.

Psychophysiological response to cognitive workload during symmetrical, asymmetrical and dual-task walking

Walking with a lower limb prosthesis comes at a high cognitive workload for amputees, possibly affecting their mobility, safety and independency. A biocooperative prosthesis which is able to reduce the cognitive workload of walking could offer a solution. Therefore, we wanted to investigate whether different levels of cognitive workload can be assessed during symmetrical, asymmetrical and dual-task walking and to identify which parameters are the most sensitive. Twenty-four healthy subjects participated in this study. Cognitive workload was assessed through psychophysiological responses, physical and cognitive performance and subjective ratings. The results showed that breathing frequency and heart rate significantly increased, and heart rate variability significantly decreased with increasing cognitive workload during walking (p<.05). Performance measures (e.g., cadence) only changed under high cognitive workload. As a result, psychophysiological measures are the most sensitive to identify changes in cognitive workload during walking. These parameters reflect the cognitive effort necessary to maintain performance during complex walking and can easily be assessed regardless of the task. This makes them excellent candidates to feed to the control loop of a biocooperative prosthesis in order to detect the cognitive workload. This information can then be used to adapt the robotic assistance to the patient's cognitive abilities.

Gait attentional load at different walking speeds

Gait is an attention-demanding task even in healthy young adults. However, scant evidence exists about the attentional load required at various walking speeds. The aim of this study was to investigate motor-cognitive interference while walking at spontaneous, slow and very slow speed on a treadmill while carrying out a backward counting task, in a group (n = 22) of healthy young participants. Cognitive performance was also assessed while sitting. Higher DT cost on the cognitive task was found at spontaneous and very slow walking speed, while at slow walking speed the cognitive task was prioritized with higher DT cost on the motor task. The attentional allocation during DT depends on walking speed with gait prioritization at spontaneous and very slow speed that likely represent more challenging motor conditions.

Effect of backward walking on attention: possible application on ADHD

The human requires attentive effort as assessed in dual-task experiments. Consistently, an attentive task can modify the walking pattern and a attention deficit and hyperactivity disorder (ADHD) is accompanied by gait modifications. Here we investigated the relationships between backward walking and attentive performances in ADHD children (n=13) and healthy age-, height and weight matched controls (n=17). We evaluated the attentive/impulsive profile by means of a Go/No-Go task and the backward and forward gait parameters by step length, cadence and Froude number. Moreover, to test the causal relationship between attention and gait parameters, we trained children to walk backward. The training program consisted of 10 min backward walking session, thrice a week for two months. Results showed a significant negative correlation between Froude number during backward walking and reaction time in the Go/No-Go test. Besides, after training with backward walking control children increased their cadence by 9.3% and their Froude number by 17% during backward walking. Conversely, ADHD children did not modify their walking parameters after training, and showed a significant reduction in their number of errors in the Go/No-Go task (-49%) compared to the score before the training. These data suggest that specific physical training with attention-demanding tasks may improve attentive performance.

The effect of various dual task training methods with gait on the balance and gait of patients with chronic stroke

[Purpose] This study examined the effects of various dual task gait training methods (motor dual task gait training, cognitive dual task gait training, and motor and cognitive dual task gait training) on the balance and gait abilities of chronic stroke patients. [Subjects and Methods] Thirty-three outpatients performed dual task gait training for 30 minutes per day, three times a week, for eight weeks from June to August, 2012. Balance ability was measured pre-and posttest using the stability test index, the weight distribution index, the functional reach test, the timed up and go test, and the four square step test. Gait ability was measured by the 10 m walk test and a 6 min walk test before and after the training. The paired t-test was used to compare measurements before and after training within each group, and ANOVA was used to compare measurements before and after training among the groups. [Results] Comparisons within each group indicated significant differences in all variables between before and after the training in all three groups. Comparison between the groups showed that the greatest improvements were seen in all tests, except for the timed up and go test, following motor and cognitive dual task gait training. [Conclusion] In a real walking environment, the motor and cognitive dual task gait training was more effective at improving the balance and gait abilities of chronic stroke patients than either the motor dual task gait training or the cognitive dual task gait training alone.

Interaction of age, cognitive function, and gait performance in 50-80-year-olds

The variability of walking gait timing increases with age and is strongly related to fall risk. The purpose of the study was to examine the interaction of age, cognitive function, and gait performance during dual-task walking. Forty-two, healthy men and women, 50-80 years old, completed the Mini-Mental State Exam (MMSE) and Trail Making Test (TMT) to assess cognitive performance and were separated into groups by decade of life. They then performed dual-task walking, at a self-selected pace, on an instrumented treadmill during three cognitive loading conditions: (1) no cognitive load, (2) subtraction from 100 by 1s, and (3) subtraction from 100 by 3s. The treadmill recorded spatiotemporal gait parameters that were used to calculate the mean and coefficient of variation for each variable over ten strides. Time to complete the TMT was positively correlated with age, stride time, double-limb support time, and mediolateral instability and was inversely correlated with single-limb support time. Subjects in their 70s increased their stride time and double-limb support time during the most challenging dual-task condition (subtraction by 3s), whereas subjects in their 50s and 60s did not. Across conditions, the variability of stride length, stride time, and single-limb support time was greatest in the 70s. Mediolateral instability increased only for subjects in their 70s in the subtraction by 3s condition. Reduced cognitive function with age makes it difficult for older adults to maintain a normal, rhythmical gait pattern while performing a cognitive task, which may place them at greater risk for falling.

Different motor tasks impact differently on cognitive performance of older persons during dual task tests

BACKGROUND

Dual task paradigm states that the introduction of a second task during a cognitive or motor performance results in a decreased performance in either task. Treadmill walk, often used in clinical applications of dual task testing, has never been compared to overground walk, to ascertain its susceptibility to interference from a second task. We compared the effects of overground and treadmill gait on dual task performance.

METHODS

Gait kinematic parameters and cognitive performance were obtained in 29 healthy older adults (mean age 75 years, 14 females) when they were walking freely on a sensorized carpet or during treadmill walking with an optoelectronic system, in single task or dual task conditions, using alternate repetition of letters as a cognitive verbal task.

FINDINGS

During overground walking, speed, cadence, step length stride length, and double support time (all with P value<0.001) and cognitive performance (number of correct words, P<0.001) decreased substantially from single to dual task testing. When subjects walked at a fixed speed on the treadmill, cadence decreased significantly (P=0.005), whereas cognitive performance remained unaffected.

INTERPRETATION

Both motor and cognitive performances decline during dual task testing with overground walking. Conversely, cognitive performance remains unaffected in dual task testing on the treadmill. In the light of current dual task paradigm, these findings may have relevant implication for our understanding of motor control, as they suggest that treadmill walk does not involve brain areas susceptible to interference from the introduction of a cognitive task.

Effect of a vocal choice reaction time task on the kinematics of the first recovery step after a sudden underfoot perturbation during gait

Thirty-two healthy young adults (15 women) were tested for their ability to maintain their comfortable step pattern following an unpredictable underfoot perturbation in the presence and absence of a concurrent vocal choice reaction time task. Custom instrumented shoes were used to randomly deliver an unexpected medial or lateral forefoot perturbation that inverted the mid-foot an average of 10° or everted the midfoot an average of 9° during one stance phase of a gait trial. Medial and lateral perturbations were randomized between left and right feet in 12 of 30 gait trials. The results of the repeated measures analyses of variance show that, compared to the step parameters of unperturbed gait, the administration of the unexpected underfoot perturbation did not significantly lead to alterations in the step length or width of the first recovery step. In addition, the simultaneous administration of a vocal choice reaction time task with the underfoot perturbation did not significantly affect the kinematics of the first recovery step. We conclude that in young healthy adults an unexpected 9-10° underfoot perturbation, with or without a vocal reaction time task, will not affect their recovery step kinematics when walking at a comfortable gait speed.

A naïve Gaussian Bayes classifier for detection of mental activity in gait signature

A probabilistic modelling is presented to detect mental activity from gait signature recorded from healthy subjects. The proposed scheme is based on principal component analysis with reduced feature dimension followed by a naïve Gaussian Bayes classifier. The leave-one-out cross-validation shows the detection accuracy of 94% with specificity and sensitivity of 96% and 98.3%, respectively. The research has a potential application in the prevention of elderly risk falls, lie detection and rehabilitation among Parkinson's patients.

Attentional demands associated with obstacle crossing while carrying a load

The extent to which different locomotor tasks require cognitive control is not well characterized. In this article, the authors consider the potential increase in attentional demands associated with carrying an anterior load while clearing an obstacle. Nine healthy male volunteers participated in 80 walking trials, 20 in each of 4 conditions: 1 no load condition (NL) and 3 carrying conditions (2KG, 5KG, and 10KG). Of the 20 trials in each condition, 12 included a probe reaction time (PRT) test during lead limb obstacle crossing, which was used to measure cognitive load. A load-dependent increase in PRT was observed, with PRT in the 2KG condition being significantly greater than in the NL condition, and PRT in the 5KG and 10KG conditions being significantly greater than in the 2KG condition. These results suggested that cognitive load was increased when: (a) the obstacle was occluded from vision by the load, and (b) the magnitude of load was increased.

Walking patterns in Parkinson's disease with and without freezing of gait

The pathophysiology underlying freezing of gait (FOG) in Parkinson's disease remains incompletely understood. Patients with FOG ("freezers") have a higher temporal variability and asymmetry of strides compared to patients without FOG ("non-freezers"). We aimed to extend this view, by assessing spatial variability and asymmetry of steps and interlimb coordination between the upper and lower limbs during gait. Twelve freezers, 15 non-freezers, and 15 age-matched controls were instructed to walk overground and on a treadmill. Kinematic data were recorded with a motion analysis system. Both freezers and non-freezers showed an increased spatial variability of leg movements compared to controls. In addition, both patient groups had a deficit in interlimb coordination, not only between ipsilateral arms and legs, but also between diagonally positioned limbs. The only difference between freezers and non-freezers was a decreased step length during treadmill walking. We conclude that parkinsonian gait-regardless of FOG-is irregular, not only in the legs, but also with respect to interlimb coordination between the arms and legs. FOG is reflected by abnormal treadmill walking, presumably because this provides a greater challenge to the defective supraspinal control than overground walking, hampering the ability of freezers to increase their stride length when necessary.

The effectiveness of walking as an intervention for low back pain: a systematic review

As current low back pain (LBP) guidelines do not specifically advocate walking as an intervention, this review has explored for the effectiveness of walking in managing acute and chronic LBP. CINAHL, Medline, AMED, EMBASE, PubMed, Cochrane and Scopus databases, as well as a hand search of reference lists of retrieved articles, were searched. The search was restricted to studies in the English language. Studies were included when walking was identified as an intervention. Four studies met inclusion criteria, and were assessed with a quality checklist. Three lower ranked studies reported a reduction in LBP from a walking intervention, while the highest ranked study observed no effect. Heterogeneity of study design made it difficult to draw comparisons between studies. There is only low-moderate evidence for walking as an effective intervention strategy for LBP. Further investigation is required to investigate the strength of effect for walking as a primary intervention in the management of acute and chronic LBP.

Attentional requirements of walking according to the gait phase and onset of auditory stimuli

A dual-task paradigm was used to examine the influence of an attention demanding cognitive task on each phase of gait. Twenty-three participants (aged 18-27) walked on a treadmill at a 20% increase of their self-selected speed, either alone or while performing a cognitive task. Muscle activity was measured with electromyography (iEMG) for eight muscles of the dominant leg. The cognitive task consisted of subtracting one (EASY) or seven (HARD) from orally presented numbers. Reaction time (RT) and accuracy were recorded. iEMG events were selected according to stimulus onset (0-150 ms, 150-300 ms and 300-450 ms) prior to phases of gait (double-leg stance, single-leg stance and swing). There was a decrease in iEMG amplitude of fibularis longus (p=.013) and a trend in the same direction for vastus lateralis (p=.065) while walking and performing the cognitive task. When stimulus onset was considered, iEMG of medial gastrocnemius (p=.021) and lateral gastrocnemius (p=.004) were reduced during single-leg stance, when stimuli occurred between 300 and 450 ms prior to this phase. Cognitive performance was affected by task difficulty (RT, accuracy) and by dual-task load (RT). Dual-task costs were observed in both the motor and the cognitive tasks, suggesting that walking requires attention. There was a specific moment (300 ms after stimulus onset) during single-leg stance when dual-task costs were most pronounced, corroborating supraspinal involvement in the control of normal walking. Time-based approaches should be considered when analyzing attentional demands of a dynamic task such as gait.

The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy

AIMS

To compare gait parameters of older people with diabetes and no peripheral neuropathy (DM) and people with diabetes and diabetic peripheral neuropathy (DPN) and to investigate the effect of a secondary motor or cognitive task on their gait.

METHODS

Thirty subjects were recruited: 15 with DPN (mean age 69 +/- 3.0 years) and 15 with diabetes and no neuropathy (70 +/- 2.9 years). The temporal and spatial parameters of gait were determined using the GAITRite walkway. Subjects undertook four walks: under normal walking conditions (single task); four times while simultaneously undertaking an additional motor task, carrying a tray with cups of water (dual task); and four times whilst undertaking a cognitive dual task, counting backwards in sevens. This arithmetic task was also completed sitting.

RESULTS

For all gait variables, there was a statistically significant difference between the groups. Subjects with DPN walked more slowly and with smaller steps compared with those with DM. In general, the secondary task had a significant and adverse effect on the gait parameters and this effect was greater for those with DPN in both absolute and relative terms. Both groups had poorer arithmetic ability when walking compared with sitting.

DISCUSSION

Patients with DPN have different gait parameters to diabetic patients without neuropathy. Problems with divided attention when walking were more evident in the DPN group and may increase their risk of falls.

The detection and measurement of locomotor deficits in a transgenic mouse model of Huntington's disease are task- and protocol-dependent: influence of non-motor factors on locomotor function

Locomotor performance of transgenic R6/2 mice carrying the Huntington's disease (HD) mutation was assessed using four different tasks, fixed speed rotarod, accelerating rotarod, Digigait and footprint test. The tasks were compared directly in age- and CAG repeat-matched R6/2 mice. Accelerating rotarod was more sensitive than fixed speed rotarod for detecting early motor deficits in R6/2 mice. The sensitivity of accelerating rotarod increased with the acceleration rate and/or the start speed from which the rod accelerated. Differences between tasks were not due to inability of R6/2 mice to maintain balance at high speeds or increased fatigue on accelerating rotarod, but to difficulties in coordinating gait changes required by the constant change in speed on accelerating rotarod. The footprint test was sensitive to gait disturbances. However, surprisingly, R6/2 mice did not show major gait abnormalities on an automated treadmill task (Digigait), even though they showed overt gait deficits in the home cage. The fact that the sensitivity for detecting motor deficits depended strongly on the individual task, and on the protocol used, suggests that non-motor factors were differentially engaged in the different paradigms. We thus recommend that more than one task should be used for detecting and tracking different aspects of motor decay in animal models of HD. Since deficits in non-motor factors such as executive function and motivation may differentially influence motor outcome in each task, our results call for a more thorough investigation of the importance of higher level control of locomotion in animal models of HD.

Motor adaptation scaled by the difficulty of a secondary cognitive task

Background

Motor learning requires evaluating performance in previous movements and modifying future movements. The executive system, generally involved in planning and decision-making, could monitor and modify behavior in response to changes in task difficulty or performance. Here we aim to identify the quantitative cognitive contribution to responsive and adaptive control to identify possible overlap between cognitive and motor processes.

Methodology/Principal Findings

We developed a dual-task experiment that varied the trial-by-trial difficulty of a secondary cognitive task while participants performed a motor adaptation task. Subjects performed a difficulty-graded semantic categorization task while making reaching movements that were occasionally subjected to force perturbations. We find that motor adaptation was specifically impaired on the most difficult to categorize trials.

Conclusions/Significance

We suggest that the degree of decision-level difficulty of a particular categorization differentially burdens the executive system and subsequently results in a proportional degradation of adaptation. Our results suggest a specific quantitative contribution of executive control in motor adaptation.

The role of executive function and attention in gait

Until recently, gait was generally viewed as a largely automated motor task, requiring minimal higher-level cognitive input. Increasing evidence, however, links alterations in executive function and attention to gait disturbances. This review discusses the role of executive function and attention in healthy walking and gait disorders while summarizing the relevant, recent literature. We describe the variety of gait disorders that may be associated with different aspects of executive function, and discuss the changes occurring in executive function as a result of aging and disease as well the potential impact of these changes on gait. The attentional demands of gait are often tested using dual tasking methodologies. Relevant studies in healthy adults and patients are presented, as are the possible mechanisms responsible for the deterioration of gait during dual tasking. Lastly, we suggest how assessments of executive function and attention could be applied in the clinical setting as part of the process of identifying and understanding gait disorders and fall risk.

Effects of attention on the control of locomotion in individuals with chronic low back pain

Background

People who suffer from low back pain (LBP) exhibit an abnormal gait pattern, characterized by shorter stride length, greater step width, and an impaired thorax-pelvis coordination which may undermine functional walking. As a result, gait in LBP may require stronger cognitive regulation compared to pain free subjects thereby affecting the degree of automaticity of gait control. Conversely, because chronic pain has a strong attentional component, diverting attention away from the pain might facilitate a more efficient walking pattern.

Methods

Twelve individuals with LBP and fourteen controls participated. Subjects walked on a treadmill at comfortable speed, under varying conditions of attentional load: (a) no secondary task, (b) naming the colors of squares on a screen, (c) naming the colors of color words ("color Stroop task"), and (d) naming the colors of words depicting motor activities. Markers were attached to the thorax, pelvis and feet. Motion was recorded using a three-camera SIMI system with a sample frequency of 100 Hz. To examine the effects of health status and attention on gait, mean and variability of stride parameters were calculated. The coordination between thoracic and pelvic rotations was quantified through the mean and variability of the relative phase between those oscillations.

Results

LBP sufferers had a lower walking speed, and consequently a smaller stride length and lower mean thorax-pelvis relative phase. Stride length variability was significantly lower in the LBP group but no significant effect of attention was observed. In both groups gait adaptations were found under performance of an attention demanding task, but significantly more so in individuals with LBP as indicated by an interaction effect on relative phase variability.

Conclusion

Gait in LBP sufferers was characterized by less variable upper body movements. The diminished flexibility in trunk coordination was aggravated under the influence of an attention demanding task. This provides further evidence that individuals with LBP tighten their gait control, and this suggests a stronger cognitive regulation of gait coordination in LBP. These changes in gait coordination reduce the capability to deal with unexpected perturbations, and are therefore maladaptive.

Biomechanics of overground vs. treadmill walking in healthy individuals

The goal of this study was to compare treadmill walking with overground walking in healthy subjects with no known gait disorders. Nineteen subjects were tested, where each subject walked on a split-belt instrumented treadmill as well as over a smooth, flat surface. Comparisons between walking conditions were made for temporal gait parameters such as step length and cadence, leg kinematics, joint moments and powers, and muscle activity. Overall, very few differences were found in temporal gait parameters or leg kinematics between treadmill and overground walking. Conversely, sagittal plane joint moments were found to be quite different, where during treadmill walking trials, subjects demonstrated less dorsiflexor moments, less knee extensor moments, and greater hip extensor moments. Joint powers in the sagittal plane were found to be similar at the ankle but quite different at the knee and hip joints. Differences in muscle activity were observed between the two walking modalities, particularly in the tibialis anterior throughout stance, and in the hamstrings, vastus medialis and adductor longus during swing. While differences were observed in muscle activation patterns, joint moments and joint powers between the two walking modalities, the overall patterns in these behaviors were quite similar. From a therapeutic perspective, this suggests that training individuals with neurological injuries on a treadmill appears to be justified.