The effect of external lateral stabilization on the use of foot placement to control mediolateral stability in walking and running

Force-field perturbations and muscle vibration strengthen stability-related foot placement responses during steady-state gait in healthy adults

Mediolateral gait stability can be maintained by coordinating our foot placement with respect to the center-of-mass (CoM) kinematic state. Neurological impairments can reduce the degree of foot placement control. For individuals with such impairments, interventions that could improve foot placement control could thus contribute to improved gait stability. In this study we aimed to better understand two potential interventions, by investigating their effect in neurologically intact individuals. The degree of foot placement control can be quantified based on a foot placement model, in which the CoM position and velocity during swing predict subsequent foot placement. Previously, perturbing foot placement with a force-field resulted in an enhanced degree of foot placement control as an after-effect. Moreover, timed muscle vibration enhanced the degree of foot placement control whilst the vibration was applied. Here, we replicated these two findings and further investigated whether Q1) timed muscle vibration leads to an after-effect and Q2) whether combining timed muscle vibration with force-field perturbations leads to a larger after-effect, as compared to force-field perturbations only. In addition, we evaluated several potential contributors to the degree of foot placement control, by considering foot placement errors, CoM variability and the CoM position gain (βpos) of the foot placement model, next to the R2 measure as the degree of foot placement control. Timed muscle vibration led to a higher degree of foot placement control as an after-effect (Q1). However, combining timed muscle vibration and force-field perturbations did not lead to a larger after-effect, as compared to following force-field perturbations only (Q2). Furthermore, we showed that the improved degree of foot placement control following force-field perturbations and during/following muscle vibration, did not reflect diminished foot placement errors. Rather, participants demonstrated a stronger active response (higher βpos) as well as higher CoM variability.

Generalizability of foot placement control strategies during unperturbed and perturbed gait

Control of foot placement is an essential strategy for maintaining balance during walking. During unperturbed, steady-state walking, foot placement can be accurately described as a linear function of the body's centre of mass (CoM) state at midstance. However, it is uncertain if this mapping from CoM state to foot placement generalizes to larger perturbations that could potentially cause falls. Recovery from these perturbations may require reactive control strategies not observed during unperturbed walking. Here, we used unpredictable changes in treadmill belt speed to assess the generalizability of foot placement mappings identified during unperturbed walking. We found that foot placement mappings generalized poorly from unperturbed to perturbed walking and differed for forward perturbation versus backward perturbation. We also used the singular value decomposition of the mapping matrix to reveal that people were more sensitive to backward versus forward perturbations. Together, these results indicate that a single linear mapping cannot describe the foot placement control during both forward and backward losses of balance induced by treadmill belt speed perturbations. Better characterization of human balance control strategies could improve our understanding of why different neuromotor disorders result in heightened fall risk and inform the design of controllers for balance-assisting devices.

Mediolateral foot placement control can be trained: Older adults learn to walk more stable, when ankle moments are constrained

Falls are a problem, especially for older adults. Placing our feet accurately relative to the center-of-mass helps us to prevent falling during gait. The degree of foot placement control with respect to the center-of mass kinematic state is decreased in older as compared to young adults. Here, we attempted to train mediolateral foot placement control in healthy older adults. Ten older adults trained by walking on shoes with a narrow ridge underneath (LesSchuh), restricting mediolateral center-of-pressure shifts. As a training effect, we expected improved foot placement control during normal walking. A training session consisted of a normal walking condition, followed by a training condition on LesSchuh and finally an after-effect condition. Participants performed six of such training sessions, spread across three weeks. As a control, before the first training session, we included two similar sessions, but on normal shoes only. We evaluated whether a training effect was observed across sessions and weeks in a repeated-measures design. Whilst walking with LesSchuh, the magnitude of foot placement error reduced half-a-millimeter between sessions within a week (cohen's d = 0.394). As a training effect in normal walking, the magnitude of foot placement errors was significantly lower compared to the control week, by one millimeter in weeks 2 (cohen's d = 0.686) and 3 (cohen's d = 0.780) and by two millimeters in week 4 (cohen's d = 0.875). Local dynamic stability of normal walking also improved significantly. More precise foot placement may thus have led to improved stability. It remains to be determined whether the training effects were the result of walking on LesSchuh or from repeated treadmill walking itself. Moreover, enhancement of mechanisms beyond the scope of our outcome measures may have improved stability. At the retention test, gait stability returned to similar levels as in the control week. Yet, a reduction in foot placement error persisted.

Light-Weight Wearable Gyroscopic Actuators Can Modulate Balance Performance and Gait Characteristics: A Proof-of-Concept Study

Falling is a major cause of morbidity, and is often caused by a decrease in postural stability. A key component of postural stability is whole-body centroidal angular momentum, which can be influenced by control moment gyroscopes. In this proof-of-concept study, we explore the influence of our wearable robotic gyroscopic actuator "GyroPack" on the balance performance and gait characteristics of non-impaired individuals (seven female/eight male, 30 ± 7 years, 68.8 ± 8.4 kg). Participants performed a series of balance and walking tasks with and without wearing the GyroPack. The device displayed various control modes, which were hypothesised to positively, negatively, or neutrally impact postural control. When configured as a damper, the GyroPack increased mediolateral standing time and walking distance, on a balance beam, and decreased trunk angular velocity variability, while walking on a treadmill. When configured as a negative damper, both peak trunk angular rate and trunk angular velocity variability increased during treadmill walking. This exploratory study shows that gyroscopic actuators can influence balance and gait kinematics. Our results mirror the findings of our earlier studies; though, with more than 50% mass reduction of the device, practical and clinical applicability now appears within reach.

Orthopedic footwear has a positive influence on gait adaptability in individuals with hereditary motor and sensory neuropathy

BACKGROUND

Individuals with Hereditary Motor and Sensory Neuropathy (HMSN) are commonly provided with orthopedic footwear to improve gait. Although orthopedic footwear has shown to improve walking speed and spatiotemporal parameters, its effect on gait adaptability has not been established.

RESEARCH QUESTION

What is the effect of orthopedic footwear on gait adaptability in individuals with HMSN?

METHODS

Fifteen individuals with HMSN performed a precision stepping task on an instrumented treadmill projecting visual targets, while wearing either custom-made orthopedic or standardized footwear (i.e. minimally supportive, flexible sneakers). Primary measure of gait adaptability was the absolute Euclidean distance [mm] between the target center and the middle of the foot (absolute error). Secondary outcomes included the relative and variable error [mm] in both anterior-posterior (AP) and medial-lateral (ML) directions. Dynamic balance was assessed by the prediction of ML foot placement based on the ML center of mass position and velocity, using linear regression. Dynamic balance was primarily determined by foot placement deviation in terms of root mean square error. Another aspect of dynamic balance was foot placement adherence in terms of the coefficient of determination (R2). Differences between the footwear conditions were analyzed with a paired t-test or Wilcoxon signed-rank test (α = 0.05).

RESULTS

The absolute error, relative error (AP) and variable error (AP and ML) decreased with orthopedic footwear, whereas the relative error in ML-direction slightly increased. As for dynamic balance, no effect on foot placement deviation or adherence was found.

SIGNIFICANCE

Gait adaptability improved with orthopedic compared to standardized footwear in people with HMSN, as indicated by improved precision stepping. Dynamic balance, as a possible underlying mechanism, was not affected by orthopedic footwear.

Center-of-Mass Based foot Placement in Stumble Recovery

Exploring how foot placement relates to center-of-mass kinematics after unexpected disturbances for healthy adults could improve our understanding of human balance as well as inform the design/control of assistive device interventions to reduce fall risk. Therefore, in this work a kinematic dataset of stumble recovery responses from seven healthy adults was analyzed to investigate the effects of stumble perturbations on COM state, and the COM state's relationship to various foot placement metrics. COM velocity excursion after trips was significantly higher than excursion for unperturbed swing phases, increasing linearly as the trip occurred later in swing phase. Step length/width and foot position at heel-strike after the trip both increased with COM velocity at heel-strike, though weaker fits for foot positions suggest priority to other strategies. Swing durations were substantially longer for tripped swing phases versus normal swing phases and increased with COM velocity. This is the first investigation of these relationships for stumble recovery, and their alignment (or lack thereof) with previous models provides insights into the control of balance for this common daily-life disturbance.

Generalizability of foot-placement control strategies during unperturbed and perturbed gait

Control of foot placement is an essential strategy for maintaining balance during walking. During unperturbed, steady-state walking, foot placement can be accurately described as a linear function of the body's center of mass state at midstance. However, it is uncertain if this mapping from center of mass state to foot placement generalizes to larger perturbations that may be more likely to cause falls. These perturbations may cause balance disturbances and generate reactive control strategies not observed during unperturbed walking. Here, we used unpredictable changes in treadmill speed to assess the generalizability of foot placement mappings identified during unperturbed walking. We found that foot placement mappings generalized poorly from unperturbed to perturbed walking and differed for forward versus backward perturbations. We also used singular value decomposition of the mapping matrix to reveal that people were more sensitive to backward versus forward perturbations. Together, these results indicate that control of foot placement during losses of balance differs from the control strategies used during unperturbed walking. Better characterization of human balance control strategies could improve our understanding of why different neuromotor disorders result in heightened fall risk and inform the design of controllers for balance-assisting devices.

How human runners regulate footsteps on uneven terrain

Running stably on uneven natural terrain takes skillful control and was critical for human evolution. Even as runners circumnavigate hazardous obstacles such as steep drops, they must contend with uneven ground that is gentler but still destabilizing. We do not know how footsteps are guided based on the uneven topography of the ground and how those choices influence stability. Therefore, we studied human runners on trail-like undulating uneven terrain and measured their energetics, kinematics, ground forces, and stepping patterns. We find that runners do not selectively step on more level ground areas. Instead, the body's mechanical response, mediated by the control of leg compliance, helps maintain stability without requiring precise regulation of footsteps. Furthermore, their overall kinematics and energy consumption on uneven terrain showed little change from flat ground. These findings may explain how runners remain stable on natural terrain while devoting attention to tasks besides guiding footsteps.

Effects of vestibular stimulation on gait stability when walking at different step widths

Vestibular information modulates muscle activity during gait, presumably to contribute to stability. If this is the case, stronger effects of perturbing vestibular information on local dynamic stability of gait, a measure of the locomotor system's response to small, naturally occurring perturbations, can be expected for narrow-base walking (which needs more control) than for normal walking and smaller effects for wide-base walking (which needs less control). An important mechanism to stabilize gait is to coordinate foot placement to center of mass (CoM) state. Vestibular information most likely contributes to sensing this CoM state. We, therefore, expected that stochastic electrical vestibular stimulation (EVS) would decrease the correlation between foot placement and CoM state during the preceding swing phase. In 14 healthy participants, we measured the kinematics of the trunk (as a proxy of the CoM), and feet, while they walked on a treadmill in six conditions: control (usual step width), narrow-base, and wide-base, each with and without stochastic EVS (peak amplitude of 5 mA; RMS of ~ 1.2 mA; frequency band from 0 to 25 Hz). Stochastic EVS decreased local dynamic stability irrespective of step width. Foot placement correlated stronger with trunk motion during walking with EVS than without in the control condition. However, residual variance in foot placement was increased when walking with EVS, indicating less precise foot placement. Thus, a vestibular error signal leads to a decrease in gait stability and precision of foot placement, but these effects are not consistently modulated by step width.

Impaired foot placement strategy during walking in people with incomplete spinal cord injury

BACKGROUND

Impaired balance during walking is a common problem in people with incomplete spinal cord injury (iSCI). To improve walking capacity, it is crucial to characterize balance control and how it is affected in this population. The foot placement strategy, a dominant mechanism to maintain balance in the mediolateral (ML) direction during walking, can be affected in people with iSCI due to impaired sensorimotor control. This study aimed to determine if the ML foot placement strategy is impaired in people with iSCI compared to healthy controls.

METHODS

People with iSCI (n = 28) and healthy controls (n = 19) performed a two-minute walk test at a self-paced walking speed on an instrumented treadmill. Healthy controls performed one extra test at a fixed speed set at 50% of their preferred speed. To study the foot placement strategy of a participant, linear regression was used to predict the ML foot placement based on the ML center of mass position and velocity. The accuracy of the foot placement strategy was evaluated by the root mean square error between the predicted and actual foot placements and was referred to as foot placement deviation. Independent t-tests were performed to compare foot placement deviation of people with iSCI versus healthy controls walking at two different walking speeds.

RESULTS

Foot placement deviation was significantly higher in people with iSCI compared to healthy controls independent of walking speed. Participants with iSCI walking in the self-paced condition exhibited 0.40 cm (51%) and 0.33 cm (38%) higher foot placement deviation compared to healthy controls walking in the self-paced and the fixed-speed 50% condition, respectively.

CONCLUSIONS

Higher foot placement deviation in people with iSCI indicates an impaired ML foot placement strategy in individuals with iSCI compared to healthy controls.

The effects of physical and temporal certainty on human locomotion with discrete underfoot perturbations

Foot placement can be selected to anticipate upcoming perturbations, but it is unclear how this anticipatory strategy is influenced by available response time or precise knowledge of the perturbation's characteristics. This study investigates anticipatory and reactive locomotor strategies for repeated underfoot perturbations with varying levels of temporal certainty, physical certainty, and available response time. Thirteen healthy adults walked with random underfoot perturbations from a mechanized shoe. Temporal certainty was challenged by presenting the perturbations with or without warning. Available response time was challenged by adjusting the timing of the warning before the perturbation. Physical certainty was challenged by making perturbation direction (inversion or eversion) unpredictable for certain conditions. Linear-mixed effects models assessed the effect of each condition on the percentage change of margin of stability and step width. For perturbations with one stride or less of response time, we observed few changes to step width or margin of stability. As response time increased to two strides, participants adopted wider steps in anticipation of the perturbation (P=0.001). Physical certainty had little effect on gait for the step of the perturbation, but participants recovered normal gait sooner when the physical nature of the perturbation was predictable (P<0.001). Despite having information about the timing and direction of upcoming perturbations, individuals do not develop perturbation-specific feedforward strategies. Instead, they use feedback control to recover normal gait after a perturbation. However, physical certainty appears to make the feedback controller more efficient and allows individuals to recover normal gait sooner.

The effect of external lateral stabilization on ankle moment control during steady-state walking

External lateral stabilization can help identify stability control mechanisms during steady-state walking. The degree of step-by-step foot placement control and step width are known to decrease when walking with external lateral stabilization. Here, we investigated the effect of external lateral stabilization on ankle moment control in healthy participants. Ankle moment control complements foot placement, by allowing a corrective center-of-pressure shift once the foot has been placed. This is reflected by a model predicting this center-of-pressure shift based on the preceding foot placement error. Here, the absolute explained variance accounted for by this model decreased when walking with external lateral stabilization. In other words, we found a reduction in the contribution of step-by-step ankle moment control to mediolateral gait stability when externally stabilized. Concurrently, foot placement error and the average center-of-pressure shift remained unchanged.

Ankle muscles drive mediolateral center of pressure control to ensure stable steady state gait

During steady-state walking, mediolateral gait stability can be maintained by controlling the center of pressure (CoP). The CoP modulates the moment of the ground reaction force, which brakes and reverses movement of the center of mass (CoM) towards the lateral border of the base of support. In addition to foot placement, ankle moments serve to control the CoP. We hypothesized that, during steady-state walking, single stance ankle moments establish a CoP shift to correct for errors in foot placement. We expected ankle muscle activity to be associated with this complementary CoP shift. During treadmill walking, full-body kinematics, ground reaction forces and electromyography were recorded in thirty healthy participants. We found a negative relationship between preceding foot placement error and CoP displacement during single stance; steps that were too medial were compensated for by a lateral CoP shift and vice versa, steps that were too lateral were compensated for by a medial CoP shift. Peroneus longus, soleus and tibialis anterior activity correlated with these CoP shifts. As such, we identified an (active) ankle strategy during steady-state walking. As expected, absolute explained CoP variance by foot placement error decreased when walking with shoes constraining ankle moments. Yet, contrary to our expectations that ankle moment control would compensate for constrained foot placement, the absolute explained CoP variance by foot placement error did not increase when foot placement was constrained. We argue that this lack of compensation reflects the interdependent nature of ankle moment and foot placement control. We suggest that single stance ankle moments do not only compensate for preceding foot placement errors, but also assist control of the subsequent foot placement. Foot placement and ankle moment control are 'caught' in a circular relationship, in which constraints imposed on one will also influence the other.

Balance control and lower limb joint work in children with bilateral genu valgum during level walking

BACKGROUND

Genu valgum results in lower limb malalignment and altered joint mechanics. The study aimed to identify the effects of genu valgum on balance control and muscular work at the joints during gait in children.

RESEARCH QUESTION

Would bilateral genu valgum affect balance control and muscular work at the joints during gait in children?

METHODS

Thirteen children with genu valgum and thirteen healthy peers walked at their preferred speed while the body's motions and ground reaction forces were measured to calculate the inclination angles (IA) and the rates of change of IA (RCIA) of the body's center of mass (COM) relative to the center of pressure (COP), as well as the muscular work done at the joints. An independent t-test was used to compare the variables between groups (α = 0.05).

RESULTS

Compared to the controls, the patients showed significantly increased step width with altered frontal IA and RCIA variables (p < 0.05), including increased average IA over single-limb support and increased peak RCIA during double-limb support (p < 0.05). The patients significantly increased posterior RCIA at heel-strike but decreased anterior RCIA at toe-off (p < 0.05). The patients showed increased muscular work at both the hip and knee during single-limb support (p < 0.05).

SIGNIFICANCE

The children with genu valgum showed a specific balance control strategy during gait. In the frontal plane, greater hip and knee muscular work was needed to maintain balance under an increased IA, likely owing to increased step width associated with the valgus alignment. In the sagittal plane, less smooth and less stable COM-COP control with increased RCIA at the key gait events indicates faster weight transfer between double-limb and single-limb support. It is suggested that patients with genu valgum, especially in more severe cases, should be monitored for signs of decreased ability and/or muscular strength in maintaining balance during gait.

Postural Control, Dual Task Performance and Executive Function Following an Ultramarathon

As research into the postural and cognitive effects of ultramarathon running is sparse and still needed, we investigated the effect of ultramarathon running on runners' postural control, dual task postural control and a measure of executive function-the flanker test, expecting fatigue-related deterioration on each measure. We used a pre- and post-test research design with 14 runners who completed (a) postural assessment with eyes open and closed, on a flat surface and on foam during (b) a two-choice reaction time dual task postural assessment, and (c) an executive function modified flanker task. With regard to postural stability, we observed, after running, increased anterior-posterior (AP) path length and AP root mean square (RMS) and reductions in both mediolateral (ML) RMS and ML median frequency. Dual task analysis showed reduced ML RMS prior to the race, whereas the effect was absent afterwards. Reaction times were not significantly altered between pre-post or surface conditions assessments. There were no statistically significant differences in mean modified flanker scores before and after the race. These data demonstrated that, following an endurance run, there were plane specific movement adaptations in postural sway that may have resulted from neuroprotective changes under extreme fatigue.

Stabilization Strategies for Fast Walking in Challenging Environments With Incomplete Spinal Cord Injury

Gait rehabilitation following incomplete spinal cord injury (iSCI) often aims to enhance speed and stability. Concurrently increasing both may be difficult though as certain stabilization strategies will be compromised at faster speeds. To evaluate the interaction between speed and lateral stability, we examined individuals with (n = 12) and without (n = 12) iSCI as they performed straight walking and lateral maneuvers at Preferred and Fast treadmill speeds. To better detect the effects of speed on stability, we challenged lateral stability with a movement amplification force field. The Amplification field, created by a cable-driven robot, applied lateral forces to the pelvis that were proportional to the real-time lateral center of mass (COM) velocity. While we expected individuals to maintain stability during straight walking at the Fast speed in normal conditions, we hypothesized that both groups would be less stable in the Amplification field at the Fast speed compared to the Preferred. However, we found no effects of speed or the interaction between speed and field on straight-walking stability [Lyapunov exponent or lateral margin of stability (MOS)]. Across all trials at the Fast speed compared to the Preferred, there was greater step width variability (p = 0.031) and a stronger correlation between lateral COM state at midstance and the subsequent lateral foot placement. These observations suggest that increased stepping variability at faster speeds may be beneficial for COM control. We hypothesized that during lateral maneuvers in the Amplification field, MOS on the Initiation and Termination steps would be smaller at the Fast speed than at the Preferred. We found no effect of speed on the Initiation step MOS within either field (p > 0.350) or group (p > 0.200). The Termination step MOS decreased at the Fast speed within the group without iSCI (p < 0.001), indicating a trade-off between lateral stability and forward walking speed. Unexpectedly, participants took more steps and time to complete maneuvers at the Fast treadmill speed in the Amplification field. This strategy prioritizing stability over speed was especially evident in the group with iSCI. Overall, individuals with iSCI were able to maintain lateral stability when walking fast in balance-challenging conditions but may have employed more cautious maneuver strategies.

Gait and neuromuscular dynamics during level and uphill walking carrying military loads

The neuromuscular system responds to perturbation and increasing locomotor task difficulty by altering the stability of neuromuscular output signals. The purpose of this study was to determine the effects of two different military load carriage systems on the dynamic stability of gait and muscle activation signals. 14 army office cadets (20 ± 1 years) performed 4-minute treadmill walking trials on level (0%) and uphill (10%) gradients while unloaded, and with 11 kg backpack and 11 kg webbing loads while the activity of 6 leg and trunk muscles and the motion of the centre of mass (COM) were recorded. Loaded and uphill walking decreased stability and increased magnitude of muscle activations compared to loaded and level gradient walking. Backpack loads increased the medio-lateral stability of COM and uphill walking decreased stability of vertical COM motion and increased stride time variability. However, there was no difference between the two load carriage systems for any variable. The reduced stability of muscle activations in loaded and uphill conditions indicates an impaired ability of the neuromuscular control systems to accommodate perturbations in these conditions which may have implications on the operational performance of military personnel. However, improved medio-lateral stability in backpack conditions may indicate that participants were able to compensate for the loads used in this study, despite the decreased vertical stability and increased stride time variability evident in uphill walking. This study did not find differences between load carriage systems however, specific load carriage system effects may be elicited by greater load carriage masses.Highlights Loaded and uphill walking decreased dynamic stability of muscle activationsLower activation stability indicates impaired neuromotor resistance to perturbationBackpack and webbing loads produced similar effects on muscle activations.

Stabilization demands of walking modulate the vestibular contributions to gait

Stable walking relies critically on motor responses to signals of head motion provided by the vestibular system, which are phase-dependent and modulated differently within each muscle. It is unclear, however, whether these vestibular contributions also vary according to the stability of the walking task. Here we investigate how vestibular signals influence muscles relevant for gait stability (medial gastrocnemius, gluteus medius and erector spinae)-as well as their net effect on ground reaction forces-while humans walked normally, with mediolateral stabilization, wide and narrow steps. We estimated local dynamic stability of trunk kinematics together with coherence of electrical vestibular stimulation (EVS) with muscle activity and mediolateral ground reaction forces. Walking with external stabilization increased local dynamic stability and decreased coherence between EVS and all muscles/forces compared to normal walking. Wide-base walking also decreased vestibulomotor coherence, though local dynamic stability did not differ. Conversely, narrow-base walking increased local dynamic stability, but produced muscle-specific increases and decreases in coherence that resulted in a net increase in vestibulomotor coherence with ground reaction forces. Overall, our results show that while vestibular contributions may vary with gait stability, they more critically depend on the stabilization demands (i.e. control effort) needed to maintain a stable walking pattern.

Use of the margin of stability to quantify stability in pathologic gait - a qualitative systematic review

BACKGROUND

The Margin of Stability (MoS) is a widely used objective measure of dynamic stability during gait. Increasingly, researchers are using the MoS to assess the stability of pathological populations to gauge their stability capabilities and coping strategies, or as an objective marker of outcome, response to treatment or disease progression. The objectives are; to describe the types of pathological gait that are assessed using the MoS, to examine the methods used to assess MoS and to examine the way the MoS data is presented and interpreted.

METHODS

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) in the following databases: Web of Science, PubMed, UCL Library Explore, Cochrane Library, Scopus. All articles measured the MoS of a pathologically affected adult human population whilst walking in a straight line. Extracted data were collected per a prospectively defined list, which included: population type, method of data analysis and model building, walking tasks undertaken, and interpretation of the MoS.

RESULTS

Thirty-one studies were included in the final review. More than 15 different clinical populations were studied, most commonly post-stroke and unilateral transtibial amputee populations. Most participants were assessed in a gait laboratory using motion capture technology, whilst 2 studies used instrumented shoes. A variety of centre of mass, base of support and MoS definitions and calculations were described.

CONCLUSIONS

This is the first systematic review to assess use of the MoS and the first to consider its clinical application. Findings suggest the MoS has potential to be a helpful, objective measurement in a variety of clinically affected populations. Unfortunately, the methodology and interpretation varies, which hinders subsequent study comparisons. A lack of baseline results from large studies mean direct comparison between studies is difficult and strong conclusions are hard to make. Further work from the biomechanics community to develop reporting guidelines for MoS calculation methodology and a commitment to larger baseline studies for each pathology is welcomed.

Post-Stroke Adaptation of Lateral Foot Placement Coordination in Variable Environments

Individuals with stroke often have difficulty modulating their lateral foot placement during gait, a primary strategy for maintaining lateral stability. Our purpose was to understand how individuals with and without stroke adapt their lateral foot placement when walking in an environment that alters center of mass (COM) dynamics and the mechanical requirement to maintain lateral stability. The treadmill walking environments included: 1) a Null Field – where no forces were applied, and 2) a Damping Field – where external forces opposed lateral COM velocity. To evaluate the response to the changes in environment, we quantified the correlation between lateral COM state and lateral foot placement (FP), as well as step width mean and variability. We hypothesized the Damping Field would produce a stabilizing effect and reduce both the COM-FP correlation strength and step width compared to the Null Field. We also hypothesized that individuals with stroke would have a significantly weaker COM-FP correlation than individuals without stroke. Surprisingly, we found no differences in COM-FP correlations between the Damping and Null Fields. We also found that compared to individuals without stroke in the Null Field, individuals with stroke had weaker COM-FP correlations (Paretic < Control: p = 0.001, Non-Paretic < Control: p = 0.007) and wider step widths (p = 0.001). Our results suggest that there is a post-stroke shift towards a non-specific lateral stabilization strategy that relies on wide steps that are less correlated to COM dynamics than in individuals without stroke.

How does external lateral stabilization constrain normal gait, apart from improving medio-lateral gait stability?

BACKGROUND

The effect of external lateral stabilization on medio-lateral gait stability has been investigated previously. However, existing lateral stabilization devices not only constrain lateral motions but also transverse and frontal pelvis rotations. This study aimed to investigate the effect of external lateral stabilization with and without constrained transverse pelvis rotation on mechanical and metabolic gait features.

METHODS

We undertook two experiments with 11 and 10 young adult subjects, respectively. Kinematic, kinetic and breath-by-breath oxygen consumption data were recorded during three walking conditions (normal walking (Normal), lateral stabilization with (Free) and without transverse pelvis rotation (Restricted)) and at three speeds (0.83, 1.25 and 1.66 m s-1) for each condition. In the second experiment, we reduced the weight of the frame, and allowed for longer habituation time to the stabilized conditions.

RESULTS

External lateral stabilization significantly reduced the amplitudes of the transverse and frontal pelvis rotations, in addition to medio-lateral, anterior-posterior, and vertical pelvis displacements, transverse thorax rotation, arm swing, step length and step width. The amplitudes of free vertical moment, anterior-posterior drift over a trial, and energy cost were not significantly influenced by external lateral stabilization. The removal of pelvic rotation restrictions by our experimental set-ups resulted in normal frontal pelvis rotation in Experiment 1 and significantly higher transverse pelvis rotation in Experiment 2, although transverse pelvis rotation still remained significantly less than in the Normal condition. Step length increased with the increased transverse pelvis rotation.

CONCLUSION

Existing lateral stabilization set-ups not only constrain medio-lateral motions (i.e. medio-lateral pelvis displacement) but also constrain other movements such as transverse and frontal pelvis rotations, which leads to several other gait changes such as reduced transverse thorax rotation, and arm swing. Our new set-ups allowed for normal frontal pelvis rotation and more transverse pelvis rotation (yet less than normal). However, this did not result in more normal thorax rotation and arm swing. Hence, to provide medio-lateral support without constraining other gait variables, more elaborate set-ups are needed.

Active foot placement control ensures stable gait: Effect of constraints on foot placement and ankle moments

Step-by-step foot placement control, relative to the center of mass (CoM) kinematic state, is generally considered a dominant mechanism for maintenance of gait stability. By adequate (mediolateral) positioning of the center of pressure with respect to the CoM, the ground reaction force generates a moment that prevents falling. In healthy individuals, foot placement is complemented mainly by ankle moment control ensuring stability. To evaluate possible compensatory relationships between step-by-step foot placement and complementary ankle moments, we investigated the degree of (active) foot placement control during steady-state walking, and under either foot placement-, or ankle moment constraints. Thirty healthy participants walked on a treadmill, while full-body kinematics, ground reaction forces and EMG activities were recorded. As a replication of earlier findings, we first showed step-by-step foot placement is associated with preceding CoM state and hip ab-/adductor activity during steady-state walking. Tight control of foot placement appears to be important at normal walking speed because there was a limited change in the degree of foot placement control despite the presence of a foot placement constraint. At slow speed, the degree of foot placement control decreased substantially, suggesting that tight control of foot placement is less essential when walking slowly. Step-by-step foot placement control was not tightened to compensate for constrained ankle moments. Instead compensation was achieved through increases in step width and stride frequency.

Mediolateral damping of an overhead body weight support system assists stability during treadmill walking

BACKGROUND

Body weight support systems with three or more degrees of freedom (3-DoF) are permissive and safe environments that provide unloading and allow unrestricted movement in any direction. This enables training of walking and balance control at an early stage in rehabilitation. Transparent systems generate a support force vector that is near vertical at all positions in the workspace to only minimally interfere with natural movement patterns. Patients with impaired balance, however, may benefit from additional mediolateral support that can be adjusted according to their capacity. An elegant solution for providing balance support might be by rendering viscous damping along the mediolateral axis via the software controller. Before use with patients, we evaluated if control-rendered mediolateral damping evokes the desired stability enhancement in able-bodied individuals.

METHODS

A transparent, cable-driven robotic body weight support system (FLOAT) was used to provide transparent body weight support with and without mediolateral damping to 21 able-bodied volunteers while walking at preferred gait velocity on a treadmill. Stability metrics reflecting resistance to small and large perturbations were derived from walking kinematics and compared between conditions and to free walking.

RESULTS

Compared to free walking, the application of body weight support per-se resulted in gait alterations typically associated with body weight support, namely increased step length and swing phase. Frontal plane dynamic stability, measured by kinematic variability and nonlinear dynamics of the center of mass, was increased under body weight support, indicating reduced balance requirements in both damped and undamped support conditions. Adding damping to the body weight support resulted in a greater increase of frontal plane stability.

CONCLUSION

Adding mediolateral damping to 3-DoF body weight support systems is an effective method of increasing frontal plane stability during walking in able-bodied participants. Building on these results, adjustable mediolateral damping could enable therapists to select combinations of unloading and stability specifically for each patient and to adapt this in a task specific manner. This could extend the impact of transparent 3-DoF body weight support systems, enabling training of gait and active balance from an early time point onwards in the rehabilitation process for a wide range of mobility activities of daily life.

The effects of general fatigue induced by incremental exercise test and active recovery modes on energy cost, gait variability and stability in male soccer players

The aerobic endurance is considered an important physiological capacity of soccer players which is examined by Incremental Exercise Test (IET). However, it is not clear how general fatigue induced by IET influences physiological and biomechanical gait features in soccer players and how players recover optimally at post-IET. Here, the effect of general fatigue induced by IET on energy cost, gait variability and stability in soccer players was investigated. To identify an optimal recovery mode, the effect of walking at Preferred Walking Speed (PWS), running at Individual Ventilation Threshold (IVT) (two active recovery modes), and Rest (a passive recovery mode) on aforementioned features were studied. Nine male players walked 4-min at PWS on a treadmill prior IET (PreT), which was followed by four 4-min walking trials (PosT-0, 1, 2, and 3) with three 4-min recovery intervals (PWS, IVT, or Rest) between them, in three sessions (one for each recovery mode) in a random order. Energy cost, gait variability and stability were examined at PreT (baseline), and at PosT-0, 1, 2, and 3 (intervals of respectively 0-4, 8-12, 16-20, 24-28 min at post-IET). Gait variability was assessed by the standard deviation of trunk angle and gait stability was assessed by the local dynamic stability of trunk angular velocity. Gait stability was not affected by IET, despite increases in gait variability and energy cost. Different from IVT, PWS and Rest recovery modes reduced energy cost at post-IET. Gait variability and energy cost recovered at PosT-1 and PosT-2, suggesting that 8-12 and 16-20 min recovery intervals, respectively, were required for returning to their baselines. No preference for active over passive recovery was found in terms of gait variability and energy cost.

Gait Asymmetry Post-Stroke: Determining Valid and Reliable Methods Using a Single Accelerometer Located on the Trunk

Asymmetry is a cardinal symptom of gait post-stroke that is targeted during rehabilitation. Technological developments have allowed accelerometers to be a feasible tool to provide digital gait variables. Many acceleration-derived variables are proposed to measure gait asymmetry. Despite a need for accurate calculation, no consensus exists for what is the most valid and reliable variable. Using an instrumented walkway (GaitRite) as the reference standard, this study compared the validity and reliability of multiple acceleration-derived asymmetry variables. Twenty-five post-stroke participants performed repeated walks over GaitRite whilst wearing a tri-axial accelerometer (Axivity AX3) on their lower back, on two occasions, one week apart. Harmonic ratio, autocorrelation, gait symmetry index, phase plots, acceleration, and jerk root mean square were calculated from the acceleration signals. Test-retest reliability was calculated, and concurrent validity was estimated by comparison with GaitRite. The strongest concurrent validity was obtained from step regularity from the vertical signal, which also recorded excellent test-retest reliability (Spearman's rank correlation coefficients (rho) = 0.87 and Intraclass correlation coefficient (ICC21) = 0.98, respectively). Future research should test the responsiveness of this and other step asymmetry variables to quantify change during recovery and the effect of rehabilitative interventions for consideration as digital biomarkers to quantify gait asymmetry.