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Nicholas Stergiou, Yawen Yu and Anastasia Kyvelidou

Movement variability is considered essential to typical motor development. However, multiple theoretical perspectives and measurement tools have limited interpretation of the importance of movement variability in biological systems. The complementary use of linear and nonlinear measures have recently allowed for the evaluation of not only the magnitude of variability but also the temporal structure of variability. As a result, the theoretical model of optimal movement variability was introduced. The model suggests that the development of healthy and highly adaptable systems relies on the achievement of an optimal state of variability. Alternatively, abnormal development may be characterized by a narrow range of behaviors, some of which may be rigid, inflexible, and highly predictable or, on the contrary, random, unfocused, and unpredictable. In the present review, this theoretical model is described as it relates to motor development in infancy and specifically the development of sitting posture.

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Nicholas Stergiou, Jenny A. Kent and Denise McGrath

An optimal level of variability enables us to interact adaptively and safely to a continuously changing environment, where often our movements must be adjusted in a matter of milliseconds. A large body of research exists that demonstrates natural variability in healthy gait (along with variability in other, healthy biological signals such as heart rate) and a loss of this variability in aging and injury, as well as in a variety of neurodegenerative and physiological disorders. We submit that this field of research is now in pressing need of an innovative “next step” that goes beyond the many descriptive studies that characterize levels of variability in various patient populations. We need to devise novel therapies that will harness the existing knowledge on biological variability and create new possibilities for those in the grip of disease. We also propose that the nature of the specific physiological limitation present in the neuromuscular apparatus may be less important in the physiological complexity framework than the control mechanisms adopted by the older individual in the coordination of the available degrees of freedom. The theoretical underpinnings of this framework suggest that interventions designed to restore healthy system dynamics may optimize functional improvements in older adults. We submit that interventions based on the restoration of optimal variability and movement complexity could potentially be applied across a range of diseases or dysfunctions as it addresses the adaptability and coordination of available degrees of freedom, regardless of the internal constraints of the individual.

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Joshua Haworth, Anastasia Kyvelidou, Wayne Fisher and Nicholas Stergiou

Children with autism spectrum disorder tend to have little interest in the presence, actions, and motives of other persons. In addition, these children tend to present with a limited and overly redundant movement repertoire, often expressing hyperfixation and aversion to novelty. We explore whether this is related to a more fundamental lack of appreciation for various temporal dynamics, including periodic, chaotic, and aperiodic motion structures. Seven children with ASD (age, gender, and height matched with children without ASD) were asked to stand and watch the motion of a visual stimulus displayed on a large (55") video monitor. Gaze and posture movements were recorded and assessed using cross recurrence quantification analysis for qualities of coordination, including rate and duration of bouts of coordination. Results showed that children with ASD do not express an affinity to chaotic motion of the stimulus in the same way as children without ASD. We contend that this indifference to chaotic motion is foundational to their general disinterest in biological motion.

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Shane R. Wurdeman, Jessie M. Huisinga, Mary Filipi and Nicholas Stergiou

Patients with multiple sclerosis (MS) have less-coordinated movements of the center of mass resulting in greater mechanical work. The purpose of this study was to quantify the work performed on the body’s center of mass by patients with MS. It was hypothesized that patients with MS would perform greater negative work during initial double support and less positive work in terminal double support. Results revealed that patients with MS perform less negative work in single support and early terminal double support and less positive work in the terminal double support period. However, summed over the entire stance phase, patients with MS and healthy controls performed similar amounts of positive and negative work on the body’s center of mass. The altered work throughout different periods in the stance phase may be indicative of a failure to capitalize on passive elastic energy mechanisms and increased reliance upon more active work generation to sustain gait.

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Jessie M. Huisinga, Mary L. Filipi and Nicholas Stergiou

Postural disturbances are one of the first reported symptoms in patients with Multiple Sclerosis (MS). The purpose of this study was to investigate the effect of supervised resistance training on postural control in MS patients. Postural control was assessed using amount of sway variability [Root Mean Square (RMS)] and temporal structure of sway variability [Lyapunov Exponent (LyE)] from 15 MS patients. Posture was evaluated before and after completion of three months of resistance training. There were significant differences between MS patients pretraining and healthy controls for both LyE (p = .000) and RMS (p = .002), but no differences between groups after training. There was a significant decrease in RMS (p = .025) and a significant increase in LyE (p = .049) for MS patients pre- to posttraining. The findings suggested that postural control of MS patients could be affected by a supervised resistance training intervention.

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Jeffrey P. Kaipust, Jessie M. Huisinga, Mary Filipi and Nicholas Stergiou

The purpose of this study was to determine the differences in gait variability between patients with multiple sclerosis (MS) and healthy controls during walking at a self-selected pace. Methods: Kinematics were collected during three minutes of treadmill walking for 10 patients with MS and 10 healthy controls. The Coefficient of Variation (CoV), the Approximate Entropy (ApEn) and the Detrended Fluctuation Analysis (DFA) were used to investigate the fluctuations present in stride length and step width from continuous strides. Results: ApEn revealed that patients with MS had significantly lower values than healthy controls for stride length (p < .001) and step width (p < .001). Conclusions: ApEn results revealed that the natural fluctuations present during gait in the stride length and step width time series are more regular and repeatable in patients with MS. These changes implied that patients with MS may exhibit reduced capacity to adapt and respond to perturbations during gait.

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Joanna B. Morley, Leslie M. Decker, Tracy Dierks, Daniel Blanke, Jeffrey A. French and Nicholas Stergiou

Despite extensive research on running mechanics, there is still a knowledge gap with respect to the degree of relationship between mediolateral ground reaction forces (ML-GRF) and foot pronation. Our goal was to investigate whether differences exist in ML-GRF among runners that exhibit different degrees of pronation. Seventeen male and 13 female recreational runners ran with and without shoes while ML-GRF and frontal kinematics were collected simultaneously. Subjects were divided into groups based upon their peak eversion (low pronation, middle pronation, high pronation). Discrete parameters from the ML-GRF were peak forces, respective times of occurrence, and impulses. No significant differences were found between groups regarding the magnitude of ML-GRF. Based upon the relative times of occurrence, the peak medial GRF occurred closer to the peak eversion than the peak lateral GRF. Findings support the idea that the ML-GRF have less to do with pronation than previous research suggested.

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Jessie M. Huisinga, Iraklis I. Pipinos, Nicholas Stergiou and Jason M. Johanning

Pharmacological treatment has been used to alleviate the claudication symptoms and improve walking performance in peripheral arterial disease (PAD) patients. However, the effects of claudication treatments on gait mechanics have not been objectively indentified with biomechanical techniques. For this study, 20 PAD patients were assigned to take either pentoxifylline (n = 11) or cilostazol (n = 9), the two FDA-approved pharmacological therapies used to treat intermittent claudication symptoms. All patients completed a gait evaluation protocol that involved the acquisition of kinematic and kinetic gait data before use of the medication and after 12 weeks of treatment. Results showed that treatment with either pentoxifylline or cilostazol resulted in limited overall improvement in gait parameters including joint angles and joint moments. Walking speed was unchanged, in either treatment group, as a result of the medication. These results suggest that to improve biomechanical walking parameters of PAD patients, clinicians cannot rely on drug therapies alone.

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Jessie M. Huisinga, Kendra K. Schmid, Mary L. Filipi and Nicholas Stergiou

Patients with multiple sclerosis (MS) experience abnormal gait patterns and reduced physical activity. The purpose of this study was to determine if an elliptical exercise intervention for patients with MS would change joint kinetics during gait toward healthy control values. Gait analysis was performed on patients with MS (n = 24) before and after completion of 15 sessions of supervised exercise. Joint torques and powers were calculated, while also using walking velocity as a covariate, to determine the effects of elliptical exercise on lower extremity joint kinetics during gait. Results show that elliptical exercise significantly altered joint torques at the ankle and hip and joint powers at the ankle during stance. The change in joint power at the ankle indicates that, after training, patients with MS employed a walking strategy that is more similar to that of healthy young adults. These results support the use of elliptical exercise as a gait training tool for patients with MS.

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Jessie M. Huisinga, Kendra K. Schmid, Mary L. Filipi and Nicholas Stergiou

Multiple sclerosis (MS) causes severe gait problems in relatively young individuals, yet there have been limited studies to quantitatively identify the specific gait parameters that are affected. The purpose of this study was to define any differences in biomechanical gait parameters between patients with MS and healthy controls. A total of 31 MS patients and 31 healthy controls were evaluated: joint torques and joint powers were calculated at the ankle, knee, and hip during the stance phase of gait. The self-selected walking velocity was used as a covariate in the analysis to ensure that group differences were not due to differences in walking velocity between the MS and healthy control groups. Reduced angular range, less joint torque, and reduced joint power were seen in patients with MS. We also found significant correlations between biomechanical gait parameters and EDSS score, which provides a clinical rating of disease severity. Our findings provide a quantitative assessment of the gait mechanics employed in patients with MS. The altered lower extremity mechanics observed in patients with MS reflect both a neurological and strength deficit compared with healthy controls during walking.