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Michiel Punt, Sjoerd M. Bruijn, Ingrid G. van de Port, Ilona J.M. de Rooij, Harriet Wittink and Jaap H. van Dieën

people with Parkinson’s disease. 7 At present, it is unknown whether this type of intervention is effective for decreasing falls in stroke survivors. Most falls occur during walking, 1 , 8 and we recently found that gait characteristics derived from daily-life gait and from a laboratory gait assessment

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Timo Rantalainen, Nicolas H. Hart, Sophia Nimphius and Daniel W. Wundersitz

Inertial measurement units (IMU) provide a convenient tool for gait stability assessment. However, it is unclear how various gait characteristics relate to each other and whether gait characteristics can be obtained from resultant acceleration. Therefore, step duration variability was measured in treadmill walking from 39 young ambulant volunteers (age 24.2 [± 2.5] y; height 1.79 [± 0.09] m; mass 71.6 [± 12.0] kg) using motion capture. Accelerations and gyrations were simultaneously recorded with an IMU. Harmonic ratio, maximum Lyapunov exponents, and multiscale sample entropy (MSE) were calculated. Step duration variability was positively associated with MSE with coarseness levels = 3–6 (r = –.33 to –.42, P ≤ .045). Harmonic ratio and MSE with all coarseness levels were negatively associated (r = –.45 to –.57, P ≤ .004). The MSE with coarseness level = 2 was negatively associated with short-term maximum Lyapunov exponents (r = –.32, P = .047). The agreement between resultant and vertical acceleration derived gait characteristics was excellent (ICC = 0.97–0.99). In conclusion, MSE with varying coarseness levels was associated with the other gait characteristics evaluated in the study. Resultant and vertical acceleration derived results had excellent agreement, which suggests that resultant acceleration is a viable alternative to considering the acceleration dimensions independently.

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Myriam Verstappen and Peter Aerts

Spatio-temporal gait characteristics are determined for walking, running, and out of phase hopping magpies, at velocities ranging from 0.4 to 4 m/s. Below 1 m/s, magpies walk. At higher velocities they either run or hop, the latter being preferred. Stride length and frequency during walking and running relate to speed in an identical way. It is suggested that the control of walking and running, despite the abrupt drop in duty factor and step length at the transition from walking to either running or hopping, is represented by one single intrinsic pattern. Swing phase duration is independent of speed and similar of the three gaits, pointing to a passive, mechanical control. Stride frequencies during hopping barely change with velocity, while its stride length relates to velocity in a way highly comparable to that of walking and running. Hopping step length and duty factor are indifferent from those of running. These facts, combined with the similar spatio-temporal behavior of both legs in hopping suggest fairly comparable intra-limb coordination for running and hopping, and a simple phase-shift in inter-limb coordination to transform a run into a hop.

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Thorlene Egerton, Kade Paterson and Jorunn L. Helbostad

This study aimed to determine if temporal-spatial gait characteristics are associated with free-living ambulatory physical activity in relatively-healthy older people. A total of 630 women and 593 men had valid data from gait tests and activity monitoring. Gait speed alone was associated with daily step count. Gait speed along with cadence, walk ratio, step length, step time, and swing time were associated with measures of higher intensity activity and overall activity. Those who walked slower were less active. After controlling for gait speed, shorter step length, shorter step time, shorter swing time, and higher cadence were associated with less activity. This finding may be an indication of the functional consequences of a breakdown in the stride length–cadence relationship and/or compensations to increase stability. Asymmetry measures at preferred and fast walking speeds showed no association with physical activity levels. Gait speed was the only predictor of change in activity over the subsequent 12 months.

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Jinah Kim, Sung Cheol Lee, Youngmin Chun, Hyung-Pil Jun, Jeffrey G. Seegmiller, Kyung Min Kim and Sae Yong Lee

Context: Clinically, it has been suggested that increased activation of intrinsic foot muscles may alter the demand of extrinsic muscle activity surrounding the ankle joint in patients with stage II posterior tibial tendon dysfunction. However, there is limited empirical evidence supporting this notion. Objective: The purpose of this study was to investigate the effects of a 4-week short-foot exercise (SFE) on biomechanical factors in patients with stage II posterior tibial tendon dysfunction. Design: Single-group pretest–posttest. Setting: University laboratory. Participants: Fifteen subjects (8 males and 7 females) with stage II posterior tibial tendon dysfunction who had pain in posterior tibial tendon, pronated foot deformity (foot posture index ≥+6), and flexible foot deformity (navicular drop ≥10 mm) were voluntarily recruited. Intervention: All subjects completed a 4-week SFE program (15 repetitions × 5 sets/d and 3 d/wk) of 4 stages (standing with feedback, sitting, double-leg, and one-leg standing position). Main Outcome Measures: Ankle joint kinematics and kinetics and tibialis anterior and fibularis longus muscle activation (% maximum voluntary isometric contraction) during gait were measured before and after SFE program. Cohen d effect size (ES [95% confidence intervals]) was calculated. Results: During the first rocker, tibialis anterior activation decreased at peak plantarflexion (ES = 0.75 [0.01 to 1.49]) and inversion (ES = 0.77 [0.03 to 1.51]) angle. During the second rocker, peak dorsiflexion angle (ES = 0.77 [0.03 to 1.51]) and tibialis anterior activation at peak eversion (ES = 1.57 [0.76 to 2.39]) reduced. During the third rocker, the peak abduction angle (ES = 0.80 [0.06 to 1.54]) and tibialis anterior and fibularis longus activation at peak plantarflexion (ES = 1.34 [0.54 to 2.13]; ES = 1.99 [1.11 to 2.86]) and abduction (ES = 1.29 [0.50 to 2.08]; ES = 1.67 [0.84 to 2.50]) decreased. Conclusions: Our 4-week SFE program may have positive effects on changing muscle activation patterns for tibialis anterior and fibularis longus muscles, although it could not influence their structural deformity and ankle joint moment. It could produce a potential benefit of decreased tibialis posterior activation.

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Chanel T. LoJacono, Ryan P. MacPherson, Nikita A. Kuznetsov, Louisa D. Raisbeck, Scott E. Ross and Christopher K. Rhea

Obstacle crossing, such as stepping over a curb, becomes more challenging with natural aging and could lead to obstacle-related trips and falls. To reduce fall-risk, obstacle training programs using physical obstacles have been developed, but come with space and human resource constraints. These barriers could be removed by using a virtual obstacle crossing training program, but only if the learned gait characteristics transfer to a real environment. We examined whether virtual environment obstacle crossing behavior is transferred to crossing real environment obstacles. Forty participants (n = 20 younger adults and n = 20 older adults) completed two sessions of virtual environment obstacle crossing, which was preceded and followed by one session of real environment obstacle crossing. Participants learned to cross the virtual obstacle more safely and that change in behavior was transferred to the real environment via increased foot clearance and alterations in foot placement before and after the real environment obstacle. Further, while both age groups showed transfer to the real environment task, they differed on the limb in which their transfer effects applied. This suggests it is plausible to use virtual reality training to enhance gait characteristics in the context of obstacle avoidance, potentially leading to a novel way to reduce fall-risk.

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Tom Melai, Nicolaas C. Schaper, T. Herman IJzerman, Paul J.B. Willems, Ton L.H. de Lange, Kenneth Meijer, Aloysius G. Lieverse and Hans H.C.M. Savelberg

Increased forefoot loading in diabetic polyneuropathy plays an important role in the development of plantar foot ulcers and can originate from alterations in muscle strength, joint moments and gait pattern. The current study evaluated whether strength training can improve lower extremity joint moments and spatiotemporal gait characteristics in patients with diabetic polyneuropathy. An intervention group receiving strength training during 24 weeks and a control group receiving no intervention. Measurements were performed in both groups at t = 0, t = 12, t = 24 and t = 52 weeks at an individually preferred and standardized imposed gait velocity. The strength training did not affect the maximal amplitude of hip, knee and ankle joint moments, but did result in an increase in stance phase duration, stride time and stride length of approximately 5%, during the imposed gait velocity. In addition, both groups increased their preferred gait velocity over one year. Future longitudinal studies should further explore the possible effects of strength training on spatiotemporal gait characteristics. The current study provides valuable information on changes in gait velocities and the progressive lower extremity problems in patients with polyneuropathy.

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Hwang-Jae Lee, Won Hyuk Chang, Sun Hee Hwang, Byung-Ok Choi, Gyu-Ha Ryu and Yun-Hee Kim

The purpose of this study was to examine age-related gait characteristics and their associations with balance function in older adults. A total of 51 adult volunteers participated. All subjects underwent locomotion analysis using a 3D motion analysis and 12-channel dynamic electromyography system. Dynamic balance function was assessed by the Berg Balance Scale. Older adults showed a higher level of muscle activation than young adults, and there were significant positive correlations between increased age and activation of the trunk and thigh muscles in the stance and swing phase of the gait cycle. In particular, back extensor muscle activity was mostly correlated with the dynamic balance in older adults. Thus, back extensor muscle activity in walking may provide a clue for higher falling risk in older adults. This study demonstrates that the back extensor muscles play very important roles with potential for rehabilitation training to improve balance and gait in older adults.

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Elizabeth J. Bradshaw and W.A. Sparrow

Adjustments to gait were examined when positioning the foot within a narrow target at the end of an approach for two impact conditions, hard and soft. Participants (6 M, 6 F) ran toward a target of three lengths along a 10-m walkway consisting of two marker strips with alternating black and white 0.5-m markings. Five trials were conducted for each target length and impact task, with trials block randomized between the 6 participants of each gender. A 50Hz digital video camera panned and filmed each trial from an elevated position adjacent to the walkway. Video footage was digitized to deduce the gait characteristics. A linear speed/accuracy tradeoff between target length and approach time was found for both impact tasks (hard, r = 0.99, p < 0.01; soft, r = 0.96, p < 0.05). For the hard-impact task, visual control time increased linearly (r = 0.99, p < 0.05) when whole-body approach velocity decreased. Visual control time was unaffected by whole-body approach velocity in the soft-impact task. A constant tau-margin of 1.08 describes the onset of visual control when approaching a target while running, with the control of braking during visual control described by a tau-dot of –0.85. Further research is needed to examine the control of braking in different targeting tasks.

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Lars Donath, Oliver Faude, Stephanie A. Bridenbaugh, Ralf Roth, Martin Soltermann, Reto W. Kressig and Lukas Zahner

This study examined transfer effects of fall training on fear of falling (Falls Efficacy Scale—International [FES–I]), balance performance, and spatiotemporal gait characteristics in older adults. Eighteen community-dwelling older adults (ages 65–85) were randomly assigned to an intervention or control group. The intervention group completed 12 training sessions (60 min, 6 weeks). During pre- and posttesting, we measured FES–I, balance performance (double limb, closed eyes; single limb, open eyes; double limb, open eyes with motor-interfered task), and gait parameters (e.g., velocity; cadence; stride time, stride width, and stride length; variability of stride time and stride length) under single- and motor-interfered tasks. Dual tasks were applied to appraise improvements of cognitive processing during balance and gait. FES–I (p = .33) and postural sway did not significantly change (0.36 < p < .79). Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task (p = .05, ηp 2 = .22). Fall training did not sufficiently improve fear of falling, balance, or gait performance under single- or dual-task conditions in healthy older adults.