Walking speed and spatiotemporal step mean measures are reliable during feedback-controlled treadmill walking; however,spatiotemporal step variability is not reliable

The purpose of the study was to compare the effects of a feedback-controlled treadmill (FeedbackTM) to a traditional fixed-speed treadmill (FixedTM) on spatiotemporal gait means, variability, and dynamics. The study also examined inter-session reliability when using the FeedbackTM. Ten young adults walked on the FeedbackTM for a 5-minute familiarization followed by a 16-minute experimental trial. They returned within one week and completed a 5-minute familiarization followed by a 16-minute experimental trial each for FeedbackTM and FixedTM conditions. Mean walking speed and step time, length, width, and speed means and coefficient of variation were calculated from all experimental conditions. Step time, length, width, and speed gait dynamics were analyzed using detrended fluctuation analysis. Mean differences between experimental trials were determined using ANOVAs and reliability between FeedbackTM sessions was determined by intraclass correlation coefficient. No difference was found in mean walking speed nor spatiotemporal variables, with the exception of step width, between the experimental trials. All mean spatiotemporal variables demonstrated good to excellent reliability between sessions, while coefficient of variation was not reliable. Gait dynamics of step time, length, width, and speed were significantly more persistent during the FeedbackTM condition compared to FixedTM, especially step speed. However, gait dynamics demonstrated fair to poor reliability between FeedbackTM sessions. When walking on the FeedbackTM, users maintain a consistent set point, yet the gait dynamics around the mean are different when compared to walking on a FixedTM. In addition, spatiotemporal gait dynamics and variability may not be consistent across separate days when using the FeedbackTM.     

The effects of step width and arm swing on energetic cost and lateral balance during running

In walking, humans prefer a moderate step width that minimizes energetic cost and vary step width from step-to-step to maintain lateral balance. Arm swing also reduces energetic cost and improves lateral balance. In running, humans prefer a narrow step width that may present a challenge for maintaining lateral balance. However, arm swing in running may improve lateral balance and help reduce energetic cost. To understand the roles of step width and arm swing, we hypothesized that net metabolic power would be greater at step widths greater or less than preferred and when running without arm swing. We further hypothesized that step width variability (indicator of lateral balance) would be greater at step widths greater or less than preferred and when running without arm swing. Ten subjects ran (3m/s) at four target step widths (0%, 15%, 20%, and 25% leg length (LL)) with arm swing, at their preferred step width with arm swing, and at their preferred step width without arm swing. We measured metabolic power, step width, and step width variability. When subjects ran at target step widths less (0% LL) or greater (15%, 20%, and 25% LL) than preferred, both net metabolic power demand (by 3%, 9%, 12%, and 15%) and step width variability (by 7%, 33%, 46%, and 69%) increased. When running without arm swing, both net metabolic power demand (by 8%) and step width variability (by 9%) increased compared to running with arm swing. It appears that humans prefer to run with a narrow step width and swing their arms so as to minimize energetic cost and improve lateral balance.     

Mechanical and metabolic requirements for active lateral stabilization in human walking

Walking appears to be passively unstable in the lateral direction, requiring active feedback control for stability. The central nervous system may control stability by adjusting medio-lateral foot placement, but potentially with a metabolic cost. This cost increases with narrow steps and may affect the preferred step width. We hypothesized that external stabilization of the body would reduce the active control needed, thereby decreasing metabolic cost and preferred step width. To test these hypotheses, we provided external lateral stabilization, using springs pulling bilaterally from the waist, to human subjects walking on a force treadmill at 1.25 m/s. Ten subjects walked, with and without stabilization, at a prescribed step width of zero and also at their preferred step width. We measured metabolic cost using indirect calorimetry, and step width from force treadmill data. We found that at the prescribed zero step width, external stabilization resulted in a 33% decrease in step width variability (root-mean-square) and a 9.2% decrease in metabolic cost. In the preferred step width conditions, external stabilization caused subjects to prefer a 47% narrower step width, with a 32% decrease in step width variability and a 5.7% decrease in metabolic cost. These results suggest that (a). human walking requires active lateral stabilization, (b). body lateral motion is partially stabilized via medio-lateral foot placement, (c). active stabilization exacts a modest metabolic cost, and (d). humans avoid narrow step widths because they are less stable.     

Can stability really predict an impending slip-related fall among older adults?

The primary purpose of this study was to systematically evaluate and compare the predictive power of falls for a battery of stability indices, obtained during normal walking among community-dwelling older adults. One hundred and eighty seven community-dwelling older adults participated in the study. After walking regularly for 20 strides on a walkway, participants were subjected to an unannounced slip during gait under the protection of a safety harness. Full body kinematics and kinetics were monitored during walking using a motion capture system synchronized with force plates. Stability variables, including feasible-stability-region measurement, margin of stability, the maximum Floquet multiplier, the Lyapunov exponents (short- and long-term), and the variability of gait parameters (including the step length, step width, and step time), were calculated for each subject. Sensitivity of predicting slip outcome (fall vs. recovery) was examined for each stability variable using logistic regression. Results showed that the feasible-stability-region measurement predicted fall incidence among these subjects with the highest sensitivity (68.4%). Except for the step width (with an sensitivity of 60.2%), no other stability variables could differentiate fallers from those who did not fall for the sample included in this study. The findings from the present study could provide guidance to identify individuals at increased risk of falling using the feasible-stability-region measurement or variability of the step width.     

Lateral stabilization improves walking in people with myelomeningocele

Muscle weakness and sensory deficits in people with myelomeningocele (MMC) make their walking control a greater challenge. We know little about how people with MMC optimize their walking balance. Recently, researchers have argued that medial-lateral control of gait requires more active neural input than the anterior-posterior direction, which is more passive. Our goal was to investigate the effect of providing external lateral stabilization (ELS) on walking patterns in people with MMC. We examined 12 people with MMC who could perform at least 4-6 independent steps. We found that the normalized step width (SW) was decreased 20% from without stabilizer to with stabilizer, where as the normalized step length (SL) was increased 4.17% from without stabilizer to with stabilizer. The ELS resulted in 25.10% reduction in centre of mass (COM) ranges of motions in the medial-lateral direction and 13.43% reduction in pelvic range of motions in the frontal plane. Our results suggested that by decreasing the medial-lateral control demands in people with MMC, we could improve gait with smaller SW, longer SL as well as reduced COM and pelvic ranges of motion in the frontal plane. In addition, ELS decreased energy cost and muscle co-activation of soleus and vastus lateralis that may help in diminishing the chances of pain and fatigue in people with MMC. Exploring the effect of the ELS provided us information that might be used to increase mobility safety and to develop a superior rehabilitation intervention for people with MMC.     

Active control of lateral balance in human walking

We measured variability of foot placement during gait to test whether lateral balance must be actively controlled against dynamic instability. The hypothesis was developed using a simple dynamical model that can walk down a slight incline with a periodic gait resembling that of humans. This gait is entirely passive except that it requires active control for a single unstable mode, confined mainly to lateral motion. An especially efficient means of controlling this instability is to adjust lateral foot placement. We hypothesized that similar active feedback control is performed by humans, with fore-aft dynamics stabilized either passively or by very low-level control. The model predicts that uncertainty within the active feedback loop should result in variability in foot placement that is larger laterally than fore-aft. In addition, loss of sensory information such as by closing the eyes should result in larger increases in lateral variability. The control model also predicts a slight coupling between step width and length. We tested 15 young normal human subjects and found that lateral variability was 79% larger than fore-aft variability with eyes open, and a larger increase in lateral variability (53% vs. 21%) with eyes closed, consistent with the model's predictions. We also found that the coupling between lateral and fore-aft foot placements was consistent with a value of 0.13 predicted by the control model. Our results imply that humans may harness passive dynamic properties of the limbs in the sagittal plane, but must provide significant active control in order to stabilize lateral motion.     

Dynamic balance in persons with multiple sclerosis who have a falls history is altered compared to non-fallers and to healthy controls

Around 60% of persons with multiple sclerosis (MS) experience falls, however the dynamic balance differences between those who fall and those who don’t are not well understood. The purpose of this study is to identify distinct biomechanical features of dynamic balance during gait that are different between fallers with MS, non-fallers with MS, and healthy controls. 27 recurrent fallers with MS, 28 persons with MS with no falls history, and 27 healthy controls walked on a treadmill at their preferred speed for 3 min. The variability of trunk accelerations and the average and variability of minimum toe clearance, spatiotemporal parameters, and margin of stability were compared between groups. Fallers with MS exhibited a slower cautious gait compared to non-fallers and healthy controls, but had decreased anterior-posterior margin of stability and minimum toe clearance. Fallers walked with less locally stable and predictable trunk accelerations, and increased variability of step length, stride time, and both anterior-posterior and mediolateral margin of stability compared to non-fallers and healthy controls. The present work provides evidence that within a group of persons with MS, there are gait differences that are influenced by falls history. These differences indicate that in persons with MS who fall, the center of mass is poorly controlled through base of support placement and the foot is closer to the ground during swing phase relative to the non-fallers. These identified biomechanical differences could be used to evaluate dynamic balance in persons with MS and to help improve fall prevention strategies.     

Effect of stable and unstable load carriage on walking gait variability,dynamic stability and muscle activity of older adults

Load carriage perturbs the neuromuscular system, which can be impaired due to ageing. The ability to counteract perturbations is an indicator of neuromuscular function but if the response is insufficient the risk of falls will increase. However, it is unknown how load carriage affects older adults. Fourteen older adults (65 ± 6 years) attended a single visit during which they performed 4 min of walking in 3 conditions, unloaded, stable backpack load and unstable backpack load. During each walking trial, 3-dimensional kinematics of the lower limb and trunk movements and electromyographic activity of 6 lower limb muscles were recorded. The local dynamic stability (local divergence exponents), joint angle variability and spatio-temporal variability were determined along with muscle activation magnitudes. Medio-lateral dynamic stability was lower (p = 0.018) and step width (p = 0.019) and step width variability (p = 0.015) were greater in unstable load walking and step width variability was greater in stable load walking (p = 0.009) compared to unloaded walking. However, there was no effect on joint angle variability. Unstable load carriage increased activity of the Rectus Femoris (p = 0.001) and Soleus (p = 0.043) and stable load carriage increased Rectus Femoris activity (p = 0.006). These results suggest that loaded walking alters the gait of older adults and that unstable load carriage reduces dynamic stability compared to unloaded walking. This can potentially increase the risk of falls, but also offers the potential to use unstable loads as part of fall prevention programmes.     

A shoe sole-based apparatus and method for randomly perturbing the stance phase of gait: test-retest reliability in young adults

Walking on an irregular surface is associated with an elevated risk for a fall at any age. Yet, relatively little is known about how a human responds to an unexpected underfoot perturbation during gait. This is partly due to the difficulty of generating an intermittent but repeatable, unexpected, underfoot perturbation whose size and location are precisely known. So we developed a shoe sole-embedded apparatus for randomly perturbing the stance phase of gait. Medial and lateral flaps were concealed in the soles of pairs of sandals, along with their actuators. Either flap could be deployed within 400ms in the parasagittal plane under a swing foot; this altered the resulting sagittal and frontal plane orientations of the foot during the next stance phase, whereafter the flap was retracted following toe-off for the rest of that gait trial. We tested six healthy young subjects by randomly presenting a single medial or lateral perturbation in 12 of 30 gait trials. Traditional step kinematic measures were used to evaluate the test-retest reliability of the response to the stimulus at two different walking speeds in 60 randomized trials conducted 1 week apart. The method was effective in systematically inducing an alteration in gait, reproducible across visits, as evidenced by acceptable intraclass correlation coefficients for step width, time and length. We conclude that the apparatus and method has potential for measuring the ability of humans to reject one or more unexpected underfoot perturbations during gait.     

Increasing step width reduces the requirements for subtalar joint moments and powers

The subtalar joint (STJ) contributes to the absorption and generation of mechanical energy (and power) during walking to maintain frontal plane stability. Previous observational studies have suggested that there may be a relationship between step width and STJ supination moment. This study directly tests the hypothesis that walking with a step width greater than preferred would reduce STJ moments, energy absorption, and power generation requirements, while increasing energy absorption at the hip during initial contact. Participants (n = 12, 7 females) were asked to walk on an instrumented treadmill at a constant velocity and cadence at a range of fixed step widths ranging from 0.1 to 0.4 times leg length (L). Walking at step widths greater than preferred (0.149 ± 0.04 L) reduced peak STJ moments at initial contact and propulsion which subsequently reduced the negative and positive work performed at the STJ. There was a 43% reduction in energy absorption (negative work) and approximately 30% decrease in positive work at the STJ as step width increased from 0.1 L to 0.4 L. An increase in energy absorption at the knee and hip was evident with an increase in step width during initial contact, although minimal mechanical changes were observed at the proximal joints during propulsion. These results suggest an increase in step width reduces the forces generated by muscles at the STJ across stance and is therefore likely to be beneficial in the prevention and treatment of their injuries. In terms of rehabilitation, the increase in mechanical costs occurring due to an increase in energy absorption by the hip and knee is of minimal concern.     

Control of center of mass motion state through cuing and decoupling of spontaneous gait parameters in level walking

Can the center of mass (COM) motion state, i.e., its position and velocity relative to the base of support (BOS), which dictate gait stability, be predictably controlled by the global gait parameters of step length and gait speed, or by extension, cadence? The precise relationships among step length and gait speed, and the COM motion state are unknown, partially due to the interdependence between step length and gait speed and the difficulty in independent control of both parameters during spontaneous level walking. The purposes of this study were to utilize simultaneous audio-visual cuing to independently manipulate step length and gait speed, and to determine the extent to which the COM position and velocity can be subsequently controlled. Fifty-six young adults were trained at one of the three gait patterns in which both the step length and gait speed were targeted simultaneously. The results showed that the cuing could successfully “decouple” gait speed from step length. Although this approach did yield reliable control of the COM velocity through manipulation of gait speed (R²=0.97), the manipulation of step length yielded less precise control of COM position (R²=0.60). This latter control appears to require manipulation of an additional degree-of-freedom at the local segment level, such that the inclusion of trunk inclination with step length improved the prediction of COM position (R²=0.80).     

Effects of step length and step frequency on lower-limb muscle function in human gait

The aim of this study was to quantify the effects of step length and step frequency on lower-limb muscle function in walking. Three-dimensional gait data were used in conjunction with musculoskeletal modeling techniques to evaluate muscle function over a range of walking speeds using prescribed combinations of step length and step frequency. The body was modeled as a 10-segment, 21-degree-of-freedom skeleton actuated by 54 muscle-tendon units. Lower-limb muscle forces were calculated using inverse dynamics and static optimization. We found that five muscles – GMAX, GMED, VAS, GAS, and SOL – dominated vertical support and forward progression independent of changes made to either step length or step frequency, and that, overall, changes in step length had a greater influence on lower-limb joint motion, net joint moments and muscle function than step frequency. Peak forces developed by the uniarticular hip and knee extensors, as well as the normalized fiber lengths at which these muscles developed their peak forces, correlated more closely with changes in step length than step frequency. Increasing step length resulted in larger contributions from the hip and knee extensors and smaller contributions from gravitational forces (limb posture) to vertical support. These results provide insight into why older people with weak hip and knee extensors walk more slowly by reducing step length rather than step frequency and also help to identify the key muscle groups that ought to be targeted in exercise programs designed to improve gait biomechanics in older adults.     

Fat King Penguins Are Less Steady on Their Feet

Returning to the shore after a feeding sojourn at sea, king penguins often undertake a relatively long terrestrial journey to the breeding colony carrying a heavy, mostly frontal, accumulation of fat along with food in the stomach for chick-provisioning. There they must survive a fasting period of up to a month in duration, during which their complete reliance on endogenous energy stores results in a dramatic loss in body mass. Our aim was to determine if the king penguin’s walking gait changes with variations in body mass. We investigated this by walking king penguins on a treadmill while instrumented with an acceleration data logger. The stride frequency, dynamic body acceleration (DBA) and posture of fat (pre-fasting; 13.2 kg) and slim (post fasting; 11 kg) king penguins were assessed while they walked at the same speed (1.4km/h) on a treadmill. Paired statistical tests indicated no evidence for a difference in dynamic body acceleration or stride frequency between the two body masses however there was substantially less variability in both leaning angle and the leaning amplitude of the body when the birds were slimmer. Furthermore, there was some evidence that the slimmer birds exhibited a decrease in waddling amplitude. We suggest the increase in variability of both leaning angle and amplitude, as well as a possibly greater variability in the waddling amplitude, is likely to result from the frontal fat accumulation when the birds are heavier, which may move the centre of mass anteriorly, resulting in a less stable upright posture. This study is the first to use accelerometry to better understand the gait of a species within a specific ecological context: the considerable body mass change exhibited by king penguins.     

A practical step length algorithm using lower limb angular velocities

The use of Inertial Measurement Units (IMUs) for spatial gait analysis has opened the door to unconstrained measurements within the home and community. Bandwidth, cost limitations, and ease of use has historically restricted the number and location of sensors worn on the body. In this paper, we describe a four-sensor configuration of IMUs placed on the shanks and thighs that is sufficient to provide an accurate measure of temporal gait parameters, spatial gait parameters, and joint angle dynamics during ambulation. Estimating spatial gait parameters solely from gyroscope data is preferred because gyroscopes are less susceptible to sensor noise and a system comprised of only gyroscopes uses decreased bandwidth compared to a typical 9 degree-of-freedom IMU. The purpose of this study was to determine the validity of a novel method of step length estimation using gyroscopes attached to the shanks and thighs. An Inverted Pendulum Model algorithm (IPM) was proposed to calculate step length, stride length, and gait speed. The algorithm incorporates heel-strike events and average forward velocity per step to make these assessments. IMU algorithm accuracy was determined via concurrent validity with an instrumented walkway and results explained via the collision model of gait. The IPM produced accurate estimates of step length, stride length, and gait speed with a mean difference of 3 cm and an RMSE of 6.6 cm for step length, thus establishing a new approach for spatial gait parameter calculation. The lack of numerical integration in IPM makes it well suited for use in continuous monitoring applications where sensor sampling rates are restricted.     

Influence of simulated neuromuscular noise on movement variability and fall risk in a 3D dynamic walking model

People at risk of falling exhibit increased gait variability, which may predict future falls. However, the causal mechanisms underlying these correlations are not well known. Increased neuronal noise associated with aging likely leads to increased gait variability, which could in turn lead to increased fall risk. This paper presents a model of how changes in neuromuscular noise independently affect gait variability and probability of falling, and aims to determine the extent to which changes in gait variability directly predict fall risk. We used a dynamic walking model that incorporates a lateral step controller to maintain lateral stability. Noise was applied to this controller to approximate neuromuscular noise in humans. Noise amplitude was varied between low amplitudes that did not induce falls and high amplitudes for which the model always fell. With increases in noise amplitude, the model fell more often and after fewer steps. Gait variability increased with noise amplitude and predicted increased probability of falling. Importantly, these relationships were not linear. At either low gait variability or very high gait variability, small increases in noise and variability affected probability of falling very little. Conversely, at intermediate noise and/or variability levels, the same small increases resulted in large increases in probability of falling. Our results validate the idea that age-related increases in neuromuscular noise likely play a direct contributing role in increasing fall risk. However, neuromuscular noise remains only one of many important factors that need to be considered. These findings have important implications for fall prevention research and practice.     

A mathematical model of the stability control of human thorax and pelvis movements during walking

A mathematical model is developed to study the human thorax and pelvis movements in the frontal plane during normal walking. The model comprises of two-link base-excited inverted pendulums with one-degree of rotational freedom for each link. Since the linear motion of the pelvis has a significant effect on the upper body stability, this effect is included in the model by having a base point moving in the frontal plane in a general way. Furthermore, because the postural stability is the primary requirement of normal human walking, the control law is developed based on Lyapunov's stability theory, which guarantees the stability of the pendulum system around the up-right position. To evaluate the model, the simulation results, including the angular displacement of each link and the torque applied on each link, are compared with those from gait measurements. It is shown that the simulation results match those from gait measurements closely. These results suggest that the proposed model can provide a useful framework for analysis of postural control mechanisms.     

Step length determines minimum toe clearance in older adults and people with Parkinson’s disease

Reduced foot clearance when walking may increase the risk of trips and falls in people with Parkinson’s disease (PD). Changes in foot clearance in people with PD are likely to be associated with temporal-spatial characteristics of gait such as walking slowly which evokes alterations in the temporal-spatial control of stepping patterns. Enhancing our understanding of the temporal-spatial determinants of foot clearance may inform the design of falls prevention therapies.Thirty-six people with PD and 38 age-matched controls completed four intermittent walks under two conditions: self-selected and fast gait velocity. Temporal-spatial characteristics of gait and foot (heel and toe) clearance outcomes were obtained using an instrumented walkway and 3D motion capture, respectively. A general linear model was used to quantify the effect of PD and gait velocity on gait and foot clearance. Regression evaluated the temporal and spatial gait predictors of minimum toe clearance (MTC).PD walked slower regardless of condition (p = .016) and tended to increase their step length to achieve a faster gait velocity. Step length and the walk ratio consistently explained the greatest proportion of variance in MTC (>28% and >33%, respectively) regardless of group or walking condition (p < .001).Our results suggest step length is the primary determinant of MTC regardless of pathology. Interventions that focus on increasing step length may help to reduce the risk of trips and falls during gait, however, clinical trials are required for robust evaluation.     

Adaptive control of center of mass (global) motion and its joint (local) origin in gait

Dynamic gait stability can be quantified by the relationship of the motion state (i.e. the position and velocity) between the body center of mass (COM) and its base of support (BOS). Humans learn how to adaptively control stability by regulating the absolute COM motion state (i.e. its position and velocity) and/or by controlling the BOS (through stepping) in a predictable manner, or by doing both simultaneously following an external perturbation that disrupts their regular relationship. Post repeated-slip perturbation training, for instance, older adults learned to forward shift their COM position while walking with a reduced step length, hence reduced their likelihood of slip-induced falls. How and to what extent each individual joint influences such adaptive alterations is mostly unknown. A three-dimensional individualized human kinematic model was established. Based on the human model, sensitivity analysis was used to systematically quantify the influence of each lower limb joint on the COM position relative to the BOS and the step length during gait. It was found that the leading foot had the greatest effect on regulating the COM position relative to the BOS; and both hips bear the most influence on the step length. These findings could guide cost-effective but efficient fall-reduction training paradigm among older population.     

A Mathematical Model of the Stability Control of Human Thorax and Pelvis Movements During Walking

A mathematical model is developed to study the human thorax and pelvis movements in the frontal plane during normal walking. The model comprises of two-link base-excited inverted pendulums with one-degree of rotational freedom for each link. Since the linear motion of the pelvis has a significant effect on the upper body stability, this effect is included in the model by having a base point moving in the frontal plane in a general way. Furthermore, because the postural stability is the primary requirement of normal human walking, the control law is developed based on Lyapunov's stability theory, which guarantees the stability of the pendulum system around the up-right position. To evaluate the model, the simulation results, including the angular displacement of each link and the torque applied on each link, are compared with those from gait measurements. It is shown that the simulation results match those from gait measurements closely. These results suggest that the proposed model can provide a useful framework for analysis of postural control mechanisms.