Do the hamstrings operate at increased muscle–tendon lengths and velocities after surgical lengthening?

Children with crouch gait frequently walk with improved knee extension during the terminal swing and stance phases following hamstrings lengthening surgery; however, the mechanisms responsible for these improvements are unclear. This study tested the hypothesis that surgical lengthening enables the hamstrings of persons with cerebral palsy to operate at longer muscle-tendon lengths or lengthen at faster muscle-tendon velocities during walking. Sixty-nine subjects who had improved knee extension after surgery were retrospectively examined. The muscle-tendon lengths and velocities of the subjects' semimembranosus muscles were estimated by combining kinematic data from gait analysis with a three-dimensional computer model of the lower extremity. Log-linear analyses confirmed that the subjects who walked with abnormally short muscle-tendon lengths and/or slow muscle-tendon velocities preoperatively tended to walk with longer lengths (21 of 29 subjects, p<0.01) or faster velocities (30 of 40 subjects, p<0.01) postoperatively. In these cases, surgical lengthening may have slackened the subjects' tight hamstrings and/or diminished the hamstrings' spastic response to stretch. Other subjects walked with muscle-tendon lengths and velocities that were neither shorter nor slower than normal preoperatively (22 of 69 subjects), and the semimembranosus muscles of most of these subjects did not operate at increased lengths or velocities after surgery; in these cases, the subjects' postsurgical improvements in knee extension may have been unrelated to the hamstrings surgery. Analyses of muscle-tendon lengths and velocities may help to distinguish individuals who have "short" or "spastic" hamstrings from those who do not, and thus may augment conventional methods used to describe patients' neuromusculoskeletal impairments and gait abnormalities.     

Muscle contributions to support and progression during single-limb stance in crouch gait

Pathological movement patterns like crouch gait are characterized by abnormal kinematics and muscle activations that alter how muscles support the body weight during walking. Individual muscles are often the target of interventions to improve crouch gait, yet the roles of individual muscles during crouch gait remain unknown. The goal of this study was to examine how muscles contribute to mass center accelerations and joint angular accelerations during single-limb stance in crouch gait, and compare these contributions to unimpaired gait. Subject-specific dynamic simulations were created for ten children who walked in a mild crouch gait and had no previous surgeries. The simulations were analyzed to determine the acceleration of the mass center and angular accelerations of the hip, knee, and ankle generated by individual muscles. The results of this analysis indicate that children walking in crouch gait have less passive skeletal support of body weight and utilize substantially higher muscle forces to walk than unimpaired individuals. Crouch gait relies on the same muscles as unimpaired gait to accelerate the mass center upward, including the soleus, vasti, gastrocnemius, gluteus medius, rectus femoris, and gluteus maximus. However, during crouch gait, these muscles are active throughout single-limb stance, in contrast to the modulation of muscle forces seen during single-limb stance in an unimpaired gait. Subjects walking in crouch gait rely more on proximal muscles, including the gluteus medius and hamstrings, to accelerate the mass center forward during single-limb stance than subjects with an unimpaired gait.     

Contributions of muscles to terminal-swing knee motions vary with walking speed

Many children with cerebral palsy walk with diminished knee extension during terminal swing, at speeds much slower than unimpaired children. Treatment of these gait abnormalities is challenging because the factors that extend the knee during normal walking, over a range of speeds, are not well understood. This study analyzed a series of three-dimensional, muscle-driven dynamic simulations to determine whether the relative contributions of individual muscles and other factors to angular motions of the swing-limb knee vary with walking speed. Simulations were developed that reproduced the measured gait dynamics of seven unimpaired children walking at self-selected, fast, slow, and very slow speeds (7 subjects×4 speeds=28 simulations). In mid-swing, muscles on the stance limb made the largest net contribution to extension of the swing-limb knee at all speeds examined. The stance-limb hip abductors, in particular, accelerated the pelvis upward, inducing reaction forces at the swing-limb hip that powerfully extended the knee. Velocity-related forces (i.e., Coriolis and centrifugal forces) also contributed to knee extension in mid-swing, though these contributions were diminished at slower speeds. In terminal swing, the hip flexors and other muscles on the swing-limb decelerated knee extension at the subjects’ self-selected, slow, and very slow speeds, but had only a minimal net effect on knee motions at the fastest speeds. Muscles on the stance limb helped brake knee extension at the subjects’ fastest speeds, but induced a net knee extension acceleration at the slowest speeds. These data—which show that the contributions of muscular and velocity-related forces to terminal-swing knee motions vary systematically with walking speed—emphasize the need for speed-matched control subjects when attempting to determine the causes of a patient's abnormal gait.     

Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait

Many children with cerebral palsy walk in a crouch gait that progressively worsens over time, decreasing walking efficiency and leading to joint degeneration. This study examined the effect of crouched postures on the capacity of muscles to extend the hip and knee joints and the joint flexions induced by gravity during the single-limb stance phase of gait. We first characterized representative mild, moderate, and severe crouch gait kinematics based on a large group of subjects with cerebral palsy (N=316). We then used a three-dimensional model of the musculoskeletal system and its associated equations of motion to determine the effect of these crouched gait postures on (1) the capacity of individual muscles to extend the hip and knee joints, which we defined as the angular accelerations of the joints, towards extension, that resulted from applying a 1N muscle force to the model, and (2) the angular acceleration of the joints induced by gravity. Our analysis showed that the capacities of almost all the major hip and knee extensors were markedly reduced in a crouched gait posture, with the exception of the hamstrings muscle group, whose extension capacity was maintained in a crouched posture. Crouch gait also increased the flexion accelerations induced by gravity at the hip and knee throughout single-limb stance. These findings help explain the increased energy requirements and progressive nature of crouch gait in patients with cerebral palsy.     

Contributions of muscles and passive dynamics to swing initiation over a range of walking speeds

Stiff-knee gait is a common walking problem in cerebral palsy characterized by insufficient knee flexion during swing. To identify factors that may limit knee flexion in swing, it is necessary to understand how unimpaired subjects successfully coordinate muscles and passive dynamics (gravity and velocity-related forces) to accelerate the knee into flexion during double support, a critical phase just prior to swing that establishes the conditions for achieving sufficient knee flexion during swing. It is also necessary to understand how contributions to swing initiation change with walking speed, since patients with stiff-knee gait often walk slowly. We analyzed muscle-driven dynamic simulations of eight unimpaired subjects walking at four speeds to quantify the contributions of muscles, gravity, and velocity-related forces (i.e. Coriolis and centrifugal forces) to preswing knee flexion acceleration during double support at each speed. Analysis of the simulations revealed contributions from muscles and passive dynamics varied systematically with walking speed. Preswing knee flexion acceleration was achieved primarily by hip flexor muscles on the preswing leg with assistance from biceps femoris short head. Hip flexors on the preswing leg were primarily responsible for the increase in preswing knee flexion acceleration during double support with faster walking speed. The hip extensors and abductors on the contralateral leg and velocity-related forces opposed preswing knee flexion acceleration during double support.     

Impact of ankle foot orthosis stiffness on Achilles tendon and gastrocnemius function during unimpaired gait

Ankle foot orthoses (AFOs) are designed to improve gait for individuals with neuromuscular conditions and have also been used to reduce energy costs of walking for unimpaired individuals. AFOs influence joint motion and metabolic cost, but how they impact muscle function remains unclear. This study investigated the impact of different stiffness AFOs on medial gastrocnemius muscle (MG) and Achilles tendon (AT) function during two walking speeds. We performed gait analyses for eight unimpaired individuals. Each individual walked at slow and very slow speeds with a 3D printed AFO with no resistance (free hinge condition) and four levels of ankle dorsiflexion stiffness: 0.25 Nm/°, 1 Nm/°, 2 Nm/°, and 3.7 Nm/°. Motion capture, ultrasound, and musculoskeletal modeling were used to quantify MG and AT lengths with each AFO condition. Increasing AFO stiffness increased peak AFO dorsiflexion moment with decreased peak knee extension and peak ankle dorsiflexion angles. Overall musculotendon length and peak AT length decreased, while peak MG length increased with increasing AFO stiffness. Peak MG activity, length, and velocity significantly decreased with slower walking speed. This study provides experimental evidence of the impact of AFO stiffness and walking speed on joint kinematics and musculotendon function. These methods can provide insight to improve AFO designs and optimize musculotendon function for rehabilitation, performance, or other goals.     

Biomechanical characterization and clinical implications of artificially induced crouch walking: Differences between pure iliopsoas, pure hamstrings and combination of iliopsoas and hamstrings contractures

The purpose of this study was to characterize biomechanically three different crouch walking patterns, artificially induced in eight neurologically intact subjects and to compare them to selected cases of pathological crouch walking. The subjects were equipped with a lightweight mechanical exoskeleton with artificial muscles that acted in parallel with hamstrings and iliopsoas muscles. They walked at a speed of approximately 1m/s along the walkway under four experimental conditions: normal walking (NW), hamstrings contracture emulation (HAM), iliopsoas contracture emulation (IPS) and emulation of both hamstrings and iliopsoas contractures (IPSHAM). Reflective markers and force platform data were collected and ankle, knee and hip-joint angles, moments and powers were calculated. HAM and IPSHAM shifted ankle-angle rotation profiles into dorsiflexion during midstance compared to IPS and NW where ankle-angle trajectories were similar. HAM, IPS and IPSHAM shifted the knee angle of rotation profiles into flexion during stance, compared to NW. IPS and IPSHAM shifted hip angle of rotation profiles toward pronounced flexion while HAM shifted hip angle of rotation profile toward extension, compared to NW. HAM and IPSHAM significantly increased ankle moment during midstance, compared to IPS and NW where ankle moment profiles were similar. All experimental conditions exhibited similar behavior in the knee-moment profiles during midstance while IPS and IPSHAM knee-moment profiles exhibited significantly higher knee-extension moment during terminal stance and pre-swing. In the hip joint all experimental conditions exhibited similar shape of hip moment profiles throughout the gait cycle. HAM and IPS kinematic and kinetic patterns were qualitatively compared to two selected clinical cases, showing considerable similarity. This implies that distinct differences in kinematics and kinetics between HAM, IPS and IPSHAM may be clinically relevant in helping determine the relative contribution of hamstrings and iliopsoas muscles contractures to particular crouch walking.     

Gait variability magnitude but not structure is altered in essential tremor

Essential tremor (ET) is a common tremor disorder affecting postural/action tremor of the upper extremities and midline. Recent research revealed a cerebellar-like deficit during tandem gait in persons with ET, though spatiotemporal variability during normal gait in ET has been relatively ignored. The first purpose of this study was to investigate gait variability magnitude and structure in ET as compared to healthy older adults (HOA). To address this issue, 11 ET and 11 age-matched HOAs walked on a treadmill for 5 min at preferred walking speeds. HOAs walked for an additional minute while speed-matched to an ET participant. The second purpose was to describe the clinical correlates of gait variability in this population. To address this aim, 31 persons with ET walked on a treadmill for 5 min and completed the Fahn–Tolosa–Marin Tremor Rating Scale. Gait variability magnitude was derived by calculating coefficients of variation in stride length, stride time, step length, step time, and step width. Gait variability structure was derived using a detrended fluctuation analysis technique. At preferred walking speeds, ET participants walked significantly slower with significantly increased variability magnitude in all five spatiotemporal gait parameters. At speed-matched walking, ET participants exhibited significantly higher step width variability. Gait variability structure was not different between groups. We also observed that gait variability magnitude was predicted by severity of upper extremity and midline tremors. This study revealed that self-selected gait in ET is characterized by high variability that is associated with tremor severity in the upper extremity and midline.     

Changes in relative work of the lower extremity joints and distal foot with walking speed

The modulation of walking speed results in adaptations to the lower limbs which can be quantified using mechanical work. A 6 degree-of-freedom (DOF) power analysis, which includes additional translations as compared to the 3 DOF (all rotational) approach, is a comprehensive approach for quantifying lower limb work during gait. The purpose of this study was to quantify the speed-related 6 DOF joint and distal foot work adaptations of all the lower extremity limb constituents (hip, knee, ankle, and distal foot) in healthy individuals. Relative constituent 6 DOF work, the amount of constituent work relative to absolute limb work, was calculated during the stance and swing phases of gait. Eight unimpaired adults walked on an instrumented split-belt treadmill at slow, moderate, and typical walking speeds (0.4, 0.6, and 0.8 statures/s, respectively). Using motion capture and force data, 6 DOF powers were calculated for each constituent. Contrary to previously published results, 6 DOF positive relative ankle work and negative relative distal foot work increased significantly with increased speed during stance phase (p < 0.05). Similar to previous rotational DOF results in the sagittal plane, negative relative ankle work decreased significantly with increased speed during stance phase (p < 0.05). Scientifically, these findings provide new insight into how healthy individuals adapt to increased walking speed and suggest limitations of the rotational DOF approach for quantifying limb work. Clinically, the data presented here for unimpaired limbs can be used to compare with speed-matched data from limbs with impairments.     

Differences in lower-extremity muscular activation during walking between healthy older and young adults

Previous studies have identified differences in gait kinetics between healthy older and young adults. However, the underlying factors that cause these changes are not well understood. The objective of this study was to assess the effects of age and speed on the activation of lower-extremity muscles during human walking. We recorded electromyography (EMG) signals of the soleus, gastrocnemius, biceps femoris, medial hamstrings, tibialis anterior, vastus lateralis, and rectus femoris as healthy young and older adults walked over ground at slow, preferred and fast walking speeds. Nineteen healthy older adults (age, 73 ± 5 years) and 18 healthy young adults (age, 26 ± 3 years) participated. Rectified EMG signals were normalized to mean activities over a gait cycle at the preferred speed, allowing for an assessment of how the activity was distributed over the gait cycle and modulated with speed. Compared to the young adults, the older adults exhibited greater activation of the tibialis anterior and soleus during mid-stance at all walking speeds and greater activation of the vastus lateralis and medial hamstrings during loading and mid-stance at the fast walking speed, suggesting increased coactivation across the ankle and knee. In addition, older adults depend less on soleus muscle activation to push off at faster walking speeds. We conclude that age-related changes in neuromuscular activity reflect a strategy of stiffening the limb during single support and likely contribute to reduced push off power at fast walking speeds.     

Influence of patellar position on the knee extensor mechanism in normal and crouched walking

Patella alta is common in cerebral palsy, especially in patients with crouch gait. Correction of patella alta has been advocated in the treatment of crouch, however the appropriate degree of correction and the implications for knee extensor function remain unclear. Therefore, the goal of this study was to assess the impact of patellar position on quadriceps and patellar tendon forces during normal and crouch gait. To this end, a lower extremity musculoskeletal model with a novel 12 degree of freedom knee joint was used to simulate normal gait in a healthy child, as well as mild (23 deg min knee flexion in stance), moderate (41 deg), and severe (67 deg) crouch gait in three children with cerebral palsy. The simulations revealed that quadriceps and patellar tendon forces increase dramatically with crouch, and are modulated by patellar position. For example with a normal patellar tendon position, peak patellar tendon forces were 0.7 times body weight in normal walking, but reached 2.2, 3.2 and 5.4 times body weight in mild, moderate and severe crouch. Moderate patella alta acted to reduce quadriceps and patellar tendon loads in crouch gait, due to an enhancement of the patellar tendon moment arms with alta in a flexed knee. In contrast, patella baja reduced the patellar tendon moment arm in a flexed knee and thus induced an increase in the patellar tendon loads needed to walk in crouch. Functionally, these results suggest that patella baja could also compromise knee extensor function for other flexed knee activities such as chair rise and stair climbing. The findings are important to consider when using surgical approaches for correcting patella alta in children who exhibit crouch gait patterns.     

Muscle contributions to support and progression over a range of walking speeds

Muscles actuate walking by providing vertical support and forward progression of the mass center. To quantify muscle contributions to vertical support and forward progression (i.e., vertical and fore-aft accelerations of the mass center) over a range of walking speeds, three-dimensional muscle-actuated simulations of gait were generated and analyzed for eight subjects walking overground at very slow, slow, free, and fast speeds. We found that gluteus maximus, gluteus medius, vasti, hamstrings, gastrocnemius, and soleus were the primary contributors to support and progression at all speeds. With the exception of gluteus medius, contributions from these muscles generally increased with walking speed. During very slow and slow walking speeds, vertical support in early stance was primarily provided by a straighter limb, such that skeletal alignment, rather than muscles, provided resistance to gravity. When walking speed increased from slow to free, contributions to support from vasti and soleus increased dramatically. Greater stance-phase knee flexion during free and fast walking speeds caused increased vasti force, which provided support but also slowed progression, while contralateral soleus simultaneously provided increased propulsion. This study provides reference data for muscle contributions to support and progression over a wide range of walking speeds and highlights the importance of walking speed when evaluating muscle function.     

Joint moment work during the stance-to-swing transition in hemiparetic subjects

Following stroke many individuals are left with neurological and functional deficits, including hemiparesis, which impair their ability to walk. Our previous work reported that propulsion of the paretic leg during pre-swing is impaired and may limit gait speed and knee flexion during swing. To elucidate the mechanism of this impairment, we assessed the mechanical work produced by the hip, knee, and ankle moments during pre-swing of the paretic limb in a group of stroke subjects and compared it with the work produced by non-disabled controls walking at similar speeds. Kinematic and kinetic gait data were collected from 23 hemiparetic and 10 control subjects. The hemiparetic subjects walked at their self-selected speeds. The controls walked at their self-selected and two or three slower speeds. Even when compared to controls walking at slow speeds, ankle plantarflexor work during pre-swing was greatly reduced (-0.136+/-0.062J/kg) in the hemiparetic subjects. Differences in hip (+0.006+/-0.020J/kg) and knee (+0.040+/-0.026J/kg) moment work partially offset the reduction in ankle work, but net joint moment work was still significantly reduced (-0.088+/-0.056J/kg). The reduction in work accounts for the low energy of the paretic limb at the stance-to-swing transition previously reported. Future investigation is needed to determine if targeted training of the plantarflexors in the paretic limb improves swing-phase function and locomotor performance in hemiparetic individuals.     

Control of lateral weight transfer is associated with walking speed in individuals post-stroke

Restoring functional gait speed is an important goal for rehabilitation post-stroke. During walking, transferring of one’s body weight between the limbs and maintaining balance stability are necessary for independent functional gait. Although it is documented that individuals post-stroke commonly have difficulties with performing weight transfer onto their paretic limbs, it remains to be determined if these deficits contributed to slower walking speeds. The primary purpose of this study was to compare the weight transfer characteristics between slow and fast post-stroke ambulators. Participants (N = 36) with chronic post-stroke hemiparesis walked at their comfortable and maximal walking speeds on a treadmill. Participants were stratified into 2 groups based on their comfortable walking speeds (≥0.8 m/s or <0.8 m/s). Minimum body center of mass (COM) to center of pressure (COP) distance, weight transfer timing, step width, lateral foot placement relative to the COM, hip moment, peak vertical and anterior ground reaction forces, and changes in walking speed were analyzed. Results showed that slow walkers walked with a delayed and deficient weight transfer to the paretic limb, lower hip abductor moment, and more lateral paretic limb foot placement relative to the COM compared to fast walkers. In addition, propulsive force and walking speed capacity was related to lateral weight transfer ability. These findings demonstrated that deficits in lateral weight transfer and stability could potentially be one of the limiting factors underlying comfortable walking speeds and a determinant of chronic stroke survivors’ ability to increase walking speed.     

Gait in rheumatoid arthritis: an electrogoniometric investigation

For the purpose of detecting early aberrations of gait in rheumatoid arthritis 17 women suffering from that disease were examined. They were all under 50 years of age and had an essentially normal range of motility in the hips, knees and ankles. Eleven healthy women walking at voluntary speed and 6 healthy women walking at the same slow speed as the RA patients were included as controls. The recordings were made while the subject walked on a treadmill with a computerized electrogoniometer measuring the angular excursions of the hip, knee and ankle in three planes simultaneously. The patients with RA walked at a slower speed than did the healthy subjects (0.6 vs 1.2 ms-1). The angular excursions, i.e. inward and outward rotation, abduction and adduction, flexion and extension, were significantly less in the RA patients than in the healthy subjects who walked at voluntary speed. As compared to the healthy subjects walking at a slow speed, the differences in range of motility were much smaller. The major aberrations of the gait pattern were found in the ankles and feet, which showed reduced internal rotation (7 vs 10 degrees), adduction (6 vs 12 degrees) and a less pronounced plantar flexion at toe off (1 vs 8 degrees).     

Effect of walking speed changes on tibialis anterior EMG during healthy gait for FES envelope design in drop foot correction.

Functional electrical stimulation may be used to correct hemiplegic drop foot. An optimised stimulation envelope to reproduce the EMG pattern observed in the tibialis anterior (TA) during healthy gait has been proposed by O'Keeffe et al. [O'Keeffe, D.T., Donnelly, A.E., Lyons, G.M., 2003. The development of a potential optimised stimulation intensity envelope for drop foot applications. IEEE Transactions on Neural Systems and Rehabilitation Engineering]. However this envelope did not attempt to account for changes in TA activity with walking speed. The objective of this paper was to provide data to enable the specification of an algorithm to control the adaptation of an envelope with walking speed. Ten young healthy subjects walked on a treadmill at 11 different walking speeds while TA EMG was recorded. The results showed that TA EMG recorded around initial contact and at toe off changed with walking speed. At the slowest velocities, equivalent to hemiplegic walking, the toe-off burst (TOB) of EMG activity had larger peak amplitude than that of the heel-strike burst (HSB). The peak amplitude ratio of TOB:HSB was 1:0.69 at the slowest speed compared to, 1:1.18 and 1:1.5 for the self-selected and fastest speed, respectively. These results suggest that an FES envelope, which produces larger EMG amplitude for the TOB than the HSB, would be more appropriate at walking speeds typical of hemiplegic patients.     

Contributions of muscles to mediolateral ground reaction force over a range of walking speeds

Impaired control of mediolateral body motion during walking is an important health concern. Developing treatments to improve mediolateral control is challenging, partly because the mechanisms by which muscles modulate mediolateral ground reaction force (and thereby modulate mediolateral acceleration of the body mass center) during unimpaired walking are poorly understood. To investigate this, we examined mediolateral ground reaction forces in eight unimpaired subjects walking at four speeds and determined the contributions of muscles, gravity, and velocity-related forces to the mediolateral ground reaction force by analyzing muscle-driven simulations of these subjects. During early stance (0-6% gait cycle), peak ground reaction force on the leading foot was directed laterally and increased significantly (p<0.05) with walking speed. During early single support (14-30% gait cycle), peak ground reaction force on the stance foot was directed medially and increased significantly (p<0.01) with speed. Muscles accounted for more than 92% of the mediolateral ground reaction force over all walking speeds, whereas gravity and velocity-related forces made relatively small contributions. Muscles coordinate mediolateral acceleration via an interplay between the medial ground reaction force contributed by the abductors and the lateral ground reaction forces contributed by the knee extensors, plantarflexors, and adductors. Our findings show how muscles that contribute to forward progression and body-weight support also modulate mediolateral acceleration of the body mass center while weight is transferred from one leg to another during double support.     

Crouch severity is a poor predictor of elevated oxygen consumption in cerebral palsy

Children with cerebral palsy (CP) expend more energy to walk compared to typically-developing peers. One of the most prevalent gait patterns among children with CP, crouch gait, is often singled out as especially exhausting. The dynamics of crouch gait increase external flexion moments and the demand on extensor muscles. This elevated demand is thought to dramatically increase energy expenditure. However, the impact of crouch severity on energy expenditure has not been investigated among children with CP. We evaluated oxygen consumption and gait kinematics for 573 children with bilateral CP. The average net nondimensional oxygen consumption during gait of the children with CP (0.18 ± 0.06) was 2.9 times that of speed-matched typically-developing peers. Crouch severity was only modestly related to oxygen consumption, with measures of knee flexion angle during gait explaining only 5–20% of the variability in oxygen consumption. While knee moment and muscle activity were moderately to strongly correlated with crouch severity (r² = 0.13–0.73), these variables were only weakly correlated with oxygen consumption (r² = 0.02–0.04). Thus, although the dynamics of crouch gait increased muscle demand, these effects did not directly result in elevated energy expenditure. In clinical gait analysis, assumptions about an individual’s energy expenditure should not be based upon kinematics or kinetics alone. Identifying patient-specific factors that contribute to increased energy expenditure may provide new pathways to improve gait for children with CP.     

The Combined Effects of Body Weight Support and Gait Speed on Gait Related Muscle Activity: A Comparison between Walking in the Lokomat Exoskeleton and Regular Treadmill Walking

Background

For the development of specialized training protocols for robot assisted gait training, it is important to understand how the use of exoskeletons alters locomotor task demands, and how the nature and magnitude of these changes depend on training parameters. Therefore, the present study assessed the combined effects of gait speed and body weight support (BWS) on muscle activity, and compared these between treadmill walking and walking in the Lokomat exoskeleton.

Methods

Ten healthy participants walked on a treadmill and in the Lokomat, with varying levels of BWS (0% and 50% of the participants’ body weight) and gait speed (0.8, 1.8, and 2.8 km/h), while temporal step characteristics and muscle activity from Erector Spinae, Gluteus Medius, Vastus Lateralis, Biceps Femoris, Gastrocnemius Medialis, and Tibialis Anterior muscles were recorded.

Results

The temporal structure of the stepping pattern was altered when participants walked in the Lokomat or when BWS was provided (i.e. the relative duration of the double support phase was reduced, and the single support phase prolonged), but these differences normalized as gait speed increased. Alternations in muscle activity were characterized by complex interactions between walking conditions and training parameters: Differences between treadmill walking and walking in the exoskeleton were most prominent at low gait speeds, and speed effects were attenuated when BWS was provided.

Conclusion

Walking in the Lokomat exoskeleton without movement guidance alters the temporal step regulation and the neuromuscular control of walking, although the nature and magnitude of these effects depend on complex interactions with gait speed and BWS. If normative neuromuscular control of gait is targeted during training, it is recommended that very low speeds and high levels of BWS should be avoided when possible.