Repeatability of 3D gait kinematics obtained from an electromagnetic tracking system during treadmill locomotion

The purpose of this paper was to describe a technique that enables three-dimensional (3D) gait kinematics to be obtained using an electromagnetic tracking system, and to report the intra-trial, intra-day/inter-tester and inter-day/intra-tester repeatability of kinematic gait data obtained using this technique. Ten able-bodied adults underwent four gait assessments; the same two testers tested each subject independently on two different days. Gait assessments were conducted on a custom-built long-bed treadmill with no metal components between the rollers. Each gait assessment involved familiarisation to treadmill walking, subject anatomical and functional calibration, and a period of steady-state treadmill walking at a self-selected speed. Following data collection, 3D joint kinematics were calculated using the joint coordinate system approach. 3D joint angle waveforms for 10 left and right strides were extracted and temporally normalised for each trial. Intra-trial, intra-day/inter-tester and inter-day/intra-tester repeatability of the temporally normalised kinematic waveforms were quantified using the coefficient of multiple determination (CMD). CMDs for joint kinematics averaged 0.942 intra-trial, 0.849 intra-day/inter-tester and 0.773 inter-day/intra-tester. In general, sagittal plane kinematics were more repeatable than frontal or transverse plane kinematics, and kinematics at the hip were more repeatable than at the knee or ankle. The level of repeatability of kinematic gait data obtained during treadmill walking using this protocol was equal or superior to that reported previously for overground walking using image-based protocols.     

Comparison of lower extremity kinematic curves during overground and treadmill running

Researchers conduct gait analyses utilizing both overground and treadmill modes of running. Previous studies comparing these modes analyzed discrete variables. Recently, techniques involving quantitative pattern analysis have assessed kinematic curve similarity in gait. Therefore, the purpose of this study was to compare hip, knee and rearfoot 3-D kinematics between overground and treadmill running using quantitative kinematic curve analysis. Twenty runners ran at 3.35 m/s ± 5% during treadmill and overground conditions while right lower extremity kinematics were recorded. Kinematics of the hip, knee and rearfoot at footstrike and peak were compared using intraclass correlation coefficients. Kinematic curves during stance phase were compared using the trend symmetry method within each subject. The overall average trend symmetry was high, 0.94 (1.0 is perfect symmetry) between running modes. The transverse plane and knee frontal plane exhibited lower similarity (0.86-0.90). Other than a 4.5 degree reduction in rearfoot dorsiflexion at footstrike during treadmill running, all differences were ≤1.5 degrees. 17/18 discrete variables exhibited modest correlations (>0.6) and 8/18 exhibited strong correlations (>0.8). In conclusion, overground and treadmill running kinematic curves were generally similar when averaged across subjects. Although some subjects exhibited differences in transverse plane curves, overall, treadmill running was representative of overground running for most subjects.     

The effects of alignment of an articulated ankle-foot orthosis on lower limb joint kinematics and kinetics during gait in individuals post-stroke

Mechanical tuning of an ankle-foot orthosis (AFO) is important in improving gait in individuals post-stroke. Alignment and resistance are two factors that are tunable in articulated AFOs. The aim of this study was to investigate the effects of changing AFO ankle alignment on lower limb joint kinematics and kinetics with constant dorsiflexion and plantarflexion resistance in individuals post-stroke. Gait analysis was performed on 10 individuals post-stroke under four distinct alignment conditions using an articulated AFO with an ankle joint whose alignment is adjustable in the sagittal plane. Kinematic and kinetic data of lower limb joints were recorded using a Vicon 3-dimensional motion capture system and Bertec split-belt instrumented treadmill. The incremental changes in the alignment of the articulated AFO toward dorsiflexion angles significantly affected ankle and knee joint angles and knee joint moments while walking in individuals post-stroke. No significant differences were found in the hip joint parameters. The alignment of the articulated AFO was suggested to play an important role in improving knee joint kinematics and kinetics in stance through improvement of ankle joint kinematics while walking in individuals post-stroke. Future studies should investigate long-term effects of AFO alignment on gait in the community in individuals post-stroke.     

Lower extremity control during turns initiated with and without hip external rotation

The pirouette turn is often initiated in neutral and externally rotated hip positions by dancers. This provides an opportunity to investigate how dancers satisfy the same mechanical objectives at the whole-body level when using different leg kinematics. The purpose of this study was to compare lower extremity control strategies during the turn initiation phase of pirouettes performed with and without hip external rotation. Skilled dancers (n=5) performed pirouette turns with and without hip external rotation. Joint kinetics during turn initiation were determined for both legs using ground reaction forces (GRFs) and segment kinematics. Hip muscle activations were monitored using electromyography. Using probability-based statistical methods, variables were compared across turn conditions as a group and within-dancer. Despite differences in GRFs and impulse generation between turn conditions, at least 90% of each GRF was aligned with the respective leg plane. A majority of the net joint moments at the ankle, knee, and hip acted about an axis perpendicular to the leg plane. However, differences in shank alignment relative to the leg plane affected the distribution of the knee net joint moment when represented with respect to the shank versus the thigh. During the initiation of both turns, most participants used ankle plantar flexor moments, knee extensor moments, flexor and abductor moments at the push leg׳s hip, and extensor and abductor moments at the turn leg׳s hip. Representation of joint kinetics using multiple reference systems assisted in understanding control priorities.     

Changes in knee function associated with treadmill ambulation

A comparison of level walking, on a walkway and on a treadmill, was performed using ten normal subjects. Motion about the knee was measured using a triaxial electrogoniometer, and foot-floor contact patterns were recorded by means of four foot switches attached to the sole of each shoe. On the walkway, the data were collected with the subject moving at a comfortable walking speed. The treadmill was then set at the average velocity obtained on the walkway. Knee joint rotation in the coronal and transverse planes did not change significantly between the walkway and the treadmill. In the sagittal plane, significant differences were found for total motion (p less than 0.01), swing phase motion (p less than 0.01), knee position at heel strike (p less than 0.05), and maximum swing phase extension (p less than 0.01). A comparison of the foot-floor contact patterns between walkway and treadmill ambulation revealed reduced heel contact time, with an increase in toe contact while on the treadmill. It was concluded that sagittal plane knee kinematics during level treadmill walking differ significantly from level overground walking.     

Experimentally reduced hip abductor function during walking: Implications for knee joint loads

Hip and knee functions are intimately connected and reduced hip abductor function might play a role in development of knee osteoarthritis (OA) by increasing the external knee adduction moment during walking. The purpose of this study was to test the hypothesis that reduced function of the gluteus medius (GM) muscle would lead to increased external knee adduction moment during level walking in healthy subjects. Reduced GM muscle function was induced experimentally, by means of intramuscular injections of hypertonic saline that produced an intense short-term muscle pain and reduced muscle function. Isotonic saline injections were used as non-painful control. Fifteen healthy subjects performed walking trials at their self-selected walking speed before and immediately after injections, and again after 20 min of rest, to ensure pain recovery. Standard gait analyses were used to calculate three-dimensional trunk and lower extremity joint kinematics and kinetics. Surface electromyography (EMG) of the glutei, quadriceps, and hamstring muscles were also measured. The peak GM EMG activity had temporal concurrence with peaks in frontal plane moments at both hip and knee joints. The EMG activity in the GM muscle was significantly reduced by pain (?39.6%). All other muscles were unaffected. Peaks in the frontal plane hip and knee joint moments were significantly reduced during pain (?6.4% and ?4.2%, respectively). Lateral trunk lean angles and midstance hip joint adduction and knee joint extension angles were reduced by ?1°. Thus, the gait changes were primarily caused by reduced GM function. Walking with impaired GM muscle function due to pain significantly reduced the external knee adduction moment. This study challenge the notion that reduced GM function due to pain would lead to increased loads at the knee joint during level walking.     

Biomechanical impairments and gait adaptations post-stroke: Multi-factorial associations

Understanding the potential causes of both reduced gait speed and compensatory frontal plane kinematics during walking in individuals post-stroke may be useful in developing effective rehabilitation strategies. Multiple linear regression analysis was used to select the combination of paretic limb impairments (frontal and sagittal plane hip strength, sagittal plane knee and ankle strength, and multi-joint knee/hip torque coupling) which best estimate gait speed and compensatory pelvic obliquity velocities at toeoff. Compensatory behaviors were defined as deviations from control subjects’ values. The gait speed model (n=18; p=0.003) revealed that greater hip abduction strength and multi-joint coupling of sagittal plane knee and frontal plane hip torques were associated with decreased velocity; however, gait speed was positively associated with paretic hip extension strength. Multi-joint coupling was the most influential predictor of gait speed. The second model (n=15; p<0.001) revealed that multi-joint coupling was associated with increased compensatory pelvic movement at toeoff; while hip extension and flexion and knee flexion strength were associated with reduced frontal plane pelvic compensations. In this case, hip extension strength had the greatest influence on pelvic behavior. The analyses revealed that different yet overlapping sets of single joint strength and multi-joint coupling measures were associated with gait speed and compensatory pelvic behavior during walking post-stroke. These findings provide insight regarding the potential impact of targeted rehabilitation paradigms on improving speed and compensatory kinematics following stroke.     

Knee moment outcomes using inverse dynamics and the cross product function in moderate knee osteoarthritis gait: A comparison study

Inverse dynamics are the cornerstone of biomechanical assessments to calculate knee moments during walking. In knee osteoarthritis, these outcomes have been used to understand knee pathomechanics, but the complexity of an inverse dynamic model may limit the uptake of joint moments in some clinical and research structures. The objective was to determine whether discrete features of the sagittal and frontal plane knee moments calculated using inverse dynamics compare to knee moments calculated using a cross product function. Knee moments from 74 people with moderate knee osteoarthritis were assessed after ambulating at a self-selected speed on an instrumented dual belt treadmill. Standardized procedures were used for surface marker placement, gait speed determination and data processing. Net external frontal and sagittal plane knee moments were calculated using inverse dynamics and the three-dimensional position of the knee joint center with respect to the center of pressure was crossed with the three-dimensional ground reaction forces in the cross product function. Correlations were high between outcomes of the moment calculations (r > 0.9) and for peak knee adduction moment, knee adduction moment impulse and difference between peak flexion and extension moments, the cross product function resulted in absolute values less than 10% of those calculated using inverse dynamics in this treadmill walking environment. This computational solution may allow the integration of knee moment calculations to understand knee osteoarthritis gait without data collection or computational complexity.     

Walking on high heels changes muscle activity and the dynamics of human walking significantly

The aim of the study was to investigate the distribution of net joint moments in the lower extremities during walking on high-heeled shoes compared with barefooted walking at identical speed. Fourteen female subjects walked at 4 km/h across three force platforms while they were filmed by five digital video cameras operating at 50 frames/second. Both barefooted walking and walking on high-heeled shoes (heel height: 9 cm) were recorded. Net joint moments were calculated by 3D inverse dynamics. EMG was recorded from eight leg muscles. The knee extensor moment peak in the first half of the stance phase was doubled when walking on high heels. The knee joint angle showed that high-heeled walking caused the subjects to flex the knee joint significantly more in the first half of the stance phase. In the frontal plane a significant increase was observed in the knee joint abductor moment and the hip joint abductor moment. Several EMG parameters increased significantly when walking on high-heels. The results indicate a large increase in bone-on-bone forces in the knee joint directly caused by the increased knee joint extensor moment during high-heeled walking, which may explain the observed higher incidence of osteoarthritis in the knee joint in women as compared with men.     

Identification of passive elastic joint moment-angle relationships in the lower extremity

The purpose of this study was to develop a method for identifying subject-specific passive elastic joint moment-angle relationships in the lower extremity, which could subsequently be used to estimate passive contributions to joint kinetics during gait. Twenty healthy young adults participated in the study. Subjects were positioned side-lying with their dominant limb supported on a table via low-friction carts. A physical therapist slowly manipulated the limb through full sagittal hip, knee, and ankle ranges of motion using two hand-held 3D load cells. Lower extremity kinematics, measured with a passive marker motion capture system, and load cell readings were used to compute joint angles and associated passive joint moments. We formulated a passive joint moment-angle model that included eight exponential functions to account for forces generated via the passive stretch of uni-articular structures and bi-articular muscles. Model parameters were estimated for individual subjects by minimizing the sum of squared errors between model predicted and experimentally measured moments. The model predictions closely replicated measured joint moments with average root-mean-squared errors of 2.5, 1.4, and 0.7 Nm about the hip, knee, and ankle respectively. We show that the models can be coupled with gait kinematics to estimate passive joint moments during walking. Passive hip moments were substantial from terminal stance through initial swing, with energy being stored as the hip extended and subsequently returned during pre- and initial swing. We conclude that the proposed methodology could provide quantitative insights into the potentially important role that passive mechanisms play in both normal and abnormal gait.     

Walking with increased ankle pushoff decreases hip muscle moments

In a simple bipedal walking model, an impulsive push along the trailing limb (similar to ankle plantar flexion) or a torque at the hip can power level walking. This suggests a tradeoff between ankle and hip muscle requirements during human gait. People with anterior hip pain may benefit from walking with increased ankle pushoff if it reduces hip muscle forces. The purpose of our study was to determine if simple instructions to alter ankle pushoff can modify gait dynamics and if resulting changes in ankle pushoff have an effect on hip muscle requirements during gait. We hypothesized that changes in ankle kinetics would be inversely related to hip muscle kinetics. Ten healthy subjects walked on a custom split-belt force-measuring treadmill at 1.25m/s. We recorded ground reaction forces and lower extremity kinematic data to calculate joint angles and internal muscle moments, powers and angular impulses. Subjects walked under three conditions: natural pushoff, decreased pushoff and increased pushoff. For the decreased pushoff condition, subjects were instructed to push less with their feet as they walked. Conversely, for the increased pushoff condition, subjects were instructed to push more with their feet. As predicted, walking with increased ankle pushoff resulted in lower peak hip flexion moment, power and angular impulse as well as lower peak hip extension moment and angular impulse (p<0.05). Our results emphasize the interchange between hip and ankle kinetics in human walking and suggest that increased ankle pushoff during gait may help to compensate for hip muscle weakness or injury and reduce hip joint forces.     

The effect of direct measurement versus cadaver estimates of anthropometry in the calculation of joint moments during above-knee prosthetic gait in pediatrics

Joint reaction forces, moments and powers are important in interpreting gait mechanics and compensatory strategies used by patients walking with above-knee prostheses. Segmental anthropometrics, required to calculate joint moments, are often estimated using data from cadaver studies. However, these values may not be accurate for patients following amputation as prostheses are composed of non-biologic material. The purpose of this study was to compare joint moments using anthropometrics calculated from cadaver studies versus direct measurements of the residual limb and prosthesis for children with an above-knee amputation. Gait data were collected for four subjects with above-knee prostheses walking at preferred and fast speeds. Joint moments were computed using anthropometrics from cadaver studies and direct measurements for each subject. The difference between these two methods primarily affected the inertia couple (Ialpha term) and the inertial effect due to gravity, which comprised a greater percentage of the total joint moment during swing as compared to stance. Peak hip and knee flexor and extensor moments during swing were significantly greater when calculated using cadaver data (p<0.05). These differences were greater while walking fast as compared to slow speeds. A significant difference was not found between these two methods for peak hip and knee moments during stance. A significant difference was found for peak ankle joint moments during stance, but the magnitude was not clinically important. These results support the use of direct measurements of anthropometry when examining above-knee prosthetic gait, particularly during swing.     

Invariant hip moment pattern while walking with a robotic hip exoskeleton

Robotic lower limb exoskeletons hold significant potential for gait assistance and rehabilitation; however, we have a limited understanding of how people adapt to walking with robotic devices. The purpose of this study was to test the hypothesis that people reduce net muscle moments about their joints when robotic assistance is provided. This reduction in muscle moment results in a total joint moment (muscle plus exoskeleton) that is the same as the moment without the robotic assistance despite potential differences in joint angles. To test this hypothesis, eight healthy subjects trained with the robotic hip exoskeleton while walking on a force-measuring treadmill. The exoskeleton provided hip flexion assistance from approximately 33% to 53% of the gait cycle. We calculated the root mean squared difference (RMSD) between the average of data from the last 15 min of the powered condition and the unpowered condition. After completing three 30-min training sessions, the hip exoskeleton provided 27% of the total peak hip flexion moment during gait. Despite this substantial contribution from the exoskeleton, subjects walked with a total hip moment pattern (muscle plus exoskeleton) that was almost identical and more similar to the unpowered condition than the hip angle pattern (hip moment RMSD 0.027, angle RMSD 0.134, p<0.001). The angle and moment RMSD were not different for the knee and ankle joints. These findings support the concept that people adopt walking patterns with similar joint moment patterns despite differences in hip joint angles for a given walking speed.     

Implications of increased medio-lateral trunk sway for ambulatory mechanics

The purposes of this study was to test a mechanism to reduce the knee adduction moment by testing the hypothesis that increased medio-lateral trunk sway can reduce the knee adduction moment during ambulation in healthy subjects, and to examine the possibility that increasing medio-lateral trunk sway can produce similar potentially adverse secondary gait changes previously associated with reduced knee adduction moments in patients with knee osteoarthritis. Nineteen healthy adults performed walking trials with normal and increased medio-lateral trunk sway at a self-selected normal walking speed. Standard gait analysis was used to calculate three-dimensional lower extremity joint kinematics and kinetics. Knee and hip adduction moments were lower (-65.0% and -57.1%, respectively) for the increased medio-lateral trunk sway trials than for the normal trunk sway trials. Knee flexion angle at heel-strike was 3 degrees higher for the increased than for the normal trunk sway trials. Knee and hip abduction moments were higher for the increased medio-lateral trunk sway trials, and none of the other variables differed between the two conditions. Walking with increased medio-lateral trunk sway substantially reduces the knee adduction moment during walking in healthy subjects without some of the adverse secondary effects such as increased axial loading rates at the major joints of the lower extremity. This result supports the potential of using gait retraining for walking with increased medio-lateral trunk sway as treatment for patients with degenerative joint disease such as medial compartment knee osteoarthritis.     

A normative database of hip and knee joint biomechanics during dynamic tasks using anatomical regression prediction methods

Many methodologies exist to predict the hip joint center (HJC), of which regression based on anatomical landmarks appear most common. Despite the fact that predicted HJC locations vary depending upon chosen method, inter-study comparisons and inferences about populations are commonly made. The purpose of this study was to create a normative database of hip and knee biomechanics during walking, running, and single leg landings based on five commonly utilized HJC methods to serve as a reference for inter-study comparisons. Secondarily, we devised to provide comparisons of peak knee angles and hip angles, moments, and powers from the five HJC methods. Thirty healthy young adults performed walking, running, and single leg landing tasks at self-selected speeds (walking/running) and at 90% of their maximum jump height (landing). Three-dimensional motion capture and ground reaction forces were collected during all tasks. Five different HJC prediction methods: Bell, Davis, Hara, Harrington, and Greater Trochanter were implemented separately in a 6 degree of freedom model. Predicted HJC locations, direct kinematics, and inverse dynamics were computed for all tasks. Predicted HJC mediolateral, anteroposterior, and superior-inferior locations differed between methods by an average of 1.3, 2.9, and 1.4 cm, respectively. A database was created using the mean of all subjects for all five methods. In addition, one-way ANOVAs were used to compare triplanar peak angles, moments, and powers between the methods. The database of hip and knee biomechanics illustrates (1) variability between methods increases with more dynamic tasks (running/landing vs. walking) and (2) frontal and transverse plane hip and knee biomechanics are more variable between methods. Comparisons between methods found 38 and 16 main effect differences in hip and knee biomechanics, respectively. The Greater Trochanter method provided the most differences compared with other methods, while the Davis method provided the least differences. The database constructed provides an important reference for inter-study comparisons and details the impact of anatomical regression methods for predicting the HJC.     

Assessing the Relative Contributions of Active Ankle and Knee Assistance to the Walking Mechanics of Transfemoral Amputees Using a Powered Prosthesis

Powered knee-ankle prostheses are capable of providing net-positive mechanical energy to amputees. Yet, there are limitless ways to deliver this energy throughout the gait cycle. It remains largely unknown how different combinations of active knee and ankle assistance affect the walking mechanics of transfemoral amputees. This study assessed the relative contributions of stance phase knee swing initiation, increasing ankle stiffness and powered plantarflexion as three unilateral transfemoral amputees walked overground at their self-selected walking speed. Five combinations of knee and ankle conditions were evaluated regarding the kinematics and kinetics of the amputated and intact legs using repeated measures analyses of variance. We found eliminating active knee swing initiation or powered plantarflexion was linked to increased compensations of the ipsilateral hip joint during the subsequent swing phase. The elimination of knee swing initiation or powered plantarflexion also led to reduced braking ground reaction forces of the amputated and intact legs, and influenced both sagittal and frontal plane loading of the intact knee joint. Gradually increasing prosthetic ankle stiffness influenced the shape of the prosthetic ankle plantarflexion moment, more closely mirroring the intact ankle moment. Increasing ankle stiffness also corresponded to increased prosthetic ankle power generation (despite a similar maximum stiffness value across conditions) and increased braking ground reaction forces of the amputated leg. These findings further our understanding of how to deliver assistance with powered knee-ankle prostheses and the compensations that occur when specific aspects of assistance are added/removed.     

Gait characteristics of patients with knee osteoarthritis.

The knee kinematics and kinetics of 139 patients (47 males and 92 females) with Grade II knee osteoarthritis (OA) were measured during level walking, stair ascent and stair descent. There was no significant difference in knee motion between the patients and normal subjects. The patients with knee OA had a significantly reduced internal knee extensor moment compared to normal subjects. This difference reflects the patient's compensation to reduce the knee joint loading. Further, subjects with OA and a higher body mass index have a lower knee extensor moment. The female subjects had significantly greater knee flexion and a greater knee extensor moment. This gender difference may partially explain the increased prevalence of OA in females. Most tests of OA treatments are assessed by criteria that do not reflect functional activities. This study demonstrates that objective gait analysis can be used to document gait adaptations used by patients with knee OA.     

Biomechanical characterization and clinical implications of artificially induced toe-walking: differences between pure soleus, pure gastrocnemius and combination of soleus and gastrocnemius contractures

The purpose of this study was to characterize biomechanically three different toe-walking gait patterns, artificially induced in six neurologically intact subjects and to compare them to selected cases of pathological toe-walking. The subjects, equipped with lightweight mechanical exoskeleton with elastic ropes attached to the left leg's heel on one end and on shank and thigh on the other end in a similar anatomical locations where soleus and gastrocnemius muscles attach to skeleton, walked at speed of approximately 1m/s along the walkway under four experimental conditions: normal walking (NW), soleus contracture emulation (SOL), gastrocnemius contracture emulation (GAS) and emulation of both soleus and gastrocnemius contractures (SOLGAS). Reflective markers and force platform data were collected and ankle, knee and hip joint angles, moments and powers were calculated using inverse dynamic model for both legs. Characteristic peaks of averaged kinematic and kinetic patterns were compared among all four experimental conditions in one-way ANOVA. In the left leg SOL contracture mainly influenced the ankle angle trajectory, while GAS and SOLGAS contractures influenced the ankle and knee angle trajectories. GAS and SOLGAS contractures significantly increased ankle moment during midstance as compared to SOL contracture and NW. All three toe-walking experimental conditions exhibited significant power absorption in the ankle during loading response, which was absent in the NW condition, while during preswing significant decrease in power absorption as compared to NW was seen. In the knee joint SOL contracture diminished, GAS contracture increased while SOLGAS contracture approximately halved knee extensor moment during midstance as compared to NW. All three toe-walking experimental conditions decreased hip range of motion, hip flexor moment and power requirements during stance phase. Main difference in the right leg kinematic and kinetic patterns was seen in the knee moment trajectory, where significant increase in the knee extensor moment took place in terminal stance for GAS and SOLGAS experimental conditions as compared to SOL and NW. The kinetic trajectories under SOL and GAS experimental conditions were qualitatively compared to two selected clinical cases showing considerable similarity. This implies that distinct differences in kinetics between SOL, GAS and SOLGAS experimental conditions, as described in this paper, may be clinically relevant in determining the relative contribution of soleus and gastrocnemius muscles contractures to toe-walking in particular pathological gait.     

Muscle synergies are similar when typically developing children walk on a treadmill at different speeds and slopes

BackgroundThe aim of this study was to determine whether changes in synergies relate to changes in gait while walking on a treadmill at multiple speeds and slopes. The hypothesis was that significant changes in movement pattern would not be accompanied by significant changes in synergies, suggesting that synergies are not dependent on the mechanical constraints but are instead neurological in origin.MethodsSixteen typically developing children walked on a treadmill for nine combinations (stages) of different speeds and slopes while simultaneously collecting kinematics, kinetics, and surface electromyography (EMG) data. The kinematics for each stride were summarized using a modified version of the Gait Deviation Index that only includes the sagittal plane. The kinetics for each stride were summarized using a modified version of the Gait Deviation Index – Kinetic which includes sagittal plane moments and powers. Within each synergy group, the correlations of the synergies were calculated between the treadmill stages.ResultsWhile kinematics and kinetics were significantly altered at the highest slope compared to level ground when walking on a treadmill, synergies were similar across stages.ConclusionsThe high correlations between synergies across stages indicate that neuromuscular control strategies do not change as children walk at different speeds and slopes on a treadmill. However, the multiple significant differences in kinematics and kinetics between stages indicate real differences in movement pattern. This supports the theory that synergies are neurological in origin and not simply a response to the biomechanical task constraints.     

Kinematic and kinetic features of normal level walking in patellofemoral pain syndrome: More than a sagittal plane alteration

Patients with patellofemoral pain syndrome (PFPS) often report discomfort and pain during walking. To date, most of the studies conducted to determine gait alterations in PFPS patients have focused on sagittal plane alterations. Physiological and biomechanical factors, however, suggest that frontal and transverse plane alterations may be involved in PFPS. We therefore decided to conduct a kinematic and kinetic evaluation on all three planes in 9 PFPS subjects and 9 healthy sex- and age-matched controls. General gait characteristics were similar in patients and controls, with the exception of swing velocity, which was lower in PFPS patients. Patients also displayed an increased knee abductor and external rotator moments in loading response, and reduced knee extensor moment both in loading response and in terminal stance. We speculate that these findings may be linked both to a pain-avoiding gait pattern and to alterations in the timing of activation of different components of the quadriceps muscle, which is typical of PFPS. The relevance for clinicians is this gait pattern may represent a biomechanical risk factor for future knee osteoarthritis. We therefore recommend that treatments aimed at PFPS should also attempt to restore a correct walking pattern.