Effect of walking speed and severity of hip osteoarthritis on gait variability

Gait analysis in orthopaedic and neurological examinations is important; however, few studies assess gait variability at different walking speeds in patients with varying degrees of hip osteoarthritis. We aimed to clarify (1) how different controlled speeds and (2) various severities of hip osteoarthritis influence gait variability. Gait variability was described by the standard deviation (SD) of the spatial–temporal and mean standard deviation (MeanSD) of angular parameters. The spatial positions of the anatomical points for calculating gait parameters were determined in 20 healthy elderly controls and 20 patients with moderate and 20 patients with severe hip osteoarthritis with a zebris CMS-HS ultrasound-based motion analysis system at three walking speeds. The SD of the spatial–temporal and MeanSD of angular parameters of gait, which together describe gait variability, significantly depended on speed and osteoarthritis severity. The lowest variability in the gait was found near the self-selected walking speeds. Hip joint degeneration significantly worsened variability on the affected side, with non-affected joints and the pelvis compensating by increasing flexibility and adapting to step-by-step motions. Particular attention must be paid to improving gait stability and the reliability of limb movements in the presence of and increasing severity of osteoarthritis.     

Quantifying lumbar–pelvis coordination during gait using a modified vector coding technique

The complexity of human gait patterns has become a topic of major interest in motor control and biomechanics. Range of motion is still the preferred method to quantify movement impairment, however, within these traditional linear measures, the inter-segmental coordination and movement variability is normally ignored. A dynamical systems approach using vector coding and circular statistics provides non-linear techniques to quantify coordination and variability. This study provides comprehensive vector coding and circular statistics calculations. Additionally, pelvis–lumbar coordination and coordination variability data obtained from ten healthy young male participants during five walking trials using an optoelectronic system is provided. This novel data can form the baseline information for future studies in this area of research. Finally, a new illustration to present coordination and coordination variability information of gait kinematics, combining the output from the modified vector coding technique with traditional time-series segmental angle data is presented. This technique, when applied to single patients can be beneficial to assess the effect of an intervention on the patient-specific inter-segmental coordination pattern with implications to the clinical setting.     

Differences between local and orbital dynamic stability during human walking

Currently there is no commonly accepted way to define, much less quantify, locomotor stability. In engineering, "orbital stability" is defined using Floquet multipliers that quantify how purely periodic systems respond to perturbations discretely from one cycle to the next. For aperiodic systems, "local stability" is defined by local divergence exponents that quantify how the system responds to very small perturbations continuously in real time. Triaxial trunk accelerations and lower extremity sagittal plane joint angles were recorded from ten young healthy subjects as they walked for 10 min over level ground and on a motorized treadmill at the same speed. Maximum Floquet multipliers (Max FM) were computed at each percent of the gait cycle (from 0% to 100%) for each time series to quantify the orbital stability of these movements. Analyses of variance comparing Max FM values between walking conditions and correlations between Max FM values and previously published local divergence exponent results were computed. All subjects exhibited orbitally stable walking kinematics (i.e., magnitudes of Max FM < 1.0), even though these same kinematics were previously found to be locally unstable. Variations in orbital stability across the gait cycle were generally small and exhibited no systematic patterns. Walking on the treadmill led to small, but statistically significant improvements in the orbital stability of mediolateral (p = 0.040) and vertical (p = 0.038) trunk accelerations and ankle joint kinematics (p = 0.002). However, these improvements were not exhibited by all subjects (p < or = 0.012 for subject x condition interaction effects). Correlations between Max FM values and previously published local divergence exponents were inconsistent and 11 of the 12 comparisons made were not statistically significant (r2 < or = 19.8%; p > or = 0.049). Thus, the variability inherent in human walking, which manifests itself as local instability, does not substantially adversely affect the orbital stability of walking. The results of this study will allow future efforts to gain a better understanding of where the boundaries lie between locally unstable movements that remain orbitally stable and those that lead to global instability (i.e., falling).     

Effect of severity of knee osteoarthritis on the variability of gait parameters

Gait analysis has provided important information concerning gait patterns and variability of gait in patients with knee osteoarthritis (OA) of varying severity. The objective of this study was to clarify how the variability of gait parameters is influenced by the severity of knee OA. Gait analysis was performed at three different controlled walking speeds in three groups of subjects with varying degrees of knee OA (20 healthy subjects with no OA and 90 patients with moderate or severe OA). The variability of gait parameters was characterized by the coefficient of variance (CV) of spatial-temporal parameters, as well as by the mean coefficient variance (MeanCV) of angular parameters. Based on our results, we conclude that the complexity of gait decreases if the walking speed differs from the self-selected speed. In patients with knee OA, the decreased variability of angular parameters on the affected side represents decreased joint flexibility. This leads to decreased consistency in movements of the lower limbs from stride-to-stride, as shown by increased variability of spatial-temporal parameters. Decreased joint flexibility and consistency of movement can be associated with decreased complexity of movement. Other joints of the kinetic chain, such as joints of the non-affected side and the pelvis, play an important role in compensation and adaptation of step-by step motion and in the ability of secure gait. Results suggest that the variability of gait associated with knee osteoarthritis is gender-dependent. During rehabilitation, particular attention must be paid to improving gait stability and proprioception and gender differences should be taken into account.     

Dynamic stability of individuals with transtibial amputation walking in destabilizing environments

Lower limb amputation substantially disrupts motor and proprioceptive function. People with lower limb amputation experience considerable impairments in walking ability, including increased fall risk. Understanding the biomechanical aspects of the gait of these patients is crucial in improving their gait function and their quality of life. In the present study, 9 persons with unilateral transtibial amputation and 13 able-bodied controls walked on a large treadmill in a Computer Assisted Rehabilitation Environment (CAREN). While walking, subjects were either not perturbed, or were perturbed either by continuous mediolateral platform movements or by continuous mediolateral movements of the visual scene. Means and standard deviations of both step lengths and step widths increased significantly during both perturbation conditions (all p<0.001) for both groups. Measures of variability, local and orbital dynamic stability of trunk movements likewise exhibited large and highly significant increases during both perturbation conditions (all p<0.001) for both groups. Patients with amputation exhibited greater step width variability (p=0.01) and greater trunk movement variability (p=0.04) during platform perturbations, but did not exhibit greater local or orbital instability than healthy controls for either perturbation conditions. Our findings suggest that, in the absence of other co-morbidities, patients with unilateral transtibial amputation appear to retain sufficient sensory and motor function to maintain overall upper body stability during walking, even when substantially challenged. Additionally, these patients did not appear to rely more heavily on visual feedback to maintain trunk stability during these walking tasks.     

Local dynamic stability versus kinematic variability of continuous overground and treadmill walking

This study quantified the relationships between local dynamic stabiliht and variabilitr during continuous overground and treadmill walking. Stride-to-stride standard deviations were computed from temporal and kinematic data. Marimum finite-time Lyapunov exponents were estimated to quantify local dynamic stability. Local stability of gait kinematics was shown to be achieved over multiple consecutive strides. Traditional measures of variability poorly predicted local stability. Treadmill walking was associated with significant changes in both variability and local stability. Thus, motorized treadmills may produce misleading or erroneous results in situations where changes in neuromuscular control are likely to affect the variability and/or stability of locomotion.     

Leg and Joint Stiffness in Children with Spastic Diplegic Cerebral Palsy during Level Walking

Individual joint deviations are often identified in the analysis of cerebral palsy (CP) gait. However, knowledge is limited as to how these deviations affect the control of the locomotor system as a whole when striving to meet the demands of walking. The current study aimed to bridge the gap by describing the control of the locomotor system in children with diplegic CP in terms of their leg stiffness, both skeletal and muscular components, and associated joint stiffness during gait. Twelve children with spastic diplegia CP and 12 healthy controls walked at a self-selected pace in a gait laboratory while their kinematic and forceplate data were measured and analyzed during loading response, mid-stance, terminal stance and pre-swing. For calculating the leg stiffness, each of the lower limbs was modeled as a non-linear spring, connecting the hip joint center and the corresponding center of pressure, with varying stiffness that was calculated as the slope (gradient) of the axial force vs. the deformation curve. The leg stiffness was further decomposed into skeletal and muscular components considering the alignment of the lower limb. The ankle, knee and hip of the limb were modeled as revolute joints with torsional springs whose stiffness was calculated as the slope of the moment vs. the angle curve of the joint. Independent t-tests were performed for between-group comparisons of all the variables. The CP group significantly decreased the leg stiffness but increased the joint stiffness during stance phase, except during terminal stance where the leg stiffness was increased. They appeared to rely more on muscular contributions to achieve the required leg stiffness, increasing the muscular demands in maintaining the body posture against collapse. Leg stiffness plays a critical role in modulating the kinematics and kinetics of the locomotor system during gait in the diplegic CP.     

Tibialis posterior EMG activity during barefoot walking in people with neutral foot posture

The aim of this study was to characterize the electromyographic (EMG) profile of tibialis posterior during barefoot walking in order to establish a reference database for neutral foot posture. Fifteen participants had their foot posture screened using the six-item Foot Posture Index. Bipolar intramuscular electrodes were inserted into tibialis posterior and peroneus longus utilizing ultrasound guidance. Surface electrodes were placed over medial gastrocnemius, peroneus brevis and tibialis anterior. EMG and footswitch gait characteristics were recorded whilst participants completed 10 barefoot walking trials. Individual and grand ensemble averages were used to characterize the intensity profiles for each muscle. Results indicated that for most of the participants, tibialis posterior displayed two bursts of EMG activity, with the first burst during the initial contact phase and the second burst during midstance. However, there was significant variability between participants. The grand ensemble average for tibialis posterior was comparable to peroneus longus which displayed similar temporal and intensity characteristics. It is suggested that this may reflect a synergistic relationship between these muscles during stance phase, although this was not consistent for all participants. Further research is required to determine if this relationship is altered in abnormal foot posture and whether it is clinically important. In conclusion, the EMG profile of tibialis posterior during the gait cycle appeared to be highly variable among participants. However, the authors believe that EMG findings from the participants with neutral foot posture in this study may be used for comparison to EMG patterns in people with abnormal foot posture and individuals affected by musculoskeletal disease.     

Kinematics of the Coordination of Pointing during Locomotion

In natural motor behaviour arm movements, such as pointing or reaching, often need to be coordinated with locomotion. The underlying coordination patterns are largely unexplored, and require the integration of both rhythmic and discrete movement primitives. For the systematic and controlled study of such coordination patterns we have developed a paradigm that combines locomotion on a treadmill with time-controlled pointing to targets in the three-dimensional space, exploiting a virtual reality setup. Participants had to walk at a constant velocity on a treadmill. Synchronized with specific foot events, visual target stimuli were presented that appeared at different spatial locations in front of them. Participants were asked to reach these stimuli within a short time interval after a “go” signal. We analysed the variability patterns of the most relevant joint angles, as well as the time coupling between the time of pointing and different critical timing events in the foot movements. In addition, we applied a new technique for the extraction of movement primitives from kinematic data based on anechoic demixing. We found a modification of the walking pattern as consequence of the arm movement, as well as a modulation of the duration of the reaching movement in dependence of specific foot events. The extraction of kinematic movement primitives from the joint angle trajectories exploiting the new algorithm revealed the existence of two distinct main components accounting, respectively, for the rhythmic and discrete components of the coordinated movement pattern. Summarizing, our study shows a reciprocal pattern of influences between the coordination patterns of reaching and walking. This pattern might be explained by the dynamic interactions between central pattern generators that initiate rhythmic and discrete movements of the lower and upper limbs, and biomechanical factors such as the dynamic gait stability.     

Associations between Quantitative Mobility Measures Derived from Components of Conventional Mobility Testing and Parkinsonian Gait in Older Adults

Objective

To provide objective measures which characterize mobility in older adults assessed in the community setting and to examine the extent to which these measures are associated with parkinsonian gait.

Methods

During conventional mobility testing in the community-setting, 351 ambulatory non-demented Memory and Aging Project participants wore a belt with a whole body sensor that recorded both acceleration and angular velocity in 3 directions. We used measures derived from these recordings to quantify 5 subtasks including a) walking, b) transition from sit to stand, c) transition from stand to sit, d) turning and e) standing posture. Parkinsonian gait and other mild parkinsonian signs were assessed with a modified version of the original Unified Parkinson’s Disease Rating Scale (mUPDRS).

Results

In a series of separate regression models which adjusted for age and sex, all 5 mobility subtask measures were associated with parkinsonian gait and accounted for 2% to 32% of its variance. When all 5 subtask measures were considered in a single model, backward elimination showed that measures of walking sit to stand and turning showed independent associations with parkinsonian gait and together accounted for more than 35% of its variance. Cross-validation using data from a 2^nd group of 258 older adults showed similar results. In similar analyses, only walking was associated with bradykinesia and sway with tremor.

Interpretation

Quantitative mobility subtask measures vary in their associations with parkinsonian gait scores and other parkinsonian signs in older adults. Quantifying the different facets of mobility has the potential to facilitate the clinical characterization and understanding the biologic basis for impaired mobility in older adults.     

Heel-off perturbation during gait initiation: biomechanical analysis using triaxial accelerometry and a force plate.

This study analyzes the movements of the hips, shoulders and of the body center of gravity before and at heel-off, when step execution begins to initiate gait from an upright posture. The heel-off movement was considered as a dynamic perturbation induced by the stepping movement. The experimental paradigm used for studying this perturbation was the single-step movement, in which the initial posture and voluntary movements are identical to those of gait initiation. Data were collected from accelerometer recordings of the triaxial accelerations at the joints of the upper part of the body, and by calculating the triaxial accelerations of the center of gravity using force plate measurements. The resultant vectors were used to establish and compare the magnitude and direction of the accelerations at different joints, and from them, the roles of the pelvis and the scapular girdles with respect to the objectives of the gait movement.     

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.     

Kinematic variability and local dynamic stability of upper body motions when walking at different speeds

A ubiquitous characteristic of elderly and patients with gait disabilities is that they walk slower than healthy controls. Many clinicians assume these patients walk slower to improve their stability, just as healthy people slow down when walking across ice. However, walking slower also leads to greater variability, which is often assumed to imply deteriorated stability. If this were true, then slowing down would be completely antithetical to the goal of maintaining stability. This study sought to resolve this paradox by directly quantifying the sensitivity of the locomotor system to local perturbations that are manifested as natural kinematic variability. Eleven young healthy subjects walked on a motorized treadmill at five different speeds. Three-dimensional movements of a single marker placed over the first thoracic vertebra were recorded during continuous walking. Mean stride-to-stride standard deviations and maximum finite-time Lyapunov exponents were computed for each time series to quantify the variability and local dynamic stability, respectively, of these movements. Quadratic regression analyses of the dependent measures vs. walking speed revealed highly significant U shaped trends for all three mean standard deviations, but highly significant linear trends, with significant or nearly significant quadratic terms, for five of the six finite-time Lyapunov exponents. Subjects exhibited consistently better local dynamic stability at slower speeds for these five measures. These results support the clinically based intuition that people who are at increased risk of falling walk slower to improve their stability, even at the cost of increased variability.     

Effects of neck and circumoesophageal connective lesions on posture and locomotion in the cockroach

Few studies in arthropods have documented to what extent local control centers in the thorax can support locomotion in absence of inputs from head ganglia. Posture, walking, and leg motor activity was examined in cockroaches with lesions of neck or circumoesophageal connectives. Early in recovery, cockroaches with neck lesions had hyper-extended postures and did not walk. After recovery, posture was less hyper-extended and animals initiated slow leg movements for multiple cycles. Neck lesioned individuals showed an increase in walking after injection of either octopamine or pilocarpine. The phase of leg movement between segments was reduced in neck lesioned cockroaches from that seen in intact animals, while phases in the same segment remained constant. Neither octopamine nor pilocarpine initiated changes in coordination between segments in neck lesioned individuals. Animals with lesions of the circumoesophageal connectives had postures similar to intact individuals but walked in a tripod gait for extended periods of time. Changes in activity of slow tibial extensor and coxal depressor motor neurons and concomitant changes in leg joint angles were present after the lesions. This suggests that thoracic circuits are sufficient to produce leg movements but coordinated walking with normal motor patterns requires descending input from head ganglia.Electronic Supplementary Material Supplementary material is available for this article at     

Patterns of axial and appendicular movements during aquatic walking in the salamander Siren lacertina

Most studies of salamander locomotion have focused either on swimming or terrestrial walking, but some salamanders also use limb-based locomotion while submerged under water (aquatic walking). In this study we used video motion analysis to describe the aquatic walking gait of Siren lacertina, an elongate salamander with reduced forelimbs and no hindlimbs. We found that S. lacertina uses a bipedal-undulatory gait, which combines alternating use of the forelimbs with a traveling undulatory wave. Each forelimb is in contact with the substrate for about 50% of the stride cycle and forelimbs have little temporal overlap in contact intervals. We quantified the relative timing and frequency of limb and tail movements and found that, unlike the terrestrial gaits of most salamanders, axial and appendicular movements are decoupled during aquatic walking. We found no significant relationship between stride frequency and aquatic walking velocity, but we did find a statistically significant relationship between tailbeat frequency and aquatic walking velocity, which suggests that aquatic walking speed is mainly modulated by axial movements. By comparing axial wavespeed and distance traveled per tailbeat during swimming (forelimbs not used) and aquatic walking (forelimbs used), we found lower wavespeed and greater distance traveled per tailbeat during aquatic walking. These findings suggest that the reduced forelimbs of S. lacertina contribute to forward propulsion during aquatic walking.     

Energy cost of walking and gait instability in healthy 65- and 80-yr-olds.

This study tested whether the lower economy of walking in healthy elderly subjects is due to greater gait instability. We compared the energy cost of walking and gait instability (assessed by stride to stride changes in the stride time) in octogenarians (G80, n = 10), 65-yr-olds (G65, n = 10), and young controls (G25, n = 10) walking on a treadmill at six different speeds. The energy cost of walking was higher for G80 than for G25 across the different walking speeds (P < 0.05). Stride time variability at preferred walking speed was significantly greater in G80 (2.31 +/- 0.68%) and G65 (1.93 +/- 0.39%) compared with G25 (1.40 +/- 0.30%; P < 0.05). There was no significant correlation between gait instability and energy cost of walking at preferred walking speed. These findings demonstrated greater energy expenditure in healthy elderly subjects while walking and increased gait instability. However, no relationship was noted between these two variables. The increase in energy cost is probably multifactorial, and our results suggest that gait instability is probably not the main contributing factor in this population. We thus concluded that other mechanisms, such as the energy expenditure associated with walking movements and related to mechanical work, or neuromuscular factors, are more likely involved in the higher cost of walking in elderly people.     

Sampling frequencies and measurement error for linear and temporal gait parameters in primate locomotion

Quantitative analyses of animal motion are increasingly easy to conduct using simple video equipment and relatively inexpensive software packages. With careful use, such analytical tools have the potential to quantify differences in movement between individuals or species and to allow insights into the behavioral consequences of morphological differences between taxa. However, as with any other type of measurement, there are errors associated with kinematic measurements. Because normative kinematic data on human and nonhuman primate locomotion are used to model aspects of gait of fossil hominins, errors in the extant data influence the accuracy of fossil gait reconstructions. The principal goal of this paper is to illustrate the effect of camera speeds (frame rates) on kinematic measurement errors, and to demonstrate how these errors vary with subject size, movement velocity, and sample size. Kinematic data for human walking and running (240 Hz), as well as data for primate quadrupedal walking and running (180 Hz) were used as inputs for a simulation of the measurement errors associated with various linear and temporal kinematic variables. Measurement errors were shown to increase as camera speed, subject body size, and interval duration all decrease, and as movement velocity increases. These results have implications for the methods used to calculate subject velocity and suggest that using a moving marker to measure the linear displacements of the body is preferable to the use of a stationary marker. Finally, while slower camera speeds will always result in higher measurement errors than do faster camera speeds, this effect can be moderated to some extent by collecting sufficiently large samples of data.     

Slower speeds in patients with diabetic neuropathy lead to improved local dynamic stability of continuous overground walking

Patients with diabetic peripheral neuropathy are significantly more likely to fall while walking than subjects with intact sensation. While it has been suggested that these patients walk slower to improve locomotor stability, slower speeds are also associated with increased locomotor variability, and increased variability has traditionally been equated with loss of stability. If the latter were true, this would suggest that slowing down, as a locomotor control strategy, should be completely antithetical to the goal of maintaining stability. The present study resolves these seemingly paradoxical findings by using methods from nonlinear time series analysis to directly quantify the sensitivity of the locomotor system to local perturbations that are manifested as natural kinematic variability. Fourteen patients with severe peripheral neuropathy and 12 gender-, age-, height-, and weight-matched non-diabetic controls participated. Sagittal plane angles of the right hip, knee, and ankle joints and tri-axial accelerations of the trunk were measured during 10 min of continuous overground walking at self-selected speeds. Maximum finite-time Lyapunov exponents were computed for each time series to quantify the local dynamic stability of these movements. Neuropathic patients exhibited slower walking speeds and better local dynamic stability of upper body movements in the horizontal plane than did control subjects. The differences in local dynamic stability were significantly predicted by differences in walking speed, but not by differences in sensory status. These results support the hypothesis that reductions in walking speed are a compensatory strategy used by neuropathic patients to maintain dynamic stability of the upper body during level walking.     

Rotational and translational movement features of the pelvis and thorax during adult human locomotion

The kinematics of the pelvis and thorax are important in gait studies since their movement patterns are closely related to gait efficiency and 'smoothness' of locomotion. The purpose of this study was to identify features of normal gait patterns for later comparisons with pathological and developmental gait patterns. A two camera SELSPOT system interfaced with an HP1000 minicomputer was used to obtain three-dimensional kinematic/temporal data for the pelvis and thorax. Data from treadmill walking of eight adults were used for within subject (at different speeds) analyses. The analyses revealed a very complex pattern with a set of breakpoints which was consistent over all subjects. Some features were invariant over a range of walking speeds although the total range of motion changed considerably.     

Muscular contributions to hip and knee extension during the single limb stance phase of normal gait: a framework for investigating the causes of crouch gait

Crouch gait, a troublesome movement abnormality among persons with cerebral palsy, is characterized by excessive flexion of the hips and knees during stance. Treatment of crouch gait is challenging, at present, because the factors that contribute to hip and knee extension during normal gait are not well understood, and because the potential of individual muscles to produce flexion or extension of the joints during stance is unknown. This study analyzed a three-dimensional, muscle-actuated dynamic simulation of walking to quantify the angular accelerations of the hip and knee induced by muscles during normal gait, and to rank the potential of the muscles to alter motions of these joints. Examination of the muscle actions during single limb stance showed that the gluteus maximus, vasti, and soleus make substantial contributions to hip and knee extension during normal gait. Per unit force, the gluteus maximus had greater potential than the vasti to accelerate the knee toward extension. These data suggest that weak hip extensors, knee extensors, or ankle plantar flexors may contribute to crouch gait, and strengthening these muscles--particularly gluteus maximus--may improve hip and knee extension. Abnormal forces generated by the iliopsoas or adductors may also contribute to crouch gait, as our analysis showed that these muscles have the potential to accelerate the hip and knee toward flexion. This work emphasizes the need to consider how muscular forces contribute to multijoint movements when attempting to identify the causes of abnormal gait.