Use of a backpack alters gait initiation of high school students

We assessed how backpack carriage influences the gait initiation (GI) process in high school students, who extensively use backpacks. GI involves different dynamics from gait itself, while the excessive use of backpacks can result in adverse effects. 117 high school students were evaluated in three experimental conditions: no backpack (NB), bilateral backpack (BB), and unilateral backpack (UB). Two force plates were used to acquire ground reaction forces (GRFs) and moments for each foot separately. Center of pressure (COP) scalar variables were extracted, and statistical parametric mapping analysis was performed over the entire COP/GRFs time series. GI anticipatory postural adjustments (APAs) were reduced and were faster in backpack conditions; medial–lateral COP excursion was smaller in this phase. The uneven distribution of the extra load in the UB condition led to a larger medial–lateral COP shift in the support-foot unloading phase, with a corresponding vertical GRF change that suggests a more pronounced unloading swing foot/loading support foot mechanism. The anterior–posterior GRFs were altered, but the COP was not. A possible explanation for these results may be the forward trunk lean and the center of mass proximity of the base of support boundary, which induced smaller and faster APA, increased swing foot/support foot weight transfer, and increased load transfer to the first step.     

Biomechanical reorganisation of stepping initiation during acute dorsiflexor fatigue

During voluntary step initiation (SI), propulsive forces are generated during anticipatory postural adjustments (APA) which displace the centre-of-gravity (CoG) in the desired direction. These propulsive forces are implemented by ankle synergy, bilateral soleus inhibition followed by activation of tibialis anterior (TA). The aim of this study was to investigate the effect of fatigue applied to ankle dorsiflexors on APA associated with SI and on related motor performance. Eight young healthy participants initiated stepping before and after a protocol designed to generate fatigue in ankle dorsiflexors. Fatigue was induced by series of high-level isometric contractions performed until exhaustion. Results showed that, with fatigue, the level of TA activation during APA, anticipatory postural dynamics (backward centre-of-pressure displacement and forward CoG velocity) and related motor performance (peak of CoG velocity) were attenuated, while APA duration and total SI duration increased. These changes were interpreted as reflecting a protective strategy aiming to preserve the integrity of the fatigued muscles, rather than an impairment associated with muscle weakness.     

Rhythmic movement and rhythmic auditory cues enhance anticipatory postural adjustment of gait initiation

Abstract

The purpose of this study was to determine whether the rhythmic movements or cues enhance the anticipatory postural adjustment (APA) of gait initiation. Healthy humans initiated gait in response to an auditory start cue (third cue). A first auditory cue was given 8?s before the start cue, and a second auditory cue was given 3?s before the start cue. The participants performed the rhythmic medio-lateral weight shift (ML-WS session), rhythmic anterior-posterior weight shift (AP-WS session), or rhythmic arm swing (arm swing session) in the time between the first and second cues. In the rhythmic cues session, rhythmic auditory cues with a frequency of 1?Hz were given in this time. In the stationary session, the participants maintained stationary stance in this time. The APA and initial step movement preceded by those rhythmic movements or cues were compared with those in the stationary session. The temporal characteristics of the initial step movement of the gait initiation were not changed by the rhythmic movements or cues. The medio-lateral displacement of the APA in the ML-WS and arm swing sessions was significantly greater than that in the stationary session. The anterior–posterior displacement of the APA in the rhythmic cues and arm swing sessions was significantly greater than that in the stationary session. Taken together, the rhythmic movements and cues enhance the APA of gait initiation. The present finding may be a clue or motive for the future investigation for using rhythmic movements or cues as the preparatory activity to enlarge the small APA of gait initiation in the patients with Parkinson’s disease.     

Investigation of balance strategy over gait cycle based on margin of stability

This study was conducted to investigate the balance strategy of healthy young adults through a gait cycle using the margin of stability (MoS). Thirty healthy young adults participated in this study. Each performed walking five times at a preferred speed and at a fast speed. The MoS was calculated over a gait cycle by defining the base of support (BoS) changes during a gait cycle. The MoS was divided into medial/lateral and anterior/posterior components (ML MoS and AP MoS). The central values and the values at 12 gait events of the MoS were compared. Positive/negative integration of ML MoS (ML MoS_POS and ML MoS_NEG, respectively) and the average ML/AP MoS over a cycle (ML/AP MoS_mean) were significantly lower at a fast gait than at a preferred gait. ML/AP MoS were lower at a fast speed than at the preferred speed, except for the ML MoS immediately before left heel strike (pre left HS) and right and left heel strike (HS). ML/AP MoS were significantly lower immediately before heel strike (pre-HS) than in other gait events, regardless of walking speed. It was suggested that pre-HS is the most unstable moment in both ML/AP directions and a crucial moment in control of gait stability. The results presented above might be applicable as basic data regarding dynamic stability of healthy young adults through a gait cycle for comparisons with elderly people and patients with orthopedic disorders or neurological disorders.     

Effect of local and general fatiguing exercises on disturbed and static postural control

This study compared the effect of local and general fatiguing exercise on disturbed and static postural control performances. Surface electromyography and center of pressure signals were respectively recorded during self-initiated perturbation test and static postural stability test from 7 young male subjects. Local fatiguing exercise was performed using intermittent isometric knee extensions at the level of 40% of maximal voluntary torques. General fatiguing exercise was implemented with rowing ergometer at a speed of 200 ± 5 m/min. Results of disturbed postural tests showed no significant change of anticipatory postural adjustment (APAs) organizations in individual muscles following both fatiguing exercises, but observed larger APAs coactivations in trunk and dorsal muscle pairs following local than general fatiguing exercise, and larger compensatory postural adjustments (CPAs) coactivation in dorsal muscle pair after both fatiguing exercises. In addition, the results of static postural tests indicated efficient static postural stability accompanying the down-weighting of visual input and the up-weighting of vestibular/somatosensory component following both fatiguing exercises. These findings evidenced a general compensation in the central nervous system in response to the neuromuscular deficiencies induced by local fatiguing exercise and put forward the function of sensory recalibration in maintaining postural stability under fatigue conditions.     

Dynamic gait stability of treadmill versus overground walking in young adults

Treadmill has been broadly used in laboratory and rehabilitation settings for the purpose of facilitating human locomotion analysis and gait training. The objective of this study was to determine whether dynamic gait stability differs or resembles between the two walking conditions (overground vs. treadmill) among young adults. Fifty-four healthy young adults (age: 23.9 ± 4.7 years) participated in this study. Each participant completed five trials of overground walking followed by five trials of treadmill walking at a self-selected speed while their full body kinematics were gathered by a motion capture system. The spatiotemporal gait parameters and dynamic gait stability were compared between the two walking conditions. The results revealed that participants adopted a “cautious gait” on the treadmill compared with over ground in response to the possible inherent challenges to balance imposed by treadmill walking. The cautious gait, which was achieved by walking slower with a shorter step length, less backward leaning trunk, shortened single stance phase, prolonged double stance phase, and more flatfoot landing, ensures the comparable dynamic stability between the two walking conditions. This study could provide insightful information about dynamic gait stability control during treadmill ambulation in young adults.     

Effects of general fatigue induced by incremental maximal exercise test on gait stability and variability of healthy young subjects

The purpose of this study was to determine whether general fatigue induced by incremental maximal exercise test (IMET) affects gait stability and variability in healthy subjects. Twenty-two young healthy male subjects walked in a treadmill at preferred walking speed for 4 min prior (PreT) the test, which was followed by three series of 4 min of walking with 4 min of rest among them. Gait variability was assessed using walk ratio (WR), calculated as step length normalized by step frequency, root mean square (RMS_ratio) of trunk acceleration, standard deviation of medial-lateral trunk acceleration between strides (VAR_ML), coefficient of variation of step frequency (SFCV), length (SLCV) and width (SWCV). Gait stability was assessed using margin of stability (MoS) and local dynamic stability (λ_s). VAR_ML, SFCV, SLCV and SWCV increased after the test indicating an increase in gait variability. MoS decreased and λ_s increased after the test, indicating a decrease in gait stability. All variables showed a trend to return to PreT values, but the 20-min post-test interval appears not to be enough for a complete recovery. The results showed that general fatigue induced by IMET alters negatively the gait, and an interval of at least 20 min should be considered for injury prevention in tasks with similar demands.     

The effect of walking speed on local dynamic stability is sensitive to calculation methods

Local dynamic stability has been assessed by the short-term local divergence exponent (λ_S), which quantifies the average rate of logarithmic divergence of infinitesimally close trajectories in state space. Both increased and decreased local dynamic stability at faster walking speeds have been reported. This might pertain to methodological differences in calculating λ_S. Therefore, the aim was to test if different calculation methods would induce different effects of walking speed on local dynamic stability. Ten young healthy participants walked on a treadmill at five speeds (60%, 80%, 100%, 120% and 140% of preferred walking speed) for 3 min each, while upper body accelerations in three directions were sampled. From these time-series, λ_S was calculated by three different methods using: (a) a fixed time interval and expressed as logarithmic divergence per stride-time (λ_S−a), (b) a fixed number of strides and expressed as logarithmic divergence per time (λ_S−b) and (c) a fixed number of strides and expressed as logarithmic divergence per stride-time (λ_S−c). Mean preferred walking speed was 1.16±0.09 m/s. There was only a minor effect of walking speed on λ_S−a. λ_S−b increased with increasing walking speed indicating decreased local dynamic stability at faster walking speeds, whereas λ_S−c decreased with increasing walking speed indicating increased local dynamic stability at faster walking speeds. Thus, the effect of walking speed on calculated local dynamic stability was significantly different between methods used to calculate local dynamic stability. Therefore, inferences and comparisons of studies employing λ_S should be made with careful consideration of the calculation method.     

Kinetic measures of restabilisation during volitional stepping reveal age-related alterations in the control of mediolateral dynamic stability

Research examining age-related changes in dynamic stability during stepping has recognised the importance of the restabilisation phase, subsequent to foot-contact. While regulation of the net ground reaction force (GRF_net) line of action is believed to influence dynamic stability during steady-state locomotion, such control during restabilisation remains unknown. This work explored the origins of age-related decline in mediolateral dynamic stability by examining the line of action of GRF_net relative to the centre of mass (COM) during restabilisation following voluntary stepping. Healthy younger and older adults (n=20 per group) performed three single-step tasks (varying speed and step placement), altering the challenge to stability control. Age-related differences in magnitude and intertrial variability of the angle of divergence of GRF_net line of action relative to the COM were quantified, along with the peak mediolateral and vertical GRF_net components. The angle of divergence was further examined at discrete points during restabilisation, to uncover events of potential importance to stability control. Older adults exhibited a reduced angle of divergence throughout restabilisation. Temporal and spatial constraints on stepping increased the magnitude and intertrial variability of the angle of divergence, although not differentially among the older adults. Analysis of the time-varying angle of divergence revealed age-related reductions in magnitude, with increases in timing and intertrial timing variability during the later phase of restabilisation. This work further supports the idea that age-related challenges in lateral stability control emerge during restabilisation. Age-related alterations during the later phase of restabilisation may signify challenges with reactive control.     

Effects of obesity on dynamic stability control during recovery from a treadmill-induced slip among young adults

This study sought to investigate the effects of obesity on falls and dynamic stability control in young adults when subject to a standardized treadmill-induced gait-slip. Forty-four young adults (21 normal-weight and 23 obese) participated in this study. After their muscle strength was assessed at the right knee under maximum voluntary isometric (flexion and extension) contractions, participants were moved to an ActiveStep treadmill. Following 5 normal walking trials on the treadmill, all participants encountered an identical and unexpected slip defined as a perturbation in the anterior direction with the magnitude of 24-cm slip distance and 2.4-m/s peak slip velocity. The trials were categorized as a fall or recovery based on the reliance of the subject on external support following the slip. Compared with the normal-weight group, the obese group demonstrated less relative muscle strength and fell more responding to the slip (78.3% vs. 40.0%, p=0.009). After adjusting the body height and gender, the results indicated that the obese group was 19.1-time (95% confidence interval: [2.06, 177.36]) more prone to a fall than the normal-weight group when experiencing the same treadmill-induced slip. The obese group showed significantly impaired dynamic stability after slip possibly due to the inability of controlling the trunk segment׳s backward lean movement. Obesity measurements explained more slip outcome variance than did the strength measurements (53.4% vs. 18.1%). This study indicates that obesity most likely influences the ability to recover from slip perturbations. It is important to develop interventions to improve the capability of balance recovery among individuals with obesity.     

The effect of short-term changes in body mass distribution on feed-forward postural control

It was recently shown that short-term changes in the whole body mass and associated changes in the vertical position of the center of mass (COM) modify anticipatory postural adjustments (APAs) [Li X, Aruin AS. The effect of short-term changes in the body mass on anticipatory postural adjustments. Exp Brain Res 2007;181:333–46]. In this study, we investigated whether changes in the body mass distribution and related changes in the anterior–posterior COM position affect APA generation. Fourteen subjects were instructed to catch a 2.2 kg load with their arms extended while standing with no additional weight or while carrying a 9.08 kg weight. Adding weight to a backpack, front pack or belly pocket was associated with an increase of the whole body mass, but it also involved changes in the anterior–posterior (A/P) and vertical positions of the COM. Electromyographic activity of leg and trunk muscles, body kinematics, and ground reaction forces were recorded and quantified within the typical time intervals of APAs. APAs were modified in conditions with changed body mass distribution: increased magnitude of anticipatory EMG activity in leg and trunk muscles, as well as co-activation of leg muscles and decreased anticipatory displacement of the COM in the vertical direction, were seen in conditions with increased body mass. Changes in the COM position induced in both A/P and vertical directions were associated with increased anticipatory EMG activity. In addition, they were linked to a co-activation of muscles at the ankle joints and significant changes in the center of pressure (COP) position. Modifications of the COM position induced in the A/P direction were related to increased anticipatory EMG activity in the leg and trunk muscles. At the same time, no significant differences in anticipatory EMG activity or displacement of COP were observed when changes of COM position were induced in the vertical direction. The study outcome suggests that the CNS uses different strategies while generating APAs in conditions with changes in the COM position induced in the anterior–posterior and vertical directions.     

Control of head stability during gait initiation in young and older women

Transition tasks between static and dynamic situations may challenge head stabilization and balance in older individuals. The study was designed to investigate differences between young and older women in the upper body motion during the voluntary task of gait initiation. Seven young (25 ± 2.3 years) and seven older healthy women (78 ± 3.4 years) were required to stand on a force platform and initiate walking at their self-selected preferred speed. Angles of head, neck and trunk were measured by motion analysis in the sagittal plane and a cross-correlation analysis was performed on segments pairs. Variability of head and neck angular displacements, as indicated by average standard deviation, was significantly greater in the older than in the young participants. The young women maintained dynamic stability of the upper body, as forward flexion of the trunk was consistently counteracted by coordinated head–neck extension. Differently, movement patterns employed by the older women also included a rigid motion of all upper body segments leaning forward as a single unit. These results demonstrated that older women perform the transition from standing to walking with greater variability in the patterns of upper body motion compared to young women.     

Center of pressure and center of mass behavior during gait initiation on inclined surfaces: A statistical parametric mapping analysis

This study analyzed gait initiation (GI) on inclined surfaces with 68 young adult subjects of both sexes. Ground reaction forces and moments were collected using two AMTI force platforms, of which one was in a horizontal position and the other was inclined by 8% in relation to the horizontal plane. Departing from a standing position, each participant executed three trials in the following conditions: horizontal position (HOR), inclined position at ankle dorsi-flexion (UP), and inclined position at ankle plantar-flexion (DOWN). Statistical parametric mapping analysis was performed over the entire center of pressure (COP) and center of mass (COM) time series. COP excursion did not show significant differences in the medial-lateral (ML) direction in both inclined conditions, but it was greater in the anterior-posterior (AP) direction for both inclined conditions. COP velocities are smaller in discrete portions of GI for the UP and DOWN conditions. COM displacement was greater in the ML direction during anticipatory postural adjustments (APA) in the UP condition, and COM moves faster in the ML direction during APA in the UP condition but slower at the end of GI for both the UP and the DOWN conditions. The COP-COM vector showed a greater angle in the DOWN condition. We observed changes for COP and COM in GI in both the UP and the DOWN conditions, with the latter showing changes for a great extent of the task. Both the UP and the DOWN conditions showed increased COM displacement and velocity. The predominant characteristic during GI on inclined surfaces, including APA, appears to be the displacement of the COM.     

Computational evaluation of load carriage effects on gait balance stability

Evaluating the effects of load carriage on gait balance stability is important in various applications. However, their quantification has not been rigorously addressed in the current literature, partially due to the lack of relevant computational indices. The novel Dynamic Gait Measure (DGM) characterizes gait balance stability by quantifying the relative effects of inertia in terms of zero-moment point, ground projection of center of mass, and time-varying foot support region. In this study, the DGM is formulated in terms of the gait parameters that explicitly reflect the gait strategy of a given walking pattern and is used for computational evaluation of the distinct balance stability of loaded walking. The observed gait adaptations caused by load carriage (decreased single support duration, inertia effects, and step length) result in decreased DGM values (p < 0.0001), which indicate that loaded walking motions are more statically stable compared with the unloaded normal walking. Comparison of the DGM with other common gait stability indices (the maximum Floquet multiplier and the margin of stability) validates the unique characterization capability of the DGM, which is consistently informative of the presence of the added load.     

Neuromuscular response of hip-spanning and low back muscles to medio-lateral foot center of pressure manipulation during gait

Background: Footwear-generated medio-lateral foot center of pressure manipulation has been shown to have potential positive effects on gait parameters of hip osteoarthritis patients, ultimately reducing maximum joint reaction forces. The objective of this study was to investigate effects of medio-lateral foot center of pressure manipulation on muscle activity of hip-spanning and back muscles during gait in bilateral hip osteoarthritis patients. Methods: Foot center of pressure was shifted along the medio-lateral foot axis using a foot-worn biomechanical device allowing controlled center of pressure manipulation. Sixteen female bilateral hip osteoarthritis patients underwent electromyography analysis while walking in the device set to three parasagittal configurations: neutral (control), medial, and lateral. Seven hip-spanning muscles (Gluteus Medius, Gluteus Maximus, Tensor Fascia Latae, Rectus Femoris, Semitendinosis, Biceps Femoris, Adductor Magnus) and one back muscle (Erector Spinae) were analyzed. Magnitude and temporal parameters were calculated. Results: The amplitude and temporal parameter varied significantly between foot center of pressure positions for 5 out of 8 muscles each for either the more or less symptomatic leg in at least one subphase of the gait cycle. Conclusion: Medio-lateral foot center of pressure manipulation significantly affects neuromuscular pattern of hip and back musculature during gait in female hip bilateral osteoarthritis patients.     

Multi-sensor assessment of dynamic balance during gait in patients with subacute stroke

The capacity to maintain upright balance by minimising upper body oscillations during walking, also referred to as gait stability, has been associated with a decreased risk of fall. Although it is well known that fall is a common complication after stroke, no study considered the role of both trunk and head when assessing gait stability in this population. The primary aim of this study was to propose a multi-sensor protocol to quantify gait stability in patients with subacute stroke using gait quality indices derived from pelvis, sternum, and head accelerations. Second, the association of these indices with the level of walking ability, with traditional clinical scale scores, and with fall events occurring within the six months after patients’ dismissal was investigated. The accelerations corresponding to the three abovementioned body levels were measured using inertial sensors during a 10-Meter Walk Test performed by 45 inpatients and 25 control healthy subjects. A set of indices related to gait stability were estimated and clinical performance scales were administered to each patient. The amplitude of the accelerations, the way it is attenuated/amplified from lower to upper body levels, and the gait symmetry provide valuable information about subject-specific motor strategies, discriminate between different levels of walking ability, and correlate with clinical scales. In conclusion, the proposed multi-sensor protocol could represent a useful tool to quantify gait stability, support clinicians in the identification of patients potentially exposed to a high risk of falling, and assess the effectiveness of rehabilitation protocols in the clinical routine.     

Combined effects of speed and directional change on postural adjustments during gait initiation

The study of gait initiation (GI) has primarily focused on gait initiated in a forward direction, however, in everyday life, GI is often combined with a directional change. Ten young adults initiated gait with their right foot in four directions (to the left: −15°, straight ahead: 0°, to the right: 15° and 30°) at self-selected and fast gait speeds. The relationship between starting direction of GI and the lateral center of foot pressure displacement for normal (r² = 0.57) and fast gait speed (r² = 0.75) indicated that the lateral component plays an important role with regards to controlling the desired direction of gait. At the first step of the swing limb, the progression velocity of the center of mass (CM) remained slower for the 30° condition only, whereas no difference was found between directions for CM velocity perpendicular to the intended direction. These results suggest that postural adjustments are scaled to initiate gait in a predetermined direction. By the first step, the orientation of CM is toward the intended direction of gait, however, when gait is initiated in combination with a large change in direction, additional adjustments may be required to reach the intended progression velocity.     

Gait stability,variability and complexity on inclined surfaces

This study evaluated the gait stability, variability, and complexity of healthy young adults on inclined surfaces. A total of 49 individuals walked on a treadmill at their preferred speed for 4 min at inclinations of 6%, 8%, and 10% in upward (UP) and downward (DOWN) conditions, and in horizontal (0%) condition. Gait variability was assessed using average standard deviation trunk acceleration between strides (VAR), gait stability was assessed using margin of stability (MoS) and maximum Lyapunov exponent (λs), and gait complexity was assessed using sample entropy (SEn). Trunk variability (VAR) increased in the medial-lateral (ML), anterior-posterior, and vertical directions for all inclined conditions. The SEn values indicated that movement complexity decreased almost linearly from DOWN to UP conditions, reflecting changes in gait pattern with longer and slower steps as inclination increased. The DOWN conditions were associated with the highest variability and lowest stability in the MoS ML, but not in λs. Stability was lower in UP conditions, which exhibited the largest λs values. The overall results support the hypothesis that inclined surfaces decrease gait stability and alter gait variability, particularly in UP conditions.