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.     

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.     

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

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

Stability-normalised walking speed: A new approach for human gait perturbation research

In gait stability research, neither self-selected walking speeds, nor the same prescribed walking speed for all participants, guarantee equivalent gait stability among participants. Furthermore, these options may differentially affect the response to different gait perturbations, which is problematic when comparing groups with different capacities. We present a method for decreasing inter-individual differences in gait stability by adjusting walking speed to equivalent margins of stability (MoS). Eighteen healthy adults walked on a split-belt treadmill for two-minute bouts at 0.4 m/s up to 1.8 m/s in 0.2 m/s intervals. The stability-normalised walking speed (MoS = 0.05 m) was calculated using the mean MoS at touchdown of the final 10 steps of each speed. Participants then walked for three minutes at this speed and were subsequently exposed to a treadmill belt acceleration perturbation. A further 12 healthy adults were exposed to the same perturbation while walking at 1.3 m/s: the average of the previous group. Large ranges in MoS were observed during the prescribed speeds (6–10 cm across speeds) and walking speed significantly (P < 0.001) affected MoS. The stability-normalised walking speeds resulted in MoS equal or very close to the desired 0.05 m and reduced between-participant variability in MoS. The second group of participants walking at 1.3 m/s had greater inter-individual variation in MoS during both unperturbed and perturbed walking compared to 12 sex, height and leg length-matched participants from the stability-normalised walking speed group. The current method decreases inter-individual differences in gait stability which may benefit gait perturbation and stability research, in particular studies on populations with different locomotor capacities. [Preprint: https://doi.org/10.1101/314757]     

Influence of gait speed on the control of mediolateral dynamic stability during gait initiation

This study investigated the influence of gait speed on the control of mediolateral dynamic stability during gait initiation. Thirteen healthy young adults initiated gait at three self-selected speeds: Slow, Normal and Fast. The results indicated that the duration of anticipatory postural adjustments (APA) decreased from Slow to Fast, i.e. the time allocated to propel the centre of mass (COM) towards the stance-leg side was shortened. Likely as an attempt at compensation, the peak of the anticipatory centre of pressure (COP) shift increased. However, COP compensation was not fully efficient since the results indicated that the mediolateral COM shift towards the stance-leg side at swing foot-off decreased with gait speed. Consequently, the COM shift towards the swing-leg side at swing heel-contact increased from Slow to Fast, indicating that the mediolateral COM fall during step execution increased as gait speed rose. However, this increased COM fall was compensated by greater step width so that the margin of stability (the distance between the base-of-support boundary and the mediolateral component of the “extrapolated centre of mass”) at heel-contact remained unchanged across the speed conditions. Furthermore, a positive correlation between the mediolateral extrapolated COM position at heel-contact and step width was found, indicating that the greater the mediolateral COM fall, the greater the step width. Globally, these results suggest that mediolateral APA and step width are modulated with gait speed so as to maintain equivalent mediolateral dynamical stability at the time of swing heel-contact.     

Age-related mechanical work expenditure during normal walking: The Baltimore Longitudinal Study of Aging

The aim of this cross-sectional study was to delineate age-associated kinematic and kinetic gait patterns of normal walking, and to test the hypothesis that older adults exhibit gait patterns that reduce generative mechanical work expenditures (MWEs). We studied 52 adult Baltimore Longitudinal Study of Aging participants (means age 72±9, from 60 to 92 years) who could walk 4 m unaided. Three-dimensional kinematic and kinetic parameters assessed during rotation-defined gait periods were used to estimate MWEs for the rotation of lower extremities about the medial–lateral (ML) and anterior–posterior (AP) axes of proximal joints, which represent MWEs in the AP and ML sides, respectively. Relationships between gait parameters and age were examined using regression analysis with adjustments for walking speed, sex, height, and weight. Older age was associated with slower self-selected walking speed (p<0.001), shorter stride length (p<0.001), and greater propensity of landing flat-footed (p=0.003). With older age, hip generative MWE for thigh rotation was lower about the AP axis (hip abduction and adduction) during stance (p=0.010) and higher about the ML axis (hip extension and flexion) during late stance (p<0.001). Knee absorptive MWE for shank rotation about the AP axis (knee abduction and adduction) during early stance was also lower with older age (p<0.003). These age-related gait patterns may represent a compensatory effort to maintain balance and may also reflect mobility limitations.     

Gait Variability and IEMG Variation in Gastrocnemius and Medial Hamstring Muscles on Inclined Even and Uneven Planes

ObjectivesThe deviation in gait cycle due to trunk acceleration and muscle activity on even and uneven inclined planes should be analyzed for the design of lower limb exoskeletons. This study compares the gait variability of gastrocnemius and medial hamstring muscle activity variation of twenty young male adults on inclined even and uneven planes.Material and methodsThe individuals walked on a long, 10° inclined even and uneven plane in both up-the-plane and down-the-plane directions at their preferred speed (average speed is 1.2 m/s). Gait variability during walking was calculated using an average standard deviation of trunk acceleration and the significance of change was calculated using two-way-ANOVA. For studying the difference between integrated electromyography (IEMG) values of walking on even and uneven planes, two parameters Normalized IEMG Percentage (NIP) and IEMG Variation Percentage (IVP) were chosen for the analysis.ResultsThe results strongly agree with the hypothesis that gait variability hikes in the vertical direction of subject with a p-value of 0.04. The IEMG range of medial-hamstring muscle while walking on even and uneven plane is not highly significant for swing (0.44) as well as stance phase (0.47). While walking on an inclined uneven plane, the response of gastrocnemius muscle indicated the variation of NIP between 14.31% to 64.63%. It was observed that NIP and IEMG values of medial-hamstring muscles during backward walking have a resemblance.ConclusionTrunk variability had a significant change in the vertical direction (V) and was insignificant in medial-lateral (ML) and anterior-posterior (AP) orientations for both even and uneven inclined planes during forward and reverse walking. The muscle activity of gastrocnemius and medial-hamstring muscles does not have sound variations while walking on the inclined uneven plane.     

Walk-, run- and gallop-like gait patterns in human sideways locomotion

The purpose of this study is to examine the characteristics of gait patterns in human preferred sideways locomotion at increasing speeds. Fifteen healthy young males were asked to step sideways on a treadmill at various speeds of 1.3–6.1 km/h. The times of foot contact and take-off were analyzed. Three gait patterns were observed. At slow speeds, all of the subjects performed a walk-like pattern. When the treadmill speed exceeded approximately 3.5 km/h, the subjects preferred gait patterns with a flight phase. Most of the subjects performed an asymmetric gait pattern that was similar to a forward gallop, whereas only two out of fifteen subjects performed a run-like gait pattern. Because the left and right legs are positioned along the movement direction, it might be more efficient to divide roles between the leading and trailing limbs at high speeds: the leading limb functions to produces breaking and vertical force, and the trailing limb mainly absorbs the impact of foot contact and generates propulsive forces.     

Gait modification when decreasing double support percentage

Much is still unknown about walking stability, including which aspects of gait contribute to higher stability. Walking stability appears to be related to walking speed, although the exact relationship is unclear. As walking speed decreases, the double support (DS) period of gait increases both in time and as a percentage of the gait cycle. Because humans have more control over their center of mass movement during DS, increasing DS duration may alter stability. This study examined how human gait is affected by changing DS percentage independent of walking speed. Sixteen young, healthy adults walked on a treadmill at a single speed for six one-minute trials. These trials included normal gait as well as longer- and shorter-than-normal DS percentage gaits. Subjects were consistently able to decrease DS percentage but had difficulty increasing DS percentage. In some cases, subjects altered their cadence when changing DS percentage, particularly when attempting to increase DS percentage. The changes to gait when decreasing DS percentage were similar to changes when increasing walking speed but occurred mainly during the swing period. These changes include increased hip and knee flexion during the swing period, increased swing foot height, and larger magnitude peaks in ground reaction forces. The changes in gait when attempting to increase DS percentage trended toward changes when decreasing walking speed. Altering DS percentage induced gait changes that were similar to, yet clearly distinct from, gait changes due to walking speed. Further, the difficulty of increasing DS percentage when walking at a constant speed suggests that people walk more slowly when they want to increase time spent in DS.     

Decrease in required coefficient of friction due to smaller lean angle during turning in older adults

We investigated age-related differences in the required coefficient of friction (RCOF) during 90° turning, the difference of RCOF during step and spin turn, and how affects observed differences. Sixteen healthy young and healthy older adults (eight men and eight women in each group) participated. Participants performed 90° step and spin turns to the right at a self-selected normal speed. Older adults turned with lower RCOF than the young adults during both step and spin turns. This was associated with reduced mediolateral (ML) RCOF component (RCOF_ML) for the older adults. Reduced RCOF_ML in older adults was associated with reductions in the ML component of the lean angle of the body during turning. This age-related gait changes during turning can be compensatory mechanisms that allowed older adults to turn while reducing the risk of slipping. Spin turns exhibited lower RCOF, resulting from significantly lower RCOF_ML, than step turns in young and older adults; thus, spin turning is a safer turning strategy for preventing lateral slips. This may suggest that, in older adults, slip prevention may take precedence over balance recovery after slips sustained during turning. These results illustrate a turning gait mechanism that helps prevent slips and falls, and how age affects this mechanism.     

Retention of improvement in gait stability over 14 weeks due to trip-perturbation training is dependent on perturbation dose

Perturbation training is an emerging approach to reduce fall risk in the elderly. This study examined potential differences in retention of improvements in reactive gait stability over 14 weeks resulting from unexpected trip-like gait perturbations. Twenty-four healthy middle-aged adults (41–62 years) were assigned randomly to either a single perturbation group (SINGLE, n = 9) or a group subjected to eight trip-like gait perturbations (MULTIPLE, n = 15). While participants walked on a treadmill a custom-built brake-and-release system was used to unexpectedly apply resistance during swing phase to the lower right limb via an ankle strap. The anteroposterior margin of stability (MoS) was calculated as the difference between the anterior boundary of the base of support and the extrapolated centre of mass at foot touchdown for the perturbed step and the first recovery step during the first and second (MULTIPLE group only) perturbation trials for the initial walking session and retention-test walking 14 weeks later. Group MULTIPLE retained the improvements in reactive gait stability to the perturbations (increased MoS at touchdown for perturbed and first recovery steps; p < 0.01). However, in group SINGLE no differences in MoS were detected after 14 weeks compared to the initial walking session. These findings provide evidence for the requirement of a threshold trip-perturbation dose if adaptive changes in the human neuromotor system over several months, aimed at the improvement in fall-resisting skills, are to occur.     

Active and passive contributions to joint kinetics during walking in older adults

The objectives of this study were to characterize the active and passive contributions to joint kinetics during walking in healthy young and older adults, and assess whether isokinetic ankle strength is associated with ankle power output during walking. Twenty healthy young (18–35 years) and 20 healthy older (65–85 years) adults participated in this study. We measured subject-specific passive-elastic joint moment–angle relationships in the lower extremity and tested maximum isokinetic ankle strength at 30 deg/s. Passive moment–angle relationships were used to estimate active and passive joint moment, power, and work quantities during walking at 80%, 100% and 120% of preferred walking speed. There were no significant differences in walking speed, step length, or cadence between the older and young adults. However, the older adults produced significantly more net positive work at the hip but less net positive work at the ankle at all walking speeds. Passive contributions to hip and ankle work did not significantly differ between groups, inferring that the older adults generated the additional hip work actively. Maximum isokinetic ankle strength was significantly less in the older adults, and correlated with peak positive plantar-flexor power at both the preferred and fast walking speeds. The results of this study suggest that age-related shifts in joint kinetics do not arise as a result of increased passive hip joint stiffness, but seem to be reflected in plantar-flexor weakness.     

Phase-dependent changes in local dynamic stability of human gait

Several methods derived from nonlinear time series analysis have been suggested to quantify stability in human gait kinematics. One of these methods is the definition of the maximum finite time Lyapunov exponent (λ) that quantifies how the system responds to infinitesimal perturbations. However, there are fundamental limitations to the conventional definition of λ for gait kinematics. First, exponential increase in initial perturbations cannot be assumed since real-life perturbations of gait kinematics are finite sized. Second, the transitions between single and double support phase within each stride cycle define two distinct dynamical regimes that may not be captured by a single λ. The present article presents a new method to quantify intra-stride changes λ(t) in local dynamical stability and employs the method to 3D lower extremity gait kinematics in 10 healthy adults walking on a treadmill at 3 different speeds. All participants showed an intra-stride change in λ(t) in the transition between single and double support phase. The intra-stride change reflected an both a increase and decrease in λ(t) at heel strike and toe off, respectively, with increased gait speed. Furthermore, a close relationship was found between the intra-stride change in standard deviation of foot velocity in the anterior-posterior direction and the intra-stride change of the initial perturbations. The present results indicate that local dynamical stability has gait phase-dependent changes that are not identified by conventional computation of a single λ.     

Presenting joint kinematics of human locomotion using phase plane portraits and Poincaré maps

Additional graphical tools are needed to better visualize the joint kinematics of human locomotion. Standard plots in which the joint displacements are plotted against time or percent gait cycle do not provide sufficient information about the dynamics of the system. In this article, a study based on the two graphical tools of nonlinear dynamics to visualize the steady-state kinematics of human gait is presented. An experimental setup was developed to acquire the necessary data for application of the techniques. Twenty young adults, whose medical histories are free of gait pathology, were tested. Computerized electrogoniometers and foot switches were used to measure the kinematic data of the lower extremities and capture four instants of the gait cycle: heel strike, foot flat, heel off, and toe off. Phase plane portraits of each joint were constructed for the sagittal plane by plotting angular velocity against angular displacement. Poincaré maps were obtained by periodically sampling the joint profiles at toe off and plotting the ith iterate against the (i + 1)th one. Phase plane portraits are useful in monitoring the variations of joint velocity and position on the same graph in a more compact form. Poincaré maps are effective in differentiating steady gait from transient locomotion.     

3D finite element model of the diabetic neuropathic foot: A gait analysis driven approach

Diabetic foot is an invalidating complication of diabetes that can lead to foot ulcers. Three-dimensional (3D) finite element analysis (FEA) allows characterizing the loads developed in the different anatomical structures of the foot in dynamic conditions. The aim of this study was to develop a subject specific 3D foot FE model (FEM) of a diabetic neuropathic (DNS) and a healthy (HS) subject, whose subject specificity can be found in term of foot geometry and boundary conditions. Kinematics, kinetics and plantar pressure (PP) data were extracted from the gait analysis trials of the two subjects with this purpose. The FEM were developed segmenting bones, cartilage and skin from MRI and drawing a horizontal plate as ground support. Materials properties were adopted from previous literature. FE simulations were run with the kinematics and kinetics data of four different phases of the stance phase of gait (heel strike, loading response, midstance and push off). FEMs were then driven by group gait data of 10 neuropathic and 10 healthy subjects. Model validation focused on agreement between FEM-simulated and experimental PP.     

Energetics of actively powered locomotion using the simplest walking model

We modified an irreducibly simple model of passive dynamic walking to walk on level ground, and used it to study the energetics of walking and the preferred relationship between speed and step length in humans. Powered walking was explored using an impulse applied at toe-off immediately before heel strike, and a torque applied on the stance leg. Although both methods can supply energy through mechanical work on the center of mass, the toe-off impulse is four times less costly because it decreases the collision loss at heel strike. We also studied the use of a hip torque on the swing leg that tunes its frequency but adds no propulsive energy to gait. This spring-like actuation can further reduce the collision loss at heel strike, improving walking energetics. An idealized model yields a set of simple power laws relating the toe-off impulses and effective spring constant to the speed and step length of the corresponding gait. Simulations incorporating nonlinear equations of motion and more realistic inertial parameters show that these power laws apply to more complex models as well.     

Dynamics and stability of muscle activations during walking in healthy young and older adults

To facilitate stable walking, humans must generate appropriate motor patterns and effective corrective responses to perturbations. Yet most EMG analyses do not address the continuous nature of muscle activation dynamics over multiple strides. We compared muscle activation dynamics in young and older adults by defining a multivariate state space for muscle activity. Eighteen healthy older and 17 younger adults walked on a treadmill for 2 trials of 5 min each at each of 5 controlled speeds (80–120% of preferred). EMG linear envelopes of v. lateralis, b. femoris, gastrocnemius, and t. anterior of the left leg were obtained. Interstride variability, local dynamic stability (divergence exponents), and orbital stability (maximum Floquet multipliers; FM) were calculated. Both age groups exhibited similar preferred walking speeds (p=0.86). Amplitudes and variability of individual EMG linear envelopes increased with speed (p<0.01) in all muscles but gastrocnemius. Older adults also exhibited greater variability in b. femoris and t. anterior (p<0.004). When comparing continuous multivariate EMG dynamics, older adults demonstrated greater local and orbital instability of their EMG patterns (p<0.01). We also compared how muscle activation dynamics were manifested in kinematics. Local divergence exponents were strongly correlated between kinematics and EMG, independent of age and walking speed, while variability and max FM were not. These changes in EMG dynamics may be related to increased neuromotor noise associated with aging and may indicate subtle deterioration of gait function that could lead to future functional declines.     

Assessment of the activation modalities of gastrocnemius lateralis and tibialis anterior during gait: A statistical analysis

Aim of the study was to identify the different modalities of activation of gastrocnemius lateralis (GL) and tibialis anterior (TA) during gait at self-selected speed, by a statistical analysis of surface electromyographic signal from a large number (hundreds) of strides per subject. The analysis on fourteen healthy adults showed a large variability in the number of activation intervals, in their occurrence rate, and in the on-off instants, within different strides of the same walk. For each muscle, the assessment of the different modalities of activation (five for muscle) allowed to identify a single pattern, common for all the modalities and able to characterize the behavior of muscles during normal gait. The pattern of GL activity centered in two regions of the gait cycle: the transition between flat foot contact and push-off (observed in 100% of total strides) and the final swing (67.1 ± 15.9%). Two regions characterized also the pattern of TA activity: from pre-swing to following loading response (100%), and the mid-stance (30.5 ± 15.0%). This “normality” pattern represents the first attempt for the development in healthy young adults of a reference for dynamic EMG activity of GL and TA, in terms of variability of on-off muscular activity and occurrence rate during gait.     

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.     

Postural stability during gait for adults with hereditary spastic paraparesis

Individuals with hereditary spastic paraparesis (HSP) are often impaired in their ability to control posture as a result of the neurological and musculoskeletal implications of their condition. This research aimed to assess postural stability during gait in a group of adults with HSP. Ten individuals with HSP and 10 healthy controls underwent computerized gait analysis while walking barefoot along a 10-m track. Two biomechanics methods were used to assess stability: the center of pressure and center of mass separation (COP-COM) method, and the extrapolated center of mass (XCOM) method. Spatiotemporal and kinematic variables were also investigated. The XCOM method identified deficits in mediolateral stability for the HSP group at both heel strike and mid-stance. The group with HSP also had slower walking velocity, lower cadence, more time spent in double stance, larger step widths, and greater lateral trunk flexion than the control group. These results suggest that individuals with HSP adjust characteristics of their gait to minimize the instability arising from their impairments but have residual deficits in mediolateral stability. This may result in an increased risk of falls, particularly in the sideways direction.