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.     

Role of stability and limb support in recovery against a fall following a novel slip induced in different daily activities

The purpose of this study was to determine whether stability and limb support play a similar role in governing slip outcome in gait-slip as in sit-to-stand-slip, and whether such prediction could also be derived based on measures of these variables during regular, unperturbed movements. Fifty-three and forty-one young subjects all took one recovery step following an unannounced, novel, forward slip induced in gait and in sit-to-stand, respectively. Logistic regression was used to predict recovery outcome based on preslip and reactive measures of stability and limb support across tasks. Following slip onset, all subjects in both tasks experienced rapid decay in stability and limb support (indicated by a hip descent), leading to some actual falls that could not have been predicted from regular, preslip walking. Immediately before recovery step touchdown, stability and limb support could together best predict 88.9% and 100% falls, respectively, for gait-slip and sit-to-stand-slip. Because of differences in the execution of the recovery step, stability became a better predictor of fallers in sit-to-stand-slip than in gait-slip after recovery limb touchdown. Recovery steps were highly effective in restoring stability, regardless of outcome and task. The predictive strength of stability diminished in gait-slip or reduced in sit-to-stand-slip after recovery touchdown, while limb support remained able to differentiate fallers from those who recovered in both tasks. When slip-induced instability was combined with inadequate limb support, falls were nearly inevitable in both tasks.     

Alteration in community-dwelling older adults' level walking following perturbation training

While perturbation training is promising in reducing fall-risk among older adults, its impact on altering their spontaneous gait pattern has not been investigated. The purpose of this study was to determine to what extent older adults' gait pattern would be affected by exposure to repeated slips. Seventy-three community-dwelling older adults (age: 72.6±5.4 years) underwent 24 repeated-slip exposure induced by unannounced unlocking and relocking of low-friction sections of a 7-m pathway upon which they walked. Full body kinematics and kinetics were recorded during the training. The gait parameters and the center of mass (COM) stability against backward balance loss were compared before and after the training. The results revealed that the training reduced fall incidence from 43.8% upon the novel slip to 0 at the end of training. After the training, subjects significantly improved gait stability by forward positioning of their COM relative to the base of support without altering gait speed. This forward COM shift resulted from a shortened step at the end of single stance and forward trunk leaning during double stance. They also adopted flat foot landing with knee flexed at touchdown (with an average change of 6.9 and 4.1 degrees, respectively). The perturbation training did alter community-dwelling older adults' spontaneous gait pattern. These changes enabled them to improve their volitional control of stability and their resistance to unpredictable and unpreventable slip-related postural disturbance.     

Bilateral knee osteoarthritis does not affect inter-joint coordination in older adults with gait deviations during obstacle-crossing

Fifteen elderly subjects with bilateral medial knee osteoarthritis (OA) and 15 healthy elderly subjects walked and crossed obstacles with heights of 10%, 20%, and 30% of their leg lengths while sagittal angles and angular velocities of each joint were measured and their phase angles () calculated. Continuous relative phase (CRP) were also obtained, i.e., _hip−knee and _knee−ankle. The standard deviations of the CRP curve points were averaged to obtain deviation phase (DP) values for the stance and swing phases. Significant differences between the OA and control groups were found in several of the peak and crossing angles, and angular velocities at the knee and ankle. Both groups had similar CRP patterns, and the DP values of the hip–knee and knee–ankle CRP curves were not significantly different between the two groups. Despite significant changes in the joint kinematics, knee OA did not significantly change the way the motions of the lower limb joints are coordinated during obstacle-crossing. It appears that the OA groups adopted a particular biomechanical strategy among all possible strategies that can accommodate the OA-induced changes of the knee mechanics using unaltered inter-joint coordination control. This enabled the OA subjects to accommodate reliably the mechanical demands related to bilateral knee OA in the sagittal plane during obstacle-crossing. Maintaining normal and reliable inter-joint coordination may be considered a goal of therapeutic intervention, and the patterns and variability of inter-joint coordination can be used for the evaluation of treatment effects.     

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 a novel gait retraining device on lower limb kinematics and muscle activation in healthy adults

The Re-Link Trainer (RLT) is a modified walking frame with a linkage system designed to apply a non-individualized kinematic constraint to normalize gait trajectory of the left limb. The premise behind the RLT is that a user’s lower limb is constrained into a physiologically normal gait pattern, ideally generating symmetry across gait cycle parameters and kinematics. This pilot study investigated adaptations in the natural gait pattern of healthy adults when using the RLT compared to normal overground walking. Bilateral lower limb kinematic and electromyography data were collected while participants walked overground at a self-selected speed, followed by walking in the RLT. A series of 2-way analyses of variance examined between-limb and between-condition differences. Peak hip extension and knee flexion were reduced bilaterally when walking in the RLT. Left peak hip extension occurred earlier in the gait cycle when using the RLT, but later for the right limb. Peak hip flexion was significantly increased and occurred earlier for the constrained limb, while peak plantarflexion was significantly reduced. Peak knee flexion and plantarflexion in the right limb occurred later when using the RLT. Significant bilateral reductions in peak electromyography amplitude were evident when walking in the RLT, along with a significant shift in when peak muscle activity was occurring. These findings suggest that the RLT does impose a significant constraint, but generates asymmetries in lower limb kinematics and muscle activity patterns. The large interindividual variation suggests users may utilize differing motor strategies to adapt their gait pattern to the imposed constraint.     

基于景观格局分析的雄安城市湿地生态健康评价

城市湿地是城市生态系统的重要组成部分。近年来,高度的城市化发展使城市湿地原有的自然生态本底和水文特征发生根本性的变化,严重威胁到湿地生态系统的安全。为了维持良好的城市环境质量,如何维持和保护城市湿地的生态健康和可持续发展成为人们关注的热点问题。选择雄安城区（起步区、安新组团和容城组团）为研究对象,借助ArcGIS平台对Landsat遥感影像进行地类的提取和划分,采用Fragstats软件对研究区景观格局进行分析;在此基础上,利用"压力-状态-响应"模型,构建雄安城区湿地生态系统健康评价指标体系,探讨湿地的生态系统健康状况。研究结果表明：研究区耕地和建设用地占地面积大,其完整性、聚合程度和连通性优于其他景观类型;水域、未利用地和林地占地面积小,受人为活动影响,破碎化程度高,连通性比较差。研究区整体景观破碎度、聚合度较高,连通性和均匀度不显著。研究区湿地类型主要为坑塘和沟渠,湿地分布不均匀,呈现南多北少的格局;沟渠占地面积较大,完整性和连通性较好;坑塘连通性较差,破碎化程度、聚合度高于沟渠。研究区湿地生态健康综合指数为0.262,处于不健康状态,人为活动和气候是影响湿地生态环境的重要因子,急需加强湿地保护和修复工作。本研究结果为雄安新区的可持续发展和保护城市湿地资源提供理论依据。     

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.     

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.     

基于景观格局的海岛开发潜在生态风险评价

海岛生态系统是一种相对独立的生态系统,与岛外的信息交流比较少,甚至是没有,一旦对海岛造成损害是很难恢复的,因此,对海岛进行风险评价是海岛保护和管理的重要依据.海岛风险评价通常有两个方面,海岛自然灾害风险评价和海岛开发利用风险评价.针对海岛开发利用风险评价,应用遥感手段分析了海岛景观格局与海岛开发利用风险程度的关系,定义了海岛开发利用威胁指数和强度指数,建立了基于景观格局的海岛开发利用风险评价模型.然后,以2005年4月5日获取的5m分辨率的SPOT遥感影像为数据源,将提出的模型应用到渤海海域庙岛群岛中的大黑山岛、小黑山岛、北长山岛、南长山岛和庙岛进行评价,由现场调查情况分析可知评价结果是合理的.与传统的风险评价模型相比,本模型的优势在于应用遥感影像作为数据源,大大降低了对实地调查数据的需求.     

基于景观生态风险评价的涪江流域景观格局优化

以流域为尺度进行景观生态风险评价以及景观格局优化,有利于为流域生态系统服务的提高和人类活动管控提供科学依据。以涪江流域为研究区域,从"自然-社会-景观格局"3个维度选取10个评价因子建立评价指标体系,采取空间主成分分析法（SPCA）对流域景观生态风险进行综合评价,再基于生态风险评价的结果和生态源地利用最小累积阻力模型（MCR）和网络分析等方法实现流域景观格局优化。研究结果表明：①涪江流域景观生态风险等级在空间分布上呈西北部高于东南部地区,主要是受自然和景观格局因子影响较大。②涪江流域所面临的生态风险问题较为严重,生态风险等级为中度及以上的区域面积总和为25596.51 km²,占研究区总面积比例的65.35%。③生态源地以林地和水域为主,面积为11194.28 km²,占流域总面积比例为25.58%。④构建生态廊道共41条,总长度为5229.04 km,其中原有廊道29条,新添廊道12条,提取生态节点53个;利用网络分析形成了以主廊道为"中轴",构建的生态廊道为"辅助",提取的生态节点为"枢纽"的较为完整的网络生态结构。对研究区景观格局优化前后的连通度进行对比,优化后的整体景观格局连通度得到较大幅度提升。     

Immediate effect of individual bars of insoles and their combination on gait parameters in asymptomatic healthy adults

Abstract

Objective: The way how individual bars of sensorimotor insoles influence the gait kinematics is not fully understood yet. Therefore, this study aimed to explore the effect of three sensorimotor orthotic conditions (the medial calcaneal and retrocapital lateral bars and their combination) on the gait parameters in healthy adults during the stance phase of gait cycle.

Materials and methods: Twenty-six young adults performed 20 gait cycles in each condition using their self-selected cadence and provided standardised shoes with the base-sole and the three types of orthotics. A three-dimensional motion analysis system (8 cameras; 200?Hz) was used and a six-degrees of freedom model was applied. The cadence, the stride length, the first peaks of foot external rotation, eversion and dorsal flexion as well as the first peak of hip adduction were analysed.

Results: Significant differences (p?<?0.05) were found for all parameters between the orthotic conditions, except the cadence. Significant difference in the first peak of hip adduction (p?=?0.008) was found between the dominant and non-dominant leg. There were no significant interactions between the factors of condition and leg dominance (p?>?0.05).

Conclusions: There seems to be overall tendencies in immediate changes in ankle joint kinematics caused by all three sensorimotor orthotic conditions and besides the mechanical principles, also ‘proprioceptive mechanism’ seems to play a role. However, maximum observed average angular change was 2° and some variability in reactions to each orthotic condition exists among the individuals. Therefore, clinical relevance of such changes remains unclear and careful analysis of expected outcomes should be the common part of every orthotic intervention.     

Dynamic gait stability index based on plantar pressures and fuzzy logic

Stability during locomotion, or dynamic stability, is critical to ensure safe locomotion and a high quality of life. A dynamic stability measure should be easily applied in a clinical setting and must provide a quantitative index that can be used for comparisons over a range of tasks and environments. Plantar foot pressure data acquired by shoe-insole sensors have potential to provide such a measure. To generate a quantitative dynamic gait stability index, six gait parameters were extracted from a commercial plantar pressure measurement system (F-Scan): anterior–posterior (A/P) center of force (CoF) motion, medial–lateral (M/L) CoF motion, maximum lateral position, cell triggering, stride time (ST), and double support time (DST). A fuzzy logic controller combined these six parameters and generated the index. To validate the stability index, 15 healthy subjects performed four tasks intended to induce increasing levels of instability. Fifty-seven gait parameter combinations were assessed to determine the most effective index. A combination of A/P motion, M/L motion, maximum lateral position, and cell triggering parameters was the most consistently effective index across all subjects. However, small changes in ST and DST for able-bodied subjects may have reduced the effectiveness of these measures in the index calculation. The index combining all six parameters should be investigated further with populations with disabilities or pathological gait.     

The effect on conventional gait model kinematics and kinetics of hip joint centre equations in adult healthy gait

The Conventional Gait Model (CGM) needs to benefit from large investigations on localization of the hip joint centre (HJC). Incorrect positions from the native equations were demonstrated (Sangeux et al., 2014; Harrington et al., 2007). More accurate equations were proposed but their impact on kinematics and kinetic CGM outputs was never evaluated. This short communication aims at examining if adoption of new HJC equations would alter standard CGM outputs. Sixteen able bodied participants underwent a full 3-D optoelectronic gait analysis followed by a 3-D ultrasound localization of their hips. Data were processed through the open source python package pyCGM2 replicating kinematic and kinetic processing of the native CGM. Compared with 3D ultrasound location, Hara equations improved the accuracy of sagittal plane kinematics (0.6°) and kinetics (0.02 N m kg⁻¹) for the hip. The worst case participant exhibited Harrington’s equations reached a deviation of 3° for the sagittal kinematics. In the coronal plane, Hara and Harrington equations presented similar differences (1°) for the hip whilst Davis equations had the largest deviation for hip abduction (2.7°) and hip abductor moment (0.10 N m kg⁻¹).Both Harrington and Hara equations improved the CGM location of the HJC. Hara equations improved results in the sagittal plane, plus utilise a single anthropometrics measurement, leg length, that may be more robust. However, neither set of equations had significant effect on kinematics. We reported some effects on kinetics, particularly in the coronal plane, which warrant caution in interpreting outputs using different sets of equations.     

Model of loadings acting on the femoral bone during gait

An evaluation of the model of loadings acting on the femoral bone during the whole gait cycle was the main aim of the paper. A computer simulation of the musculoskeletal system based on the gait data collected during gait was used to determine the muscle forces as well as the hip joint reaction. Kinematic parameters as well as the ground reaction force for ninety-nine healthy persons of both sexes (18–36 years old) who had no history of musculoskeletal disease were registered during normal gait with preferred speed and used as inputs for musculoskeletal modelling and numerical simulation with the use of the AnyBody software. Time waveforms of the values of force generated by 21 muscles having attachments on the femoral bone as well as the hip joint reaction force were obtained. Directions of particular forces were presented using a femoral coordinate system. Attachment points for all muscle forces were obtained on the basis of the unscaled standard model with the length of the femur equal to 0.41 m. The presented model of loadings acting on the femoral bone element can be useful for the biomechanical analysis of bone development and remodelling as well as for the optimisation of implant or bone stabilizer design and pre-clinical testing.     

基于最小累积阻力模型的东北地区生态安全格局构建

生态安全格局对于缓解生态保护与经济发展之间的矛盾具有积极意义。以东北地区为研究对象,综合参考《生态保护红线划定技术指南》、《全国生态功能区划》以及东北地区自然资源禀赋和社会经济发展水平,基于水源涵养、防风固沙、生物多样性维持与保护等功能指标和敏感性指标划分生态源地;利用夜间灯光数据修正基本生态阻力面,并运用最小累积阻力模型划分缓冲区、识别生态廊道和生态战略节点,从而构建东北地区生态安全格局。结果表明:东北地区生态源地总面积为6.50×10⁵km²,占全区土地总面积的45.02%,包括18个生态源地,主要分布在大兴安岭、小兴安岭、长白山脉和西部草原的部分区域;划分了高、中、低3个水平缓冲区,关键生态廊道中心线总长11073.52km,生态战略节点29个,在东北地区形成以生态源地为中心的网状空间布局。结果可为保障区域生态系统服务功能和可持续发展政策的制定提供科学参考。     

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.     

The relation between limb segment coordination during walking and fall history in community-dwelling older adults

Control of the swing foot during walking is important to prevent falls. The trajectories of the swing foot are adjusted by coordination of the lower limbs, which is evaluated with uncontrolled manifold (UCM) analysis. A previous study that applied this analysis to walking revealed that older adults with fall history had compensatorily great segment coordination to stabilize the swing foot during normal walking. However, it is unknown whether the increase in segment coordination helps for preventing incident falls in the future. At baseline measurement, 30 older adults walked for 20 times at a comfortable speed. UCM analysis was performed to evaluate how the segment configuration in the lower limbs contributes to the swing foot stability. One year after the baseline visit, we asked the subjects if there were incident falls through a questionnaire. The univariate and multivariable logistic regression analyses were performed to assess the association between the index of segment coordination and incident falls with and without adjustment for gait velocity. Twenty-eight older adults who responded to the questionnaire were classified into older adults (n = 12) who had the incident fall and those (n = 16) who did not have falls. It was revealed that older adults who increased the segment coordination associated with swing foot stability tended to experience at least one fall within one year of measurement. The index of the UCM analysis can be a sensitive predictor of incident falls.     

Pliocene hominid gait: New interpretations based on available footprint data from Laetoli

Normative trends in the gait patterns of modern man can be used to reconstruct crucial characteristics of the bipedal behaviour of Pliocene hominids from their fossilized footprints. In this reconstruction the interrelated parameters of velocity, stride-length, and cadence are determined from imprints made in damp volcanic ash some 3.7 million years ago. When early hominid footprint data is fitted to regression equations of high predictability for the interrelationship of these locomotor parameters in modern man, a pattern of gait emerges that contradicts previous reconstructions.     

基于CA-Markov模型的呼图壁县土地利用景观格局预测研究

以2002、2009、2016年三期遥感影像数据为基础, 运用GIS技术及景观生态学理论, 对呼图壁县近14年的土地利用景观格局变化特征及其各景观类型空间转化特点进行了分析。并结合CA-Markov模型对土地利用类型特征参数、景观格局指数等进行模拟, 预测和分析未来7年土地利用和景观格局演变特征。结果表明: 从时间尺度分析, 研究区内景观格局有较大变化, 主要表现为耕地与建设用地的增加; 从景观类型转移分析可知, 耕地与建设用地的交替变化最为显著, 其主要集中于中部地区; 景观类型水平指数分析得到, 林草地、水域及耕地整体破碎化程度低, 未利用地则表现相反; 从景观水平分析可知, 研究区内景观整体破碎度与复杂度增高, 同时斑块逐渐趋于离散分布, 景观结构不稳定性增加。研究结果可为该区域提供更为科学有效的生态环境保护措施, 以期为制定相关土地利用政策和合理配置土地资源提供参考。