Obesity does not increase external mechanical work per kilogram body mass during walking

Walking is the most common type of physical activity prescribed for the treatment of obesity. The net metabolic rate during level walking (W/kg) is ~10% greater in obese vs. normal weight adults. External mechanical work (W_ext) is one of the primary determinants of the metabolic cost of walking, but the effects of obesity on W_ext have not been clearly established. The purpose of this study was to compare W_ext between obese and normal weight adults across a range of walking speeds. We hypothesized that W_ext (J/step) would be greater in obese adults but W_ext normalized to body mass would be similar in obese and normal weight adults. We collected right leg three-dimensional ground reaction forces (GRF) while twenty adults (10 obese, BMI=35.6 kg/m² and 10 normal weight, BMI=22.1 kg/m²) walked on a level, dual-belt force measuring treadmill at six speeds (0.50–1.75 m/s). We used the individual limb method (ILM) to calculate external work done on the center of mass. Absolute W_ext (J/step) was greater in obese vs. normal weight adults at each walking speed, but relative W_ext (J/step/kg) was similar between the groups. Step frequencies were not different. These results suggest that W_ext is not responsible for the greater metabolic cost of walking (W/kg) in moderately obese adults.     

Evaluation of lower limb cross planar kinetic connectivity signatures post-stroke

Following stroke, aberrant three dimensional multijoint gait impairments emerge that present in kinematic asymmetries such as circumduction. A precise pattern of cross-planar coordination may underlie abnormal hemiparetic gait as several studies have underscored distinctive neural couplings between medio-lateral control and sagittal plane progression during walking. Here we investigate potential neuromechanical constraints governing abnormal multijoint coordination post-stroke. 15 chronic monohemispheric stroke patients and 10 healthy subjects were recruited. Coupled torque production patterns were assessed using a volitional isometric torque generation task where subjects matched torque targets for a primary joint in 4 directions while receiving visual feedback of the magnitude and direction of the torque. Secondary torques at other lower limb joints were recorded without subject feedback. We find that common features of cross-planar connectivity in stroke subjects include statistically significant frontal to sagittal plane kinetic coupling that overlay a common sagittal plane coupling in healthy subjects. Such coupling is independent of proximal or distal joint control and limb biomechanics. Principal component analysis of the stroke aggregate kinetic signature reveals unique abnormal frontal plane coupling features that explain a larger percentage of the total torque coupling variance. This study supports the idea that coupled cross-planar kinetic outflow between the lower limb joints uniquely emerges during pathological control of frontal plane degrees of freedom resulting in a generalized extension of the limb. It remains to be seen if a pattern of lower limb motor outflow that is centrally mediated contributes to abnormal hemiparetic gait.     

Biomechanical mechanism for transitions in phase and frequency of arm and leg swing during walking

As humans increase walking speed, there are concurrent transitions in the frequency ratio between arm and leg movements from 2:1 to 1:1 and in the phase relationship between the movements of the two arms from in-phase to out-of-phase. Superharmonic resonance of a pendulum with monofrequency excitation had been proposed as a potential model for this phenomenon. In this study, an alternative model of paired pendulums with multiple-frequency excitations is explored. It was predicted that the occurrence of the concurrent transitions was a function of (1) changes in the magnitude ratio of shoulder accelerations at step and stride frequencies that accompany changes in walking speed and (2) proximity of these frequencies to the natural resonance frequencies of the arms modeled as a pair of passive pendulums. Model predictions were compared with data collected from 14 healthy young subjects who were instructed to walk on a treadmill. Walking speeds were manipulated between 0.18 and 1.52 m/s in steps of 0.22 m/s. Kinematic data for the arms and shoulders were collected using a 3D motion analysis system, and simulations were conducted in which the movements of a double-pendulum system excited by the accelerations at the suspension point were analyzed to determine the extent to which the arms acted as passive pendulums. It was confirmed that the acceleration waveforms at the shoulder are composed primarily of stride and step frequency components. Between the shoulders, the stride frequency components were out-of-phase, while the step frequency components were in-phase. The amplitude ratio of the acceleration waveform components at the step and stride frequencies changed as a function of walking speed and were associated with the occurrence of the transitions. Simulation results using these summed components as excitatory inputs to the double-pendulum system were in agreement with actual transitions in 80% of the cases. The potential role of state-dependent active muscle contraction at shoulder joints on the occurrence of the transitions was discussed. Due to the tendency of arm movements to stay in the vicinity of their primary resonance frequency, these active muscle forces were hypothesized to function as escapements that created limit cycle oscillations at the shoulders resonant frequency.     

Electromechanical delay estimated by using electromyography during cycling at different pedaling frequencies

The purpose of this study was to propose a new method that can be used to calculate electromechanical delay (EMD) without the measurement of forces. A secondary purpose, as an example of the importance of measuring EMD, was to predict muscle force development events based on the EMG activity of selected muscles during cycling at different pedaling frequencies. EMD was estimated using newly derived equations based on activation dynamics hypothesis. Tibialis anterior (TA) and soleus (SL) muscles of 16 male participants were studied while subjects pedaled at targeted cadences of 60, 80, and 100 revolutions per minute. The estimated EMDs of TA and SL were significantly different from each other with means of 68.1 and 88.7 ms, respectively. The average crank angle for the initiation and time to peak TA contraction was estimated at 75±35° and 26±15° before the crank reached top-dead-center (TDC), while the contraction ended at 31±19° after the TDC on average. The projected starting, peak and end angles of SL contraction activity were 45±18°, 123±13°, and 218±35° after the TDC, respectively. There was no difference among different pedaling cadences observed for these mechanical events. The proposed method was proven to be effective in studying EMD and estimate muscle contraction patterns during cycling.     

Gait variability magnitude but not structure is altered in essential tremor

Essential tremor (ET) is a common tremor disorder affecting postural/action tremor of the upper extremities and midline. Recent research revealed a cerebellar-like deficit during tandem gait in persons with ET, though spatiotemporal variability during normal gait in ET has been relatively ignored. The first purpose of this study was to investigate gait variability magnitude and structure in ET as compared to healthy older adults (HOA). To address this issue, 11 ET and 11 age-matched HOAs walked on a treadmill for 5 min at preferred walking speeds. HOAs walked for an additional minute while speed-matched to an ET participant. The second purpose was to describe the clinical correlates of gait variability in this population. To address this aim, 31 persons with ET walked on a treadmill for 5 min and completed the Fahn–Tolosa–Marin Tremor Rating Scale. Gait variability magnitude was derived by calculating coefficients of variation in stride length, stride time, step length, step time, and step width. Gait variability structure was derived using a detrended fluctuation analysis technique. At preferred walking speeds, ET participants walked significantly slower with significantly increased variability magnitude in all five spatiotemporal gait parameters. At speed-matched walking, ET participants exhibited significantly higher step width variability. Gait variability structure was not different between groups. We also observed that gait variability magnitude was predicted by severity of upper extremity and midline tremors. This study revealed that self-selected gait in ET is characterized by high variability that is associated with tremor severity in the upper extremity and midline.     

Increased hip internal abduction moment and reduced speed are the gait strategies used by women with knee osteoarthritis

The purpose of this study was to identify the gait strategies in women with mild and moderate knee osteoarthritis (OA). Forty women diagnosed with OA of the knee and 40 healthy women participated in the study. Toe-out progression angle, trunk lateral lean, hip internal abduction moment and gait speed were measured using Qualisys ProReflex System and two force plates. Principal component analysis was applied to extract features from the gait waveforms data that characterized the waveforms main modes of temporal variation. Discriminant analysis with a stepwise model was conducted to determine which strategies could best discriminate groups. According to the discriminant model, the PC2 of the internal abduction moment of the hip and the gait speed were the most discriminatory variables between the groups. The OA group showed decreased gait speed, decreased hip internal abduction moment during the loading response phase, and increased hip internal abduction moment during the mid and terminal stance phases. Interventions that may increase hip internal abduction moment, such as the strengthening of the hip abductors muscles, may benefit women with knee OA. Training slower than normal gait speeds must be considered in light of potential adverse implications on overall physical function, daily tasks, and safety.     

How symmetric are metal-on-metal hip resurfacing patients during gait? Insights for the rehabilitation

Metal-on-metal hip resurfacing patients demonstrate hip biomechanics closer to normal in comparison to total hip arthroplasty during gait. However, it is not clear how symmetric is the gait of hip resurfacing patients. Biomechanical data of 12 unilateral metal-on-metal hip resurfacing participants were collected during gait at a mean time of 45 months (SD 24) after surgery. Ankle, knee, hip, pelvis and trunk kinematics and kinetics of both sides were measured with a motion and force-capture system. Principal component analysis and mean hypothesis’ tests were used to compare the operated and healthy sides. The operated side had prolonged ankle eversion angle during late stance and delayed increased ankle inversion angle during early swing (p = 0.008; effect size = 0.70), increased ankle inversion moment during late stance (p = 0.001; effect size = 0.78), increased knee adduction angle during swing (p = 0.044; effect size = 0.57), decreased knee abduction moment during stance (p = 0.05; effect size = 0.40), decreased hip range of motion in the sagittal plane (p = 0.046; effect size = 0.56), decreased range of hip abduction moment during stance (p = 0.02; effect size = 0.63), increased hip range of motion in the transverse plane (p = 0.02; effect size = 0.62), decreased hip internal rotation moment during the transition from loading response to midstance (p = 0.001; effect size = 0.81) and increased trunk ipsilateral lean (p = 0.03; effect size = 0.60). Therefore, hip resurfacing patients have some degree of asymmetry in long term, which may be related to hip weakness and decreased range of motion, to foot misalignments and to strategies implemented to reduce loading on the operated hip. Interventions such as muscle strengthening and stretching, insoles and gait feedback training may help improving symmetry following hip resurfacing.     

Kinetic and kinematic adjustments during perturbed walking across visible and camouflaged drops in ground level

Walking in even the most familiar environment posesses a challenge to humans due to continuously changing surface conditions such as compliance, slip, or level. These changes can be visible or invisible due to camouflage. In order to prevent falling, camouflaged changes in the ground level in particular require a quick response of the locomotor system. For ten subjects we investigated kinematics and ground reaction forces of two consecutive contacts while they were walking across visible (drops of 0, −5 and −10 cm at second contact) and camouflaged (drops of 0 or −5 cm, and drops of 0 or −10 cm at second contact) changes in the ground level. For both situations we found significant kinetic and kinematic adjustments during the perturbed second contact but also one step earlier, in the preparatory first contact. During walking across visible changes in the ground level, second peak ground reaction force at first contact decreased whereas the drop height increased at the second contact. In addition, at the end of this first contact the ankle and knee were more flexed and the trunk was more erect compared to level walking. During the perturbed second contact, first peak ground reaction force increased with drop height, whereas kinematic adjustments at touchdown were less. The visual perception of the perturbation facilitated prior adaptations. During walking across camouflaged changes in ground level such a visually guided preadaptation was not possible and the adaptations prior to the perturbation were less than those observed during walking across visible changes in the ground. However, when stepping into a camouflaged drop, the kinetic and kinematic adjustments became more obvious and they increased with increasing camouflaged drop height.     

Energy exchange between subject and belt during treadmill walking

Treadmill walking aims to simulate overground walking, but intra-stride belt speed variations of treadmills result in some interaction between treadmill and subject, possibly obstructing this aim. Especially in self-paced treadmill walking, in which the belt speed constantly adjusts to the subject, these interactions might affect the gait pattern significantly. The aim of this study was to quantify the energy exchange between subject and treadmill, during the fixed speed (FS) and self-paced (SP) modes of treadmill walking. Eighteen subjects walked on a dual-belt instrumented treadmill at both modes. The energy exchange was calculated as the integration of the product of the belt speed deviation and the fore-aft ground reaction force over the stride cycle. The total positive energy exchange was 0.44 J/stride and the negative exchange was 0.11 J/stride, which was both less than 1.6% of the performed work on the center of mass. Energy was mainly exchanged from subject to treadmill during both the braking and propulsive phase of gait. The two treadmill modes showed a similar pattern of energy exchange, with a slightly increased energy exchange during the braking phase of SP walking. It is concluded that treadmill walking is only mildly disturbed by subject-belt interactions when using instrumented treadmills with adequate belt control.