The influence of locomotor training on dynamic balance during steady-state walking post-stroke

Slow walking speed and lack of balance control are common impairments post-stroke. While locomotor training often improves walking speed, its influence on dynamic balance is unclear. The goal of this study was to assess the influence of a locomotor training program on dynamic balance in individuals post-stroke during steady-state walking and determine if improvements in walking speed are associated with improved balance control. Kinematic and kinetic data were collected pre- and post-training from seventeen participants who completed a 12-week locomotor training program. Dynamic balance was quantified biomechanically (peak-to-peak range of frontal plane whole-body angular-momentum) and clinically (Berg-Balance-Scale and Dynamic-Gait-Index). To understand the underlying biomechanical mechanisms associated with changes in angular-momentum, foot placement and ground-reaction-forces were quantified. As a group, biomechanical assessments of dynamic balance did not reveal any improvements after locomotor training. However, improved dynamic balance post-training, observed in a sub-group of 10 participants (i.e., Responders), was associated with a narrowed paretic foot placement and higher paretic leg vertical ground-reaction-force impulse during late stance. Dynamic balance was not improved post-training in the remaining seven participants (i.e., Non-responders), who did not alter their foot placement and had an increased reliance on their nonparetic leg during weight-bearing. As a group, increased walking speed was not correlated with improved dynamic balance. However, a higher pre-training walking speed was associated with higher gains in dynamic balance post-training. These findings highlight the importance of the paretic leg weight bearing and mediolateral foot placement in improving frontal plane dynamic balance post-stroke.     

Dynamic balance during running using running-specific prostheses

Running is beneficial for physical, social, and emotional health, and participating in physical activity, including running, is becoming more popular for people with an amputation. However, this population has a greater risk of falling relative to people without an amputation, which may be a barrier to running. Understanding how dynamic balance is maintained during running is important for removing this barrier. To investigate dynamic balance, we quantified whole-body angular momentum in eight people with a unilateral transtibial amputation (TTA) using running-specific prostheses (RSPs) compared to eight people without TTA during running at 2.5, 3.0, and 3.5 m/s. People with TTA had greater ranges of whole-body angular momentum compared to people without TTA in the frontal and sagittal planes (p < 0.01). These greater ranges resulted from smaller peak medial, lateral, and braking ground reaction forces from the amputated leg compared to the intact leg and people without TTA. Reduced RSP mass relative to the biological leg also influenced whole-body angular momentum as evidenced by smaller ranges of amputated leg angular momentum compared to the intact leg in the frontal and sagittal planes. Smaller amputated leg angular momentum corresponded with smaller contralateral arm angular momentum in the sagittal plane (p < 0.01). People with TTA maintain balance during running with altered muscle coordination and prosthesis characteristics. Restoring mediolateral force generation through prosthetic design advances may help in regulating the frontal plane component of whole-body angular momentum for people with TTA, with potential to improve their ability to maintain balance during running.     

Dynamic structure of lower limb joint angles during walking post-stroke

BackgroundVariability in joint kinematics is necessary for adaptability and response to everyday perturbations; however, intrinsic neuromotor changes secondary to stroke often cause abnormal movement patterns. How these abnormal movement patterns relate to joint kinematic variability and its influence on post-stroke walking impairments is not well understood.ObjectiveThe purpose of this study was to evaluate the movement variability at the individual joint level in the paretic and non-paretic limbs of individuals post-stroke.MethodsSeven individuals with hemiparesis post-stroke walked on a treadmill for two minutes at their self-selected speed and the average speed of the six-minute walk test while kinematics were recorded using motion-capture. Variability in hip, knee, and ankle flexion/extension angles during walking were quantified with the Lyapunov exponent (LyE). Interlimb differences were evaluated.ResultsThe paretic side LyE was higher than the non-paretic side at both self-selected speed (Hip: 50%; Knee: 74%), and the average speed of the 6-min walk test (Hip: 15%; Knee: 93%).ConclusionDifferences in joint kinematic variability between limbs of persons post-stroke supports further study of the source of non-paretic limb deviations as well as the clinical implications of joint kinematic variability in persons post-stroke. The development of bilaterally-targeted post-stroke gait interventions to address variability in both limbs may promote improved outcomes.     

Control of lateral weight transfer is associated with walking speed in individuals post-stroke

Restoring functional gait speed is an important goal for rehabilitation post-stroke. During walking, transferring of one’s body weight between the limbs and maintaining balance stability are necessary for independent functional gait. Although it is documented that individuals post-stroke commonly have difficulties with performing weight transfer onto their paretic limbs, it remains to be determined if these deficits contributed to slower walking speeds. The primary purpose of this study was to compare the weight transfer characteristics between slow and fast post-stroke ambulators. Participants (N = 36) with chronic post-stroke hemiparesis walked at their comfortable and maximal walking speeds on a treadmill. Participants were stratified into 2 groups based on their comfortable walking speeds (≥0.8 m/s or <0.8 m/s). Minimum body center of mass (COM) to center of pressure (COP) distance, weight transfer timing, step width, lateral foot placement relative to the COM, hip moment, peak vertical and anterior ground reaction forces, and changes in walking speed were analyzed. Results showed that slow walkers walked with a delayed and deficient weight transfer to the paretic limb, lower hip abductor moment, and more lateral paretic limb foot placement relative to the COM compared to fast walkers. In addition, propulsive force and walking speed capacity was related to lateral weight transfer ability. These findings demonstrated that deficits in lateral weight transfer and stability could potentially be one of the limiting factors underlying comfortable walking speeds and a determinant of chronic stroke survivors’ ability to increase walking speed.     

Energy cost of balance control during walking decreases with external stabilizer stiffness independent of walking speed

Human walking requires active neuromuscular control to ensure stability in the lateral direction, which inflicts a certain metabolic load. The magnitude of this metabolic load has previously been investigated by means of passive external lateral stabilization via spring-like cords. In the present study, we applied this method to test two hypotheses: (1) the effect of external stabilization on energy cost depends on the stiffness of the stabilizing springs, and (2) the energy cost for balance control, and consequently the effect of external stabilization on energy cost, depends on walking speed. Fourteen healthy young adults walked on a motor driven treadmill without stabilization and with stabilization with four different spring stiffnesses (between 760 and 1820 N m⁻¹) at three walking speeds (70%, 100%, and 130% of preferred speed). Energy cost was calculated from breath-by-breath oxygen consumption. Gait parameters (mean and variability of step width and stride length, and variability of trunk accelerations) were calculated from kinematic data. On average external stabilization led to a decrease in energy cost of 6% (p<0.005) as well as a decrease in step width (24%; p<0.001), step width variability (41%; p<0.001) and variability of medio-lateral trunk acceleration (12.5%; p<0.005). Increasing stabilizer stiffness increased the effects on both energy cost and medio-lateral gait parameters up to a stiffness of 1260 N m⁻¹. Contrary to expectations, the effect of stabilization was independent of walking speed (p=0.111). These results show that active lateral stabilization during walking involves an energetic cost, which is independent of walking speed.     

Merged plantarflexor muscle activity is predictive of poor walking performance in post-stroke hemiparetic subjects

Stroke is the leading cause of long-term disability and individuals post-stroke often experience impaired walking ability. The plantarflexor (PF) muscles are critical to walking through their contributions to the ground reaction forces and body segment energetics. Previous studies have shown muscle activity during walking can be grouped into co-excited muscle sets, or modules. Improper co-activation, or merging of modules, is a common impairment in individuals post-stroke. The purpose of this study was to determine the influence of merged PF modules on walking performance in individuals post stroke by examining balance control, body support and propulsion, and walking symmetry. Muscle modules were identified using non-negative matrix factorization to classify subjects as having an independent or merged PF module. The merged group had decreased balance control with a significantly higher frontal plane whole-body angular momentum than both the independent and control groups, while the independent and control groups were not significantly different. The merged group also had higher paretic braking and nonparetic propulsion than both the independent and control groups. These results remained when comparisons were limited to subjects who had the same number of modules, indicating this was not a general effect due to subjects with merged PF having fewer modules. It is likely that a merged PF module is indicative of general PF dysfunction even when some activation occurs at the appropriate time. These results suggest an independent PF module is critical to walking performance, and thus obtaining an independent PF module should be a crucial aim of stroke rehabilitation.     

Postural and dynamic balance while walking in adults with incomplete spinal cord injury

The purpose of this study was to characterize balance in individuals with and without an incomplete spinal cord injury (ISCI) during the single support phase of gait. Thirty-four individuals (17 with a ISCI, 17 able-bodied) walked at their self-selected walking speed. Among those, eighteen individuals (9 with ISCI, 9 able-bodied) with a similar walking speed were also analyzed. Stabilizing and destabilizing forces quantified balance during the single support phase of gait. The biomechanical factors included in the equation of the stabilizing and destabilizing forces served as explanatory factors. Individuals with ISCI had a lower stabilizing force and a higher destabilizing force compared to able-bodied individuals. The main explanatory factors of the forces extracted from the equations were the speed of the center of mass (maximal stabilizing force) and the distance between the center of pressure and the base of support (minimal destabilizing force). Only the minimal destabilizing force was significantly different among subgroups with a similar walking speed. The stabilizing and destabilizing forces suggest that individuals with ISCI were more stable than able-bodied, which was achieved by walking more slowly – which decrease the speed of the center of mass – and keeping the center of pressure away from the margin of the base of support in order to maintain balance within their range of physical ability.     

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.     

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.     

Effects of aging and arm swing on the metabolic cost of stability in human walking

To gain insight into the mechanical determinants of walking energetics, we investigated the effects of aging and arm swing on the metabolic cost of stabilization. We tested two hypotheses: (1) elderly adults consume more metabolic energy during walking than young adults because they consume more metabolic energy for lateral stabilization, and (2) arm swing reduces the metabolic cost of stabilization during walking in young and elderly adults. To test these hypotheses, we provided external lateral stabilization by applying bilateral forces (10% body weight) to a waist belt via elastic cords while young and elderly subjects walked at 1.3m/s on a motorized treadmill with arm swing and with no arm swing. We found that the external stabilizer reduced the net rate of metabolic energy consumption to a similar extent in elderly and young subjects. This reduction was greater (6-7%) when subjects walked with no arm swing than when they walked normally (3-4%). When young or elderly subjects eliminated arm swing while walking with no external stabilization, net metabolic power increased by 5-6%. We conclude that the greater metabolic cost of walking in elderly adults is not caused by a greater cost of lateral stabilization. Moreover, arm swing reduces the metabolic cost of walking in both young and elderly adults likely by contributing to stability.     

Reliability and comparison of Kinect-based methods for estimating spatiotemporal gait parameters of healthy and post-stroke individuals

Different studies have analyzed the potential of the off-the-shelf Microsoft Kinect, in its different versions, to estimate spatiotemporal gait parameters as a portable markerless low-cost alternative to laboratory grade systems. However, variability in populations, measures, and methodologies prevents accurate comparison of the results. The objective of this study was to determine and compare the reliability of the existing Kinect-based methods to estimate spatiotemporal gait parameters in healthy and post-stroke adults. Forty-five healthy individuals and thirty-eight stroke survivors participated in this study. Participants walked five meters at a comfortable speed and their spatiotemporal gait parameters were estimated from the data retrieved by a Kinect v2, using the most common methods in the literature, and by visual inspection of the videotaped performance. Errors between both estimations were computed. For both healthy and post-stroke participants, highest accuracy was obtained when using the speed of the ankles to estimate gait speed (3.6–5.5 cm/s), stride length (2.5–5.5 cm), and stride time (about 45 ms), and when using the distance between the sacrum and the ankles and toes to estimate double support time (about 65 ms) and swing time (60–90 ms). Although the accuracy of these methods is limited, these measures could occasionally complement traditional tools.     

Dynamic stability of individuals with transtibial amputation walking in destabilizing environments

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

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.     

The relationships between physical capacity and biomechanical plasticity in old adults during level and incline walking

Old compared to young adults exhibit increased hip and decreased ankle mechanical output during walking – a phenomenon known as biomechanical plasticity. Previous comparison studies suggest that low compared to high capacity old adults exhibit larger magnitudes of this plasticity, however the precise relationship between capacity and plasticity magnitude remains unclear. The purpose of this study was to quantify the relationships between physical capacity and biomechanical plasticity magnitude during level and incline walking. Data were collected for 32 old adults walking over level and inclined (+10°) surfaces at self-selected, comfortable speeds. Physical capacity was measured using the Short-Form Health Survey Physical Component (SF-36 PC) and biomechanical plasticity was quantified by ratios of hip extensor to ankle plantarfexor peak torques, angular impulses, peak positive powers, and positive work (larger ratios indicate larger magnitudes of plasticity). SF-36 PC scores correlated positively with all four biomechanical plasticity ratios during level walking and three of the four ratios during incline walking. Some of the biomechanical plasticity ratios correlated positively with comfortable walking speeds and stride frequencies, indicating better walking performance with larger magnitudes of plasticity. Additionally, all four biomechanical plasticity ratios were larger during incline compared to level walking, suggesting the need for larger magnitudes of plasticity during the more difficult task. These results indicate that larger magnitudes of biomechanical plasticity afford functional benefits such as increased level and incline walking performance for old adults. Increased walking performance has the potential to increase quality of life in the growing population of old adults.     

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.     

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.     

Subject-specific responses to an adaptive ankle prosthesis during incline walking

Individuals with lower-limb amputation often have difficulty walking on slopes, in part due to limitations of conventional prosthetic feet. Conventional prostheses have fixed ankle set-point angles and cannot fully replicate able-bodied ankle dynamics. Microprocessor-controlled ankles have been developed to help overcome these limitations. The objective of this study was to characterize how the slope adaptation feature of a microprocessor-controlled ankle affected individual prosthesis user gait biomechanics during sloped walking. Previous studies on similar microprocessor-controlled ankles have focused on group-level results (inter-subject mean), but did not report individual subject results. Our study builds upon prior work and provides new insight by presenting subject-specific results and investigating to what extent individual responses agree with the group-level results. We performed gait analysis on seven individuals with unilateral transtibial amputation while they walked on a 7.5° incline with a recently redesigned microprocessor-controlled ankle that adjusts ankle set-point angle to the slope. We computed gait kinematics and kinetics, and compared how users walked with vs. without this set-point adjustment. The microprocessor-controlled ankle increased minimum toe clearance for all subjects. Despite the microprocessor-controlled ankle behaving similarly for each user, we observed marked differences in individual responses. For instance, two users switched from a forefoot landing pattern with the microprocessor-controlled ankle locked at neutral angle to rearfoot landing when the microprocessor-controlled ankle adapted to the slope, while two maintained a forefoot and three maintained a rearfoot landing pattern across conditions. Changes in knee angle and moment were also subject-specific. Individual user responses were often not well represented by inter-subject mean. Although the prevailing experimental paradigm in prosthetic gait analysis studies is to focus on group-level analysis, our findings call attention to the high inter-subject variability which may necessitate alternative experimental approaches to assess prosthetic interventions.     

Validity and reliability of a shoe-embedded sensor module for measuring foot progression angle during over-ground walking

Wearable systems are becoming increasingly popular for gait assessment outside of laboratory settings. A single shoe-embedded sensor module can measure the foot progression angle (FPA) during walking. The FPA has important clinical utility, particularly in populations with knee osteoarthritis, as it is a target for biomechanical treatments. However, the validity and the day-to-day reliability of FPA measurement using wearable systems during over-ground walking has yet to be established. Two gait analysis sessions on 20 healthy adults were conducted. During both sessions, participants performed natural over-ground walking in a motion capture laboratory and on a 100 m linear section of outdoor athletics track. FPA was measured in the laboratory via marker trajectory data, while the sensor module measured FPA during the outdoor track walking. Validity was examined by comparing the laboratory- and sensor-measured average FPA. Day-to-day reliability was examined by comparing the sensor-measured FPA between the first and second gait analysis sessions. Average absolute error between motion capture and sensor measured FPA were 1.7° and 2.1° at session 1 and 2, respectively. A Bland and Altman plot indicated no systematic bias, with 95% limit of agreement widths of 4.2° – 5.1°. Intraclass correlation coefficient (ICC_2k) analysis resulted in good to excellent validity (ICC = 0.89 – 0.91) and reliability (ICC = 0.95). Overall, the shoe-embedded sensor module is a valid and reliable method of measuring FPA during over-ground walking without the need for laboratory equipment.     

Dynamic stability of superior vs. inferior body segments in individuals with transtibial amputation walking in destabilizing environments

Interestingly, young and highly active people with lower limb amputation appear to maintain a similar trunk and upper body stability during walking as able-bodied individuals. Understanding the mechanisms underlying how this stability is achieved after lower-leg amputation is important to improve training regimens for improving walking function in these patients. This study quantified how superior (i.e., head, trunk, and pelvis) and inferior (i.e., thigh, shank, and feet) segments of the body respond to continuous visual or mechanical perturbations during walking. Nine persons with transtibial amputation (TTA) and 12 able-bodied controls (AB) walked on a 2 m×3 m treadmill in a Computer Assisted Rehabilitation Environment (CAREN). Subjects were perturbed by continuous pseudo-random mediolateral movements of either the treadmill platform or the visual scene. TTA maintained a similar local and orbital stability in their superior body segments as AB throughout both perturbation types. However, for their inferior body segments, TTA subjects exhibited greater dynamic instability during perturbed walking. In TTA subjects, these increases in instability were even more pronounced in their prosthetic limb compared to their intact leg. These findings demonstrate that persons with unilateral lower leg amputation maintain upper body stability in spite of increased dynamic instability in their impaired lower leg. Thus, transtibial amputation does significantly impair sensorimotor function, leading to substantially altered dynamic movements of their lower limb segments. However, otherwise relatively healthy patients with unilateral transtibial amputation appear to retain sufficient remaining sensorimotor function in their proximal and contralateral limbs to adequately compensate for their impairment.     

Effect of plantarflexion resistance of an ankle-foot orthosis on ankle and knee joint power during gait in individuals post-stroke

Plantarflexion resistance of an ankle-foot orthosis (AFO) plays an important role to prevent foot-drop, but its impact on push-off has not been well investigated in individuals post-stroke. The aim of this study was to investigate the effect of plantarflexion resistance of an articulated AFO on ankle and knee joint power of the limb wearing the AFO in individuals post-stroke. Gait analysis was performed on 10 individuals with chronic stroke using a Vicon 3-dimensional motion capture system and a Bertec split-belt instrumented treadmill. They walked on the treadmill under 4 plantarflexion resistance levels (S1 < S2<S3 < S4) set on the AFO with resistance adjustable ankle joints. The ankle and knee joint power calculations were performed using Visual3D, and mean values were plotted across a gait cycle. Statistical analyses revealed significant differences in the peak ankle joint power generation according to the plantarflexion resistance of the AFO (P = 0.008). No significant differences were found in the knee joint power. Peak ankle joint power generation [Median (IQR: Interquartile range)] were S1: 0.0517 (0.0238–0.1071) W/kg, S2: 0.0342 (0.0132–0.0862) W/kg, S3: 0.0353 (0.0127–0.0821) W/kg, and S4: 0.0234 (0.0087–0.06764) W/kg. Reduction of the peak ankle joint power generation appeared to be related to reduction in the peak plantarflexion angular velocity at late stance due to increases in the plantarflexion resistance of the AFO. This study showed that peak ankle joint power generation was significantly, and somewhat systematically, affected by plantarflexion resistance of the AFO in individuals post-stroke.