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PubMed2002

Characterization of gait function in patients with postsurgical sagittal (flatback) deformity: a prospective study of 21 patients.

STUDY DESIGN: This study prospectively analyzed gait in 21 patients with flatback and reviewed radiographs and charts. OBJECTIVE: To analyze the effect of sagittal imbalance on gait and hip and knee joints. SUMMARY OF BACKGROUND DATA: Loss of lumbar lordosis causes anterior displacement of the center of gravity, which creates instability and increases the work of gait. Several compensatory changes occur in response. The long-term effect of these changes on extra-axial joints has not been reported, nor have many studies analyzed the gait deviations in patients with flatback. Over time, as patients' ability to compensate is limited, increased gait deviations result. METHODS: A total of 21 of 44 patients who had gait analysis as part of the preoperative workup were selected based on outlined criteria. Kinetics and kinematics data were analyzed along with radiographic and chart review. Normal healthy individuals served as controls. RESULTS: Gait deviations were present in gait kinetics and kinematics, including decreased stride length and velocity, to almost 60% of controls. Stance duration was prolonged with increased hip and knee flexion during stance. Hip and knee extensor moments were decreased with vertical ground reaction force showing slower rate of loading, reduced peak values, and flattening of normal loading response. CONCLUSION: Patients with flatback develop several compensatory mechanisms. The goal of the compensation is to maintain an efficient gait and decrease joint damage, but these safeguards fail over time. Flatback not only causes backache, abnormal posture, and abnormal body mechanics but also compromises the stability of gait and taxes the knee and hip joints adversely.

Adaptation, Physiological↗
PubMed2001

Real-time gait event detection for paraplegic FES walking.

A real-time method for the detection of gait events that occur during the electrically stimulated locomotion of paraplegic subjects is described. It consists of a two-level algorithm for the processing of sensor signals and the determination of gait event times. Sensor signals and information about the progression of the stimulator though its pre-specified stimulation "pattern" are processed by a machine intelligence (fuzzy logic) algorithm to determine an initial estimate of the patient's current phase of gait. This is then reviewed and modified by a second algorithm that removes spurious gait estimates, and determines gait event times. These gait event times are known to the system within approximately one-half of a gait cycle. The resulting gait event detection system was successfully evaluated on three subjects. Detection accuracy is not adversely affected by day-to-day gait variability. This work resolved technical and practical issues that previously limited the real time application of these methods. In particular, cosmetically acceptable insole force transducers were used. This gait event detector is designed for use in a real time controller for the automatic adjustment of the intensity and timing of stimulation while the subject is walking using functional electrical stimulation (FES).

Adult↗
PubMed2005

Prevalence and severity of gait disorders in Alzheimer's and non-Alzheimer's dementias.

OBJECTIVES: To compare the prevalence, severity, and type of gait and balance disorders in Alzheimer's disease (AD), vascular dementia (VaD), Parkinson's disease with dementia (PDD), dementia with Lewy bodies (DLB), Parkinson's disease without dementia (PD), and age-matched controls. DESIGN: Cross-sectional. SETTING: Secondary care clinics in geriatric psychiatry, neurology, and geriatrics. PARTICIPANTS: Two hundred forty-five participants aged 65 and older (AD, n=40; VaD, n=39; PDD, n=46; DLB, n=32; PD, n=46; and controls, n=42). MEASUREMENTS: Prevalence and severity of gait and balance disorders were assessed using the Tinetti gait and balance scale. The types of gait disorders in each diagnostic group were classified using the Nutt et al. classification. RESULTS: Gait and balance disorders were more common with PDD (93%), VaD (79%), and DLB (75%) than with PD (43%) and AD (25%) and in controls (7%). The risk of gait and balance disorder was higher in the non-Alzheimer's dementia groups (VaD, PDD, and DLB) than in the AD group (odds ratio=15 (95% confidence interval=6-37). If a gait disorder was present in mild dementia (Cambridge Examination for Mental Disorders of the Elderly cognitive subsection score >65), this was diagnostic of non-Alzheimer's dementia, with sensitivity of 78% and specificity of 100%. Non-Alzheimer's dementia groups had worse Tinetti gait and balance scores than the AD group (all P<.001). The types of gait disorders discriminated between non-Alzheimer's dementias. CONCLUSION: The findings support the idea that gait and balance assessment may augment the diagnostic evaluation of dementia.

Aged↗
PubMedDate not supplied

Investigation of gait in elderly subjects over 88 years of age.

To evaluate senile gait patterns in octagenarians and nonagenarians, we provided a standardized questionnaire on gait disabilities to 153 elderly subjects over 88 years of age. Subjects represented a relatively healthy subgroup of noninstitutionalized residents who participated in a gerontological survey of all inhabitants of the city of Leiden who were 85 years of age or older. Of the 142 subjects who responded to this questionnaire, 87 persons (61%) claimed distinct diseases as a cause of gait impairment. Forty-two of the remaining 55 persons were investigated neurologically and received a standardized assessment of gait. Twenty-five persons (18% of all responders) had a completely normal gait, whereas a wide spectrum of gait abnormalities--mainly with ataxic features--was encountered in the remaining persons. It is concluded that a surprisingly high number of very old community residents can have a completely normal gait. Gait disorders in this age group are most frequently associated with common distinct diseases. In addition, many elderly have a gait disturbance of variable clinical nature and unclear pathologic basis, which may represent the "idiopathic senile gait."

Aged↗
PubMed2003

Whole-body mechanics and gaits in the gray short-tailed opossum Monodelphis domestica: integrating patterns of locomotion in a semi-erect mammal.

Gaits (footfall patterns) and external mechanical energy patterns of the center of mass were quantified in a generalized, semi-erect mammal in order to address three general questions. First, do semi-erect mammals exhibit the walk/run gait transitions that have been proposed as the primitive condition for tetrapods? Second, do small, semi-erect mammals employ the energy-saving pendular and spring-based mechanics used by erect mammals? Third, how well do mechanical locomotor patterns of the center of mass correlate with gaits? Monodelphis domestica utilizes only fast walking and running trot gaits over a fivefold increase in speed, over which we could illicit constant velocity steps, although running trots were their preferred gait. In sustained level locomotion the opossums did not use other walking gaits presumed to be primitive for tetrapods. Across the full range of speeds their trotting gaits exhibited force patterns and in-phase mechanical energy fluctuations that are characteristic of spring-mass mechanics. Thus, opossums appear to prefer trotting gaits with bouncing mechanics for sustained locomotion. Integration of center-of-mass versus footfall perspectives reveals that spring-mass mechanics is associated with both walking trot and running trot gaits. Furthermore, the onset of an aerial phase was not clearly associated with either the walk/run gait transition (50% duty factor) or a change in center-of-mass mechanics. The assumption that energy-saving mechanisms are ubiquitous among mammals is tenuous because small non-cursorial mammals do not appear to use pendular-based mechanics for sustained locomotion and, although they prefer spring-based mechanics, they probably lack clear musculoskeletal spring elements that could store energy during running. Thus, it appears that simply paying for locomotion with muscular work may be the primitive condition for mammals.

Animals↗
PubMed2004

Neuromuscular control of trout swimming in a vortex street: implications for energy economy during the Karman gait.

Approximating the complexity of natural locomotor conditions provides insight into the diversity of mechanisms that enable animals to successfully navigate through their environment. When exposed to vortices shed from a cylinder, fishes hold station by adopting a mode of locomotion called the Kármán gait, whereby the body of the fish displays large, lateral oscillations and the tail-beat frequency matches the vortex shedding frequency of the cylinder. Although field studies indicate that fishes often prefer turbulent flows over uniform currents, the effect of hydrodynamic perturbations on the mechanics, control and energetics of locomotion is still poorly understood. In this study, electromyography is used to measure red and white axial muscle activity for rainbow trout (Oncorhynchus mykiss) holding station in a vortex street. When trout Kármán gait, they show a significantly reduced but still rhythmic pattern of muscle activity compared with that seen when they swim steadily in uniform flow. Specifically, trout selectively activated only their anterior red axial muscles and abandoned the antero-posterior wave of red muscle activity that drives undulatory locomotion in uniform flow. This supports a previously proposed hypothesis that trout are not just swimming in the reduced flow behind a cylinder (drafting). Anterior axial muscle activity was correlated to head amplitude during steady swimming but not during the Kármán gait, indicating that while activation of muscles during the Kármán gait may aid in stability and control, vortices determined overall head motion. Furthermore, anterior red axial muscle activity, the only region of muscle activity shared between both the Kármán gait and steady swimming, had a lower intensity and longer duration during the Kármán gait. At times when paired fins were active during the Kármán gait, there was no axial muscle activity measured, lending support to a passive mechanism of thrust generation in oscillating flows. Comparisons with dead trout towed behind a cylinder confirm this intriguing observation that live trout may temporarily adopt the Kármán gait with no axial muscle activity, revealing paradoxically that at times fish can passively move against turbulent flow. To Kármán gait for prolonged periods, however, trout must adapt to the demands of turbulence by eliciting a shift in neural control strategy. By decoupling motor output both down and across the body, the pattern of rhythmic Kármán gait muscle activity may reflect the entrainment of a central pattern generator to environmental vortices.

Animals↗
PubMed1997

Postnatal development of body architecture and gait in several rodent species.

Observations on five species of rodents, vole (Microtus socialis), gerbil (Gerbillus dasyurus), jird (Meriones tristrami), dormouse (Eliomys melanurus) and jerboa (Jaculus orientalis), revealed that, during the period when their neonates share a matching morphology, they also share the same forms of quadruped locomotion (gaits). The order in which the different gaits develop is similar in all species, beginning with the basic gaits of lateral walk and trot. Gaits and body morphology do not undergo further changes in voles, whereas the other species incorporate more specialized gaits later in ontogeny, when the adult body morphology has been attained. Gerbils and jirds incorporate a bounding gait, dormice incorporate galloping and jerboas incorporate bipedal running. Species with more specialized locomotion thus undergo more developmental stages than those with less specialized locomotion. Except for the jerboa, the nesting period was roughly the same for all species, but those with more specialized locomotion exhibited earlier onset of the basic gaits as if condensing their development in order to reach the adult gait within the same nesting period. Consequently, the adult gait emerges approximately 10 days before the end of nesting, regardless of nesting duration. Since growth rate does not seem to account for the differences in morphology and onset of gaits, the heterochrony in the observed species probably stems from differences in the duration of growth, which seems to be the key factor in the diversion from the basic common morphology. The present results reconfirm the traditional generalities of functional morphology derived from cross-species comparisons. In addition, they provide another perspective by comparing form and function within the same individuals in the course of ontogeny.

Animals↗
PubMed1996

Influence of speed on gait parameters and on symmetry in trans-tibial amputees.

Normal gait is characterised by a high level of inter-leg symmetry of gait parameters. Therefore, efforts in rehabilitation of amputees are directed at the construction of a prosthesis which provides normal leg function and allows a more symmetrical gait. Analysis of the gait of trans-tibial amputees was performed when they were ambulating at their own freely selected speed and at a faster speed. The effect of speed on selected gait parameters in each leg was evaluated and the influence on symmetry established by comparing the inter-leg changes for each of the selected parameters. The faster gait trail affected significantly all temporal and distance parameters in both legs but not the level of symmetry between legs. At the faster speed, the hip angles at heel-strike and during swing and the knee angle during load response, in the normal leg, and the knee angle during swing in the amputated leg, all increased significantly. Speed of gait significantly affected symmetry between knee angles as reflected by the increased differences measured during load response (from 2.62 +/- 5.2 to 7.06 +/- 4.2 degrees) and during toe-off (from 1.80 +/- 7.4 to 9.50 +/- 9.1 degrees). Timing and sequence of selected gait events, as related to stride time, were not significantly affected by speed of gait. These results might contribute to a better understanding of gait characteristics in trans-tibial amputees and provide design guidance for prosthetic components.

Adult↗
PubMed2000

A biomechanical analysis of gait during pregnancy.

BACKGROUND: There are many anatomical changes during pregnancy that could potentially lead to substantial alterations in gait. Gait deviations may contribute to a variety of musculoskeletal overuse conditions associated with pregnancy, such as low-back, hip, and calf pain. Because we are aware of little research on this topic, the purpose of this study was to objectively analyze gait during pregnancy. METHODS: Three-dimensional gait analysis was performed on fifteen women during the second half of the last trimester of pregnancy and again one year post partum. Selected kinematic and kinetic parameters for the pregnancy and one-year postpartum conditions were compared with use of paired t tests (95 percent significance level). RESULTS: Overall, gait kinematics were remarkably unchanged during pregnancy. No evidence of a so-called waddling gait during pregnancy was found. Maximum anterior pelvic tilt during gait increased a mean of 4 degrees during pregnancy, although individual subject-to-subject variation (range, an increase of 13 degrees to a decrease of 10 degrees) was observed. Significant increases in hip and ankle kinetic gait parameters, however, were observed during pregnancy (p < 0.05). CONCLUSIONS: Significant increases in kinetic gait parameters during pregnancy (p < 0.05) explain how gait motion remained relatively unchanged despite increases in body mass and width as well as changes in mass distribution about the trunk. This finding indicates that during pregnancy there may be an increased demand placed on hip abductor, hip extensor, and ankle plantar flexor muscles during walking.

Adult↗
PubMed2003

[Parkinson's disease as a model of aging: prospective analysis of gait discorders].

Falls are a dramatic consequence of the age-related gait disorders. There are few prospective studies on falls predictive of the biomechanical features of gait. According to the literature, there are similarities between the gait observed in older people and in parkinsonian subjects. The objective of this study was to apply multiparametric gait analysis to demonstrate changes of the neuromotor gait pattern connected with falls. This prospective study included two groups of 16 subjects aged more than 60 years, who had not fallen during the previous year. One group included 16 minimally disabled parkinsonian patients off drugs, and the other group 16 healthy people. Gait recordings were obtained with a three-dimensional optoelectronic movement analysis system coupled with 2 force platforms in all persons who were followed for 1 year to collect data on all new events, particularly falls. Data analysis concerned spatiotemporal stride and three-dimensional power peaks developed in each lower limb joint. Cluster analysis of the 32 persons was used to determine various infraclinic neuromotor gait patterns. A post hoc analysis of variance was then applied to identify discriminating parameters. Three groups of subjects were identified with 3 different neuromotor gait patterns, independently of the presence of Parkinson disease. There were no fallers in first group (n=18). The second group (n=8) had 20 p.cent fallers and the third group (n=4) 100 p.cent fallers. The groups differed by 4 spatiotemporal parameters and 3 joint power peaks in the sagittal plane. Functional capacity was good in the first group with no falls recorded. This group of subjects had characteristics reported in the literature corresponding to a category of persons who compensate well for the phenomena of aging. Functional capacity was intermediary in the second group (20 p. cent were fallers). The kinematic pattern appeared to be less successful, revealing a tendency for stiff posture. The third group (100 p. cent fallers) exhibited inferior functional capacity. In this group, the kinematic pattern appeared to be disrupted. The subjects were unable to adapt satisfactorily to situations other than by stereotypical neuromotor reactions. In conclusion this study demonstrated a close determinism between physiological neuromotor aging and Parkinson's disease. The prospective follow-up demonstrated that falls that occurred were related to changes in neuromotor gait patterns. Three phases of gait pattern were also identified from minimal to major risk of falls.

Aged↗
PubMed2006

Effect of therapeutic exercise on gait speed in community-dwelling elderly people: a meta-analysis.

BACKGROUND AND PURPOSE: Inconsistent research findings make it unclear whether therapeutic exercise improves gait speed in community-dwelling elderly people. Using meta-analytical procedures, we examined the effect of therapeutic exercise on changing gait speed in community-dwelling older adults and the effect of type, intensity, and dose of therapeutic exercise on gait speed. METHOD: Studies were retrieved using a comprehensive database search. Two independent reviewers determined study eligibility based on inclusion criteria, rated study quality, and extracted information on study methods, design, intervention, and results. Data were combined to obtain an overall effect size, its 95% confidence interval, and a measure of significance. In addition, analyses to characterize the clinical relevance of the findings were performed. RESULTS: One hundred seventeen studies were evaluated, with 24 studies (n=1,302 subjects) meeting the inclusion criteria for habitual gait speed and 18 studies (n=752 subjects) meeting the inclusion criteria for fast gait speed. Therapeutic exercise--or, more specifically, strength training and combination training (aerobic plus other exercise)--had significant effects (r=.145, P=.017; r=.176, P=.002, respectively) on habitual gait speed. High-intensity (effort expended by subjects) exercise and high-dosage (frequency and duration of exercise sessions) intervention also had a significant effect (r=.184, P=.001; r=.190, P=.001, respectively) on gait speed, whereas there was no effect for moderate- and low-intensity exercise or for low-dosage exercise. No exercise intervention affected fast gait speed in this analysis. DISCUSSION AND CONCLUSION: The results provide support for the belief that therapeutic exercise can improve gait speed in community-dwelling elderly people and that intensity and dosage are important contributing factors. The relatively weak correlation found between therapeutic exercise and gait speed merits further study.

Aged↗
PubMed1975

Assessing nonprofessional mental health workers with the GAIT. An evaluation of peer ratings.

Coed groups of undergraduates took the Group Assessment of Interpersonal Traits (GAIT) twice with either a 3-week or a 9-week interval. Peer ratings of the nine GAIT scales were unrelated to sex. Test-retest correlations were significantly positive for the short-interim Ss (N = 41) but were generally low for the long-interim Ss (N = 29). Peer-rated GAIT Therapeutic Talent variables (Understand, Accepting-Warm, Open) were significantly correlated with the self-reported Comrey Personality Scale of Empathy, and GAIT Open was significantly correlated with Comrey Activity. GAIT Open, Accepting-Warm, and Best Counselor ratings were significantly correlated with total verbal responses (as counted from audiotapes of the GAIT interactions). The highly intercorrelated GAIT Therapeutic Talent variables may not be discriminated by peer raters. It is suggested that peer GAIT Therapeutic Talent ratings may be tapping an underlying global dimension, Help-Oriented Activity. Attention is called to the need for standardizing Gait ratings and for retaining the economy and ease of the GAIT.

Allied Health Personnel↗
PubMed2005

Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed.

BACKGROUND: Decreased gait speed and increased stride time, stride length, double support time, and stance time variability have consistently been associated with falling whereas step width variability has not been strongly related to falls. The purpose was to examine the linear and nonlinear associations between gait variability and fall history in older persons and to examine the influence of gait speed. METHODS: Gait characteristics and fall history were obtained in 503 older adults (mean age = 79; 61% female) participating in the Cardiovascular Health Study who could ambulate independently. Gait characteristics were recorded from two trials on a 4 meter computerized walkway at the subject's self-selected walking speed. Gait variability was calculated as the coefficient of variation. The presence of a fall in the past 12 months was determined by interview. The nonlinear association between gait variability and fall history was examined using a simple three level classification derived from the distribution of the data and from literature based cut-points. Multivariate logistic regression was used to examine the association between step width variability (extreme or moderate) and fall history stratifying by gait speed (1.0 m/s) and controlling for age and gender. RESULTS: Step length, stance time, and step time variability did not differ with respect to fall history (p > .33). Individuals with extreme step width variability (either low or high step width variability) were more likely to report a fall in the past year than individuals with moderate step width variability. In individuals who walked > or = 1.0 m/s (n = 281), after controlling for age, gender, and gait speed, compared to individuals with moderate step width variability individuals with either low or high step width variability were more likely to have fallen in the past year (OR and 95% CI 4.38 [1.79-10.72]). The association between step width variability and fall history was not significant in individuals who walked < 1.0 m/s (n = 224). CONCLUSION: Extreme (either too little or too much) step width variability is associated with falls in the past year in older persons who walk at or near normal gait speed and not in older persons who walk slowly (< 1.0 m/s).

Journal Article↗
PubMed2000

Intrasubject repeatability of gait analysis data in normal and spastic children.

OBJECTIVE: To evaluate intrasubject repeatability of data obtained from computer-aided motion analysis in normal and spastic children. DESIGN: Prospective controlled study. BACKGROUND: Information from gait analysis is used in selecting therapeutic interventions for gait improvement in cerebral palsy. While there are several studies regarding repeatability of normal gait, there are no studies evaluating the repeatability of spastic gait. METHODS: Forty children (20 normal, 20 with diplegic type of cerebral palsy) were subjected to gait analysis. Kinematic, kinetic and time distance parameters obtained from gait analysis were studied for intrasubject variability within-day and between-day using statistical measures. RESULTS: Normal children had lower variability in time distance parameters than spastic children both within and between days. The repeatability of kinetics was better than those of kinematics, and values for normal children were better than those for spastic children. Within-day repeatability of kinematics and kinetics was better in normal children. Between-day repeatability of kinematics was better in normal children, while spastic children showed better repeatability for kinetics. CONCLUSIONS: We found lower repeatability of gait analysis data in spastic children compared to normal children. Restricted joint range of motion due to spasticity in the group of cerebral palsy patients may be responsible for the lower repeatability of data. Some errors due to marker placement are inadvertent and contribute to the lower between-day repeatability. RELEVANCE: The results of this study should be of interest to clinicians who make therapeutic decisions in patients with cerebral palsy using gait analysis data, and for scientists studying normal and pathological gait.

Adolescent↗
PubMed2003

A new classification of higher level gait disorders in patients with cerebral multi-infarct states.

BACKGROUND: cerebral multi-infarct states may lead to gait disorders in the absence of cognitive impairment. Where these gait disorders occur in the absence of neurological signs they have been termed gait apraxia or more recently higher-level gait disorders. In this paper we hypothesise three main types based on presumptive sites of anatomical damage: (a) Ignition Apraxia, where damage is predominantly in the supplementary motor area and its connections, with good responses to external clues; (b) Equilibrium Apraxia, where damage is predominantly in the pre-motor area in its connections, with poor responses to external cues and (c) Mixed Gait Apraxia. SUBJECTS: the clinical features and measured gait parameters of 13 patients with cerebral multi-infarct states and higher-level gait disorder are described (7 with Ignition Apraxia and 6 with Equilibrium Apraxia) along with those of 6 healthy elderly control subjects. METHODS: baseline gait characteristics were assessed on a walkway, which measured the following: step lengths, width of base and velocity. RESULTS: measured baseline gait parameters support the above hypothesis. CONCLUSIONS: it is suggested, though not proven, that patients with Ignition Apraxia could have problems with internal cueing due to lesions in the supplementary motor area or its connections whereas those with Equilibrium Apraxia could have dysfunction predominantly in the pre-motor area and its connections.

Apraxia, Ideomotor↗
PubMed2002

Gait analysis of patients with neurogenic intermittent claudication.

STUDY DESIGN: The gait of patients with neurogenic intermittent claudication was analyzed before and after surgery using a ground reaction force plate. OBJECTIVES: To analyze the gait characteristics of patients with neurogenic intermittent claudication, to evaluate quantitatively their gait improvement after surgical treatment, and to examine the differences in gait characteristics and postoperative improvement among different types of neuropathy. SUMMARY OF BACKGROUND DATA: A number of reports have been published on the pathophysiology or treatment of neurogenic intermittent claudication. However, almost no detailed reports exist on the gait abnormalities associated with this condition. METHODS: The subjects were 60 lumbar canal stenosis patients with intermittent claudication who underwent surgery at the authors' hospital. A ground reaction force plate was used for the analysis, and factors related to time and distance (speed, stride, interval, and pitch) were analyzed, as well as factors related to the style of walking (symmetry, reappearance, smoothness, sway, rhythm, and impact). RESULTS: Before surgery, there were abnormalities of various factors related to the style of walking soon after the patients began to walk. Gait analysis also showed that the pattern of gait abnormality and its improvement after surgery varied depending on the type of neuropathy. CONCLUSIONS: Gait analysis permits objective and quantitative evaluation of the gait characteristics of patients with lumbar canal stenosis and is useful for evaluating responses to surgical treatment in these patients.

Aged↗
PubMed1988

Fast head tilt has only a minor effect on quick compensatory reactions during the regulation of stance and gait.

Sudden tilts of the head to the front or rear were induced during stance, balancing, gait and during perturbations of gait. The most prominent response in the leg muscle electromyogram (e.m.g.) to head tilt occurred in the tibialis anterior muscle (latency about 55 ms) following a backward tilt induced during balancing. During stance and gait, the e.m.g. activity related to head tilt was only a minor component of the leg muscle activity normally occurring during gait. When the head tilt was induced shortly after a perturbation of gait (treadmill acceleration impulse), the compensatory reaction in the leg muscles did not significantly differ from that seen after the gait perturbation alone. In addition, the rate of acceleration of the head was tested against the compensatory e.m.g. responses: No correlation of influence could be discerned. The results indicate that sudden head tilts and the resulting head acceleration have little influence on the e.m.g. patterns that occur during gait and perturbations of gait. It is assumed that these patterns are regulated by central programs, and that the compensation for leg perturbation is achieved mainly by spinal reflex mechanisms. It is discussed whether the lack of head tilt responses is the result of an antagonistic vestibular-neck interaction, or whether it indicates a reduced effectiveness of vestibulo- and cervico-spinal reflexes during gait.

Adult↗
PubMed2004

Gait retraining after anterior cruciate ligament reconstruction.

OBJECTIVES: To examine the effects of 2 gait retraining protocols on the gait patterns of patients with bone-patellar tendon-bone anterior cruciate ligament (ACL) reconstruction. DESIGN: Randomized control, repeated-measures design. SETTING: Private orthopedic center and research facility. PARTICIPANTS: Sixteen patients with bone-patellar tendon-bone ACL reconstruction, randomly subdivided into 2 groups (group 1, n=8; group 2, n=8), and a healthy control group of 8 subjects. INTERVENTION: The 16 subjects with ACL reconstruction were randomly assigned to 2 different gait retraining protocols over a 6-week training interval: (1). a protocol using a predicted stride frequency calculated from the resonant frequency of a force-driven harmonic oscillator (FDHO) model or (2). a protocol using the preferred stride frequency (PSF). MAIN OUTCOME MEASURES: Gait analyses examining the lower-extremity kinematic, kinetic, and energetic gait patterns of each group. RESULTS: Gait retraining with the FDHO model showed improvements in lower-extremity positions, hip and knee extensor angular impulse, and work parameters. Gait retraining with the PSF demonstrated no statistical improvements. The FDHO training protocol facilitated a greater midstance knee range of motion (ROM) and greater rates of improvement for midstance ROM, hip extensor angular impulse, and concentric hip extensor work. CONCLUSIONS: Gait retraining with the resonant frequency of an FDHO model facilitated a greater recovery of gait function compared with training with the PSF.

Adult↗