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PubMed2002

Performance-based gait tests for acute stroke patients.

OBJECTIVE: Qualitative measures may not differentiate severity of deficits after an acute or subacute stroke. The aim of this study was to contrast the utility of performance-based gait tests with qualitative measures in a sample of acute stroke patients. DESIGN: Twenty acute stroke subjects had their performance-based gait measured by gait speed, walking distance, gait energy expenditure, and gait energy cost. They were also qualitatively evaluated for cognition, functional outcomes, motor impairment, and Functional Ambulation Category. RESULTS: Strong and significant correlations were observed among performance-based gait tests. Qualitative scales indicated moderate to minimal deficits in each domain evaluated, although they were not correlated among themselves, except for Functional Ambulation Category and FIM and FIM and Mini-Mental State Exam. Functional Ambulation Category correlated with performance-based gait tests. CONCLUSIONS: Performance-based gait tests are feasible to conduct during early recovery after a stroke and allow better discrimination among the patients than qualitative measures.

Aged↗
PubMedDate not supplied

Gait patterns after fracture of the femoral shaft in children, managed by external fixation or early hip spica cast.

The authors prospectively studied three-dimensional kinematics and kinetics of gait in children recovering from a closed, isolated, nonpathologic fracture of the femoral diaphysis, who had been randomly assigned to management by monolateral external fixation or early hip spica casting. The aims were to investigate the gait patterns soon after injury and at 2 years after injury. Children treated with external fixation, walking with the external fixator in situ, demonstrated asymmetric gait abnormalities in all three anatomic planes affecting the trunk, pelvis, hip, knee, and ankle. This appears to be a strategy to minimize movement and pain at the fixator pin sites. The gait pattern normalized rapidly after removal of the external fixator with few kinematic or kinetic abnormalities and no clinically significant disturbances of gait at 2 years after injury. In contrast, children in the early hip spica cast group developed a "crouch gait" pattern in the sagittal plane, most likely due to weakness. They also had abnormal coronal plane kinematics related to shortening of the injured side. Gait patterns improved, but at 2 years there were some persistent gait deviations, probably related to residual limb length discrepancy.

Biomechanical Phenomena↗
PubMed2001

Preoperative gait comparisons between adults undergoing long spinal deformity fusion surgery (thoracic to L4, L5, or sacrum) and controls.

STUDY DESIGN: This investigation compared the gait of revision and primary spinal deformity patients about to undergo surgical reconstruction with that of a group of able-bodied controls. OBJECTIVES: The hypothesis of the study was that both patient groups would have significantly compromised gait, spine motion, and gait endurance compared with the able-bodied group. SUMMARY OF BACKGROUND DATA: There is a population of adults with degenerative changes superimposed on idiopathic scoliosis who present for reconstructive spinal surgery (primary patients). There is another group of adults who have already had spinal deformity surgery and present for revision surgery (revision patients). METHODS: Twenty-seven women were recruited (8 primary, 13 revision, 6 able-bodied controls). A typical gait analysis was performed. Walking endurance was estimated from a submaximal graded treadmill exercise test. Three motion variables describing the orientation of the shoulders with respect to the pelvis in the three principal planes of the body were determined. Also, gait speed, stride length, cadence, and step width were calculated. The variable for the endurance test was the length of time walked on the treadmill. RESULTS: Results for the revision group indicated a slower walking speed, greater sagittal plane trunk flexion, reduced range of motion in the coronal and transverse planes, and poorer endurance relative to age-matched controls. The primary group demonstrated a slower walking speed relative to age-matched controls. The revision group had poorer endurance scores relative to the primary group. CONCLUSION: This investigation is an objective report describing the compromised gait and walking endurance of adult patients with spinal deformity before spinal fusion surgery. Results supported subjective observations regarding the preoperative gait of these patients and presented results difficult to observe in a clinical setting. The techniques appear useful in providing objective information regarding the gait abilities of these patients.

Adult↗
PubMedDate not supplied

Gait improvement surgery in diplegic children: how long do the improvements last?

Gait improvement surgery in ambulatory children with cerebral palsy performed as single-event multilevel surgery is today a well-established modality of treatment, but follow-up studies are lacking. Preoperative and follow-up gait analysis data of 32 diplegic children who underwent single-event multilevel surgery for gait improvement between 1995 and 1998 were evaluated retrospectively. Relevant sagittal plane kinematic parameters of the hip, knee, and ankle joint and time-distance parameters were considered for outcome measures in this study. Postoperative gait analysis was performed three times in all the cases: after discontinuation of the dynamic AFOs (mean 1.0 +/- 0.3 years), after discontinuation of the night splints (mean 2.3 +/- 0.7 years), and at least 1.5 years after discontinuation of physiotherapy and splints (mean 4.4 +/- 1.1 years). The aim of the study was to ascertain whether the improvements in gait function were maintained over these examinations. The authors found that gait function continued to change over 1, 2, and 3 years of follow-up. A general decrease in gait function was measurable in this collective between the first postoperative and the second postoperative evaluations. The results indicate that evaluation of gait improvement surgery in cerebral palsy performed at a minimum of 3 years after surgery would give the most predictive outcome of treatment.

Adolescent↗
PubMed2004

Gait selection in the ostrich: mechanical and metabolic characteristics of walking and running with and without an aerial phase.

It has been argued that minimization of metabolic-energy costs is a primary determinant of gait selection in terrestrial animals. This view is based predominantly on data from humans and horses, which have been shown to choose the most economical gait (walking, running, galloping) for any given speed. It is not certain whether a minimization of metabolic costs is associated with the selection of other prevalent forms of terrestrial gaits, such as grounded running (a widespread gait in birds). Using biomechanical and metabolic measurements of four ostriches moving on a treadmill over a range of speeds from 0.8 to 6.7 m s(-1), we reveal here that the selection of walking or grounded running at intermediate speeds also favours a reduction in the metabolic cost of locomotion. This gait transition is characterized by a shift in locomotor kinetics from an inverted-pendulum gait to a bouncing gait that lacks an aerial phase. By contrast, when the ostrich adopts an aerial-running gait at faster speeds, there are no abrupt transitions in mechanical parameters or in the metabolic cost of locomotion. These data suggest a continuum between grounded and aerial running, indicating that they belong to the same locomotor paradigm.

Animals↗
PubMed2001

A reliable gait phase detection system.

A new highly reliable gait phase detection system, which can be used in gait analysis applications and to control the gait cycle of a neuroprosthesis for walking, is described. The system was designed to detect in real-time the following gait phases: stance, heel-off, swing, and heel-strike. The gait phase detection system employed a gyroscope to measure the angular velocity of the foot and three force sensitive resistors to assess the forces exerted by the foot on the shoe sole during walking. A rule-based detection algorithm, which was running on a portable microprocessor board, processed the sensor signals. In the presented experimental study ten able body subjects and six subjects with impaired gait tested the device in both indoor and outdoor environments (0-25 degrees C). The subjects were asked to walk on flat and irregular surfaces, to step over small obstacles, to walk on inclined surfaces, and to ascend and descend stairs. Despite the significant variation in the individual walking styles the system achieved an overall detection reliability above 99% for both subject groups for the tasks involving walking on flat, irregular, and inclined surfaces. In the case of stair climbing and descending tasks the success rate of the system was above 99% for the able body subjects and above 96 % for the subjects with impaired gait. The experiments also showed that the gait phase detection system, unlike other similar devices, was insensitive to perturbations caused by nonwalking activities such as weight shifting between legs during standing, feet sliding, sitting down, and standing up.

Adult↗
PubMed1996

A mechanical model to study the relationship between gait speed and muscular strength.

This study proposes a mechanical model to investigate the relationship between gait speed and strength of the ankle plantarflexor muscles. The model calculates the muscular utilization ratio (MUR) of the plantarflexor muscles during gait by comparing the plantarflexion moment used while walking to the maximal moment of the plantarflexors estimated from dynamometric measurements. To verify the model, MURs of the plantarflexor muscles were calculated for five healthy subjects and one hemiparetic subject walking at different speeds (slow, self-selected, and fast). Generally, the results of the healthy subjects revealed that MURs increase with an increasing gait speed: average (+/-SD) peak values of MUR reached 58.8% (+/-18.5), 65.6% (+/-17.2) and 71.0% (+/-17.8) for the slow, self-selected, and fast speeds, respectively. The average peak value of MURs at the self-selected speed corresponds to values reported in electromyographic studies of the plantarflexor muscles. At self-selected gait speed, the hemiparetic subject presented a higher peak MUR (80.5%) of the plantarflexors and a lower gait velocity when compared to healthy subjects. For the hemiparetic subject, peak values of MUR of the plantarflexor muscles at maximal walking speed reached 100% suggesting that full activation of the plantarflexors had been reached preventing him from walking faster. From these preliminary results, it appears that MURs calculated by the proposed model are sensitive to the mechanical demands imposed on a group of muscles during a task (eg., increase in gait speed) and to change in the maximal plantarflexor's strength (eg., weakness). The proposed model seems to have the potential to demonstrate whether muscle weakness limits maximal gait speed in hemiparetic subjects. However, considering the complexity of gait speed regulation in hemiparetic patients, the model should be tested on a large number of hemiparetic subjects.

Adolescent↗
PubMed1999

Kinetics of stiff-legged gait: induced acceleration analysis.

Treating spastic paretic stiff-legged gait, defined as reduced knee flexion in swing, holds a high priority in the rehabilitation of patients with upper motor neuron lesions. We propose a method to determine the relative contributions of hip, knee, and ankle impairments to this disability. We analyzed the gait of ten patients with stiff-legged gait (SLG) due to a single stroke and ten healthy, able-bodied controls. Using subject specific models, we analyzed the induced accelerations (IA's) at the knee. Knee IA's throughout the gait cycle were calculated and the sum of the IA's was compared to the knee joint angular acceleration estimated from kinematic data. The preswing and early swing IA's were the focus of our examination as these largely determine knee kinematics in swing. Knee angular accelerations estimated from IA's and kinematic data agreed for both controls and patients. Gait cycle IA analysis of individual patients identified highly variable causes of SLG including ankle and hip joint impairments. Induced acceleration analysis (IAA) suggested that multiple impairments, not just about the knee, but also about the hip and ankle, lead to this disability. Individual subjects are likely to have individual reasons for their stiff-legged gait. Defining the link between the patients specific impairments and their gait disability should be a goal of clinical gait analysis. IAA is a useful tool for this purpose with a strong potential for clinical application.

Acceleration↗
PubMed2006

Individual recognition using gait energy image.

In this paper, we propose a new spatio-temporal gait representation, called Gait Energy Image (GEI), to characterize human walking properties for individual recognition by gait. To address the problem of the lack of training templates, we also propose a novel approach for human recognition by combining statistical gait features from real and synthetic templates. We directly compute the real templates from training silhouette sequences, while we generate the synthetic templates from training sequences by simulating silhouette distortion. We use a statistical approach for learning effective features from real and synthetic templates. We compare the proposed GEI-based gait recognition approach with other gait recognition approaches on USF HumanID Database. Experimental results show that the proposed GEI is an effective and efficient gait representation for individual recognition, and the proposed approach achieves highly competitive performance with respect to the published gait recognition approaches.

Algorithms↗
PubMed1997

Stability and energy criteria in healthy and paraplegic subject gait.

The functional electrical stimulation (FES) assisted gait of paraplegic patients is inferior to that of healthy subjects. The difference can be observed in terms of speed, upright balance, biomechanical energy consumption, and generation of propulsion forces in the direction of walking. The biomechanical structure of paraplegic subjects is the same as that of normal ones; however, the mode of walking differs significantly because of the reduced number of activated muscles and primitive control. The healthy subject is utilizing a 2-point dynamically stable gait. The paraplegic patient is using 4-channel FES and utilizing a 4-point statically stable gait. We believe that the FES gait can be improved if converted into a semidynamically or dynamically stable gait. The gait is considered statically stable if the center of gravity (COG) projection on the ground (PCOG) is inside the supporting area. For a quadruped, this is only possible if it is utilizing a creeping crawl gait. In this paper, the relationship between PCOG and the supporting area are discussed as a criterion for dynamic stability assessment. Results are shown for 3 different modes of 2-point and 4-point gaits.

Biomechanical Phenomena↗
PubMed1997

Gait changes in older adults: predictors of falls or indicators of fear.

OBJECTIVE: To determine, in a cohort of ambulatory older adults, whether spatial-temporal measures of foot placement during gait can predict the likelihood of future falls or whether these measures are more likely to be indicative of adaptations associated with pre-existing fear of falling. DESIGN: Prospective cohort study. SETTING: Baseline gait measurements were performed in a gait and balance laboratory; subsequent history of falling was monitored prospectively for 1 year in two self-care facilities. PARTICIPANTS: Fourteen male and 61 female consecutive volunteers (mean age = 82, SD = 6) who were independent in activities of daily living and able to walk 10 m unaided. MEASUREMENTS: Spatial gait parameters were derived from digitized "footprints"; temporal parameters were derived using footswitches. A clinical activity-based gait assessment was also performed. The dependent variables were pre-existing fear of falling (reported at baseline) and future falling (experiencing one or more falls during the 1-year follow-up). MAIN RESULTS: Reduced stride length, reduced speed, increased double-support time, and poorer clinical gait scores were associated with fear but showed little evidence of an independent association with falling. Conversely, increased stride-to-stride variability in stride length, speed, and double-support was associated independently with falling but showed little evidence of relationship to fear. Increased stride width showed some evidence of association with both falling and fear. Stride-to-stride variability in speed was the single best independent predictor of falling. CONCLUSIONS: Changes in gait cited previously as risk factors for falling, i.e., decreased stride length and speed and prolonged double support, may in fact be stabilizing adaptations related to fear of falling. Stride-to-stride variability in the control of gait is an independent predictor of falling and may be a useful measure for identifying high-risk individuals and evaluating preventive interventions. Stride width may also be a useful outcome measure. Contrary to common expectation, a wider stride does not necessarily increase stability but instead seems to predict an increased likelihood of experiencing falls.

Accidental Falls↗
PubMed2001

Gait transitions during unrestrained locomotion in dogs.

Gait transitions during long distance, unrestrained locomotion were studied in 22 mongrel dogs. Spatial and temporal limb movement parameters were collected and the phase relationships between limb movements based upon a 2-dimensional (2-D) gait diagram were computed. During most of the trials, the dogs trotted within a relatively narrow velocity range. Gait transitions were observed during radical changes of the movement velocity. In most cases the gait switches were abrupt and completed within 2 strides of the gait cycle. The dogs walked, depending on the animal size, within the upper velocity range of 0.93-1.21 m/s. Most of the walk-trot transitions were observed within this range. All of them had a typical pattern that involved changes of the phase shift between diagonal limb movements from 0.31 +/- 0.02 (a typical value for a walking dog) down to 0.02 +/- 0.03. These changes appeared abruptly within one stride cycle for each diagonal pair of limbs; therefore, the transition was completed in 2 strides of the gait cycle. The switch involved momentary shortening of the hindlimb amplitudes. During the next gait cycle, all limb movement amplitudes were reduced with a concomitant increase in limb movement frequencies. In contrast to the clear border between the symmetrical gaits, the dogs switched to gallop at any speed within the trot range (most frequently between 1.5-2.6 m/s). The transitions were usually completed within one stride of the diagonal limbs. In most cases, the switch from trot to gallop had a similar pattern; while maintaining synchronous movement of one diagonal pair of limbs, the other pair movement control was modified accordingly. The typical transition pattern involved the shortening of the swing phase in the front limb with simultaneous lengthening of the swing phase in the diagonal hindlimb. These transient modifications had their equivalent in the analogous limb movement amplitude changes. A mirror-image pattern of phase changes was observed in the majority (82%) of the gallop-trot transitions. Three of the dogs, however, besides the typical gallop-trot switch, occasionally employed a second pattern of transition.

Animals↗
PubMed2007

Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial.

OBJECTIVES: Gait and mobility problems are difficult to treat in people with Parkinson's disease. The Rehabilitation in Parkinson's Disease: Strategies for Cueing (RESCUE) trial investigated the effects of a home physiotherapy programme based on rhythmical cueing on gait and gait-related activity. METHODS: A single-blind randomised crossover trial was set up, including 153 patients with Parkinson's disease aged between 41 and 80 years and in Hoehn and Yahr stage II-IV. Subjects allocated to early intervention (n = 76) received a 3-week home cueing programme using a prototype cueing device, followed by 3 weeks without training. Patients allocated to late intervention (n = 77) underwent the same intervention and control period in reverse order. After the initial 6 weeks, both groups had a 6-week follow-up without training. Posture and gait scores (PG scores) measured at 3, 6 and 12 weeks by blinded testers were the primary outcome measure. Secondary outcomes included specific measures on gait, freezing and balance, functional activities, quality of life and carer strain. RESULTS: Small but significant improvements were found after intervention of 4.2% on the PG scores (p = 0.005). Severity of freezing was reduced by 5.5% in freezers only (p = 0.007). Gait speed (p = 0.005), step length (p<0.001) and timed balance tests (p = 0.003) improved in the full cohort. Other than a greater confidence to carry out functional activities (Falls Efficacy Scale, p = 0.04), no carry-over effects were observed in functional and quality of life domains. Effects of intervention had reduced considerably at 6-week follow-up. CONCLUSIONS: Cueing training in the home has specific effects on gait, freezing and balance. The decline in effectiveness of intervention effects underscores the need for permanent cueing devices and follow-up treatment. Cueing training may be a useful therapeutic adjunct to the overall management of gait disturbance in Parkinson's disease.

Aged↗
PubMed2003

Effects of levodopa on upper limb mobility and gait in Parkinson's disease.

BACKGROUND: Most clinicians rely on clinical scales such as the unified Parkinson's disease rating scale (UDPRS) for evaluating parkinsonian patients and assessing their response to levodopa. Gait analysis is not commonly used, probably because of the equipment required and the time needed. Few data have been published on the relations between gait variables and measures of arm and hand mobility. OBJECTIVES: To evaluate the correlation between dopa induced gait improvement and upper limb motor improvement using a rapid and simple method; and to evaluate the correlation between gait improvement and UPDRS III improvement. METHODS: A finger tapping test and a simple walking test were used to measure the OFF-ON variations of upper limb motor function and gait in 23 patients with Parkinson's disease. The UPDRS motor score and the Hoehn and Yahr stage were measured in the OFF and the ON state. RESULTS: There was no correlation between OFF-ON variation of the number of hits with the finger tapping test and OFF-ON variation in the gait variables. OFF-ON variation in the UPDRS motor score was not correlated with OFF-ON variation in the gait variables. CONCLUSIONS: There was a dissociation between the effect of levodopa on upper limb and gait. The findings suggest that simple measures like the finger tapping test and a walking test should be included in the usual evaluation of patients with Parkinson's disease.

Aged↗
PubMed2005

[Gait analysis in Parkinson's disease and response to dopaminergic treatment].

BACKGROUND AND OBJECTIVE: The objective of this study was to analyze the gait abnormalities in patients with idiopathic Parkinson's disease (PD), and their response to dopaminergic treatment. PATIENTS AND METHOD: 15 patients and 15 healthy age-matched subjects were included for comparison between pathologic and "normal" gait, and 24 PD patients were included to assess the effects of treatment. Gait analysis was achieved with a new 3D-photogrammetry system. RESULTS: Patients had significative lower velocity, stride length, step length and hip and knee ranges when compared with control subjects. There were no differences in cadence, step width and relative times of gait-cycle. There were no differences in the patients' gait variables after administration of a dopaminergic medication. CONCLUSIONS: Gait analysis allows quantification of gait disturbances in patients with PD and the potential effects of treatment. The results of this study suggest a certain degree of "levodopa-resistance" in gait in these patients.

Dopamine Agents↗
PubMedDate not supplied

Dual-task-related gait changes in transitionally frail older adults: the type of the walking-associated cognitive task matters.

BACKGROUND: Changes in gait patterns due to a simultaneously performed cognitive task have been reported previously and associated with an increased falling risk among older adults. Little is known whether the type of cognitive task performed while walking is important concerning possible gait interference in older fall-prone individuals. OBJECTIVE: To quantify and compare the effects of two different cognitive tasks on gait in transitionally frail older adults. MEASUREMENTS: Gait was tested in 30 transitionally frail older adults (mean age 82.6 +/- 7.1 years, 90% female) while either walking alone, performing a simple arithmetic task, or performing a task of verbal fluency. Walking time in seconds, number of steps, frequency of lateral line stepping-over, and stops were recorded. Health status was assessed using standard instruments of geriatric assessment. The classification of Speechley and Tinetti was used to define the participants' degree of frailty. RESULTS: Walking time and number of steps increased significantly under both dual-task conditions compared to walking alone (p < 0.001) without reaching a significant difference between the two dual-task conditions (respectively, p = 0.131 and p = 0.407), whereas lateral gait instability (frequency of lateral line stepping-over) increased significantly in association with counting backward (p = 0.006) but not with the verbal fluency task (p = 1). CONCLUSION: Among the studied sample of transitional older adults, a walking- associated arithmetic task significantly interfered with lateral gait stability, whereas no lateral gait deviations were seen in association with a verbal fluency task. We, therefore, suggest that the choice of the attention-splitting task in dual-task gait assessment among older adults must be made carefully.

Aged↗
PubMed2004

Rehabilitation management of Friedreich ataxia: lower extremity force-control variability and gait performance.

We describe the rehabilitation management during a 12-month period of a 14-year-old female with Friedreich ataxia. Interventions included task-oriented bimanual reaching activities, functional strengthening, and gait training using a walker featuring tension-controlled wheels and a reverse-braking system. Her physical status was assessed with the Nine-Hole Peg Test, single limb stance time, manual muscle testing, self-reported falls, isometric force control testing, and 3-dimensional gait analysis in a motion-capture laboratory. Although measures of the patient's Nine-Hole Peg Test, single limb stance time, and manual muscle testing reflected minimal changes, her gait speed decreased by 69.4%. However, the force-control targeting of her dominant knee extensors showed a 43.7% increase in force variability that was concomitant with her decline in gait performance. The decrement of her initial gait speed was reduced to 42.9% on replacing the wheeled walker with the U-Step Walking Stabilizer at the end of the intervention period. Although the patient's gait remained significantly impaired, extended use of the U-Step Walking Stabilizer modestly improved her gait performance, and her rate of falls decreased from 10 to 3 per month. Our observations suggest that use of force-control testing as proxy measures of ataxia and tension-controlled gait aids show promise in the management of Friedreich ataxia and merit further investigation.

Adolescent↗
PubMed2006

Association between the metabolic syndrome and its components and gait speed among U.S. adults aged 50 years and older: a cross-sectional analysis.

BACKGROUND: To examine the relationship between the metabolic syndrome and its components and gait speed among older U.S. men and women. Whether these associations are independent of physical activity was also explored. METHODS: Eight hundred and thirty-five men and 850 women aged > or =50 years from the continuous National Health and Nutrition Examination Survey 1999-2002 were examined. We used the definition of the metabolic syndrome developed by the U.S. National Cholesterol Education Program Adult Treatment Panel III. Gait speed was measured with a 6.10-meter timed walk examination. RESULTS: The prevalence of the metabolic syndrome was 40.2% in men and 45.6% in women (P = .127). The prevalence of gait speed impairment was 29.3% in men and 12.5% in women (P < .001). No association was found between the metabolic syndrome and gait speed impairment. After including the individual components of the metabolic syndrome in a logistic model adjusted for age and leisure-time physical activity, abdominal obesity, low HDL cholesterol, and high fasting glucose were significantly associated with gait speed impairment among women (adjusted odds ratio [AOR] = 0.48, 95% confidence interval [CI] = 0.26 to 0.89; AOR = 2.26, 95% CI = 1.08 to 4.75; and AOR = 2.05, 95% CI = 1.12 to 3.74, respectively). Further adjustment for race/ethnicity, education, smoking status, alcohol consumption, arthritis status, and use of an assistive device attenuated these associations; among women, abdominal obesity and low HDL cholesterol remained significantly associated with gait speed impairment (AOR = 0.37, 95% CI = 0.18 to 0.76 and AOR = 2.45, 95% CI = 1.07 to 5.63, respectively) while the association between hyperglycemia and impaired gait speed attenuated to nonsignificance. CONCLUSION: Among women, gait speed impairment is associated with low HDL cholesterol and inversely with abdominal obesity. These associations may be sex-dependent and warrant further research.

Abdominal Fat↗