Gait symmetric adaptation: Comparing effects of implicit visual distortion versus split-belt treadmill on aftereffects of adapted step length symmetry

Diabetic peripheral neuropathy (DPN) is associated with peripheral sensory and motor nerve damage that affects up to half of diabetes patients and is an independent risk factor for falls. Clinical implications of DPN-related falls include injury, psychological distress and physical activity curtailment. This review describes how the sensory and motor deficits associated with DPN underpin biomechanical alterations to the pattern of walking (gait), which contribute to balance impairments underpinning falls. Changes to gait with diabetes occur even before the onset of measurable DPN, but changes become much more marked with DPN. Gait impairments with diabetes and DPN include alterations to walking speed, step length, step width and joint ranges of motion. These alterations also impact the rotational forces around joints known as joint moments, which are reduced as part of a natural strategy to lower the muscular demands of gait to compensate for lower strength capacities due to diabetes and DPN. Muscle weakness and atrophy are most striking in patients with DPN, but also present in non-neuropathic diabetes patients, affecting not only distal muscles of the foot and ankle, but also proximal thigh muscles. Insensate feet with DPN cause a delayed neuromuscular response immediately following foot–ground contact during gait and this is a major factor contributing to increased falls risk. Pronounced balance impairments measured in the gait laboratory are only seen in DPN patients and not non-neuropathic diabetes patients. Self-perception of unsteadiness matches gait laboratory measures and can distinguish between patients with and without DPN. Diabetic foot ulcers and their associated risk factors including insensate feet with DPN and offloading devices further increase falls risk. Falls prevention strategies based on sensory and motor mechanisms should target those most at risk of falls with DPN, with further research needed to optimise interventions.

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Acute Effects on Impact Accelerations Running with Objects in the Hand

Life ◽

10.3390/life11060550 ◽

2021 ◽

Vol 11 (6) ◽

pp. 550

Author(s):

Roberto Sanchis-Sanchis ◽

Alberto Encarnación-Martínez ◽

Jose I. Priego-Quesada ◽

Inmaculada Aparicio ◽

Irene Jimenez-Perez ◽

...

Keyword(s):

Mobile Phone ◽

Step Length ◽

Stride Frequency ◽

Acute Effects ◽

Shock Attenuation ◽

Acceleration Rate ◽

Recreational Runners ◽

Impact Acceleration ◽

Spatio Temporal ◽

Extra Weight

Amateur runners usually run carrying implements in their hands (keys, a mobile phone, or a bottle of water). However, there is a lack of literature about the effects of different handloads on impact accelerations. Thus, this study aimed to analyse the effects of carrying different objects in the hand on impact accelerations during running. Nineteen male recreational runners (age 24.3 ± 6.8 years, training volume of 25 ± 7.38 km/week) performed twenty minutes of running on a treadmill at 2.78 m/s with four different conditions: no extra weight, with keys, with a mobile phone, and with a bottle of water. Impact acceleration and spatio-temporal parameters were analysed through a wireless triaxial accelerometry system composed of three accelerometers: two placed in each tibia and one placed on the forehead. A higher tibia acceleration rate in the dominant leg was observed when participants ran holding both a mobile phone (p = 0.027; ES = 0.359) and a bottle of water (p = 0.027; ES = 0.359), compared to no extra weight. No changes were observed in peak acceleration, acceleration magnitude, and shock attenuation in any other conditions. Likewise, neither stride frequency nor step length was modified. Our results suggest that recreational runners should not worry about carrying objects in their hands, like a mobile phone or a bottle of water, in short races because their effect seems minimal.

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Optimized stable gait planning of biped robot using multi-objective evolutionary JAYA algorithm

International Journal of Advanced Robotic Systems ◽

10.1177/1729881420976344 ◽

2020 ◽

Vol 17 (6) ◽

pp. 172988142097634

Author(s):

Huan Tran Thien ◽

Cao Van Kien ◽

Ho Pham Huy Anh

Keyword(s):

Inverse Kinematics ◽

Biped Robot ◽

Step Length ◽

Jaya Algorithm ◽

Kinetic Chain ◽

Biped Walking ◽

Gait Planning ◽

Multi Objective ◽

Simulation And Experiment ◽

Stable Gait

This article proposes a new stable biped walking pattern generator with preset step-length value, optimized by multi-objective JAYA algorithm. The biped robot is modeled as a kinetic chain of 11 links connected by 10 joints. The inverse kinematics of the biped is applied to derive the specified biped hip and feet positions. The two objectives related to the biped walking stability and the biped to follow the preset step-length magnitude have been fully investigated and Pareto optimal front of solutions has been acquired. To demonstrate the effectiveness and superiority of proposed multi-objective JAYA, the results are compared to those of MO-PSO and MO-NSGA-2 optimization approaches. The simulation and experiment results investigated over the real small-scaled biped HUBOT-4 assert that the multi-objective JAYA technique ensures an outperforming effective and stable gait planning and walking for biped with accurate preset step-length value.

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Biomechanics of Trail Running Performance: Quantification of Spatio-Temporal Parameters by Using Low Cost Sensors in Ecological Conditions

Applied Sciences ◽

10.3390/app11052093 ◽

2021 ◽

Vol 11 (5) ◽

pp. 2093

Author(s):

Noé Perrotin ◽

Nicolas Gardan ◽

Arnaud Lesprillier ◽

Clément Le Goff ◽

Jean-Marc Seigneur ◽

...

Keyword(s):

Heart Rate ◽

Low Cost ◽

Step Length ◽

Measurement Unit ◽

Ecological Conditions ◽

Sports Science ◽

Ground Contact Time ◽

Spatio Temporal ◽

Performance Results ◽

Trail Running

The recent popularity of trail running and the use of portable sensors capable of measuring many performance results have led to the growth of new fields in sports science experimentation. Trail running is a challenging sport; it usually involves running uphill, which is physically demanding and therefore requires adaptation to the running style. The main objectives of this study were initially to use three “low-cost” sensors. These low-cost sensors can be acquired by most sports practitioners or trainers. In the second step, measurements were taken in ecological conditions orderly to expose the runners to a real trail course. Furthermore, to combine the collected data to analyze the most efficient running techniques according to the typology of the terrain were taken, as well on the whole trail circuit of less than 10km. The three sensors used were (i) a Stryd sensor (Stryd Inc. Boulder CO, USA) based on an inertial measurement unit (IMU), 6 axes (3-axis gyroscope, 3-axis accelerometer) fixed on the top of the runner’s shoe, (ii) a Global Positioning System (GPS) watch and (iii) a heart belt. Twenty-eight trail runners (25 men, 3 women: average age 36 ± 8 years; height: 175.4 ± 7.2 cm; weight: 68.7 ± 8.7 kg) of different levels completed in a single race over a 8.5 km course with 490 m of positive elevation gain. This was performed with different types of terrain uphill (UH), downhill (DH), and road sections (R) at their competitive race pace. On these sections of the course, cadence (SF), step length (SL), ground contact time (GCT), flight time (FT), vertical oscillation (VO), leg stiffness (Kleg), and power (P) were measured with the Stryd. Heart rate, speed, ascent, and descent speed were measured by the heart rate belt and the GPS watch. This study showed that on a ≤10 km trail course the criteria for obtaining a better time on the loop, determined in the test, was consistency in the effort. In a high percentage of climbs (>30%), two running techniques stand out: (i) maintaining a high SF and a short SL and (ii) decreasing the SF but increasing the SL. In addition, it has been shown that in steep (>28%) and technical descents, the average SF of the runners was higher. This happened when their SL was shorter in lower steep and technically challenging descents.

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Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00857-9 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Heidi Nedergård ◽

Ashokan Arumugam ◽

Marlene Sandlund ◽

Anna Bråndal ◽

Charlotte K. Häger

Keyword(s):

Kinetic Parameters ◽

Step Length ◽

Gait Training ◽

Risk Of Bias ◽

Current Evidence ◽

Temporal Asymmetry ◽

Robotic Assisted ◽

Post Stroke ◽

Gait Biomechanics ◽

Affected Side

Abstract Background Robotic-Assisted Gait Training (RAGT) may enable high-intensive and task-specific gait training post-stroke. The effect of RAGT on gait movement patterns has however not been comprehensively reviewed. The purpose of this review was to summarize the evidence for potentially superior effects of RAGT on biomechanical measures of gait post-stroke when compared with non-robotic gait training alone. Methods Nine databases were searched using database-specific search terms from their inception until January 2021. We included randomized controlled trials investigating the effects of RAGT (e.g., using exoskeletons or end-effectors) on spatiotemporal, kinematic and kinetic parameters among adults suffering from any stage of stroke. Screening, data extraction and judgement of risk of bias (using the Cochrane Risk of bias 2 tool) were performed by 2–3 independent reviewers. The Grading of Recommendations Assessment Development and Evaluation (GRADE) criteria were used to evaluate the certainty of evidence for the biomechanical gait measures of interest. Results Thirteen studies including a total of 412 individuals (mean age: 52–69 years; 264 males) met eligibility criteria and were included. RAGT was employed either as monotherapy or in combination with other therapies in a subacute or chronic phase post-stroke. The included studies showed a high risk of bias (n = 6), some concerns (n = 6) or a low risk of bias (n = 1). Meta-analyses using a random-effects model for gait speed, cadence, step length (non-affected side) and spatial asymmetry revealed no significant differences between the RAGT and comparator groups, while stride length (mean difference [MD] 2.86 cm), step length (affected side; MD 2.67 cm) and temporal asymmetry calculated in ratio-values (MD 0.09) improved slightly more in the RAGT groups. There were serious weaknesses with almost all GRADE domains (risk of bias, consistency, directness, or precision of the findings) for the included outcome measures (spatiotemporal and kinematic gait parameters). Kinetic parameters were not reported at all. Conclusion There were few relevant studies and the review synthesis revealed a very low certainty in current evidence for employing RAGT to improve gait biomechanics post-stroke. Further high-quality, robust clinical trials on RAGT that complement clinical data with biomechanical data are thus warranted to disentangle the potential effects of such interventions on gait biomechanics post-stroke.

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Using Biofeedback to Reduce Step Length Asymmetry Impairs Dynamic Balance in People Poststroke

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211019346 ◽

2021 ◽

pp. 154596832110193

Author(s):

Sungwoo Park ◽

Chang Liu ◽

Natalia Sánchez ◽

Julie K. Tilson ◽

Sara J. Mulroy ◽

...

Keyword(s):

Angular Momentum ◽

Sagittal Plane ◽

Dynamic Balance ◽

Objective Measure ◽

Frontal Plane ◽

Step Length ◽

Berg Balance Scale ◽

Whole Body ◽

Functional Gait ◽

Full Body

Background People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods We performed clinical balance assessments and measured whole-body angular momentum during walking using a full-body marker set in a sample of 36 people with chronic stroke. We then used a biofeedback-based approach to modify step length asymmetry in a subset of 15 of these individuals who had marked asymmetry and we measured the resulting changes in whole-body angular momentum. Results When participants walked without biofeedback, whole-body angular momentum in the sagittal and frontal plane was negatively correlated with scores on the Berg Balance Scale and Functional Gait Assessment supporting the validity of whole-body angular momentum as an objective measure of dynamic balance. We also observed that when participants walked more symmetrically, their whole-body angular momentum in the sagittal plane increased rather than decreased. Conclusions Voluntary reductions of step length asymmetry in people poststroke resulted in reduced measures of dynamic balance. This is consistent with the idea that after stroke, individuals might have an implicit preference not to deviate from their natural asymmetry while walking because it could compromise their balance. Clinical Trials Number: NCT03916562.

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Gait and Balance Changes with Investigational Peripheral Nerve Cell Therapy during Deep Brain Stimulation in People with Parkinson’s Disease

Brain Sciences ◽

10.3390/brainsci11040500 ◽

2021 ◽

Vol 11 (4) ◽

pp. 500

Author(s):

Geetanjali Gera ◽

Zain Guduru ◽

Tritia Yamasaki ◽

Julie A. Gurwell ◽

Monica J. Chau ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Peripheral Nerve ◽

Brain Stimulation ◽

Step Length ◽

Gait Velocity ◽

Balance Performance ◽

Improved Performance ◽

Deep Brain

Background: The efficacy of deep brain stimulation (DBS) and dopaminergic therapy is known to decrease over time. Hence, a new investigational approach combines implanting autologous injury-activated peripheral nerve grafts (APNG) at the time of bilateral DBS surgery to the globus pallidus interna. Objectives: In a study where APNG was unilaterally implanted into the substantia nigra, we explored the effects on clinical gait and balance assessments over two years in 14 individuals with Parkinson’s disease. Methods: Computerized gait and balance evaluations were performed without medication, and stimulation was in the off state for at least 12 h to best assess the role of APNG implantation alone. We hypothesized that APNG might improve gait and balance deficits associated with PD. Results: While people with a degenerative movement disorder typically worsen with time, none of the gait parameters significantly changed across visits in this 24 month study. The postural stability item in the UPDRS did not worsen from baseline to the 24-month follow-up. However, we measured gait and balance improvements in the two most affected individuals, who had moderate PD. In these two individuals, we observed an increase in gait velocity and step length that persisted over 6 and 24 months. Conclusions: Participants did not show worsening of gait and balance performance in the off therapy state two years after surgery, while the two most severely affected participants showed improved performance. Further studies may better address the long-term maintanenace of these results.

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A Proposal of a Motion Measurement System to Support Visually Impaired People in Rehabilitation Using Low-Cost Inertial Sensors

Entropy ◽

10.3390/e23070848 ◽

2021 ◽

Vol 23 (7) ◽

pp. 848

Author(s):

Karla Miriam Reyes Leiva ◽

Milagros Jaén-Vargas ◽

Miguel Ángel Cuba ◽

Sergio Sánchez Lara ◽

José Javier Serrano Olmedo

Keyword(s):

Visually Impaired ◽

Inertial Sensors ◽

Personal Autonomy ◽

Low Cost ◽

Step Length ◽

Hand Position ◽

Visually Impaired People ◽

Gait Parameters ◽

Impaired Person ◽

Further Development

The rehabilitation of a visually impaired person (VIP) is a systematic process where the person is provided with tools that allow them to deal with the impairment to achieve personal autonomy and independence, such as training for the use of the long cane as a tool for orientation and mobility (O&M). This process must be trained personally by specialists, leading to a limitation of human, technological and structural resources in some regions, especially those with economical narrow circumstances. A system to obtain information about the motion of the long cane and the leg using low-cost inertial sensors was developed to provide an overview of quantitative parameters such as sweeping coverage and gait analysis, that are currently visually analyzed during rehabilitation. The system was tested with 10 blindfolded volunteers in laboratory conditions following constant contact, two points touch, and three points touch travel techniques. The results indicate that the quantification system is reliable for measuring grip rotation, safety zone, sweeping amplitude and hand position using orientation angles with an accuracy of around 97.62%. However, a new method or an improvement of hardware must be developed to improve gait parameters’ measurements, since the step length measurement presented a mean accuracy of 94.62%. The system requires further development to be used as an aid in the rehabilitation process of the VIP. Now, it is a simple and low-cost technological aid that has the potential to improve the current practice of O&M.

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Identifying Fall Risk Predictors by Monitoring Daily Activities at Home Using a Depth Sensor Coupled to Machine Learning Algorithms

Sensors ◽

10.3390/s21061957 ◽

2021 ◽

Vol 21 (6) ◽

pp. 1957

Author(s):

Amandine Dubois ◽

Titus Bihl ◽

Jean-Pierre Bresciani

Keyword(s):

Machine Learning ◽

Fall Prevention ◽

Fall Risk ◽

Learning Algorithms ◽

Step Length ◽

Machine Learning Algorithms ◽

Daily Activities ◽

Sitting Time ◽

Behavioral Parameters ◽

At Home

Because of population ageing, fall prevention represents a human, economic, and social issue. Currently, fall-risk is assessed infrequently, and usually only after the first fall occurrence. Home monitoring could improve fall prevention. Our aim was to monitor daily activities at home in order to identify the behavioral parameters that best discriminate high fall risk from low fall risk individuals. Microsoft Kinect sensors were placed in the room of 30 patients temporarily residing in a rehabilitation center. The sensors captured the patients’ movements while they were going about their daily activities. Different behavioral parameters, such as speed to sit down, gait speed or total sitting time were extracted and analyzed combining statistical and machine learning algorithms. Our algorithms classified the patients according to their estimated fall risk. The automatic fall risk assessment performed by the algorithms was then benchmarked against fall risk assessments performed by clinicians using the Tinetti test and the Timed Up and Go test. Step length, sit-stand transition and total sitting time were the most discriminant parameters to classify patients according to their fall risk. Coupling step length to the speed required to stand up or the total sitting time gave rise to an error-less classification of the patients, i.e., to the same classification as that of the clinicians. A monitoring system extracting step length and sit-stand transitions at home could complement the clinicians’ assessment toolkit and improve fall prevention.

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