Independent and sensitive gait parameters for objective evaluation in knee and hip osteoarthritis using wearable sensors

AbstractObjectiveTo identify non-redundant gait parameters sensitive to end-stage knee and hip osteoarthritis (OA), with a specific focus on turning, dual task performance, and upper body motion in addition to straight-ahead gait.DesignGait was compared between individuals with unilateral, end-stage knee (n=25) or hip OA (n=26) scheduled for joint replacement, and healthy controls (n=27). For 2 minutes, subjects walked back-and-forth along a 6 meter trajectory making 180° turns, with and without a secondary cognitive task. Gait parameters were collected using 4 inertial measurement units on the feet and trunk. The dataset was reduced using factor analysis. One gait parameter from each factor was selected based on factor loading and effect size of the comparison between OA groups and healthy controls.ResultsFour independent domains of gait were obtained: speed-spatial, speed-temporal, dual task cost, and upper body motion. Turning parameters did not constitute a separate domain. From these domains, stride length (speed-spatial) and cadence (speed-temporal) had the strongest factor loadings and effect sizes for both knee and hip OA, and lumbar sagittal range of motion (upper body motion) for hip OA only.ConclusionsStride length, cadence, and lumbar sagittal range of motion were non-redundant and sensitive parameters, representing gait adaptations in individuals with knee or hip OA. Turning or dual task parameters had no additional value for evaluating gait in knee and hip OA. These findings hold promise for the objective evaluation of gait in the clinic. Future steps should include testing of responsiveness to interventions aiming to improve mobility.

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Independent and sensitive gait parameters for objective evaluation in knee and hip osteoarthritis using wearable sensors

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04074-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ramon J. Boekesteijn ◽

José M. H. Smolders ◽

Vincent J. J. F. Busch ◽

Alexander C. H. Geurts ◽

Katrijn Smulders

Keyword(s):

Dual Task ◽

Wearable Sensors ◽

Body Motion ◽

Effect Sizes ◽

Upper Body ◽

Healthy Controls ◽

Gait Parameters ◽

Dual Task Cost ◽

Dual Task Performance ◽

Spatiotemporal Parameters

Abstract Background Although it is well-established that osteoarthritis (OA) impairs daily-life gait, objective gait assessments are not part of routine clinical evaluation. Wearable inertial sensors provide an easily accessible and fast way to routinely evaluate gait quality in clinical settings. However, during these assessments, more complex and meaningful aspects of daily-life gait, including turning, dual-task performance, and upper body motion, are often overlooked. The aim of this study was therefore to investigate turning, dual-task performance, and upper body motion in individuals with knee or hip OA in addition to more commonly assessed spatiotemporal gait parameters using wearable sensors. Methods Gait was compared between individuals with unilateral knee (n = 25) or hip OA (n = 26) scheduled for joint replacement, and healthy controls (n = 27). For 2 min, participants walked back and forth along a 6-m trajectory making 180° turns, with and without a secondary cognitive task. Gait parameters were collected using 4 inertial measurement units on the feet and trunk. To test if dual-task gait, turning, and upper body motion had added value above spatiotemporal parameters, a factor analysis was conducted. Effect sizes were computed as standardized mean difference between OA groups and healthy controls to identify parameters from these gait domains that were sensitive to knee or hip OA. Results Four independent domains of gait were obtained: speed-spatial, speed-temporal, dual-task cost, and upper body motion. Turning parameters constituted a gait domain together with cadence. From the domains that were obtained, stride length (speed-spatial) and cadence (speed-temporal) had the strongest effect sizes for both knee and hip OA. Upper body motion (lumbar sagittal range of motion), showed a strong effect size when comparing hip OA with healthy controls. Parameters reflecting dual-task cost were not sensitive to knee or hip OA. Conclusions Besides more commonly reported spatiotemporal parameters, only upper body motion provided non-redundant and sensitive parameters representing gait adaptations in individuals with hip OA. Turning parameters were sensitive to knee and hip OA, but were not independent from speed-related gait parameters. Dual-task parameters had limited additional value for evaluating gait in knee and hip OA, although dual-task cost constituted a separate gait domain. Future steps should include testing responsiveness of these gait domains to interventions aiming to improve mobility.

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The effects of a secondary task on gait in axial spondyloarthritis

Scientific Reports ◽

10.1038/s41598-021-98732-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Julie Soulard ◽

Jacques Vaillant ◽

Athan Baillet ◽

Philippe Gaudin ◽

Nicolas Vuillerme

Keyword(s):

Dual Task ◽

Secondary Task ◽

Stride Length ◽

Axial Spondyloarthritis ◽

Healthy Controls ◽

Dual Tasking ◽

Double Support ◽

Manual Task ◽

Gait Parameters ◽

Stance Time

AbstractStudies on the effects of dual tasking in patients with chronic inflammatory rheumatic diseases are limited. The aim of this study was to assess dual tasking while walking in patients with axial spondyloarthritis (axSpA) in comparison to healthy controls. Thirty patients with axSpA and thirty healthy controls underwent a 10-m walk test at a self-selected comfortable walking speed in single- and dual-task conditions. Foot-worn inertial sensors were used to compute spatiotemporal gait parameters. Analysis of spatiotemporal gait parameters showed that the secondary manual task negatively affected walking performance in terms of significantly decreased mean speed (p < 0.001), stride length (p < 0.001) and swing time (p = 0.008) and increased double support (p = 0.002) and stance time (p = 0.008). No significant interaction of group and condition was observed. Both groups showed lower gait performance in dual task condition by reducing speed, swing time and stride length, and increasing double support and stance time. Patients with axSpA were not more affected by the dual task than matched healthy controls, suggesting that the secondary manual task did not require greater attention in patients with axSpA. Increasing the complexity of the walking and/or secondary task may increase the sensitivity of the dual-task design to axial spondyloarthritis.

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Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed

Gerontology ◽

10.1159/000515939 ◽

2021 ◽

pp. 1-10

Author(s):

He Zhou ◽

Catherine Park ◽

Mohammad Shahbazi ◽

Michele K. York ◽

Mark E. Kunik ◽

...

Keyword(s):

Older Adults ◽

Steady State ◽

Dual Task ◽

Gait Speed ◽

Stride Length ◽

Cognitive Frailty ◽

Single Task ◽

Double Support ◽

Gait Parameters ◽

Digital Biomarkers

Background: Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. Methods: Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m2) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. Results: Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size d = 0.42–0.97, p < 0.050). The largest effect size was observed in normalized dual-task gait speed (d = 0.97, p < 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. Conclusions: This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

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Transfer Effects of Fall Training on Balance Performance and Spatiotemporal Gait Parameters in Healthy Community-Dwelling Older Adults: A Pilot Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2013-0010 ◽

2014 ◽

Vol 22 (3) ◽

pp. 324-333 ◽

Cited By ~ 9

Author(s):

Lars Donath ◽

Oliver Faude ◽

Stephanie A. Bridenbaugh ◽

Ralf Roth ◽

Martin Soltermann ◽

...

Keyword(s):

Older Adults ◽

Dual Task ◽

Stride Length ◽

Fear Of Falling ◽

Community Dwelling ◽

Stride Time ◽

Balance Performance ◽

Transfer Effects ◽

Gait Parameters ◽

Community Dwelling Older Adults

This study examined transfer effects of fall training on fear of falling (Falls Efficacy Scale—International [FES–I]), balance performance, and spatiotemporal gait characteristics in older adults. Eighteen community-dwelling older adults (ages 65–85) were randomly assigned to an intervention or control group. The intervention group completed 12 training sessions (60 min, 6 weeks). During pre- and posttesting, we measured FES–I, balance performance (double limb, closed eyes; single limb, open eyes; double limb, open eyes with motor-interfered task), and gait parameters (e.g., velocity; cadence; stride time, stride width, and stride length; variability of stride time and stride length) under single- and motor-interfered tasks. Dual tasks were applied to appraise improvements of cognitive processing during balance and gait. FES–I (p = .33) and postural sway did not significantly change (0.36 < p < .79). Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task (p = .05, ηp2 = .22). Fall training did not sufficiently improve fear of falling, balance, or gait performance under single- or dual-task conditions in healthy older adults.

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A-26 Performance on Design Fluency and Visuoperception Measures is Related to Single and Dual Task Treadmill Gait Parameters in Healthy Adults

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.26 ◽

2019 ◽

Vol 34 (6) ◽

pp. 885-885

Author(s):

L Wadia ◽

C Higginson ◽

M Bifano ◽

K Seymour ◽

R Orr ◽

...

Keyword(s):

Dual Task ◽

Stride Length ◽

Block Design ◽

Healthy Adults ◽

Step Width ◽

Single Task ◽

Gait Characteristics ◽

Gait Parameters ◽

Design Fluency ◽

Task Step

Abstract Objective Research suggests a link between gait and cognition. Executive functions have been related to gait speed, however the relation between design fluency and visuoperception and other spatiotemporal gait characteristics that are related to falling is unclear. The objective of the study was to determine whether performance on design fluency and visuoperception tasks is related to spatiotemporal gait parameters during single and dual task treadmill walking in a sample of healthy adults. Method Nineteen healthy adults averaging 40 years of age completed cognitive measures of design fluency, visual attention, and visuoperception. They underwent gait analysis while walking on an instrumented treadmill in single task and dual task conditions. Results Performance on Spatial Span significantly correlated with single task stride length, r = 0.47, p = 0.043. Performance on Block Design significantly correlated with dual task stride length, r = 0.46, p = 0.049. Performance on Design Fluency significantly correlated with single task stride length variability, r = -0.50, p = 0.030, dual task stride length variability, r = -0.62, p = 0.005, and dual task step width variability, r = -0.56, p = 0.012. Performance on Picture Completion also correlated with dual task step width variability, r = -0.54, p = 0.017. Conclusions Design fluency and visuoperception appear related to spatiotemporal gait parameters in healthy adults. Worse cognitive performance was related to greater variability in dual task stride length and step width, gait characteristics associated with falling in aging and neurological populations.

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Effects of Walking Direction and Cognitive Challenges on Gait in Persons with Multiple Sclerosis

Multiple Sclerosis International ◽

10.1155/2013/859323 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Douglas A. Wajda ◽

Brian M. Sandroff ◽

John H. Pula ◽

Robert W. Motl ◽

Jacob J. Sosnoff

Keyword(s):

Multiple Sclerosis ◽

Stride Length ◽

Cognitive Task ◽

Cognitive Test ◽

Control Group ◽

Healthy Controls ◽

Backward Walking ◽

Gait Parameters ◽

Walking Performance ◽

Testing Condition

Declines in walking performance are commonly seen when undergoing a concurrent cognitive task in persons with multiple sclerosis (MS). The purpose of this study was to determine the effect of walking direction and simultaneous cognitive task on the spatiotemporal gait parameters in persons with MS compared to healthy controls. Ten persons with MS (Median EDSS, 3.0) and ten healthy controls took part in this pilot study. Participants performed 4 walking trials at their self-selected comfortable pace. These trials included forward walking, forward walking with a cognitive task, backward walking, and backward walking with a cognitive task. Walking performance was indexed with measures of velocity, cadence, and stride length for each testing condition. The MS group walked slower with significantly reduced stride length compared to the control group. The novel observation of this investigation was that walking differences between persons with MS and healthy controls were greater during backward walking, and this effect was further highlighted during backward walking with added cognitive test. This raises the possibility that backward walking tests could be an effective way to examine walking difficulties in individuals with MS with relatively minimal walking impairment.

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Pathological Gait Signatures of Post-stroke Dementia With Toe-Off and Heel-to-Ground Angles Discriminate From Alzheimer’s Disease

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.766884 ◽

2021 ◽

Vol 13 ◽

Author(s):

Linhui Ni ◽

Wen Lv ◽

Di Sun ◽

Yi Sun ◽

Yu Sun ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Dual Task ◽

Stride Length ◽

Statistical Significance ◽

Swing Phase ◽

Post Stroke ◽

Gait Characteristics ◽

Gait Parameters ◽

Demographic Covariates

Given the limited power of neuropsychological tests, there is a need for a simple, reliable means, such as gait, to identify mild dementia and its subtypes. However, gait characteristics of patients with post-stroke dementia (PSD) and Alzheimer’s disease (AD) are unclear. We sought to describe their gait signatures and to explore gait parameters distinguishing PSD from post-stroke non-dementia (PSND) and patients with AD. We divided 3-month post-stroke patients into PSND and PSD groups based on the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the activity of daily living (ADL). Thirty-one patients with AD and thirty-two healthy controls (HCs) were also recruited. Ten gait parameters in one single and two dual-task gait tests (counting-backward or naming-animals while walking) were compared among the groups, with adjustment for baseline demographic covariates and the MMSE score. The area under the receiver operating characteristic curve (AUC) was used to identify parameters discriminating PSD from individuals with PSND and AD. Patients with PSD and patients with AD showed impaired stride length, velocity, stride time, and cadence while patients with PSD had altered stance and swing phase proportions (all p ≤ 0.01, post hoc). Patients with AD had smaller toe-off (ToA) and heel-to-ground angles (HtA) (p ≤ 0.01) than HCs in dual-task gait tests. Individuals with PSD had a shorter stride length, slower velocity, and altered stance and swing phase percentages in all tests (p ≤ 0.01), but a higher coefficient of variation of stride length (CoVSL) and time (CoVST) only in the naming animals-task gait test (p ≤ 0.001) than individuals with PSND. ToA and HtA in the naming animals-task gait test were smaller in individuals with AD than those with PSD (p ≤ 0.01). Statistical significance persisted after adjusting for demographic covariates, but not for MMSE. The pace and the percentage of stance or swing phase in all tests, CoVST in the dual-task paradigm, and CoVSL only in the naming animals-task gait test (moderate accuracy, AUC > 0.700, p ≤ 0.01) could distinguish PSD from PSND. Furthermore, the ToA and HtA in the naming animals-task gait paradigm discriminated AD from PSD (moderate accuracy, AUC > 0.700, p ≤ 0.01). Thus, specific gait characteristics could allow early identification of PSD and may allow non-invasive discrimination between PSD and AD, or even other subtypes of dementia.

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Considerations regarding the optimisation of the spike in modern volleyball

Timisoara Physical Education and Rehabilitation Journal ◽

10.1515/tperj-2016-0006 ◽

2016 ◽

Vol 9 (16) ◽

pp. 40-44

Author(s):

Hans-Eric Reitmayer ◽

Sorin Grădinaru

Keyword(s):

Range Of Motion ◽

Body Motion ◽

Upper Body ◽

Movement Speed ◽

Accelerated Motion ◽

Video Footage ◽

Vertical Leap ◽

The Moment

Abstract The aim of this paper is to analyse in detail the aspects regarding increased efficiency of the spike in the game of volleyball, given the requirements of a flawless technique that will maximize the potential of the players. Our intention was to verify whether the steps of approach are unfolding in a uniformly accelerated motion and are leading to a vertical leap in the desired parameters at the moment of take off. We also wanted to check if the range of upper body motion is a determinant in the efficiency of the spike consisting in a high striking point and a remakable hitting force. Material and methods: The video footage was obtained from 6 players of “U” Timisoara's volleyball team and 6 international players. For the analysis and processing of the footage the program Kinovea was used and the following parameters were assessed: striking speed(m/s), range of motion (cm and °), flexion between arm and forearm, angle of arm with the vertical at contact, movement speed for the first, second and third approach steps. Results: The international subjects had a 12 cm longer path of the hand in striking motion. Given the shorter segments of “U” Timisoara's players, they compensate by having a 2° larger range of motion, above the elite players. We recorded diferent angles of the spiking arm with the vertical for the 2 groups, namely a mean of 24.5° for the elite players and just 15° for the players of “U” Timisoara. These aspects lead to a striking speed 3m/s higher for the international spikers compared to “U” Timisoara sportsmen. Having measured a uniformly accelerated approach for the international subjects, “U” Timisoara's players don't respond to the same requirement with close values of the second and third step of approach.

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Critical spatiotemporal gait parameters for individuals with dementia: A systematic review and meta-analysis

Hong Kong Physiotherapy Journal ◽

10.1142/s101370252130001x ◽

2020 ◽

pp. 1-14

Author(s):

Rita Chiaramonte ◽

Matteo Cioni

Keyword(s):

Systematic Review ◽

Gait Analysis ◽

Dual Task ◽

Stride Length ◽

Meta Analysis ◽

Time Variability ◽

Stride Time ◽

Single Task ◽

Gait Parameters ◽

Risk Of Falls

Instrumented gait analysis allows for the identification of walking parameters to predict cognitive decline and the worsening of dementia. The aim of this study was to perform a meta-analysis to better clarify which gait parameters are affected or modified with the progression of the dementia in a larger sample, as well as which gait assessment conditions (single-task or dual-task conditions) would be more sensitive to reflect the influence of dementia. Literature searches were conducted with the keywords “quantitative gait” OR “gait analysis” AND “dementia” AND “single-task” AND “dual-task,” and for “quantitative gait” OR “gait analysis” AND “dementia” AND “fall risk” on PubMed, EMBASE, the Cochrane Library, Scopus, and Web of Science. The results were used to perform a systematic review focussing on instrumental quantitative assessment of the walking of patients with dementia, during both single and dual tasks. The search was performed independently by two authors (C. R. and C. M.) from January 2018 to April 2020 using the PICOS criteria. Nine publications met the inclusion criteria and were included in the systematic review. Our meta-analysis showed that during a single task, most of the spatiotemporal parameters of gait discriminated best between patients with dementia and healthy controls, including speed, cadence, stride length, stride time, stride time variability, and stance time. In dual tasks, only speed, stride length, and stride time variability discriminated between the two groups. In addition, compared with spatial parameters (e.g. stride length), some temporal gait parameters were more correlated to the risk of falls during the comfortable walking in a single task, such as cadence, stride time, stride time variability, and stance time. During a dual task, only the variability of stride time was associated with the risk of falls.

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