Gait Assessment in College Athletes: Do Concussion History, Symptoms, Gender, and Type of Sport Matter?

Context: Though previous research has focused on examining the effects of concussion history using a dual-task paradigm, the influence of factors like symptoms (unrelated to concussion), gender, and type of sport on gait in college athletes is unknown. Objective: To examine the effect of concussion history, symptoms, gender, and type of sport (noncontact/limited contact/contact) individually on gait among college athletes. Design: Exploratory cross-sectional study. Setting: Laboratory. Participants: In total, 98 varsity athletes (age, 18.3 [1.0] y; height, 1.79 [0.11] m; mass, 77.5 [19.2] kg; 27 with concussion history, 58 reported at least one symptom, 44 females; 8 played noncontact sports and 71 played contact sports) walked under single- and dual-task (walking while counting backward by 7) conditions. Interventions: Not applicable. Main Outcome Measures: Dual-task cost (DTC; % difference between single task and dual task) of gait speed, cadence, step length and width, percentage of swing and double-support phases, symptom score, and total symptom severity score. Independent samples t tests and 1-way analysis of variance were conducted (α value = .05). Results: Self-reported concussion history resulted in no significant differences (P > .05). Those who reported symptoms at testing time showed significantly greater DTC of step length (mean difference [MD], 2.7%; 95% confidence interval [CI], 0.3% to 5.1%; P = .012), % of swing phase (MD, 1.0%; 95% CI, −0.2 to 2.1%; P = .042), and % of double-support phase (MD, 3.9%; 95% CI, 0.2% to 7.8%; P = .019). Females demonstrated significantly higher DTC of gait speed (MD, 5.3%; 95% CI, 1.3% to 9.3%; P = .005), cadence (MD, 4.0%; 95% CI, 1.4% to 6.5%; P = .002), % of swing phase (MD, 1.2%; 95% CI, 0.1% to 2.3%; P = .019), and % of double-support phase (MD, 4.1%; 95% CI, 0.4% to 7.9%; P = .018). Noncontact sports athletes had significantly greater step width DTC than contact sports athletes (MD, 14.2%; 95% CI, 0.9% to 27.6%; P = .032). Conclusions: Reporting symptoms at testing time may influence gait under dual-task conditions. Additionally, female athletes showed more gait changes during a dual task. Sports medicine professionals should be aware that these variables, while unrelated to injury, may affect an athlete’s gait upon analysis.

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Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes

Hong Kong Physiotherapy Journal ◽

10.1142/s1013702519500100 ◽

2019 ◽

Vol 39 (02) ◽

pp. 115-124

Author(s):

Wan-Yun Huang ◽

Sheng-Hui Tuan ◽

Min-Hui Li ◽

Xin-Yu Liu ◽

Pei-Te Hsu

Keyword(s):

Gait Speed ◽

Stride Length ◽

Stance Phase ◽

Gait Cycle ◽

Swing Phase ◽

Heel Strike ◽

Assist Device ◽

Double Support ◽

Strike Angle ◽

Support Phase

Background: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients.Objective: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke.Methods: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age [Formula: see text] years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20[Formula: see text]m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser.Results: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 ([Formula: see text], and [Formula: see text], respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser.Conclusion: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.

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Walking while Talking in Older Adults with Chronic Kidney Disease

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.12401019 ◽

2020 ◽

Vol 15 (5) ◽

pp. 665-672

Author(s):

Jim Q. Ho ◽

Joe Verghese ◽

Matthew K. Abramowitz

Keyword(s):

Factor Analysis ◽

Confidence Interval ◽

Dual Task ◽

Gait Speed ◽

Swing Phase ◽

Community Dwelling ◽

Double Support ◽

Dual Task Cost ◽

Lower Egfr ◽

Gait Abnormalities

Background and objectivesWalking while talking is a dual cognitive-motor task that predicts frailty, falls, and cognitive decline in the general elderly population. Adults with CKD have gait abnormalities during usual walking. It is unknown whether they have greater gait abnormalities and cognitive-motor interference during walking while talking.Design, setting, participants, & measurementsCommunity-dwelling, nondisabled adults (n=330) ≥65 years of age underwent quantitative gait analysis, including walking while talking. Differences in walking-while-talking performance by CKD status were evaluated, and relative changes between walking-while-talking and walking alone performance were computed to quantify cognitive-motor interference (dual-task cost). Associations were tested using multivariable linear spline regression models, and independent gait domains were derived using factor analysis. CKD was defined as an eGFR<60 ml/min per 1.73 m2.ResultsCKD was present in 134 (41%) participants. Participants with CKD had slower gait speed along with various gait cycle abnormalities during walking while talking: among those with CKD, every 10-ml/min per 1.73 m2 lower eGFR was associated with 3.3-cm/s (95% confidence interval, 0.4 to 6.1) slower gait speed, 1.8-cm (95% confidence interval, 0.6 to 3.0) shorter step length, 1.1% (95% confidence interval, 0.6 to 1.7) less time in the swing phase, and 1.4% (95% confidence interval, 0.5 to 2.3) greater time in double support after multivariable adjustment. When comparing walking while talking with walking alone, every 10-ml/min per 1.73 m2 lower eGFR was associated with 1.8% (95% confidence interval, 0.5 to 3.2) greater decrease in time in the swing phase and 0.9% (95% confidence interval, 0.2 to 1.5) greater increase in time in the stance phase. Factor analysis identified three walking-while-talking domains and three dual-task cost domains: eGFR was associated specifically with the rhythm domain for both walking-while-talking and dual-task cost. Every 10-ml/min per 1.73 m2 lower eGFR was associated with a poorer performance of 0.2 SD (95% confidence interval, 0.1 to 0.3) for walking while talking and 0.2 SD (95% confidence interval, 0.03 to 0.3) for dual-task cost.ConclusionsDuring walking while talking, CKD is associated with gait abnormalities, possibly due to increased cognitive-motor interference.

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Physiological and Cognitive Determinants of Dual-Task Costs for Gait Parameters: The Yishun Study

Gerontology ◽

10.1159/000514171 ◽

2021 ◽

pp. 1-10

Author(s):

Lay Khoon Lau ◽

Jagadish Ullal Mallya ◽

Wei Jun Benedict Pang ◽

Kexun Kenneth Chen ◽

Khalid bin Abdul Jabbar ◽

...

Keyword(s):

Dual Task ◽

Gait Speed ◽

Postural Sway ◽

Step Length ◽

Double Support ◽

Immediate Memory ◽

Gait Parameters ◽

Primary Determinant ◽

Double Support Time ◽

Support Time

Background: Studies indicate that physiological and cognitive aging are causally related and functionally interdependent. However, the relative contribution of physiological factors and cognition to dual-task costs (DTC) of gait parameters has not been well studied. In this cross-sectional study, we examined the trajectory of DTC of gait parameters across the adult age spectrum for both sexes and identified the contributions of physical and cognitive performance to DTC of gait. Methods: A total of 492 community-dwelling adults, aged 21–90 years, were randomly recruited into the study. Participants were divided into 7 age groups, with 10-year age range for each group. Demographic data, height, body mass, education level, and information on comorbidities were recorded. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status. Physical performance included visual contrast sensitivity, postural sway, hand reaction time, handgrip strength, knee extensor strength, and single-task and dual-task gait assessments. Stepwise multivariable regression was used to examine the association between physical and cognitive performance with DTC of gait parameters. Results: Women were found to have significantly higher DTC of gait speed (p = 0.01), cadence (p < 0.01), and double support time (p < 0.01) than men. However, significant aging effect on DTC of gait speed (p = 0.01), step length (p = 0.01), and double support time (p = 0.01) was observed in men but not in women. Immediate memory was the primary determinant for the DTC of gait speed (β = −0.25, p < 0.01), step length (β = −0.22, p < 0.01), and cadence (β = −0.15, p = 0.03) in men. Besides immediate memory, postural sway (β = −0.13, p = 0.03) and hand reaction (β = 0.14, p = 0.02) were also significantly associated with DTC of step length and cadence, respectively, in women. Conclusion: There were sex differences in the amplitude and trajectories of DTC of gait parameters. The DTC increased with age in men but not in women. Immediate memory was the primary determinant of DTC of gait parameters in men while immediate memory, postural sway, and reaction time were associated with DTC of gait in women. Future studies should investigate the clinical implications of the sex differences in the DTC with fall risks.

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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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The Effect of Two Different Cognitive Tests on Gait Parameters during Dual Tasks in Healthy Postmenopausal Women

BioMed Research International ◽

10.1155/2016/1205469 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Magdalena Hagner-Derengowska ◽

Krystian Kałużny ◽

Wojciech Hagner ◽

Anna Kałużna ◽

Bartosz Kochański ◽

...

Keyword(s):

Postmenopausal Women ◽

Dual Task ◽

Gait Speed ◽

System Analysis ◽

Cognitive Task ◽

Cognitive Tests ◽

Smart System ◽

Time Space ◽

Gait Parameters ◽

Support Phase

Introduction. The paper aims to evaluate the influence of two different demanding cognitive tasks on gait parameters using BTS SMART system analysis.Patients and Methods. The study comprised 53 postmenopausal women aged 64.5 ± 6.7 years (range: 47–79). For every subject, gait analysis using a BTS SMART system was performed in a dual-task study design under three conditions: (I) while walking only (single task), (II) walking while performing a simultaneous simple cognitive task (SCT) (dual task), and (III) walking while performing a simultaneous complex cognitive task (CCT) (dual task). Time-space parameters of gait pertaining to the length of a single support phase, double support phase, gait speed, step length, step width, and leg swing speed were analyzed.Results. Performance of cognitive tests during gait resulted in a statistically significant prolongation of the left (by 7%) and right (by 7%) foot gait cycle, shortening of the length of steps made with the right extremity (by 4%), reduction of speed of swings made with the left (by 11%) and right (by 8%) extremity, and reduction in gait speed (by 6%).Conclusions. Performance of cognitive tests during gait changes its individual pattern in relation to the level of the difficulty of the task.

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Mild Cognitive Impairment Affects Obstacle Negotiation in Older Adults: Results from “Gait and Brain Study”

Gerontology ◽

10.1159/000492931 ◽

2018 ◽

Vol 65 (2) ◽

pp. 164-173 ◽

Cited By ~ 13

Author(s):

Frederico Pieruccini-Faria ◽

Yanina Sarquis-Adamson ◽

Manuel Montero-Odasso

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Executive Function ◽

Mild Cognitive Impairment ◽

Dual Task ◽

Gait Speed ◽

Step Length ◽

Gait Control ◽

Dual Tasking ◽

Brain Study

Background: Older adults with Mild Cognitive Impairment (MCI) are at higher risk of falls and injuries, but the underlying mechanism is poorly understood. Inappropriate anticipatory postural adjustments to overcome balance perturbations are affected by cognitive decline. However, it is unknown whether anticipatory gait control to avoid an obstacle is affected in MCI. Objective: Using the dual-task paradigm, we aim to assess whether gait control is affected during obstacle negotiation challenges in older adults with MCI. Methods: Seventy-nine participants (mean age = 72.0 ± 2.7 years; women = 30.3%) from the “Gait and Brain Study” were included in this study (controls = 27; MCI = 52). In order to assess the anticipatory control behaviour for obstacle negotiation, a 6-m electronic walkway embedded with sensors recorded foot prints to measure gait speed and step length variability, during early (3 steps before the late phase) and late (3 steps before the obstacle) pre-crossing phases of an ad hoc obstacle, set at 15% of participant’s height. Participants walked under single- and dual-task gait (counting backwards by 1’s from 100 while walking) conditions. Three-way mixed repeated-measures analysis of variance models examined differences in gait performance between groups when transitioning between pre-crossing phases towards an obstacle during single- and dual-task conditions. Analyses were adjusted for age, sex, years of education, lower limb function, fear of falling, medical status, depressive symptoms, baseline gait speed and executive function. Results: A significant three-way interaction among groups, pre-crossing phases and task showed that participants with MCI attenuated the gait deceleration (p = 0.02) and performed fewer step length adjustments (p = 0.03) when approaching the obstacle compared with controls while dual-tasking. These interactions were attenuated when executive function performance was added as a covariate in the adjusted statistical model. Conclusion: Older adults with MCI attenuate the anticipatory gait adjustments needed to avoid an obstacle when dual-tasking. Deficits in higher-order cognitive processing may limit obstacle negotiation capabilities in MCI populations, being a potential falls risk factor.

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Implementation and Integration of Fuzzy Algorithms for Descending Stair of KMEI Humanoid Robot

EMITTER International Journal of Engineering Technology ◽

10.24003/emitter.v8i2.535 ◽

2020 ◽

pp. 372-388

Author(s):

Wulandari Puspita Sari ◽

R. Sanggar Dewanto ◽

Dadet Pramadihanto

Keyword(s):

Humanoid Robot ◽

Fuzzy Logic Controller ◽

Integrated Control ◽

Step Length ◽

Smooth Transition ◽

Double Support ◽

Walking Gait ◽

Single Support Phase ◽

Support Phase ◽

Double Support Phase

Locomotion of humanoid robot depends on the mechanical characteristic of the robot. Walking on descending stairs with integrated control systems for the humanoid robot is proposed. The analysis of trajectory for descending stairs is calculated by the constrains of step length stair using fuzzy algorithm. The established humanoid robot on dynamically balance on this matter of zero moment point has been pretended to be consisting of single support phase and double support phase. Walking transition from single support phase to double support phase is needed for a smooth transition cycle. To accomplish the problem, integrated motion and controller are divided into two conditions: motion working on offline planning and controller working online walking gait generation. To solve the defect during locomotion of the humanoid robot, it is directly controlled by the fuzzy logic controller. This paper verified the simulation and the experiment for descending stair of KMEI humanoid robot.

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Identification of Postconcussion Dual-Task Gait Abnormalities Using Normative Reference Values

Journal of Applied Biomechanics ◽

10.1123/jab.2018-0454 ◽

2019 ◽

Vol 35 (4) ◽

pp. 290-296 ◽

Cited By ~ 3

Author(s):

David R. Howell ◽

Thomas A. Buckley ◽

Brant Berkstresser ◽

Francis Wang ◽

William P. Meehan

Keyword(s):

Reference Values ◽

Dual Task ◽

Gait Speed ◽

Step Length ◽

Normative Values ◽

Control Group ◽

Single Task ◽

Abnormal Gait ◽

Confounding Variables ◽

Gait Abnormalities

The purpose of this study was to identify the rate of abnormal single-task and dual-task gait performance following concussion compared to uninjured controls using previously established normative reference values. The authors examined athletes with a concussion (n = 54; mean age = 20.3 [1.1] y, 46% female, tested 2.9 [1.5] d postinjury), and healthy controls were tested during their preseason baseline examination (n = 60; mean age = 18.9 [0.7] y, 37% female). Participants completed an instrumented single-/dual-task gait evaluation. Outcome variables included average walking speed, cadence, and step length. A significantly greater number of those with concussion walked with abnormal dual-task gait speed compared with the control group (56% vs 30%,P = .01). After adjusting for potential confounding variables (age, concussion history, symptom severity, and sleep), concussion was associated with lower dual-task gait speed (β = −0.150; 95% confidence interval [CI] = −0.252 to −0.047), cadence (β = −8.179; 95% CI = −14.49 to −1.871), and stride length (β = −0.109; 95% CI = −0.204 to −0.014). Although group analyses indicated that those with a concussion performed worse on single-task and dual-task gait compared with controls, a higher rate of abnormal gait was detected for the concussion group compared with the control group for dual-task gait speed only. Dual-task gait speed, therefore, may be considered as a measure to compare against normative values to detect postconcussion impairments.

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3D visual cueing shortens the double support phase of the gait cycle in patients with advanced Parkinson's disease treated with DBS of the STN

PLoS ONE ◽

10.1371/journal.pone.0244676 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244676

Author(s):

Kamila Poláková ◽

Evžen Růžička ◽

Robert Jech ◽

David Kemlink ◽

Jan Rusz ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Freezing Of Gait ◽

Step Length ◽

Double Support ◽

Visual Cueing ◽

Stn Dbs ◽

Support Phase ◽

Double Support Phase

Background Gait disturbances have emerged as some of the main therapeutic concerns in late-stage Parkinson’s disease (PD) treated with dopaminergic therapy and deep brain stimulation (DBS). External cues may help to overcome freezing of gait (FOG) and improve some of the gait parameters. Aim To evaluate the effect of 3D visual cues and STN-DBS on gait in PD group. Methods We enrolled 35 PD patients treated with DBS of nucleus subthalamicus (STN-DBS). Twenty-five patients (5 females; mean age 58.9 ±6.3) and 25 sex- and age-matched controls completed the gait examination. The gait in 10 patients deteriorated in OFF state. The severity of PD was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (HY). The PD group filled the Falls Efficacy Scale-International (FES) and Freezing of Gait Questionnaire (FOGQ). Gait was examined using the GaitRite Analysis System, placed in the middle of the 10m marked path. The PD group was tested without dopaminergic medication with and without visual cueing together with the DBS switched ON and OFF. The setting of DBS was double-blind and performed in random order. Results The UPDRS was 21.9 ±9.5 in DBS ON state and 41.3 ±13.7 in DBS OFF state. HY was 2.5 ±0.6, FES 12.4 ±4.1 and FOGQ 9.4 ±5.7. In the DBS OFF state, PD group walked more slowly with shorter steps, had greater step length variability and longer duration of the double support phase compared to healthy controls. The walking speed and step length increased in the DBS ON state. The double support phase was reduced with 3D visual cueing and DBS; the combination of both cueing and DBS was even more effective. Conclusion Cueing with 3D visual stimuli shortens the double support phase in PD patients treated with DBS-STN. The DBS is more effective in prolonging step length and increasing gait speed. We conclude that 3D visual cueing can improve walking in patients with DBS.

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Stepping Asymmetry Among Individuals With Unilateral Transtibial Limb Loss Might Be Functional in Terms of Gait Stability

Physical Therapy ◽

10.2522/ptj.20130431 ◽

2014 ◽

Vol 94 (10) ◽

pp. 1480-1488 ◽

Cited By ~ 23

Author(s):

Laura Hak ◽

Jaap H. van Dieën ◽

Peter van der Wurff ◽

Han Houdijk

Keyword(s):

Center Of Mass ◽

Step Length ◽

Cross Sectional Study ◽

Initial Contact ◽

Cross Sectional ◽

Transtibial Amputation ◽

Functional Compensation ◽

Double Support ◽

Support Phase ◽

Double Support Phase

BackgroundThe asymmetry in step length in prosthetic gait is often seen as a detrimental effect of the impairment; however, this asymmetry also might be a functional compensation. An advantage of a smaller step length of the nonprosthetic leg, and specifically foot forward placement (FFP), might be that it will bring the center of mass closer to the base of support of the leading foot and thus increase the backward margin of stability (BW MoS).ObjectiveThe purpose of this study was to characterize differences in step length, FFP, and the concomitant difference in BW MoS between steps of the prosthetic and nonprosthetic legs (referred to as prosthetic and nonprosthetic steps, respectively) of people after transtibial amputation.DesignThis was an observational and cross-sectional study.MethodsTen people after transtibial amputation walked for 4 minutes on a self-paced treadmill. Step length and FFP were calculated at initial contact. The size of the BW MoS was calculated for the moment of initial contact and at the end of the double-support phase of gait.ResultsStep length (5.4%) and FFP (7.9%) were shorter for the nonprosthetic step than for the prosthetic step. The BW MoS at initial contact was larger for the nonprosthetic step, but because of a significant leg × gait event interaction effect, BW MoS did not differ significantly at the end of the double-support phase.LimitationsAll participants were relatively good walkers (score of E on the Special Interest Group in Amputee Medicine [SIGAM] scale).ConclusionsThe smaller step length and FFP of the nonprosthetic step help to create a larger BW MoS at initial contact for the nonprosthetic step compared with the prosthetic step. Hence, step length asymmetry in people after transtibial amputation might be seen as a functional compensation to preserve BW MoS during the double-support phase to cope with the limited push-off power of the prosthetic ankle.

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