scholarly journals Individuals Poststroke Do Not Perceive Their Spatiotemporal Gait Asymmetries as Abnormal

2015 ◽  
Vol 95 (9) ◽  
pp. 1244-1253 ◽  
Author(s):  
Clinton J. Wutzke ◽  
Richard A. Faldowski ◽  
Michael D. Lewek
Keyword(s):  
Step Length ◽  
Gait Pattern ◽  
Conscious Awareness ◽  
Gait Patterns ◽  
Temporal Asymmetry ◽  
Gait Asymmetry ◽  
Stance Time ◽  
The Asymmetry ◽  
Asymmetric Gait

Background Following stroke, spatiotemporal gait asymmetries persist into the chronic phases, despite the neuromuscular capacity to produce symmetric walking patterns. This persistence of gait asymmetry may be due to deficits in perception, as the newly established asymmetric gait pattern is perceived as normal. Objective The purpose of this study was to determine the effect of usual overground gait asymmetry on the ability to consciously and unconsciously perceive the presence of gait asymmetry in people poststroke. Design An observational study was conducted. Methods Thirty people poststroke walked overground and on a split-belt treadmill with the belts moving at different speeds (0%–70% difference) to impose varied step length and stance time asymmetries. Conscious awareness and subconscious detection of imposed gait patterns were determined for each participant, and the asymmetry magnitudes at those points were compared with overground gait. Results For both spatial and temporal asymmetry variables, the asymmetry magnitude at the threshold of awareness was significantly greater than the asymmetry present at the threshold of detection or during overground gait. Participants appeared to identify belt speed differences using the type of gait asymmetry they typically exhibited (ie, step length or stance time asymmetries during overground gait). Limitations Very few individuals with severe spatiotemporal asymmetry were tested, and participants were instructed to identify asymmetric belt speeds rather than interlimb movements. Conclusions The data suggest that asymmetry magnitudes need to exceed usual overground levels to reach conscious awareness. Therefore, it is proposed that the spatiotemporal asymmetry that is specific to each participant may need to be augmented beyond what he or she usually has during walking in order to promote awareness of asymmetric gait patterns for long-term correction and learning.

scholarly journals Effects of Auditory Cueing on Cadence and Gait Pattern

2020 ◽  
Vol 64 (1) ◽  
pp. 1233-1237
Author(s):  
Andrei Carballo ◽  
Matthew Chang ◽  
Brian Hirmiz ◽  
Nicolette Lambright ◽  
Vivian Lee ◽  
...  
Keyword(s):  
Fall Risk ◽  
Stride Length ◽  
Step Length ◽  
Gait Pattern ◽  
Stride Time ◽  
Auditory Cues ◽  
Gait Patterns ◽  
Swing Time ◽  
Stance Time ◽  
Auditory Cueing

A large portion of the population participate in gait rehabilitation, especially those with conditions such as increased fall risk such as stroke, or Parkinson’s Disease. Some studies have shown that auditory cues help improve gait and reduce fall risk, but relationship with gait patterns is missing. In this study, eight participants walked at their preferred cadence and at increased and reduced cadence by 20%. We found that step length and step width were not significantly different in all walking conditions. Decreased cadence resulted in an increase of swing time, stance time, stride time, and stance to swing ratio, and a decrease in stride length. Increased cadence resulted in a decrease in stance time, stride time, swing time, and stance to swing ratio, and an increase in stride length. The results suggest there is a strong correlation between auditory cues and gait patterns that can improve rehabilitative processes in the future.

Altering Footwear Type Influences Gait During Level Walking and Downhill Transitions

2012 ◽  
Vol 28 (5) ◽  
pp. 481-490 ◽  
Author(s):  
Keith A. Stern ◽  
Jinger S. Gottschall
Keyword(s):  
Gait Cycle ◽  
Dynamic Balance ◽  
Step Length ◽  
Lower Leg ◽  
Step Width ◽  
Lateral Gastrocnemius ◽  
Gait Patterns ◽  
Level Walking ◽  
Stance Time ◽  
Stable Gait

The purpose of our study was to determine if altering the insoles within footwear or walking barefoot, as an attempt to increase or decrease cutaneous stimuli, would improve dynamic balance during a hill-walking task. We hypothesize that compared with foam insoles or iced bare feet, textured insoles or bare feet will result in greater speeds, longer step lengths, narrower step width, shorter stance time, and less tibialis anterior (TA), soleus (SOL), and lateral gastrocnemius (LG) activity during key gait cycle phases. Ten, healthy college students, 5 men and 5 women, completed the protocol that consisted of level walking and downhill transition walking in five different footwear insole or barefoot conditions. During level walking, conditions with the hypothesized greater cutaneous stimuli resulted in greater step length, which relates to a more stable gait. In detail, the texture insole condition average step length was 3% longer than the regular insole condition, which was 5% longer than the ice condition (p < .01). The same signals of increased stability were evident during the more challenging downhill transition stride. Step length during the barefoot condition was 8% longer than the ice condition (p < .05) and step width during the regular footwear condition was 5% narrower than the foam condition (p = .05). To add, during the preswing phase of level walking, TA activity of the textured insole condition was 30% less than the foam insole. Although our data show that footwear conditions alter gait patterns and lower leg muscle activity during walking, there is not enough evidence to support the hypothesis that textured insoles will improve dynamic balance as compared with other footwear types.

scholarly journals An experimental study of passive dynamic walking

Robotica ◽  
2004 ◽  
Vol 22 (3) ◽  
pp. 251-262 ◽  
Author(s):  
Q. Wu ◽  
N. Sabet
Keyword(s):  
Surface Friction ◽  
Step Length ◽  
Gait Pattern ◽  
Dynamic Walking ◽  
Bipedal Robots ◽  
Passive Dynamic Walking ◽  
Gait Patterns ◽  
Flat Feet ◽  
Walking Mechanism ◽  
Walking Efficiency

A two-straight-legged walking mechanism with flat feet is designed and built to study the passive dynamic gait. It is shown that the mechanism having flat feet can exhibit passive dynamic walking as those with curved feet, but the walking efficiency is significantly lower. It is also shown that the balancing mass and its orientation are effective for controlling side-to-side rocking and yaw, which have significant effects on steady walking. The effects of various parameters on the gait patterns are also studied. lt is shown that changes in the ramp angle have the most dominant effect on the gait pattern as compared with the changes in the hip mass, ramp surface friction and size of the flat feet. More specifically, as the ramp angle increases, the step length increases while the range of the side-to side rocking angle decreases and the step length dictates the walking speed and the gravitational power. Another finding, is that adding a hip mass improves the walking efficiency by allowing the mechanism to walk on a flatter ramp. This research enables us to gain a better understanding of the mechanics of walking. Such an understanding will have a direct impact on better design of prostheses and on the active control aspects of bipedal robots.

scholarly journals Novel velocity estimation for symmetric and asymmetric self-paced treadmill training

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Santiago Canete ◽  
Daniel A. Jacobs
Keyword(s):  
Visual Feedback ◽  
Muscle Activity ◽  
Walking Speed ◽  
Step Length ◽  
Velocity Estimation ◽  
Gait Patterns ◽  
Joint Torques ◽  
Locked Knee ◽  
Walking Velocity ◽  
Asymmetric Gait

Abstract Background Self-paced treadmills (SPT) can provide an engaging setting for gait rehabilitation by responding directly to the user’s intent to modulate the external environment and internal effort. They also can improve gait analyses by allowing scientists and clinicians to directly measure the effect of an intervention on walking velocity. Unfortunately, many common SPT algorithms are not suitable for individuals with gait impairment because they are designed for symmetric gait patterns. When the user’s gait is asymmetric due to paresis or if it contains large accelerations, the performance is diminished. Creating and validating an SPT that is suitable for asymmetric gait will improve our ability to study rehabilitation interventions in populations with gait impairment. The objective of this study was to test and validate a novel self-paced treadmill on both symmetric and asymmetric gait patterns and evaluate differences in gait kinematics, kinetics, and muscle activity between fixed-speed and self-paced treadmill walking. Methods We collected motion capture, ground reaction force data, and muscle activity from 6 muscles in the dominant leg during walking from 8 unimpaired subjects. In the baseline condition, the subjects walked at 3 fixed-speeds normalized to their leg length as Froude numbers. We developed a novel kinematic method for increasing the accuracy of the user’s estimated walking velocity and compared our method against other published algorithms at each speed. Afterward, subjects walked on the SPT while matching their walking speed to a given target velocity using visual feedback of the treadmill speed. We evaluated the SPT by measuring steady-state error and the number of steps to reach the desired speed. We split the gait cycle into 7 phases and compared the kinematic, kinetic, and muscle activity between the fixed speed and self-paced mode in each phase. Then, we validated the performance of the SPT for asymmetric gait by having subjects walk on the SPT while wearing a locked-knee brace set to 0° on the non-dominant leg. Results Our SPT enabled controlled walking for both symmetric and asymmetric gait patterns. Starting from rest, subjects were able to control the SPT to reach the targeted speeds using visual feedback in 13–21 steps. With the locked knee brace, subjects controlled the treadmill with substantial step length and step velocity asymmetry. One subject was able to execute a step-to gait and halt the treadmill on heel-strikes with the braced leg. Our kinematic correction for step-length outperformed the competing algorithms by significantly reducing the velocity estimation error at the tested velocities. The joint kinematics, joint torques, and muscle activity were generally similar between fixed-speed and self-paced walking. Statistically significant differences were found in 5 of 63 tests for joint kinematics, 2 of 63 tests for joint torques, and 9 of 126 tests for muscle activity. The differences that were statistically significant were not found across all speeds and were generally small enough to be of limited clinical relevance. Conclusions We present a validated method for implementing a self-paced treadmill for asymmetric and symmetric gaits. As a result of the increased accuracy of our estimation algorithm, our SPT produced controlled walking without including a position feedback controller, thereby reducing the influence of the controller on measurements of the user’s true walking speed. Our method relies only on a kinematic correction to step length and step time which can support transfer to systems outside of the laboratory for symmetric and asymmetric gaits in clinical populations.

scholarly journals Changes in Gait Pattern During Smartphone and Tablet Use

2020 ◽  
Vol 18 (4) ◽  
pp. 475-484
Author(s):  
Sirinthip Pakdee ◽  
◽  
Praphatson Sengsoon ◽  
Keyword(s):  
Text Message ◽  
Step Length ◽  
Gait Pattern ◽  
Gait Velocity ◽  
Stride Time ◽  
Normal Walking ◽  
Time Step ◽  
Gait Patterns ◽  
Significant Difference ◽  
Smartphone Use

Objectives: There exists no study concerning gait pattern while engaging in dual-task activities on different sizes of mobile devices. The present study aimed to compare gait patterns during normal walking, walking with smartphone use, and walking with tablet use. Methods: Seventeen healthy female participants with an age range of 19-24 years (Mean±SD age: 20.29±1.61 years, weight: 49.82±4.46 kg, height: 156.59±4.87 cm, body mass index: 20.47±0.84 kg/m2, and leg length: 81.35±3.79 cm.) participated in the present research. The study subjects were requested to walk for 10 meters under the following conditions: normal walking; walking while typing a text message with a smartphone, and walking while typing a text message with a tablet. The Vicon® Three-Dimensional (3D) motion analysis recorded the motion of reflective markers attached to the study participant’s body. Gait parameters (step length, stride length, step time, stride time, step width, velocity, and cadence) were compared between the explored walking conditions. Results: The gait parameter of normal walking, compared with walking during smartphone use as well as tablet use were significantly different in the gait pattern (P<0.05). Using either a smartphone or tablet during walking presented decreased step length for legs, gait velocity, and cadence. However, there was an increase in the right leg’s step time and stride time. Moreover, there was no significant difference in gait patterns between walking during smartphone use and walking during tablet use (P>0.05). Discussion: Changes in gait pattern during walking while typing a text message with either a smartphone or tablet may lead to greater attention and concentration required to type the message; such actions resulted in decreased gait speed and step length.

Effect of osteopathic manipulation on gait asymmetry

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Cherice N. Hill ◽  
M’Lindsey Romero ◽  
Mark Rogers ◽  
Robin M. Queen ◽  
Per Gunnar Brolinson
Keyword(s):  
Ground Reaction Force ◽  
Reaction Force ◽  
Step Length ◽  
Vertical Ground Reaction Force ◽  
Osteopathic Manipulation ◽  
Somatic Dysfunction ◽  
Peak Knee ◽  
Gait Asymmetry ◽  
Stance Time ◽  
Vertical Ground

Abstract Context Movement and loading asymmetry are associated with an increased risk of musculoskeletal injury, disease progression, and suboptimal recovery. Osteopathic structural screening can be utilized to determine areas of somatic dysfunction that could contribute to movement and loading asymmetry. Osteopathic manipulation treatments (OMTs) targeting identified somatic dysfunctions can correct structural asymmetries and malalignment, restoring the ability for proper compensation of stresses throughout the body. Little is currently known about the ability for OMTs to reduce gait asymmetries, thereby reducing the risk of injury, accelerated disease progression, and suboptimal recovery. Objectives To demonstrate whether osteopathic screening and treatment could alter movement and loading asymmetry during treadmill walking. Methods Forty-two healthy adults (20 males, 22 females) between the ages of 18 and 35 were recruited for this prospective intervention. Standardized osteopathic screening exams were completed by a single physician for each participant, and osteopathic manipulation was performed targeting somatic dysfunctions identified in the screening exam. Three-dimensional (3-D) biomechanical assessments, including the collection of motion capture and force plate data, were performed prior to and following osteopathic manipulation to quantify gait mechanics. Motion capture and loading data were processed utilizing Qualisys Track Manager and Visual 3D software, respectively. Asymmetry in the following temporal, kinetic, and kinematic measures was quantified utilizing a limb symmetry index (LSI): peak vertical ground reaction force, the impulse of the vertical ground reaction force, peak knee flexion angle, step length, stride length, and stance time. A 2-way repeated-measures analysis of variance model was utilized to evaluate the effects of time (pre/post manipulation) and sex (male/female) on each measure of gait asymmetry. Results Gait asymmetry in the peak vertical ground reaction force (−0.6%, p=0.025) and the impulse of the vertical ground reaction force (−0.3%, p=0.026) was reduced in males following osteopathic manipulation. There was no difference in gait asymmetry between time points in females. Osteopathic manipulation did not impact asymmetry in peak knee flexion angle, step length, stride length, or stance time. Among the participants, 59.5% (25) followed the common compensatory pattern, whereas 40.5% (17) followed the uncommon compensatory pattern. One third (33.3%, 14) of the participants showed decompensation at the occipitoatlantal (OA) junction, whereas 26.2% (11), one third (33.3%, 14), and 26.2% (11) showed decompensation at the cervicothoracic (CT), thoracolumbar (TL), and lumbosacral (LS) junctions, respectively. Somatic dysfunction at the sacrum, L5, right innominate, and left innominate occurred in 88.1% (37), 69.0% (29), 97.6% (41), and 97.6% (41) of the participants, respectively. Conclusions Correcting somatic dysfunction can influence gait asymmetry in males; the sex-specificity of the observed effects of osteopathic manipulation on gait asymmetry is worthy of further investigation. Osteopathic structural examinations and treatment of somatic dysfunctions may improve gait symmetry even in asymptomatic individuals. These findings encourage larger-scale investigations on the use of OMT to optimize gait, prevent injury and the progression of disease, and aid in recovery after surgery.

The Relationship Between Spatiotemporal Gait Asymmetry and Balance in Individuals With Chronic Stroke

2014 ◽  
Vol 30 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Michael D. Lewek ◽  
Claire E. Bradley ◽  
Clinton J. Wutzke ◽  
Steven M. Zinder
Keyword(s):  
Weight Distribution ◽  
Balance Control ◽  
Step Length ◽  
Chronic Stroke ◽  
Step Width ◽  
Time Asymmetry ◽  
Swing Time ◽  
Gait Asymmetry ◽  
Stance Time ◽  
The Relationship

Falls are common after stroke and often attributed to poor balance. Falls often occur during walking, suggesting that walking patterns may induce a loss of balance. Gait after stroke is frequently spatiotemporally asymmetric, which may decrease balance. The purpose of this study is to determine the relationship between spatiotemporal gait asymmetry and balance control. Thirty-nine individuals with chronic stroke walked at comfortable and fast speeds to calculate asymmetry ratios for step length, stance time, and swing time. Balance measures included the Berg Balance Scale, step width during gait, and the weight distribution between legs during standing. Correlational analyses determined the relationships between balance and gait asymmetry. At comfortable and fast gait speeds, step width was correlated with stance time and swing time asymmetries (r= 0.39−0.54). Berg scores were correlated with step length and swing time asymmetries (r= –0.36 to –0.63). During fast walking, the weight distribution between limbs was correlated with stance time asymmetry (r= –0.41). Spatiotemporal gait asymmetry was more closely related to balance measures involving dynamic tasks than static tasks, suggesting that gait asymmetry may be related to the high number of falls poststroke. Further study to determine if rehabilitation that improves gait asymmetry has a similar influence on balance is warranted.

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

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.

Clinical overlap of functional neurologic symptom disorder and complex regional pain syndrome in pediatrics: A case report

2021 ◽  
pp. 1-8
Author(s):  
Heidi Kempert
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Gait Pattern ◽  
Rehabilitation Program ◽  
Neurologic Symptom ◽  
Physical Mobility ◽  
Unsteady Gait ◽  
Full Day

This case study documents a 13-year-old female who presented to our intensive inpatient chronic pain rehabilitation program with complex regional pain syndrome (CRPS) of her left leg, which was significantly interfering with her normal daily functioning. She participated in a full day of traditional interdisciplinary therapies, including physical and occupational therapy for 3 hours daily. As assistive equipment was altered or weaned her physical mobility, balance, and tremors worsened and/or increased. As she began advancing her legs more independently (versus requiring physical assist), she demonstrated more variable functional strength and stability, inconsistent balance reactions, and a more unsteady gait pattern. The team was treating her according to her incoming CRPS diagnosis; however, as treatment progressed, her physical and psychological presentation seemed more aligned with diagnostic criteria of functional neurologic symptom disorder (FND). Staff then treated according to the FND diagnosis resulting in successful long-term outcomes. The clinical impact from this case study includes highlighting the commonalities between CPRS and FND clinically, discussing differentiating treatment suggestions depending on the diagnosis, and emphasizing key components of family/patient education.

scholarly journals Gait Disorders In Patients After Polytrauma

2015 ◽  
Vol 69 (1-2) ◽  
pp. 27-32
Author(s):  
Ruta Jakušonoka ◽  
Zane Pavāre ◽  
Andris Jumtiņš ◽  
Aleksejs Smolovs ◽  
Tatjana Anaņjeva
Keyword(s):  
Ground Reaction Force ◽  
Knee Flexion ◽  
Reaction Force ◽  
Three Dimensional ◽  
Step Length ◽  
Vertical Load ◽  
Lower Limb Injuries ◽  
Limb Injuries ◽  
Stance Time ◽  
Polytrauma Patients

Abstract Evaluation of the gait of patients after polytrauma is important, as it indicates the ability of patients to the previous activities and work. The aim of our study was to evaluate the gait of patients with lower limb injuries in the medium-term after polytrauma. Three-dimensional instrumental gait analysis was performed in 26 polytrauma patients (16 women and 10 men; mean age 38.6 years), 14 to 41 months after the trauma. Spatio-temporal parameters, motions in pelvis and lower extremities joints in sagittal plane and vertical load ground reaction force were analysed. Gait parameters in polytrauma patients were compared with a healthy control group. Polytrauma patients in the injured side had decreased step length, cadence, hip extension, maximum knee flexion, vertical load ground reaction force, and increased stance time and pelvic anterior tilt; in the uninjured side they had decreased step length, cadence, maximum knee flexion, vertical load ground reaction force and increased stance time (p < 0.05). The use of the three-dimensional instrumental gait analysis in the evaluation of polytrauma patients with lower limb injuries consequences makes it possible to identify the gait disorders not only in the injured, but also in the uninjured side.

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