Characterising gait over different walking speeds in patients with bilateral vestibular loss: preliminary results

Bilateral vestibular hypofunction (BVH) is a bilateral reduction or loss of vestibular function resulting in balance deficits and an increased falls risk. As part of a larger study, this experiment aimed to assess how spatiotemporal gait characteristics and their variability change across different walking speeds in patients with BVH. Nine patients (55±15y) with BVH have participated thus far. Experiments were conducted on the CAREN Extended system (Motekforce Link, Amsterdam, The Netherlands). Following multiple familiarisation trials, the participants completed five recorded two minute walking bouts at different speeds (0.6m/s, 0.8m/s, 1.0m/s, 1.2m/s and 1.4m/s). 60 strides per speed were analysed and the means, standard deviations and coefficients of variation (CV) of stride length and time, step length and width, double support time and swing phase toe clearance were calculated. Stride length, step length and toe clearance all increased with increases in walking speed (P<0.001). Stride and double support time decreased with increased walking speed (P<0.0001). No walking speed effect was found for step width (P=0.25). Significant reductions in variability with increases in walking speed were found for stride length, stride time, step length, toe clearance (P<0.01) and double support time (P<0.05). A significant increase in step width variability was observed with increases in walking speed (P=0.0033). These preliminary data suggest that while anteroposterior gait characteristics may improve in terms or variability with increases in walking speed in these patients, mediolateral motions may become more variable, which may have implications for mediolateral stability and falls risk in patients with BVH.
Listed In: Biomechanics, Gait, Neuroscience

Bilateral assessment of cartilage with UTE-T2* quantitative MRI and associations with knee center of rotation following anterior cruciate ligament reconstruction

Purpose: Anterior cruciate ligament (ACL) tear greatly increases the risk of knee osteoarthritis (OA), even when patients undergo ACL reconstruction surgery (ACLR). Changes to walking kinematics following ACLR have been suggested to play a role in this degenerative path to post-traumatic OA by shifting the location of repetitive joint contact loads that occur during walking to regions of cartilage not conditioned for altered loads. Recent work has shown that changes to the average knee center of rotation during walking (KCOR) between 2 and 4 years after ACLR are associated with long term changes in patient reported outcomes at 8 years. Changes to KCOR result in changes to contact patterns between the femur and the tibial plateau. However, it is unknown if changes to this kinematic measure are reflected by changes to cartilage as early as 2 years after surgery. Ultrashort TE-enhanced T2* (UTE-T2*) mapping has been shown to be sensitive to subsurface changes occurring in deep articular cartilage early after ACL injury and over 2 years after ACLR that were not detectable by standard morphological MRI. Thus, the purpose of this study was to test the hypothesis that side to side differences in KCOR correlate with side to side differences in UTE-T2* quantitative MRI (qMRI) in the central weight bearing regions of the medial and lateral tibial plateaus at 2 years following ACLR. Methods: Thirty-five human participants (18F, Age: 33.8±10.5 yrs, BMI: 24.1±3.3) with a history of unilateral ACL reconstruction (2.19±0.22 yrs post-surgery) and no other history of serious lower limb injury received bilateral examinations on a 3T MRI scanner. UTE-T2* maps were calculated via mono-exponential fitting on a series of T2*-weighted MR images acquired at eight TEs (32μs -16 ms, non-uniform echo spacing) using a radial out 3D cones acquisition. All subjects completed bilateral gait analysis. Medial-lateral (ML) and anterior-posterior (AP) coordinates of average KCOR during stance of walking were calculated for both knees. Side to side differences in KCOR were tested for correlations with side to side differences in mean full thickness UTE-T2* quantitative values in the central weight bearing regions of the medial and lateral tibial plateau using Pearson correlation coefficients. Results: There was a distribution in UTE-T2* values, with some subjects having higher UTE-T2* and some lower in the ACLR knee relative to the contralateral knee. A significant correlation (R=0.407, p=0.015, Figure 1A) was observed between UTE-T2* and the ML KCOR with a more lateral KCOR corresponding to higher values of UTE-T2* for the medial tibia. Similarly, for the lateral tibia, a lower UTE-T2* was correlated with a more posterior KCOR (R=0.363, p=0.032, Figure 1B). Significant correlations were not observed for UTE-T2* in the lateral tibia with the ML position of KCOR or for UTE-T2* in the medial tibia with the AP position of KCOR. Conclusions: The results of this study support the hypothesis that side to side differences in mean full thickness UTE-T2* qMRI correlate with side to side differences in knee kinematics at 2 years after ACLR. The finding that a more lateral KCOR in the ACLR knee correlates with UTE T2* values in the medial tibia that were higher than the contralateral side suggests that this kinematic change, which has been previously shown to result in more relative motion between the femur and tibia in the medial compartment, could be affecting subsurface matrix integrity, inducing changes detectable by UTE-T2* mapping. Additionally, the finding that a more posterior KCOR in the ACLR knee correlated with UTE-T2* values in the lateral tibia that were lower than the contralateral knee further suggests that the UTE-T2* metric may reflect early changes in cartilage health. When interpreted within the context of prior work showing that a posterior shift in KCOR from 2 to 4 years post-surgery correlated with improved clinical outcomes at 8 years, the observed lower UTE-T2* with a more posterior KCOR, which is reflective of improved quadriceps recruitment, suggests positive cartilage matrix properties. In spite of the limitations of this cross-sectional and exploratory study, and the difficulty accounting for changes in the contralateral knee, these results support future studies of the relationship between UTE-T2* and KCOR to provide new insight into predicting the risk for OA after ACLR.
Listed In: Biomechanical Engineering, Biomechanics, Gait, Mechanical Engineering, Orthopedic Research, Sports Science

Locomotor Stability Control and Vestibular Function among Older Adults: Implications for Falls Prevention and Research

In the following project, we explored the relationships between age, vestibulopathy and stability control, in order to determine the age and vestibulopathy-related effects on stability control, and to establish if a relationship existed between static and dynamic stability task performance. The first study examined the response to repeated trip perturbations of healthy middle aged adults and vestibulopathy patients, the second examined feedforward adaptation of gait in young, middle aged and older adults to a sustained mechanical perturbation and the third examined the relationship between standing balance and recovery following a tripping perturbation in vestibulopathy patients. The results showed that vestibulopathy is related to a diminished ability to control and recover gait stability after an unexpected perturbation, and to a deficient reactive adaptation potential. With ageing, the ability to recalibrate locomotor commands to control stability is preserved, although this recalibration may be slower in old age compared to middle and young age. Given that a decline in vestibular function is seen with increasing age, we suggest that assessment of vestibular function may be necessary when investigating locomotor stability and falls risk in both research and clinical settings. Finally, despite static balance tasks and parameters being commonly used in clinical settings, we did not find a consistent relationship between static and dynamic stability task performance, indicating the importance of dynamic stability tests when assessing falls risk in clinical settings.
Listed In: Biomechanics, Gait, Posturography

Prolonged Cycling&#039;s Effect on Transition Run Mechanics in Triathletes

A period of incoordination and fatigue is commonly associated with the transition run in triathletes, in which running mechanics are thought to be altered. Few studies have examined the changes in ground reaction forces and vertical loading rate during the transition run. Our purpose was to assess the changes that occur in ground reaction forces during a fatigued transition run in triathletes. 13 recreational male triathletes (34 ± 4.2 years) performed an incremental cycling test and a cycle to run transition on separate testing sessions. A 15-camera Vicon motion capture system collecting at 200 Hz and an AMTI force instrumented treadmill collecting at 2000 Hz were used in conjunction with a modified Plug-In Gait marker to collect trajectory and analog data for pre and post-cycling running trials. Ground reaction forces and temporal spatial parameters were assessed during stance of all running trials using Visual 3D software. Peak vertical ground reaction force and step length decreased significantly from pre-cycling to immediate post-cycling measures (p=.003, p<.001), no difference existed for either variable for pre-cycling vs. 10min post-cycling. Instantaneous peak vertical loading rate (IVLR) and step rate increased significantly from pre-cycling to immediate post-cycling measures (p=.05, p<.001), no difference existed for stride rate for pre-cycling vs. 10min post-cycling. IVLR remained significantly increased at the 10 min post-cyling (p=.035). The study findings suggest that fatigue from prolonged cycling can negatively impact triathletes’ ability to attenuate ground reaction forces in subsequent running.
Listed In: Biomechanics, Gait, Sports Science

Sensitivity to Marker Placement in the TSRHC Foot Model

Multi-segmented foot and ankle (FandA) models provide more information regarding intrinsic foot motion compared to rigid-body models due to additional markers on bony landmarks of the foot. Marker placement sensitivity is a concern, especially in patients with bony abnormalities, because kinematics vary with marker placement deviations. PURPOSE: Assess kinematic changes due to marker placement error using the TSRHC multi-segmented FandA model. METHODS: Our participant was an 18yo female lacking any prior orthopedic conditions. The Plug-in-Gait model was used with the TSRHC model. An experienced clinician executed all marker placements, systematically moving each marker approximately 2.5mm within two planes. Three dynamic trials were collected for each condition, and static trials were used to calculate exact distances markers moved. Six force plates (AMTI) were utilized to confirm a consistent walking pattern. Graphs analyzed included: 1)PIG–ankle dorsiflexion, foot rotation, foot progression angle, 2)TSRHC–hindfoot, forefoot, FF-tibia. For each condition, the peaks of affected kinematic graphs were compared to assess correlations. Intra-trial error was determined by the maximum difference across walking trials. CONCLUSION: The hindfoot was most sensitive to transverse plane marker placement errors. Markers on metatarsals periodically rose vertically when moved laterally due to foot curvature causing errors in the sagittal plane as well. The forefoot also had transverse plane errors when metatarsal markers were moved. This case study illustrates the importance of proper marker placement training when utilizing a multi-segmented foot model. A thorough understanding of a utilized model is imperative, including how sensitive the model is to marker placement.
Listed In: Biomechanics, Gait, Orthopedic Research

Dance May Improve Quality of Life But Not Gait in Individuals with Parkinson’s Disease

Purpose: Research supports the use of ballroom dance to improve balance in individuals with Parkinson’s disease (PD). This study used the Mark Morris Dance for PD program as a template for dance classes to examine the effects of dance on gait, balance, and quality of life in individuals with PD. Subjects : Eleven individuals with mild to moderate PD participated in the study. Methods : A trained instructor led dance classes for subjects once a week for 12 weeks. Participants were encouraged to use the Mark Morris Dance for PD At Home DVD twice a week for 45 minutes. Classes included a 20 min. seated warm up; a 20 min. supported standing portion focused on balance and strength; and 30 min. partnered movements for swing, shag, or tango. Data collected before and after the intervention included gait parameters (Protokinetics Zeno walkway), sway area (AMTI force platform) during mCTSIB, Mini-BESTest, Falls Efficacy Scale, Apathy Scale and PDQ-39. A paired-samples t-test was performed. Results : Participants had significant decrease in apathy following the intervention (P = 0.018). A significant decrease in the percentage of the double support phase of gait indicated individuals spent less time with both feet in contact with the ground (P = 0.019). Conclusions : An instructor-led dance class based on the Dance for PD program once per week for 12 weeks improved certain aspects of quality of life, but not necessarily gait and balance. Further research with increased frequency of supervised dance classes is indicated.
Listed In: Gait, Neuroscience, Physical Therapy

Static postural control does not strongly predict dynamic gait stability recovery following a trip in adults with and without vestibular dysfunction

Unilateral peripheral vestibular disorder (UPVD) negatively affects upper and lower body motor performance, but postural control during quiet stance in UPVD patients has not been directly compared with dynamic stability control after an unexpected perturbation during locomotion. We analysed centre of pressure (COP) characteristics during static posturography in UPVD patients and healthy controls and compared this with performance of a trip recovery task. 17 UPVD patients and 17 healthy controls were unexpectedly tripped while walking on a treadmill. The margin of stability (MoS) was calculated at touchdown (TD) of the perturbed step and the first six recovery steps. Posturography was used to assess postural stability during 30 seconds of standing with eyes open and closed using a force plate. The trip reduced the MoS of the perturbed leg (p<0.05) with no significant differences in MoS between the groups. Controls returned to MoS baseline level in five steps and patients did not return within the six steps. UPVD patients showed a greater total COP sway path excursion (closed eyes only), anterior-posterior range of COP distance and a more posterior COP position in relation to the posterior boundary of the base of support. There were no significant correlations between COP sway path excursion and MoS values. We concluded that UPVD patients have a diminished ability to control and recover dynamic gait stability after an unexpected trip and lower static postural stability control compared to healthy matched controls, but that trip recovery and static postural control rely on different control mechanisms.
Listed In: Biomechanics, Gait, Neuroscience, Physical Therapy, Posturography

Comparison of accelerometry stride time calculation methods

The purpose of this study was to investigate how a newly proposed method of stride time calculation, utilising data filtered at 2 Hz, compared to previous methods. Tibial accelerometry data for 6 participants completing half marathon running training were collected. One run was selected for each participant at random, from which five consecutive running strides were ascertained. Four calculation methods were employed to derive each stride time and results were compared. No significant difference was found between methods (p=1.00). The absolute difference in stride time, when comparing the proposed method to previous methods, ranged from 0.000 seconds to 0.039 seconds. Filtered data could offer a simplified technique for stride time output during running gait analysis, particularly when applied during automated data processing for large data sets.
Listed In: Biomechanics, Gait, Sports Science

Marathon Stride Rate Dynamics: A Case Study

The purpose of this study was to investigate stride rate (SR) dynamics of a recreational runner participating in his debut marathon. Tibial accelerometry data obtained during a half marathon (R1) and marathon (R2) were utilised. SR data were extracted utilising novel computational methods and descriptive statistics were utilised for analysis of R2, and comparison of the first half of the marathon (R2half) to R1. Results indicate that the participant employed comparable SR strategy in R1 and R2half. For R2 a combined decreasing trend in SR and increased variance in SR from 30 km (R2 =0.0238) was observed. Results indicate that the participant had the ability to maintain SR strategy for the first half of the marathon, however as fatigue onset occurred this ability decreased. Running strategies on SR during fatigue may be of future use to recreational runners.
Listed In: Biomechanics, Gait, Sports Science

Effects of Adiposity on Walking Muscle Function in Children: Implications for Bio-Feedback and Assistive Devices

Altered gait biomechanics associated with pediatric obesity may increase the risk of musculoskeletal injury/pathology during physical activity and/or diminish a child’s ability to engage in sufficient physical activity. The biomechanical mechanisms responsible for the altered gait in obese children are not well understood, particularly as they relate to increases in adipose tissue. The purpose of this study was to investigate the role of adiposity (i.e. body fat percentage, BF%) on lower extremity kinematics, muscle force requirements and their individual contributions to the acceleration of the center of mass (COM) during walking. We scaled a musculoskeletal model to the anthropometrics of each participant (n=14, 8-12 years old, BF%: 16-41%) and generated dynamic simulations of walking to predict muscle forces and their contributions to the acceleration of the COM. Muscle force output was normalized to muscle mass. BF% was correlated with average knee flexion angle during stance (r=−0.54) and pelvic obliquity range of motion (r=0.78), as well as with relative vasti (r=−0.60), gluteus medius (r=0.65) and soleus (r=0.59) force production. Contributions to COM acceleration from the vasti were negatively correlated to BF% (vertical: r=−0.75, posterior: r=−0.68, respectively), but there was no correlation between BF% and COM accelerations produced by the gluteus medius. The functional demands and relative force requirements of the hip abductors during walking in pediatric obesity may contribute to altered gait kinematics. Our results provide insight into the muscle force requirements during walking in pediatric obesity that may be used to improve the quality/quantity of locomotor activity in this population.
Listed In: Biomechanical Engineering, Biomechanics, Gait