Accuracy of the SenseWear Armband during Short Bouts of Exercise.

A goal of mobile monitoring is to approximate metabolic energy expenditure (EE) during activities of daily living and exercise. Many physical activity monitors are inaccurate with respect to estimated EE and differentiating between activities that occur over short intervals. The objective of our study was to assess the validity of the SenseWear Armband (SWA) compared to indirect calorimetry (IC) during short intervals of walking and running. Twenty young, fit participants walked (preferred speed) and ran (75%, 85%, and 95% of predicted VO2max run speeds) on a treadmill. EE estimates from IC, SWA, and prediction equations that used the SWA, speed, and heart rate were examined during each 4 min interval and across the whole protocol (Total). The level of significance was p < 0.05. The SWA overestimated EE relative to IC by 1.62 kcal·min-1 while walking and 1.05 kcal·min-1 while running at 75%. However, it underestimated EE at the 85% (0.05 kcal·min-1) and 95% (0.92 kcal·min-1) speeds, but not significantly, and overestimated total EE by 28.29 kcal. Except for walking, our results suggest that the SWA displayed a good level of agreement (ICC = 0.76 to 0.84) with IC measures. Activity-specific algorithms using SWA, speed, and heart rate improved EE estimates, based on the standard error of the estimates, but perhaps not enough to justify extra sensors. The SWA may enable EE estimation of locomotion outside the laboratory, including those with short bouts of high intensity activity, but continued development of the SWA, or devices like it, is needed to enable accurate monitoring.

Tibiofemoral Load Magnitude and Distribution During Load Carriage.

Chronic exposure to high tibiofemoral joint (TFJ) contact forces can be detrimental to knee joint health. Load carriage increases TFJ contact forces, but it is unclear whether medial and lateral tibiofemoral compartments respond similarly to incremental load carriage. The purpose of our study was to compare TFJ contact forces when walking with 15% and 30% added body weight. Young healthy adults (n = 24) walked for 5 minutes with no load, 15% load, and 30% load on an instrumented treadmill. Total, medial, and lateral TFJ contact peak forces and impulses were calculated via an inverse dynamics informed musculoskeletal model. Results of 1-way repeated measures analyses of variance (α = .05) demonstrated total, medial, and lateral TFJ first peak contact forces and impulses increased significantly with increasing load. Orthogonal polynomial trends demonstrated that the 30% loading condition led to a curvilinear increase in total and lateral TFJ impulses, whereas medial first peak TFJ contact forces and impulses responded linearly to increasing load. The total and lateral compartment impulse increased disproportionally with load carriage, while the medial did not. The medial and lateral compartments responded differently to increasing load during walking, warranting further investigation because it may relate to risk of osteoarthritis.

Are lower back demands reduced by improving gait symmetry in unilateral transtibial amputees?

BACKGROUND: Gait asymmetry and a high incidence of lower back pain are typical for people with unilateral lower limb amputation. A common therapeutic objective is to improve gait symmetry; however, it is unknown whether better gait symmetry reduces lower back pain risk. To begin investigating this important clinical question, we examined a preexisting dataset to explore whether L5/S1 vertebral joint forces in people with unilateral lower limb amputation can be improved with better symmetry. METHODS: L5/S1 compression and resultant shear forces were estimated in each participant with unilateral lower limb amputation (n = 5) with an OpenSim musculoskeletal model during different levels of guided gait asymmetry. The amount of gait asymmetry was defined by bilateral stance times and guided via real-time feedback. A theoretical lowest L5/S1 force was determined from the minimum of a best-fit quadratic curves of L5/S1 forces at levels of guided asymmetry ranging from -10 to +15%. The forces found at the theoretical lowest force and during the 0% asymmetry level were compared to forces at preferred levels of asymmetry and to those from an able-bodied group (n = 5). FINDINGS: Results indicated that the forces for the people with unilateral lower limb amputation group at the preferred level of asymmetry were not different then at their 0% asymmetry condition, theoretical lowest L5/S1 forces, or the able-bodied group (all p-values > .23). INTERPRETATION: These preliminary results challenge the premise that restoring symmetric gait in people with unilateral lower limb amputation will reduce risk of lower back pain.

Metabolic cost of transport and stance time asymmetry in individuals with unilateral transtibial amputation using a passive prostheses while walking.

BACKGROUND: People with unilateral amputation typically walk with greater metabolic cost than able-bodied individuals, while preferring asymmetric walking characteristics. It is unclear if asymmetric walking is energetically optimal and how metabolic cost accounts for asymmetric patterns in people with amputation. The purpose of this study was to determine the effects of stance-time asymmetry on the metabolic cost of transport. METHODS: Fourteen participants (seven with amputation) completed two laboratory sessions where they walked on a treadmill while receiving real-time visual feedback about stance-time asymmetry. Expired gases were collected to determine the metabolic cost for a range of asymmetries (-15% to +15% in 5% increments, positive percentages represent more time on intact [dominant] limb). FINDINGS: Participants with amputation walked with greater (P = 0.008) stance-time asymmetry (4.34 ± 1.09%) compared with able-bodied participants (0.94 ± 2.44%). Stance-time asymmetry had a significant effect on metabolic cost (P < 0.001). The asymmetries coinciding with the predicted minimum metabolic cost for people with (3.23 ± 2.90%) and without (1.81 ± 2.18%) amputation were not different from preferred asymmetries (P = 0.365; p = 0.513), respectively. The cost of symmetric walking was 13.6% greater than near preferred walking for people with amputation (5% more time on intact limb). INTERPRETATION: Metabolic cost is not the only objective of walking, but like able-bodied individuals, it may influence how people with amputation walk. Rehabilitation typically tries to restore inter-limb symmetry after an injury, yet if the limbs are asymmetric, symmetric gait may not be optimal with current assistive devices.

Comparison of measurement protocols to estimate preferred walking speed between sites.

BACKGROUND: Walking speed influences a variety of typical outcome measures in gait analysis. Many researchers use a participant's preferred walking speed (PWS) during gait analysis with a goal of trying to capture how a participant would typically walk. However, the best practices for estimating PWS and the impact of laboratory size and walk distance are still unclear. RESEARCH QUESTION: Is measured PWS consistent across different distances and between two laboratory sites? METHODS: Participants walked overground at a "comfortable speed" for six different conditions with either dynamic (4, 6, 10, and 400 m) or static (4 and 10 m) starts and stops at two different data collection sites. Repeated measures ANOVA with Bonferroni corrections were used to test for differences between conditions and sites. RESULTS: Participants walked significantly faster in the 4, 6, and 10 m dynamic conditions than in the 400 m condition. On average, participants walked slower in the static trials than the dynamic trials of the same distance. There was a significant interaction of lab and condition and so results were examined within each lab. Across both labs, we found that the 4 and 10 m dynamic conditions were not different than the 6 m dynamic condition at both sites, while other tests did not provide consistent results at both sites. SIGNIFICANCE: We recommend researchers use a 6 m distance with acceleration and deceleration zones to reliably test for PWS across different laboratories. Given some of the differences found between conditions that varied by site, we also emphasize the need to report the test environment and methods used to estimate PWS in all future studies so that the methods can be replicated between studies.

Preliminary study of a robotic foot-ankle prosthesis with active alignment.

Robotic prosthetic foot-ankle prostheses typically aim to replace the lost joint with revolute joints aimed at replicating normal joint biomechanics. In this paper, a previously developed robotic ankle prosthesis with active alignment is evaluated. It uses a four-bar mechanism to inject positive power into the gait cycle while altering the kinematics of the ankle joint and pylon segment to reduce loading on the residual limb. In a single-subject biomechanics analysis, there was a 10% reduction in peak limb pressures and evidence of greater gait symmetry in ground reaction forces when active alignment was implemented compared to walking with the daily use prosthesis. These results provide preliminary evidence that an alternative lower limb prosthesis may be capable of improving gait characteristics over traditional revolute designs.

The effect of orthotics on intersegmental foot kinematics and the EMG activity of select lower leg muscles.

BACKGROUND: Persons with exertional related leg pain are managed using orthoses. This study aimed to determine the effectiveness of two orthoses in altering foot motion and muscle activity in symptomatic individuals. METHODS: 52 subjects with lower extremity pain complaints of a non-traumatic, mechanical origin received one of two orthoses. Foot kinematics and EMG activity were recorded while treadmill walking in 3 footwear conditions. The peak EMG activity of the sandal and sandal orthotic trials (normalized to peak barefoot values) and foot motion during 4 subphases of stance were obtained. Using a multivariate multilevel model via linear mixed models, the effect of orthoses within these phases on motion and EMG was determined. RESULTS: An effect of orthotic type was not present for any of the rearfoot or forefoot motions (p>.10). A significant effect of footwear and orthotic type on first ray motion (p<.05) during subphases 2 and 4 was seen. During subphase 4 an interaction effect between footwear condition and orthotic type on tibialis posterior EMG activity (p=.036) was present. CONCLUSION: Orthoses are unable to control rear or midfoot motion but appear to control first ray motion and during late stance, affect tibialis posterior muscle activity. Public trials registry number: NCRT02143947.