Relationship between the thoracic asymmetry in standing position and the asymmetry of ankle moment in the frontal plane during gait.

[Purpose] We aimed to investigate the relationship of thoracic asymmetry in standing position with asymmetry of the internal ankle moment in the frontal plane during gait. [Participants and Methods] The following measurements were recorded in 22 healthy adult males using a 3D motion analyzer and force plates: thoracic lateral deviation, asymmetrical ratios of the upper and lower thoracic shape, internal ankle moment in the frontal plane, mediolateral deviations of the center of mass and center of pressure. [Results] In the standing position, the thorax was deviated to the left relative to the pelvis, and the upper and lower thoracic shapes were asymmetrical. During gait, significant lateralities were observed in the internal ankle moment in the frontal plane, mediolateral deviations of the center of mass and the center of pressure. Significant positive correlations were observed between the asymmetrical ratio of the lower thoracic shape and both the asymmetry of the internal ankle moment in the frontal plane and the mediolateral deviation of the center of pressure. [Conclusion] These results suggest that thoracic asymmetry is associated with mediolateral control of the ankle during gait.

Ankle stiffness modulation during different gait speeds in individuals post-stroke.

BACKGROUND: Neurotypical individuals alter their ankle joint quasi-stiffness in response to changing walking speed; however, for individuals post-stroke, the ability to alter their ankle quasi-stiffness is unknown. Individuals post-stroke commonly have weak plantarflexor muscles, which may limit their ability to alter ankle quasi-stiffness. The objective was to investigate the relationship between ankle quasi-stiffness and propulsion, at two walking speeds. We hypothesized that in individuals post-stroke, there would be no difference in their paretic ankle quasi-stiffness between walking at a self-selected versus a fast speed. However, we hypothesized that ankle quasi-stiffness would correlate with gait speed and propulsion across individuals. METHODS: Twenty-eight participants with chronic stroke walked on an instrumented treadmill at their self-selected and fast-walking speeds. Multilevel models were used to determine the relationships between ankle quasi-stiffness, speed, and propulsion. FINDINGS: Overall, ankle quasi-stiffness did not increase within individuals from a self-selected to a fast gait speed (p = 0.69). A 1 m/s increase in speed across participants predicted an increase in overall ankle quasi-stiffness of 0.02 Nm/deg./kg (p = 0.03) and a 1 N/BW change in overall propulsion across participants predicted a 0.265 Nm/deg./kg increase in overall ankle quasi-stiffness (p < 0.0001). INTERPRETATION: Individuals post-stroke did not modulate their ankle quasi-stiffness with increased speed, but across individuals there was a positive relationship between ankle quasi-stiffness and both speed and peak propulsion. Walking speed and propulsion are limited in individuals post-stroke, therefore, improving either could lead to a higher functional status. Understanding post-stroke ankle stiffness may be important in the design of therapeutic interventions and exoskeletons, where these devices augment the biological ankle quasi-stiffness to improve walking performance.

Mechanisms used to increase propulsive forces on a treadmill in older adults.

Older adults typically demonstrate reductions in overground walking speeds and propulsive forces compared to young adults. These reductions in walking speeds are risk factors for negative health outcomes. Therefore, this study aimed to determine the effect of an adaptive speed treadmill controller on walking speed and propulsive forces in older adults, including the mechanisms and strategies underlying any change in propulsive force between conditions. Seventeen participants completed two treadmill conditions, one with a fixed comfortable walking speed and one with an adaptive speed controller. The adaptive speed treadmill controller utilized a set of inertial-force, gait parameters, and position-based controllers that respond to an instantaneous anterior inertial force. A biomechanical-based model previously developed for individuals post-stroke was implemented for older adults to determine the primary gait parameters that contributed to the change in propulsive forces when increasing speed. Participants walked at faster average speeds during the adaptive speed controller (1.20 m/s) compared to the fixed speed controller conditions (0.98 m/s); however, these speeds were not as fast as their overground speed (1.44 m/s). Although average trailing limb angle (TLA) (p < 0.001) and ankle moment (p = 0.020) increased when speed also increased between treadmill conditions, increasing TLA contributed more to the increased propulsive forces seen during faster treadmill speeds. Our findings show that older adults chose faster walking speeds and increased propulsive force when walking on an adaptive speed treadmill compared to a fixed speed treadmill, suggesting that an adaptive speed treadmill controller has the potential to be a beneficial alternative to current exercise interventions for older adults.

Increasing the Propulsive Demands of Walking to their Maximum Elucidates Functionally Limiting Impairments in Older Adult Gait.

We elucidated functional limitations in older adult gait by increasing horizontal impeding forces and walking speed to their maximums compared to dynamometry and to data from their young counterparts. Specifically, we investigated which determinants of push-off intensity represent genuine functionally limiting impairments in older adult gait versus biomechanical changes that do not directly limit walking performance. We found that older adults walked at their preferred speed with hallmark deficits in push-off intensity. These subjects were fully capable of overcoming deficits in propulsive ground reaction force, trailing limb positive work, trailing leg and hip extension, and ankle power generation when the propulsive demands of walking were increased to maximum. Of the outcomes tested, age-related deficits in ankle moment emerged as the lone genuine functionally limiting impairment in older adults. Distinguishing genuine functional limitations from age-related differences masquerading as limitations represents a critical step toward the development and prescription of effective interventions.

Haptic biofeedback induces changes in ankle push-off during walking.

BACKGROUND: Ankle push-off drives forward progression during gait. Reduced peak ankle moment and peak ankle power may contribute to the increased metabolic cost of walking observed in certain clinical populations. Biofeedback is an effective gait training tool, however biofeedback targeting ankle moment has not been previously studied. RESEARCH QUESTION: Does haptic biofeedback directly targeting ankle moment enable able-bodied adults to modulate peak ankle moment during gait? METHODS: 20 able-bodied adults participated in the study. Participants completed a 90-second baseline walking trial, followed by two 2-minute trials with haptic biofeedback. Haptic biofeedback guided participants to either increase peak ankle moment (Feedback High), or decrease peak ankle moment (Feedback Low). Ten participants received haptic biofeedback alone; the other ten participants additionally received verbal suggestions of movement strategies they could adopt during the biofeedback trials. Two-way analysis of variance was used to determine the effect of walking condition and verbal instruction on key gait parameters. RESULTS: A main effect of walking condition on peak ankle moment and peak ankle power was observed (all P < 0.001). Peak ankle moment did not change from baseline during Feedback High, however peak ankle power was increased (P < 0.001). A decrease in peak ankle moment and peak ankle power was observed during Feedback Low (all P < 0.001). Verbal instruction had a significant interaction effect with walking condition in only a limited number of parameters (all P < 0.05). SIGNIFICANCE: This study demonstrates the effects of haptic biofeedback targeting peak ankle moment during gait. While this study demonstrates that able-bodied individuals have some capacity to modulate their gait pattern in response to direct biofeedback on ankle moment, further investigation is required to develop a biofeedback paradigm that can increase peak ankle moment.

Evaluating the relationship between gait and clinical measures of plantar flexor function.

Individuals with plantar flexor weakness often require rehabilitation and/or orthoses, which should be personalized based on level of weakness. While plantar flexor weakness can be measured via peak plantar flexion moment during gait (MGAIT), motion analysis systems are often not clinically available. Clinical measures, such as the single-leg heel rise (SLHR) test and isometric muscle test, may provide surrogate measures of plantar flexor function during gait. However, it is currently unknown if a relationship(s) exists between such measures. This study evaluated the relationship between gait and clinical measures of plantar flexor function for typical individuals. Twenty-four participants underwent an instrumented gait analysis, from which MGAIT was calculated. Next, participants performed an isometric plantar flexor test, from which the maximum plantar flexion moment (MISO) was calculated. Finally, participants performed a SLHR test, from which maximum plantar flexion moment (MSLHR) and total work (Wtot_SLHR) were calculated. Via Pearson correlations, MSLHR was most strongly correlated to MGAIT (r = 0.56; p = 0.005). Wtot_SLHR was significantly correlated to MGAIT (r = 0.47; p = 0.019). MISO was not significantly correlated to MGAIT (r = 0.19; p = 0.363). MSLHR and/or Wtot_SLHR may provide clinically-feasible surrogate measures of plantar flexor function during gait.

Quantifying Achilles tendon force in vivo from ultrasound images.

This study evaluated a procedure for estimating in vivo Achilles tendon (AT) force from ultrasound images. Two aspects of the procedure were tested: (i) accounting for subject-specific AT stiffness and (ii) accounting for changes in the relative electromyographic (EMG) intensities of the three triceps surae muscles. Ten cyclists pedaled at 80rpm while a comprehensive set of kinematic, kinetic, EMG, and ultrasound data were collected. Subjects were tested at four crank loads, ranging from 14 to 44Nm (115 to 370W). AT forces during cycling were estimated from AT length changes and from AT stiffness, which we derived for each subject from ultrasound data and from plantar flexion torques measured during isometric tests. AT length changes were measured by tracking the muscle-tendon junction of the medial gastrocnemius (MG) relative to its insertion on the calcaneus. Because the relative EMG intensities of the triceps surae muscles varied with load during cycling, we divided subjects׳ measured AT length changes by a scale factor, defined as the square root of the relative EMG intensity of the MG, weighted by the fractional physiological cross-sectional areas of the three muscles, to estimate force. Subjects׳ estimated AT forces during cycling increased with load (p<0.05). On average, peak forces ranged from 920±96N (14Nm, 115W) to 1510±129N (44Nm, 370W). For most subjects, ankle moments derived from the ultrasound-based AT strains were 5-12% less than the net ankle moments calculated from inverse dynamics (r2=0.71±0.28, RMSE=8.1±0.33Nm). Differences in the moments increased substantially when we did not account for changes in the muscles׳ relative EMG intensities with load or, in some subjects, when we used an average stiffness, rather than a subject-specific value. The proposed methods offer a non-invasive approach for studying in vivo muscle-tendon mechanics.

Determination of loads carried by polypropylene ankle-foot orthoses: a preliminary study.

Ankle-foot orthoses (AFOs) are prescribed for the management of gait-related problems. Prescription of AFOs is based on empirical techniques due to the low level of evidence-based research on their efficacy, but primarily poor understanding of their mechanical characteristics. This study aimed to establish a method that would allow the quantification of the contribution of AFOs in the control of the ankle joint during gait. A possible way of achieving this aim would be to measure strain on the AFO during walking by the use of strain gauges. Following successful experimentation with the application of strain gauges to polypropylene tensile specimens, an AFO was instrumented by attaching strain gauges to it so as to allow the moment generated on the AFO in the sagittal plane about the ankle to be measured. Walking trials using this AFO on an able-bodied subject indicated good step-to-step repeatability. The use of an instrumented AFO in conjunction with kinematic and kinetic data acquisition would allow the contribution of the AFO and the residual anatomical loads to be determined. The advantage of such procedure over previously reported ones resides on the use of the actual orthosis being worn by patients thereby conducting tests under real-life situations. It is believed that such analysis of the load actions of an orthosis, which may in future be carried out in three dimensions, would allow a better understanding of the interaction between the leg and the orthosis. This should ultimately enhance AFO prescription criteria and help in optimising patient/device matching.

The relative contribution of ankle moment and trailing limb angle to propulsive force during gait.

A major factor for increasing walking speed is the ability to increase propulsive force. Although propulsive force has been shown to be related to ankle moment and trailing limb angle, the relative contribution of each factor to propulsive force has never been determined. The primary purpose of this study was to quantify the relative contribution of ankle moment and trailing limb angle to propulsive force for able-bodied individuals walking at different speeds. Twenty able-bodied individuals walked at their self-selected and 120% of self-selected walking speed on the treadmill. Kinematic data were collected using an 8-camera motion-capture system. A model describing the relationship between ankle moment, trailing limb angle and propulsive force was obtained through quasi-static analysis. Our main findings were that ankle moment and trailing limb angle each contributes linearly to propulsive force, and that the change in trailing limb angle contributes almost as twice as much as the change in ankle moment to the increase in propulsive force during speed modulation for able-bodied individuals. Able-bodied individuals preferentially modulate trailing limb angle more than ankle moment to increase propulsive force. Future work will determine if this control strategy can be applied to individuals poststroke.