Spatiotemporal parameters and kinematics differ between race stages in trail running-a field study.

Introduction: Trail running is an emerging discipline with relatively few studies performed in ecological conditions. The aim of this work was to investigate if and how spatiotemporal parameters (STP) and kinematics differ between initial and final stage of a field trial. Methods: Twenty trail runners (10 F, 10 M) were recruited and ran a solo 9.1 km trial. During the test, participants wore a GPS watch and an IMU-based motion capture system. Running speed, elapsed time, STP and kinematics were compared between initial and final stage, separately for uphill (UH) and downhill (DH) sections. Results: Running speed decreased in the final stage ( p < 0.05 ). Total test time was more correlated to the time elapsed in UH sections. In the final stage and in both UH and DH sections, contact time and duty factor increased, whilst stride length and flight time decreased ( p < 0.05 ). In the final stage, ankle joint was more dorsiflexed in stance and swing phases in UH sections and stance phase only in DH sections ( p < 0.05 ). In the final stage, knee joint was less extended in swing phase in UH and DH sections, as well as less extended in stance in UH sections ( p < 0.05 ). In the final stage, hip joint was less flexed in the swing phase in UH and DH sections ( p < 0.05 ). In the final stage, forward trunk lean was higher across the entire gait cycle in in UH sections ( p < 0.05 ). Trunk contralateral axial rotation was lower, in DH sections ( p < 0.05 ). Discussion: During the final stage, results indicate a less efficient propulsion phase, in both UH and DH sections. In UH sections, results suggest lower energy generation at the ankle joint. In DH sections, results suggest that the kinematics of swing leg may play a role in sub-optimizing propulsion phase. This study demonstrates how, in UH and DH sections, similar changes in spatiotemporal parameters can be elicited by dissimilar changes in running kinematics. To optimize performance in trail running, coaches and practitioners are advised to work on different (incline-specific) aspects of running technique.

Normative 3D gait data of healthy adults walking at three different speeds on an instrumented treadmill in virtual reality.

A normative gait dataset of 246 healthy adults (122 men / 124 women, range in age 18-91 years, body weight 46.80-116.10 kg, height 1.53-1.97 m and BMI 18.25-35.63 kg/m2) is presented and publicly shared for three walking speed conditions. Raw and processed data are presented for each subject separately and for each walking speed, including data of every single step of both legs. The subject demographics and results from the physical examination are also presented which allows researchers and clinicians to create a self-selected reference group based on specific demographics. Besides the data per individual, data are also presented in age and gender groups. This provides a quick overview of healthy gait parameters which is relevant for use in clinical practice. Three dimensional gait analysis was performed at the Computer Assisted Rehabilitation Environment (CAREN) at the Maastricht University Medical Centre (MUMC+). Subjects walked on the instrumented treadmill surrounded with twelve 3D cameras, three 2D cameras and a virtual industrial environment projected on a 180° screen using the Human Body Lower Limb Model with trunk markers (HBM-II) as biomechanical model [1], [2]. Subjects walked at comfortable walking speed, 30% slower and 30% faster. These walking speed conditions were applied in a random sequence. Comfortable walking speed was determined using a RAMP protocol: subjects started to walk at 0.5m/s and every second the speed was increased with 0.01 m/s until the preferred speed was reached. The average of three repetitions was considered the comfortable speed. For each walking speed condition, 250 steps were recorded. The 3D gait data was collected using the D-flow CAREN software. For each subject, raw data of each walking speed condition is provided in .mox files, including the output from the model such as subject data (e.g. gender, body mass, knee and ankle width), center of mass (CoM), marker and force data, kinematic data (joint angles) and kinetic data (joint moments, ground reaction forces (GRFs) and joint powers) for each single step of both legs. Unfiltered and filtered data are included. C3D files with raw marker and GRF data were recorded in Nexus (Vicon software, version 2.8.1) and are available upon request. Raw data were processed in Matlab (Mathworks 2016), including quality check, step determination and the exportation of data to .xls files. For each adult and for each walking speed, an .xls file was created, containing spatiotemporal parameters, medio-lateral (ML) and back-forward (BF) margins of stability (MoS), 3D joint angles, anterior-posterior (AP) and vertical GRFs, 3D joint moments and 3D joint power of each step of both legs. Overview files per walking speed condition are created in .xls, presenting the averaged gait parameters (calculated as average over all valid steps) of every subject. The processed data is also presented and visualized per gender for different age groups (18-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, ≥70 years). This can serve as normative data for treadmill based 3D gait analyses in adults, applicable for clinical and research purposes. Data is available at OSF.io (https://osf.io/t72cw/).

Gait alterations in patients with adult spinal deformity.

Background: Adult spinal deformity patients (ASD) experience altered spinal alignment affecting spatiotemporal parameters and joint kinematics. Differences in spinal deformity between patients with symptomatic idiopathic scoliosis (ID-ASD) and patients with "de novo" scoliosis (DN-ASD) may affect gait characteristics differently. This study aims to compare gait characteristics between ID-ASD, DN-ASD, and asymptomatic healthy matched controls. Methods: In this observational case-control study, ID-ASD (n = 24) and DN-ASD (n = 26) patients visiting the out-patient spine clinic and scheduled for long-segment spinal fusion were included. Patients were matched, based on age, gender, leg length and BMI, with asymptomatic healthy controls. Gait was measured at comfortable walking speed on an instrumented treadmill with 3D motion capture system. Trunk, pelvic and lower extremities range of motion (ROM) and spatiotemporal parameters (SPT) are presented as median (first and thirds quartile). Independent t-test or Mann-Whitney U test was used to compare ID-ASD, DN-ASD and controls. Statistical Parametric Mapping (independent t-test) was used to compare 3D joint kinematics. Results: DN-ASD patients walk with increased anterior trunk tilt during the whole gait cycle compared with ID-ASD patients and controls. ID-ASD walk with decreased trunk lateroflexion compared with DN-ASD and controls. DN-ASD showed decreased pelvic obliquity and -rotation, increased knee flexion, and decreased ankle plantar flexion. ID-ASD and DN-ASD displayed decreased trunk, pelvic and lower extremity ROM compared with controls, but increased pelvic tilt ROM. ID-ASD patients walked with comparable SPT to controls, whereas DN-ASD patients walked significantly slower with corresponding changes in SPT and wider steps. Conclusions: DN-ASD patients exhibit distinct alterations in SPT and kinematic gait characteristics compared with ID-ASD and controls. These alterations seem to be predominantly influenced by sagittal spinal malalignment and kinematic findings in ASD patients should not be generalized as such, but always be interpreted with consideration for the nature of the ASD.

Clinical study on low-frequency repetitive transcranial magnetic stimulation for the treatment of walking dysfunction following stroke through three-dimensional gait analysis.

BACKGROUND: The recovery of walking capacity is of great significance in stroke rehabilitation. We evaluated changes in post-stroke gait function after low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) treatment. METHODS: Stroke patients were randomly assigned to control (conventional treatment)/LF-rTMS (LF-rTMS treatment based on conventional treatment) groups. Gait spatiotemporal parameters/affected side joint motion angle/affected side dynamic parameters were analyzed by 3D gait analyses. Motor evoked potential (MEP)/central motor conduction time (CMCT) changes were detected. Correlations between MEP latency/CMCT and gait parameters after LF-rTMS were analyzed by Pearson analysis. RESULTS: The two groups exhibited boosted stride speed/frequency/length, affected side stride length/swing phase percentage/hip/knee/ankle joint plantar flexion angle, and affected side ahead ground reaction force/ upward ground reaction force (AGRF/UGRF)/ankle joint plantar flexion moment, along with reduced affected side gait period/stance phase percentage after treatment, and the LF-rTMS group manifested better efficacy. MEP latency/CMCT of stroke patients treated with LF-rTMS was adversely linked to stride speed, affected side stride length/swing phase percentage/knee flexion angle, AGRF and UGRF, and positively correlated with affected side stance phase percentage. CONCLUSION: LF-rTMS significantly improved gait spatiotemporal parameters/affected joint motion angles/neurophysiologic parameters (MEP latency/CMCT) in patients with post-stroke walking dysfunction. MEP latency/CMCT after LF-rTMS treatment were prominently correlated with gait parameters. Relative to the traditional scale assessment, we provided a more accurate, objective and reliable evaluation of the effects of LF-rTMS on lower limb mobility and functional recovery effects in stroke patients from the perspective of 3D gait analysis and neurophysiology, which provided more evidence to support the clinical application of LF-rTMS in post-stroke walking dysfunction treatment.

Time course of surface electromyography during walking of children with spastic cerebral palsy treated with botulinum toxin type A and its rehabilitation implications.

BACKGROUND: The timing of the effects of botulinum toxin A on spastic muscles is not yet fully clarified. The goal of this study was to follow the temporal changes of surface electromyographic activity of lower limb muscles during walking, after a therapeutic dose of botulinum toxin A injected into the calf muscles of children with spastic cerebral palsy. METHODS: A group of children with spastic equinus foot was administered botulinum toxin A into the gastrocnemius medialis and lateralis muscles. Surface electromyographic activity of the tibialis anterior, gastrocnemius medialis, rectus femoris and medial hamstrings, was recorded before botulinum toxin A injections and after 4, 8, and 16 weeks. Children walked on ground and on a treadmill at an incline of 0% and 12%. The area of electromyographic activity and the index of muscle co-contraction were calculated for specific segments of gait cycle. FINDINGS: Botulinum toxin A did not modify the speed of gait on ground. ANOVA showed significant differences in electromyography during the stance phase segments with a maximum decrease between 4 and 8 weeks' post botulinum toxin A and a full recovery at 16 weeks. A significant co-contraction of rectus femoris/gastrocnemius medialis, between 0 and 20% and 35-50% of the gait cycle, was observed from the 4th to the 8th week post- botulinum toxin A for both treadmill settings. INTERPRETATION: The temporal identification of deterioration/recovery of electromyographic activity as well as of muscle co-contractions, could be key elements in a rehabilitation program planning combined with botulinum toxin A.

Agreement between Optoelectronic System and Wearable Sensors for the Evaluation of Gait Spatiotemporal Parameters in Progressive Supranuclear Palsy.

The use of wearable sensors for calculating gait parameters has become increasingly popular as an alternative to optoelectronic systems, currently recognized as the gold standard. The objective of the study was to evaluate the agreement between the wearable Opal system and the optoelectronic BTS SMART DX system for assessing spatiotemporal gait parameters. Fifteen subjects with progressive supranuclear palsy walked at their self-selected speed on a straight path, and six spatiotemporal parameters were compared between the two measurement systems. The agreement was carried out through paired data test, Passing Bablok regression, and Bland-Altman Analysis. The results showed a perfect agreement for speed, a very close agreement for cadence and cycle duration, while, in the other cases, Opal system either under- or over-estimated the measurement of the BTS system. Some suggestions about these misalignments are proposed in the paper, considering that Opal system is widely used in the clinical context.

Reference values of gait parameters in healthy Chinese university students: A cross-sectional observational study.

BACKGROUND: Gait is influenced by race, age, and diseases type. Reference values for gait are closely related to numerous health outcomes. To gain a comprehensive understanding of gait patterns, particularly in relation to race-related pathologies and disorders, it is crucial to establish reference values for gait in daily life considering sex and age. Therefore, our objective was to present sex and age-based reference values for gait in daily life, providing a valuable foundation for further research and clinical applications. AIM: To establish reference values for lower extremity joint kinematics and kinetics during gait in asymptomatic adult women and men. METHODS: Spatiotemporal, kinematics and kinetics parameters were measured in 171 healthy adults (70 males and 101 females) using the computer-aided soft tissue foot model. Full curve statistical parametric mapping was performed using independent and paired-samples t-tests. RESULTS: Compared with females, males required more time (cycle time, double-limb support time, stance time, swing time, and stride time), and the differences were statistically significant. In addition, the step and stride lengths of males were longer. Compared to males, female cadence was faster, and statures-per-second and stride-per-minute were higher. There were no statistical differences in speed and stride width between the two groups. After adjusting for height, it was observed that women walked significantly faster than men, and they also had a higher cadence. However, in terms of step length, stride length, and stride width, both genders exhibited similarities. CONCLUSION: We established reference values for gait speed and spatiotemporal gait parameters in Chinese university students. This contributes to a valuable database for gait assessment and evaluation of preventive or rehabilitative programs.

Gait initiation in multiple sclerosis patients with and without functional loss.

BACKGROUND: Gait initiation (GI) is an important functional task related to balance and gait performance. In addition, it has predictive importance for falls and postural instability in patient with multiple sclerosis (MS). However, it is uncertain how GI is affected in patients in the early stage of MS (Expanded Disability Status Scale (EDSS) ≤3). In this study, it was aimed to investigate the anticipatory postural adjustments (APAs), posterior center of pressure (COPap) displacement, and spatiotemporal variability during GI in patients with and without functional loss in the early stage of MS. METHODS: Forty-four participants (31 MS patients and 13 healthy subjects) involved in this prospective cross-sectional study were divided into three groups: Group-I: Patients without functional loss (EDSS 0 to 1.5) (n = 14), Group-II: Patients with functional loss (EDSS 2 to 3) (n = 17) and Group-III: Healthy subjects (n = 13). Electromyographic activity of the bilateral tibialis anterior (TA) and gastrocnemius medialis (GM) and COPap displacement were recorded during the postural phase of GI. Additionally, spatiotemporal parameters were recorded within the first three steps, and the coefficient of variation was calculated with 40 walks for variability. RESULTS: There were significant differences in the Kruskal-Wallis tests of variables (p<0.05). Group-I demonstrated smaller APAs magnitudes in TA [stance (p = 0.01), swing (p = 0.01)], GM of swing limb (p<0.0001), and smaller COPap displacement (p<0.0001) compared to group-III. Group-II demonstrated smaller APAs magnitudes in all muscles (p<0.0001) compared to group-III and the smallest COPap displacement (p<0.0001). Group-I showed a significant increase in stride width variability compared to group-III (p = 0.01). Group-II showed a significant increase in several variabilities [first stride length (p<0.0001), second stride time (p<0.0001), first double support time (p<0.0001), stride width (p<0.0001)] compared to group-III. CONCLUSION: Patients in the early stage of MS had impairment in both the postural and locomotor phases of GI with more obvious in the patients with functional loss. The results indicate that MS patients without functional loss have difficulty initiating gait. Although there is no functional loss, the patients have a risk of falls, postural instability, and gait impairment due to their inability to initiate gait effectively. As a result, rehabilitation is necessary even if there is no functional loss in patients with MS.

Impacts of gait biomechanics of patients with thoracolumbar kyphosis secondary to Scheuermann's disease.

Introduction: Thoracolumbar kyphosis (TLK) is a common feature in patients with spinal deformities. However, due to limited studies, the impacts of TLK on gait have not been reported. The objective of the study was to quantify and evaluate the impacts of gait biomechanics of patients with TLK secondary to Scheuermann's disease. Methods: Twenty cases of Scheuermann's disease patients with TLK and twenty cases of asymptomatic participants were recruited into this study. And the gait motion analysis was conducted. Results: The stride length was shorter in the TLK group compared to control group (1.24 ± 0.11 m vs. 1.36 ± 0.21 m, p = 0.04). Compared to control group, the stride time and step time were more prolonged in the TLK group (1.18 ± 0.11s vs. 1.11 ± 0.08 s, p = 0.03; 0.59 ± 0.06 s vs. 0.56 ± 0.04 s, p = 0.04). The gait speed of the TLK group was significantly slower than it of control group (1.05 ± 0.12 m/s vs. 1.17 ± 0.14 m/s, p = 0.01); In the sagittal plane, the range of motion (ROM) of the hip in the TLK group was significantly smaller than that of the control group (37.71 ± 4.35° vs. 40.05 ± 3.71°, p = 0.00). In the transverse plane, the adduction/abduction ROMs of the knee and ankle, as well as the internal and external rotation of the knee, were smaller in TLK group than ROMs in the control group (4.66 ± 2.21° vs. 5.61 ± 1.82°, p = 0.00; 11.48 ± 3.97° vs. 13.16 ± 5.6°, p = 0.02; 9.00 ± 5.14° vs. 12.95 ± 5.78°, p = 0.00). Discussion: The main finding of this study was that measurements of gait patterns and joint movement of the TLK group were significantly lower than those of the control group. And these impacts have the potential to exacerbate degenerative progress of joints in the lower extremities. These abnormal features of gait can also serve as a guideline for physicians to focus on TLK in these patients.

Dataset of 3D gait analysis in typically developing children walking at three different speeds on an instrumented treadmill in virtual reality.

In this article, gait data of typically developing (TD) children (24 boys/31 girls, mean (95% confidence interval) age 9.38 (8.51 - 10.25) years, body mass 35.67 (31.40 - 39.94) kg, leg length 0.73 (0.70 - 0.76) m, and height 1.41 (1.35 - 1.46) m) walking at different walking speeds is shared publicly. Raw and processed data is presented for each child separately and includes data of each single step of both legs. Beside, the subject demographics and the results from the physical examination are presented allowing to select TD children from the database to create a matched group, based on specific parameters (e.g. sex and body weight). For clinical application, gait data is also presented per age group, which provides quick insight into the normal gait pattern of TD children of varying age. Gait analysis was performed during treadmill walking in a virtual environment using the Computer Assisted Rehabilitation Environment (CAREN). The human body lower limb model with trunk markers (HBM2) was used as biomechanical model. Children walked at comfortable walking speed, 30% slower and 30% faster (random sequence) while wearing gymnastic shoes and a safety harness to prevent falling. For each speed condition, 250 steps were recorded. Data quality check, step detection and the calculation of gait parameters was done by custom made Matlab algorithms. Raw data files are provided per walking speed, for each child separately. The raw data is exported from the CAREN software (D-flow) and is provided in .mox and .txt files. It includes the output from the models such as subject data, marker and force data, kinematic data (joint angles), kinetic data (joint moments, GRFs, joint powers), as well as CoM data and EMG data (the last two are not described in this manuscript), for each speed condition and each child. Unfiltered and filtered data are included. C3D files with raw marker and GRF data were recorded in Nexus (Vicon software) and are available upon request. After analyzing the raw data into Matlab (R2016a, Mathworks) using custom made Matlab algorithms, processed data is obtained. The processed data is provided in .xls files and is also presented for each child separately. It contains spatiotemporal parameters, 3D joint angles, anterior-posterior and vertical ground reaction forces (GRF), 3D joint moments and sagittal joint power of each step of the left and right leg. In addition to each individual's data, overview files (.xls) are created per walking speed condition. These overviews present the averaged gait parameter (e.g. joint angle), calculated over all valid steps, of each child.

Balance impairment in cerebrotendinous xanthomatosis: Ankle strategy deficit. A case study.

BACKGROUND: Cerebrotendinous xanthomatosis is a rare autosomal-recessive lipid storage disorder causing an elevation in cholestanol and cholesterol levels and their deposition in the central nervous system and tendons with consequent posture and gait disturbances. METHODS: This report shows the case of a 36-year-old male affected by Cerebrotendinous xanthomatosis with static and dynamic instability. We aimed to provide an instrumented quantification of quiet upright standing using a piezoelectric force platform measuring the variations of center of pressure with the foot position 10 cm and 20 cm apart or extra-rotated with an opening angle of 30°, with eyes open or closed. The area of center of pressure and the length of its trajectory in the anterior-posterior and medial-lateral directions were computed. The temporal variability of center of pressure was evaluated by means of the Root Mean Square. FINDINGS: In comparison with a control group, the area, the trajectory length of center of pressure in anterior-posterior and medial-lateral directions and the temporal variability increased in all static conditions. Intra-patient comparison showed that foot position 10 cm apart was the position that most influenced stability causing a marked worsening of area and trajectory length of center of pressure in both anterior-posterior and medial-lateral directions, particularly for the eyes closed condition. INTERPRETATION: We found a large static instability due to internal neural and biomechanical constraints causing an insufficiency of ankle strategy. A physical therapy program based on instrumented proprioceptive exercises is to be implemented to teach the use of a hip strategy.

Barefoot walking is more stable in the gait of balance recovery in older adults.

BACKGROUND: Perturbation-based balance training on a treadmill is an emerging method of gait stability training with a characteristic task nature that has had positive and sustained effects on balance recovery strategies and fall reduction. Little is known about the effects produced by shod and barefoot walking. We aimed to investigate which is more appropriate, shod or barefoot walking, for perturbation-based balance training in older adults. METHODS: Fourteen healthy older adults (age: 68.29 ± 3.41 years; body height: 1.76 ± 0.10 m; body mass: 81.14 ± 14.52 kg) performed normal and trip-like perturbed walking trials, shod and barefoot, on a treadmill of the Gait Real-time Analysis Interactive Lab. The marker trajectories data were processed by Human Body Model software embedded in the Gait Offline Analysis Tool. The outcomes of stride length variability, stride time variability, step width variability, and swing time variability were computed and statistically analyzed by a two-way repeated-measures analysis of variance (ANOVA) based on gait pattern (normal gait versus perturbed recovery gait) and footwear condition (shod versus barefoot). RESULTS: Footwear condition effect (p = 0.0310) and gait pattern by footwear condition interaction effect (p = 0.0055) were only observed in swing time variability. Gait pattern effects were detected in all four outcomes of gait variability. CONCLUSIONS: Swing time variability, independent of gait speed, could be a valid indicator to differentiate between footwear conditions. The lower swing time variability in perturbed recovery gait suggests that barefoot walking may be superior to shod walking for perturbation-based balance training in older adults.

Maximum aerobic speed, maximum oxygen consumption, and running spatiotemporal parameters during an incremental test among middle- and long-distance runners and endurance non-running athletes.

Background: Maximal aerobic speed (MAS) is a useful parameter to assess aerobic capacity and estimate training intensity in middle- and long-distance runners. However, whether middle- and long-distance runners reach different levels of MAS compared to other endurance athletes with similar V̇O2max has not been previously studied. Therefore, we aimed to compare V̇O2max, MAS and spatiotemporal parameters between sub-elite middle- and long-distance runners (n = 6) and endurance non-runners (n = 6). In addition, we aimed to compare the maximal blood lactate concentration [BLa] experienced by participants after conducting these tests. Methods: Telemetric portable respiratory gas analysis, contact and flight time, and stride length and rate were measured using a 5-m contact platform during an incremental test at a synthetic athletics track. V̇O2, heart rate, respiratory quotient values in any 15 s average period during the test were measured. [BLa] was analyzed after the test . Running spatiotemporal parameters were recorded at the last two steps of each 400 m lap. A coefficient of variation (%CV) was calculated for each spatiotemporal variable in each participant from 8 km h-1 onwards. Results: Whereas runners reported faster MAS (21.0 vs. 18.2 km h-1) than non-runners (p  =  0.0001, ES = 3.0), no differences were found for V̇O2max and maximum blood lactate concentration during the running tests (p > 0.05). While significant increases in flight time and stride length and frequency (p < 0.001, 0.52 ≤ η p 2 ≤ 0.8) were observed throughout the tests, decreases in contact time (p < 0.001, η p 2 = 0 . 9 ) were reported. Runners displayed a greater %CV (p = 0.015) in stride length than non-runners. We conclude that middle- and long-distance runners can achieve a faster MAS compared to non-running endurance athletes despite exhibiting a similar V̇O2max. This superior performance may be associated to a greater mechanical efficiency. Overall, runners displayed a greater ability to modify stride length to achieve fast speeds, which may be related to a more mechanically efficient pattern of spatiotemporal parameters than non-runners.

Effectiveness of Early Rehabilitation with Exergaming in Virtual Reality on Gait in Patients after Total Knee Replacement.

Total knee replacement (TKR) is the treatment of choice for advanced stages of osteoarthritis but it requires good postoperative rehabilitation. This study aimed to assess the effectiveness of exercises using virtual reality to improve gait parameters in patients after TKR. Fifty-nine patients 7−14 days after TKR surgery were divided into a study group (VRG, n = 38) and a control group (CG, n = 21). Both groups underwent the same 4-week rehabilitation protocol. The VRG group had 12 additional nonimmersive virtual reality game sessions on the Virtual Balance Clinic prototype system at 30 min each, focusing on gait and balance improvement. Spatiotemporal, force and foot plantar pressure parameters were collected on an instrumented treadmill during a 30 s walk. The most significant improvement was in the symmetry indices of forefoot force, maximum forefoot force, loading response time, and preswing time (p < 0.05) in both groups. Gait speed increased by 31.25% and 44% in the VRG and CG groups, respectively (p < 0.005). However, the extra exergaming sessions did not significantly improve rehabilitation outcomes. Therefore, additional VR training does not improve gait better than standard rehabilitation alone, but the improvement of gait, especially its symmetry, is significant within the first six weeks after surgery.

Fiabilidad y validez de Kinovea para analizar parámetros espaciotemporales de la marcha / Reliability and Validity of Kinovea to Analyze Spatiotemporal Gait Parameters

Los objetivos del presente estudio son evaluar la fiabililidad test-retest e inter-observador del software Kinovea® para la obtención de los principales parámetros espaciotemporales de la marcha, así como, estudiar la validez de criterio respecto a un sistema tridimensional de análisis del movimiento. Los resultados obtenidos son significativamente estadísticos (p < 0,05) en todos los parámetros estudiados. La fiabilidad test-retest muestra una correlación excelente en los parámetros de longitud de paso, longitud de zancada, tiempo de paso y tiempo de zancada (CCI > 0,90), y buena en la velocidad (CCI = 0,76-0,90). La fiabilidad inter-observador es excelente (CCI > 0,90) en todos los parámetros espaciotemporales estudiados en ambos observadores. La validez de criterio entre Kinovea® y VICON Motion System® es excelente para los parámetros estudiados (r > 0,80) en ambos evaluadores. Estos hallazgos respaldan el empleo de Kinovea® como una herramienta accesible y de fácil manejo, con la que obtener datos objetivos de la marcha. (AU)

The aims of this study are to evaluate test-retest ant inter-rater reliability of the software Kinovea® to obtain the spatiotemporal gait parameters, as well as to study the criterion validity with respect to a three-dimensional motion capture system. The results obtained are statically significant (p < 0.05) in all the parameters studied. The test-retest reliability shows an excellent correlation in the parameters of step length, stride length, step time and stride time (ICC > 0.90), and good in speed (ICC = 0.76-0.90). The inter-rater evaluation is excellent (ICC > 0.90) in all the spatiotemporal parameters studied in both raters. The criterion validity between Kinovea® and VICON Motion System® is excellent for the parameters studied (r > 0.80) in both raters. These findings support the use of Kinovea® as an accessible and easy-to-use tool with which to obtain objective gait data. (AU)

Evaluation of Arm Swing Features and Asymmetry during Gait in Parkinson's Disease Using the Azure Kinect Sensor.

Arm swinging is a typical feature of human walking: Continuous and rhythmic movement of the upper limbs is important to ensure postural stability and walking efficiency. However, several factors can interfere with arm swings, making walking more risky and unstable: These include aging, neurological diseases, hemiplegia, and other comorbidities that affect motor control and coordination. Objective assessment of arm swings during walking could play a role in preventing adverse consequences, allowing appropriate treatments and rehabilitation protocols to be activated for recovery and improvement. This paper presents a system for gait analysis based on Microsoft Azure Kinect DK sensor and its body-tracking algorithm: It allows noninvasive full-body tracking, thus enabling simultaneous analysis of different aspects of walking, including arm swing characteristics. Sixteen subjects with Parkinson's disease and 13 healthy controls were recruited with the aim of evaluating differences in arm swing features and correlating them with traditional gait parameters. Preliminary results show significant differences between the two groups and a strong correlation between the parameters. The study thus highlights the ability of the proposed system to quantify arm swing features, thus offering a simple tool to provide a more comprehensive gait assessment.

Lower extremity joint compensatory effects during the first recovery step following slipping and stumbling perturbations in young and older subjects.

BACKGROUND: The lower extremity may play a crucial role in compensating for gait perturbations. The study aimed to explore the mechanism of perturbation compensation by investigating the gait characteristics and lower extremity joint moment effects in young (YS) and older subjects (OS) during the first recovery gait following slipping (slipping_Rec1) and stumbling (stumbling_Rec1). METHOD: An automatic perturbation-triggered program was developed using D-Flow software based on the Gait Real-time Analysis Interactive Lab to induce the two aforementioned perturbations. Marker trajectories and ground reaction forces were recorded from 15 healthy YS (age: 26.53 ± 3.04 years; body height: 1.73 ± 0.07 m; body mass: 66.81 ± 11.44 kg) and 15 healthy OS (age: 68.33 ± 3.29 years; body height: 1.76 ± 0.10 m; body mass: 81.13 ± 13.99 kg). The Human Body Model was used to compute the variables of interest. One-way analysis of variance and independent samples t-test statistical analyses were performed. RESULTS: In slipping_Rec1 and stumbling_Rec1, the change in gait pattern was mainly reflected in a significant increase in step width, no alterations in step length and stance/swing ratio were revealed. Based on perturbed task specificity, lower extremity joint moments increased or decreased at specific phases of the gait cycle in both YS and OS in slipping_Rec1 and stumbling_Rec1 compared to normal gait. The two perturbed gaits reflected the respective compensatory requirements for the lower extremity joints, with both sagittal and frontal joint moments producing compensatory effects. The aging effect was not reflected in the gait pattern, but rather in the hip extension moment during the initial stance of slipping_Rec1. CONCLUSIONS: Slipping appears to be more demanding for gait recovery than stumbling. Gait perturbation compensatory mechanisms for OS should concentrate on ankle strategy in the frontal plane and counter-rotation strategy around the hip.

Comparison of sagittal plane gait characteristics between the overground and treadmill approach for gait analysis in typically developing children.

Background: Instrumented treadmills have become more mainstream in clinical assessment of gait disorders in children, and are increasingly being applied as an alternative to overground gait analysis. Both approaches differ in multiple elements of set-up (e.g., overground versus treadmill, Pug-in Gait versus Human Body Model-II), workflow (e.g., limited amount of steps versus many successive steps) and post-processing of data (e.g., different filter techniques). These individual elements have shown to affect gait. Since the approaches are used in parallel in clinical practice, insight into the compound effect of the multiple different elements on gait is essential. This study investigates whether the outcomes of two approaches for 3D gait analysis are interchangeable in typically developing children. Methods: Spatiotemporal parameters, sagittal joint angles and moments, and ground reaction forces were measured in typically developing children aged 3-17 years using the overground (overground walking, conventional lab environment, Plug-In Gait) and treadmill (treadmill walking in virtual environment, Human Body Model-II) approach. Spatiotemporal and coefficient of variation parameters, and peak values in kinematics and kinetics of both approaches were compared using repeated measures tests. Kinematic and kinetic waveforms from both approaches were compared using statistical parametric mapping (SPM). Differences were quantified by mean differences and root mean square differences. Results: Children walked slower, with lower stride and stance time and shorter and wider steps with the treadmill approach than with the overground approach. Mean differences ranged from 0.02 s for stride time to 3.3 cm for step width. The patterns of sagittal kinematic and kinetic waveforms were equivalent for both approaches, but significant differences were found in amplitude. Overall, the peak joint angles were larger during the treadmill approach, showing mean differences ranging from 0.84° (pelvic tilt) to 6.42° (peak knee flexion during swing). Mean difference in peak moments ranged from 0.02 Nm/kg (peak knee extension moment) to 0.32 Nm/kg (peak hip extension moment), showing overall decreased joint moments with the treadmill approach. Normalised ground reaction forces showed mean differences ranging from 0.001 to 0.024. Conclusion: The overground and treadmill approach to 3D gait analysis yield different sagittal gait characteristics. The systematic differences can be due to important changes in the neuromechanics of gait and to methodological choices used in both approaches, such as the biomechanical model or the walkway versus treadmill. The overview of small differences presented in this study is essential to correctly interpret the results and needs to be taken into account when data is interchanged between approaches. Together with the research/clinical question and the context of the child, the insight gained can be used to determine the best approach.

Identifying the Effects of Age and Speed on Whole-Body Gait Symmetry by Using a Single Wearable Sensor.

Studies on gait symmetry in healthy population have mainly been focused on small range of age categories, neglecting Teenagers (13-18 years old) and Middle-Aged persons (51-60 years old). Moreover, age-related effects on gait symmetry were found only when the symmetry evaluation was based on whole-body acceleration than on spatiotemporal parameters of the gait cycle. Here, we provide a more comprehensive analysis of this issue, using a Symmetry Index (SI) based on whole-body acceleration recorded on individuals aged 6 to 84 years old. Participants wore a single inertial sensor placed on the lower back and walked for 10 m at comfortable, slow and fast speeds. The SI was computed using the coefficient of correlation of whole-body acceleration measured at right and left gait cycles. Young Adults (19-35 years old) and Adults (36-50 years old) showed stable SI over the three speed conditions, while Children (6-12 years old), Teenagers (13-18 years old), Middle-Aged persons and Elderly (61-70 and 71-84 years old) exhibited lower SI values when walking at fast speed. Overall, this study confirms that whole-body gait symmetry is lower in Children and in Elderly persons over 60 years of age, showing, for the first time, that asymmetries appear also during teenage period and in Middle-Aged persons (51-60 years old).

Investigation of postural control and spatiotemporal parameters of gait during dual tasks in ataxic individuals.

BACKGROUND: Concurrent cognitive and motor tasks in ataxic individuals cause functional limitations and negatively affect the independence of patients in daily life. OBJECTIVES: This study aimed to examine the effects of dual task on postural control and spatiotemporal parameters of gait in ataxic individuals. METHODS: The study included 20 individuals with ataxia. Disease severity was evaluated using the International Cooperative Ataxia Rating Scale. A force platform was used to evaluate postural sway and limits of stability and a GAITRite electronic walkway to evaluate the spatiotemporal parameters of gait. Postural control and gait were evaluated without a simultaneous task (task-1) and with dual tasks consisting of counting the names starting with "a selected letter such as A" (task-2), counting backwards aloud in threes from 100 (task-3), carrying a glass of water with a tray (task-4), and speaking on a mobile phone (task-5). The effects of dual task on postural control and gait parameters were examined with multiple comparisons. RESULTS: The tasks requiring cognitive skills (tasks 2, 3, 5) were determined to have a greater effect on the increase of body sway, and gait was seen to be affected by motor and/or cognitive tasks (tasks 2, 4, 5). CONCLUSION: From the results of the present study, it is thought that evaluations of postural control and gait performance of ataxic individuals together with the dual tasks they may encounter in daily life are important in terms of their independence in activities of daily living.