Gait & posture
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Comparative Study
Gait analysis post anterior cruciate ligament reconstruction: knee osteoarthritis perspective.
Individuals with anterior cruciate ligament (ACL) reconstruction are at increased risk to develop knee osteoarthritis (OA). Gait analysis describing kinetics of the lower extremity during walking and stair use (stair ascent and stair descent) can provide insight to everyday dynamic knee joint loading. In this study, we compared lower extremity gait patterns of those with ACL reconstruction (>1 year) to a control group. ⋯ Walking and stair ambulation highlight altered joint loading in those with ACL reconstruction surgery. Individuals appeared to compensate for lower knee extension moments by increasing hip extension moments. Furthermore, the load distribution on the articular cartilage is likely shifted as evidenced by reduced knee flexion angles in the ACL reconstructed leg.
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In the present study we aimed to track the influence of natural gaze behaviour on postural control from early childhood into adulthood. We measured time series of centre of pressure (COP) as well as head movement in three children groups aged around five (n=16), eight (n=15), and eleven (n=14) and in one group of young adults (n=15) during quiet stance with eyes closed, gaze fixed on a dot, and with gaze shifts between two dots. We adopted magnitude and irregularity of COP displacement as indexes of postural control and cross correlation between COP displacement and target oscillation as an index of the dynamical coupling between the postural and visual systems. ⋯ Across conditions, and most prominently in the gaze shift conditions, 5-year-olds showed both more head movement and lower postural stability than other age groups. Finally, only in 5-year-olds did we find a marked deterioration of postural stability with gaze shifts. We thus conclude that excessive head movement, particularly during gaze shifts, may be a primary cause of lower postural stability in young children compared to older children and adults.
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Comparative Study
Predictors of gait velocity among community-dwelling stroke survivors.
Gait velocity is an objective, fundamental indicator of post-stroke walking ability. Most stroke survivors have diminished aerobic endurance or paretic leg strength affecting their walking ability. Other reported underlying factors affecting gait velocity include functional disability, balance, cognitive impairment, or the distance they are required to walk. ⋯ Diminished aerobic endurance and leg strength are major contributors to slow gait velocity in chronic stroke. Long term rehabilitation efforts are needed to improve gait velocity in chronic stroke, and may need to incorporate multifaceted strategies concurrently, focusing on aerobic endurance and leg strength, to maximize community ambulation and reintegration.
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Comparative Study
Long-term evaluation of gait initiation in six Parkinson's disease patients with bilateral subthalamic stimulation.
Defined as the transient state between standing and walking, gait initiation is negatively affected in Parkinson's disease (PD), which often results in significant disability. Although deep brain stimulation (DBS) is the most common surgical procedure for PD, the long-term effects of DBS on gait initiation are not well studied. The present study evaluated the long-term effects of subthalamic nucleus (STN) DBS on the preparation phase of gait initiation using principal component (PC) analysis. ⋯ The Friedman test showed a significant difference in standard distance among conditions (P=0.004), with the post-hoc test recognizing differences among P1 conditions and P2 medication-on condition. The eigenvector loading factors pointed to major differences between PD conditions surrounding the maximum amplitude of vertical and anterior-posterior GRF. For the studied sample, all distances increased in the follow-up evaluation (P2) with and without medications, indicating a worsening in gait initiation after seven years.
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Comparative Study
Coordination of push-off and collision determine the mechanical work of step-to-step transitions when isolated from human walking.
In human walking, each transition to a new stance limb requires redirection of the center of mass (COM) velocity from one inverted pendulum arc to the next. While this can be accomplished with either negative collision work by the leading limb, positive push-off work by the trailing limb, or some combination of the two, physics-based models of step-to-step transitions predict that total positive work is minimized when the push-off and collision work are equal in magnitude. Here, we tested the importance of the coordination of push-off and collision work in determining transition work using ankle and knee joint braces to limit the ability of a leg to perform positive work on the body. ⋯ We found that reduced push-off work increased the collision work required to complete the redirection of the COM velocity during each transition. A greater amount of total mechanical work was required when rocking departed from the predicted optimal coordination of step-to-step transitions, in which push-off and collision work are equal in magnitude. Our finding that transition work increases if one or both legs do not push-off with the optimal coordination may help explain the elevated metabolic cost of pathological gait irrespective of etiology.