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Objective: The aim of the study is to evaluate how gait kinematics and muscle activity during robot-assisted gait training are affected by different combinations of parameter settings and a number of instruction types, ranging from no instructions to goal-specific instructions. Design: Robots for gait therapy provide a haptic guidance, but too much guidance can limit the active participation. Therapists can stimulate this active participation either with instructions or by adapting device parameters. How these two factors interact is still unknown. In the present study, we test the interaction of three different parameter settings and four instruction types in a cross-sectional study with 20 children and adolescents without impairment. Gait kinematics and surface electromyography were measured to evaluate the immediate effects. Results: We found that only goal-specific instructions in combination with a low guidance led to a moderate but significant change in gait kinematics. The muscle activity was altered by all instructions, but the biggest effect was found for goal-specific instructions with a 2.5 times higher surface electromyography amplitude compared to no instruction. Conclusions: Goal-specific instructions are a key element of robot assisted gait therapy interventions and device parameter adjustments may be used to modulate their effects. Therapists should pay close attention to how they instruct patients. [ABSTRACT FROM AUTHOR]

Objective: Pediatric athletes with concussion present with a variety of impairments on clinical assessment and require individualized treatment. The Buffalo Concussion Physical Examination is a brief, pertinent clinical assessment for individuals with concussion. The purpose of this study was to identify physical examination subtypes in pediatric athletes with concussion within 2 weeks of injury that are relevant to diagnosis and treatment. Design: Secondary analysis of a published cohort study and clinician consensus. Setting: Three university-affiliated sports medicine centers. Participants: Two hundred seventy children (14.961.9 years). Independent Variables: Orthostatic intolerance, horizontal and vertical saccades, smooth pursuits, vestibulo-ocular reflex, near-point convergence, complex tandemgait, neck range of motion, neck tenderness, and neck spasm. Main Outcome Measures: Correlations between independent variables were calculated, and network graphs were made. k-means and hierarchical clustering were used to identify clusters of impairments. Optimal number of clusters was assessed. Results were reviewed by experienced clinicians and consensus was reached on proposed subtypes. Results: Physical examination clusters overlapped with each other, and no optimal number of clusters was identified. Clinician consensus suggested 3 possible subtypes: (1) visio-vestibular (horizontal and vertical saccades, smooth pursuits, and vestibulo-ocular reflex), (2) cervicogenic (neck range of motion and spasm), and (3) autonomic/balance (orthostatic intolerance and complex tandemgait). Conclusions: Although we identified 3 physical examination subtypes, it seemed that physical examination findings alone are not enough to define subtypes that are both statistically supported and clinically relevant, likely because they do not include symptoms, assessment of mood or cognitive problems, or graded exertion testing. [ABSTRACT FROM AUTHOR]

Purpose: High body mass index (BMI) is a strong predictor of posttraumatic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR). Altered gait mechanics are independently affected by BMI and ACLR, and influence OA risk. Yet, evidence directly assessing the impact of high BMI on gait or cartilage characteristics after ACLR are limited. Here, we evaluated if high BMI moderates associations between gait and trochlear cartilage structure in individuals with ACLR. Methods: Treadmill walking biomechanics were evaluated in 40 normal BMI and 24 high BMI participants with ACLR at self-selected speeds. Normalized and absolute peak and cumulative loads (i.e., impulse) were extracted for peak knee flexion and adduction moments (KFM, KAM) and vertical ground reaction force (GRF).Medial and lateral femoral cartilage thickness and medial/lateral thickness ratios were assessed via ultrasound. Results: Those with ACLR and high BMI walked with reduced normalized peak vertical GRFs, and greater absolute peak and cumulative loads compared with normal BMI individuals with ACLR. Those with ACLR and high BMI also exhibited thinner cartilage and greater medial/lateral ratios in ACLR limbs compared with contralateral limbs whereas norma lBMI individuals with ACLR exhibited thicker ACLR limb cartilage. Lastly, greater peak KAM and KAM cumulative load were associated with thicker lateral cartilage and lesser medial/lateral thickness ratios, but only in the high BMI group. Conclusions: We observed those with high BMI after ACLR exhibited trochlear cartilage structural alterations not observed in normal BMI patients, whereas differential associations between loading outcomes and cartilage thickness in ACLR knees were observed between groups. Those with high BMI after ACLR may require different therapeutic strategies to optimize joint health in this subset of patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of sensorimotor training on gait, ankle joint proprioception, and quality of life in diabetic peripheral neuropathy patients. Design: A prospective, single-blind, randomized controlled experiment was performed. Forty patients with diabetic peripheral neuropathy aged 50–65 yrs were distributed randomly into two groups, the sensorimotor training group (n = 20), and the control group (n = 20). Both groups attended awareness sessions about diabetes and foot care for 30 mins, every 2 wks. Moreover, the sensorimotor training group received 6 wks (3 d/wk) of sensorimotor training. Spatiotemporal gait parameters, proprioception accuracy of the ankle joint, and quality of life were measured before and after 6 wks of intervention. Results: Regarding baseline data, no significant differences were identified among groups (P > 0.05). After 6-wk intervention, the sensorimotor training group exhibited significant improvements in all outcome variables (P < 0.001), while the control group showed significant changes in quality of life only (P = 0.03). Comparing groups after intervention reveals statistically significant differences in all measured variables in favor of the sensorimotor training group (P < 0.001). Conclusions: Sensorimotor training may improve spatiotemporal gait parameters, ankle joint proprioception, and quality of life of patients with diabetic peripheral neuropathy. [ABSTRACT FROM AUTHOR]

Objective: Verbal instruction is one of the most commonly used methods that therapists use to correct walking pattern for people with Parkinson disease. This study aimed to compare the long-term training effects of two different verbal instructions that either asked the participants to "take big steps" or "strike the ground with the heel" on walking ability in individuals with Parkinson disease. Design: Forty-five participants with Parkinson disease were randomized into the big-step or heel strike group. The participants underwent 12 sessions of treadmill and overground gait training. Throughout the interventions, the big-step group received an instruction to "take big steps," while the heel strike group received an instruction to "strike the ground with your heel." The primary outcome was gait performance, including velocity, stride length, cadence, and heel strike angle. The participants were assessed before, immediately after, and 1 mo after training. Results: Both groups showed significant improvements in gait performance after training. The heel strike group showed continuous improvements in velocity and stride length during the follow-up period; however, the big-step group showed slightly decreased performance. Conclusions: A verbal instruction emphasizing heel strike can facilitate long-term retention of walking performance in people with Parkinson disease. [ABSTRACT FROM AUTHOR]

Objective: To compare clinical measures between patients with chronic exertional compartment syndrome (CECS) and healthy controls and evaluate running biomechanics, physical measurements, and exertional intracompartmental (ICP) changes in adolescent athletes with lower leg CECS. Design: Cross-sectional case-control study. Setting: Large tertiary care hospital and affiliated injury prevention center. Participants: Forty-nine adolescents with CECS (39 F, 10 M; age: 16.9 ± 0.8 years; body mass index (BMI): 23.1 ± 2.9 kg/m²; symptom duration: 8 ± 12 months) were compared with 49 healthy controls (39 F, 10 M; age: 6.9 ± 0.8 years; BMI: 20.4 ± 3.7 kg/m²). Interventions: All participants underwent gait analyses on a force plate treadmill and clinical lower extremity strength and range of motion testing. Patients with chronic exertional compartment syndrome underwent Stryker monitor ICP testing. Main outcome measures: Symptoms, menstrual history, and ICP pressures of the patients with CECS using descriptive statistics. Mann-Whitney U and χ² analyses were used to compare CECS with healthy patients for demographics, clinical measures, and gait biomechanics continuous and categorical outcomes, respectively. For patients with CECS, multiple linear regressions analyses were used to assess associations between gait biomechanics, lower extremity strength and range of motion, and with ICP measures. Results: The CECS group demonstrated higher mass-normalized peak ground reaction force measures (xBW) compared with controls (0.21 ± 0.05 xBW ( P < 0.001) and were more likely to have impact peak at initial contact ( P = 0.04). Menstrual dysfunction was independently associated with higher postexertion ICP (ß = 14.6; P = 0.02). Conclusions: The CECS group demonstrated increased total force magnitude and vertical impact transient peaks. In women with CECS, menstrual dysfunction was independently associated with increased postexertion ICP. These biomechanical and physiological attributes may play a role in the development of CECS. [ABSTRACT FROM AUTHOR]

Introduction: In nonimpaired human locomotion, sagittal-plane slope adaptation of the ankle-foot complex is a function driven by neuromotor control to support upright posture and forward ambulation. Loss of this adaptation due to transtibial amputation can lead to instability and compensatory motions as most commercially available prosthetic feet do not permit automatic slope adjustments. A selection of slope-adaptive ankle-feet (SAAF) has been developed to promote biomimetic ankle motion while ambulating over slopes. This review evaluated the current literature to assess the effects of SAAF prostheses on sloped gait performance in unilateral transtibial prosthesis users. Methods: Four databases (PubMed, Embase, CINAHL, IEEE Xplore) were searched on April 28, 2022, for relevant articles. Search keywords covered the general terms “transtibial,” “amputation,” “slope,” “adaptive,” and “gait,” and included articles comparing an SAAF prosthesis to a non-SAAF prosthesis condition. Data were extracted for analysis, and results were grouped according to outcomes to identify trends and aid interpretation of slope adaptation effects on gait. Results: Of the 672 articles screened, 24 met the selection criteria and were included in this review, published between 2009 and 2022. The non-SAAF condition included dynamic response feet and SAAF prostheses with the adaptability function inactive. Outcomes included biomechanical variables (joint dynamics, gait symmetry, toe clearance), clinical outcome measures, and energy expenditure. All SAAF demonstrated some form of foot-ankle slope gradient adaptability, but effects on other joint dynamics were inconsistent. Minimum toe clearance during incline and decline walking was greater when using SAAF compared with non-SAAF in all reporting studies. Conclusions: Results generally suggest improvements in gait quality, comfort, and safety with use of SAAF compared with non-SAAF during sloped walking. However, variations in tested SAAF and walking gradients across studies highlight the need for research to elucidate walking condition effects and advantages of specific designs [ABSTRACT FROM AUTHOR]

Increasing step rate has been proposed to reduce overuse injury risk in runners by reducing the magnitude of musculoskeletal loading. Although estimating structure-specific loads is challenging, during level running, changes in a runner's vertical ground reaction force (vGRF) may provide insight to changes in their musculoskeletal loading. Further, vGRF can be approximated using force sensing insoles. Purpose: The primary goal of this study was to examine changes in peak insole force and cumulative weighted peak force (CWPF)/km with increased step rate in collegiate runners. The secondary goal was to determine whether sacral acceleration correlates with insole force when increasing step rate. Methods: Twelve collegiate distance runners ran 1000 m outdoors at 3.83 m⋅s-1 at preferred and 10% increased step rates while insole force and sacral acceleration were recorded. Cumulative weighted peak force/km was calculated from insole force based on cumulative damage models. The effects of step rate on peak insole force and CWPF⋅km-1 were tested using paired t tests or Wilcoxon tests. Correlation coefficients between peak axial (approximately vertical) sacral acceleration times body mass and peak insole force were calculated on cohort and individual levels. Results: Peak insole force and CWPF⋅km-1 decreased (P < 0.001) with increased step rate. Peak axial sacral acceleration did not correlate with peak insole force on the cohort level (r = 0.3 5, P = 0.109) but did within individuals (mean, r = 0.69-0.78; P < 0.05). Conclusions: Increasing step rate may reduce peak vGRF and CWPF⋅km-1 in collegiate runners. Therefore, clinicians should consider step rate interventions to reduce peak and cumulative vGRF in this population. Individual-specific calibrations may be required to assess changes in peak vGRF in response to increasing step rate using wearable accelerometers. [ABSTRACT FROM AUTHOR]

Purpose: Hip and knee arthroplasty aims to reduce joint pain and increase functional mobility in patients with osteoarthritis; however, the degree to which arthroplasty is associated with higher physical activity is unclear. The current study sought to assess the association of hip and knee arthroplasty with objectively measured physical activity. Methods: This cross-sectional study analyzed wrist-worn accelerometer data collected in 2013-2016 from UK Biobank participants (aged 43-78 yr). Multivariable linear regression was performed to assess step count, cadence, overall acceleration, and activity behaviors between nonarthritic controls, end-stage arthritic, and postoperative cohorts, controlling for demographic and behavioral confounders. From a cohort of 94,707 participants with valid accelerometer wear time and complete self-reported data, electronic health records were used to identify 3506 participants having undergone primary or revision hip or knee arthroplasty and 68,389 nonarthritic controls. Results: End-stage hip or knee arthritis was associated with taking 1129 fewer steps per day (95% confidence interval (CI), 811-1447; P < 0.001) and having 5.8 fewer minutes per day (95% CI, 3.0-8.7; P < 0.001) of moderate-to-vigorous activity compared with nonarthritic controls. Unilateral primary hip and knee arthroplasties were associated with 877 (95% CI, 284-1471; P = 0.004) and 893 (95% CI, 232-1554; P = 0.008) more steps than end-stage osteoarthritic participants, respectively. Postoperative unilateral hip arthroplasty participants demonstrated levels of moderate-to-vigorous physical activity and daily step count equivalent to nonarthritic controls. No difference in physical activity was observed between any cohorts in terms of overall acceleration, or time spent in daily light activity, sedentary behavior, or sleep. Conclusions: Hip and knee arthroplasties are associated with higher levels of physical activity compared with participants with end-stage arthritis. Unilateral hip arthroplasty patients, in particular, demonstrate equivalence to nonarthritic peers at more than 1 yr after surgery. [ABSTRACT FROM AUTHOR]

Welwalk is a one-leg robotic-assisted gait system for stroke hemiplegic patients. This study examined the feasibility and efficacy of gait training using Welwalk (Welwalk training) for hemiplegic patients in the early phase after stroke onset, via cooperation between acute care and rehabilitation hospitals. Seven acute stroke patients (mean number of days fromonset = 7.9) with severe lower extremity paralysis participated. Patients underwent Welwalk training for 40 min/d, 5 d/wk in an acute care hospital, then 7 d/wk in a rehabilitation hospital with a seamless transition. Functional IndependenceMeasure scores for walking were assessed weekly. The endpoint was reaching Functional Independence Measurewalk score of 5 (supervision level). The primary outcomewas improvement efficiency of Functional IndependenceMeasure walk, which was the increase in Functional IndependenceMeasure walk score divided by the number of weeks required. Functional Independence Measure walk score for all patients improved from 1.1 to 5 (P = 0.01, r = 0.96). The mean number of weeks to achieve Functional Independence Measure walk score of 5 was 5 wks, and the improvement efficiency of Functional Independence Measure walk had a mean value of 0.9. No adverse events were reported duringWelwalk training. Hemiparetic patients' gait independence may be safely and rapidly improved by startingWelwalk training in the early phase after stroke onset. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to verify the effects of a 3-mo dual-task training on motor and cognitive functions in community-dwelling older adults. Design: In this prospective, single-blinded, controlled clinical trial, a total of 40 participants were allocated to either the experimental or the control (no-exercise) group. The intervention program consisted of a combination of motor and cognitive exercises conducted twice a week on nonconsecutive days. The main outcome measures were postural stability, mobility, fear of falling, and cognitive functions. Multiple analyses of variancewere used to assess the impact of the dual-task training. Effect sizes (η²p) were reported. Significance was set at 5%. Results: Compared with the control group, participants who underwent the dual-task training showed positive outcomes in terms of postural stability (η²p = 0.298, P = 0.020), mobility (η²p = 0.285, P = 0.003), and cognitive functions (η²p = 0.536, P = 0.001). No significant differences were observed between the groups in terms of the fear of falling (P = 0.566). Conclusions: Three-month dual-task training was beneficial for postural control, mobility, and cognitive functions in community-dwelling older adults. Based on the present findings, healthcare professionals should consider incorporating dual-task training into clinical practice. [ABSTRACT FROM AUTHOR]

Running economy is a key component of distance running performance and is associated with gait parameters. However, there is no consensus of the link between the running economy (RE), ground contact time, and footstrike patterns. Thus, this study aimed to clarify the relationship between RE, ground contact time, and thigh muscle cross-sectional area (CSA) in highly trained distance runners and to compare these parameters between 2 habitual footstrike patterns (midfoot vs. rearfoot). Seventeen male distance runners ran on a treadmill to measure RE and gait parameters. We collected the CSAs of the right thigh muscle using a magnetic resonance imaging scanner. The RE had a significant negative relationship with distance running performance (r = -0.50) and ground contact time (r = -0.51). The ground contact time had a significant negative relationship with the normalized CSAs of the vastus lateralis muscle (r = -0.60) and hamstrings (r = -0.54). No significant differences were found in RE, ground contact time, or normalized CSAs of muscles between midfoot (n = 10) and rearfoot (n = 7) strikers. These results suggest that large CSAs of knee extensor muscles results in short ground contact time and worse RE. The effects of the footstrike pattern on the RE appear insignificant, and the preferred footstrike pattern can be recommended for running in highly trained runners. [ABSTRACT FROM AUTHOR]

Introduction: To determine the optimum prescription and dosage for an ankle-foot orthosis and footwear, clinicians and families need to agree on goals for intervention. To facilitate family-centered collaborative goal setting, a table of potential goals and its pictorial representation had been developed previously. These tools incorporated the International Classification of Functioning, Disability, and Health (ICF) and International Organization for Standardization (ISO) clinical objectives for orthoses and were structured in an approach understandable to families. This study aimed to obtain consensus on the content validity of the Table and Pictorial Tools. Methods: Seventeen experts from seven countries (orthotists, physical therapists, physicians, surgeons, and engineers) were invited. A modified Delphi technique was used to evaluate and refine the Table Tool (rounds 1 and 2) and Pictorial Tool (rounds 3 and 4). Participants rated their agreement with overall tool structure, content, and feasibility of use on a 4-point Likert scale, and provided open-ended feedback. Consensus was defined as a median score ≥3 (agree) with 75% of responses ≥3. Data were collected using REDCap. After each round, thematic analysis guided document revisions and anonymized feedback. Results: Ten experts from four countries completed the study. Round 1 (Table Tool): median ratings were all 3; consensus was achieved for 3/5 questions. Round 2: full consensus was achieved. Round 3 (Pictorial Tool): median ratings were ≥3 for 10/11 questions; consensus was achieved for 4/11 questions. Round 4: full consensus was achieved. Conclusions: The content validity for the Table and Pictorial Tools was established by modified Delphi consensus. These tools represent a comprehensive selection of goals across all ICF components. Clinical Relevance: These novel tools have the potential to facilitate collaborative goal setting between families and clinicians and aid clinical education. A goal-setting framework specific to orthotic management may improve outcomes within the context of family-centered care. [ABSTRACT FROM AUTHOR]

Introduction: Modular prosthetic ankle components have been shown to improve walking in transtibial prosthesis users, but they may reduce stability during standing. Therefore, the stiffness of the prosthetic foot-ankle components may need to be appropriately tuned to provide a balance between walking mobility and standing balance. The present research investigates both concepts to improve our knowledge about how prosthetic ankle stiffness influences standing and walking performance. Methods: Ten individuals with unilateral transtibial amputation and categorized as minimum K3-level ambulators participated. Standing balance and gait analyses at three self-selected speeds were performed at three different levels of ankle dorsiflexion stiffness (Soft, Medium, and Firm) using the College Park Venture foot (College Park Industries, Warren, MI, USA). Repeated-measures analyses of variance (ANOVAs) were performed on relevant standing balance, gait spatiotemporal, and roll-over shape (ROS) outcomes. Gait kinetic and kinematic data were analyzed using a one-dimension statistical parametric analysis. Results: Ankle dorsiflexion stiffness influenced balance and gait. Overall, the Firm dorsiflexion stiffness provided a smaller body sway on standing balance, a ROS radius close to the one of able-bodied individuals, and reduced step length asymmetry while walking. Furthermore, walking speed had an influence on ROS radii, resulting in a larger radius for slow walking speeds and a smaller one for fast walking speeds. Discussion: The Firm stiffness appeared to offer the most advantages for balance and gait. The radius of ROS under the Firm condition, close to the radius of able-bodied individuals, could have caused the improvement in step length symmetry by a greater progression of the center of pressure, resulting in further progression of the prosthetic side. This information, in addition to the observed walking speed effect on ROS radii, encourages us to develop studies to examine the effect of walking speed on foot performance and improve prosthetic foot design to maintain the same gait characteristics under different walking speeds. Clinical Relevance: These results improve our understanding of how a specific prosthetic ankle dorsiflexion stiffness affects standing balance and gait, which supports the prosthetist's evaluation process to determine specific individual stiffness for each prosthesis user. [ABSTRACT FROM AUTHOR]

Introduction: Ankle-foot orthoses (AFOs) are devices used to control the position and motion of the ankle and foot, so a safe and more efficient gait pattern results for people with lower-limb dysfunction. To provide the ankle and foot control, an AFO is typically made of hard plastic material. Research has shown that discomfort, difficulty using the device, or perceived lack of walking improvement results in low adherence to AFO use. The purpose of this study was to investigate an AFO made of a more flexible material to see if these drawbacks are improved. Methods: Participants with a wide range of neurologic and musculoskeletal pathologies were issued a flexible AFO (FAFO). Performance and satisfaction data were collected at baseline, 2-week, and 3-month time points. Data collection included measures of balance (Berg Balance Scale) and temporal and spatial gait parameters (collected via the GAITRite Walkway System). Walking endurance was measured with the 6-minute walk test. Patient satisfaction was investigated using the Orthotic and Prosthetic User Satisfaction Survey (OPUS). Wearing adherence was measured as a percentage of the number of hours of wearing the FAFO per day. Results: Statistical analysis using a paired t -test showed improvement was found from baseline to 2 weeks for balance and gait parameters of normalized velocity, double-limb support, and the Functional Ambulation Profile. These improvements were maintained at the 3-month follow-up. No improvement was found in patient satisfaction or walking endurance. Wearing adherence (number of hours per day) was found to be at the highest level of traditional AFO adherence-reported prior research. Conclusions: This study found sufficient evidence to indicate the FAFO may be a feasible alternative to traditional hard material AFOs. Experimental trials comparing the FAFO to known gait improvements of currently accepted/traditional AFOs are needed. Clinical Relevance: The FAFO investigated in this study provides beginning support for the feasibility of using ethylene-vinyl acetate thermoplastic as the sole material (coupled with the FAFO strapping system) for manufacturing an AFO. If further investigation confirms our findings, the FAFO can provide patients and orthotists another option to materials currently used in the manufacturing of an AFO. [ABSTRACT FROM AUTHOR]

Purpose: Less physical activity has been associated with systemic biomarkers of cartilage breakdown after anterior cruciate ligament reconstruction (ACLR). However, previous research lacks analysis of deleterious cartilage compositional changes and objective physical activity after ACLR. The purpose of this study was to determine the association between physical activity quantified via accelerometer-based measures of daily steps and time in moderate-to-vigorous physical activity (MVPA), and T1rho magnetic resonance imaging (MRI) of the femoral articular cartilage, a marker of proteoglycan density in individuals with ACLR. Methods: Daily steps and MVPA were assessed over 7 d using an accelerometer worn on the hip in 26 individuals between 6 and 12 months after primary unilateral ACLR. Resting T1rho MRI was collected bilaterally, and T1rho MRI interlimb ratios (ILR: ACLR limb/contralateral limb) were calculated for lateral and medial femoral condyle regions of interest. We conducted univariate linear regression analyses to determine associations between T1rho MRI ILRs and daily steps and MVPA with and without controlling for sex. Results: Greater T1rho MRI ILR of the central lateral femoral condyle, indicative of less proteoglycan density in the ACLR limb, was associated with greater time in MVPA (R 2 = 0.178, P = 0.032). Sex-adjusted models showed significant interaction terms between daily steps and sex in the anterior (P = 0.025), central (P = 0.002), and posterior (P = 0.002) medial femoral condyle. Conclusions: Lesser physical activity may be a risk factor for maintaining cartilage health after ACLR; additionally, the relationship between physical activity and cartilage health may be different between males and females. [ABSTRACT FROM AUTHOR]

Aberrant gait biomechanics in individuals with anterior cruciate ligament reconstruction (ACLR) are linked to posttraumatic osteoarthritis (PTOA) development, indicating a need to normalize gait biomechanics to prevent PTOA. Anterior cruciate ligament reconstruction individuals walk slower than uninjured controls and slower speeds are associated with aberrant gait biomechanics. Yet, it is unclear if increasing walking speed normalizes gait biomechanics post-ACLR. Purpose: To determine the effect of acutely increasing walking speed on gait biomechanics in ACLR individuals compared with their habitual speed and uninjured matched-controls. Methods: Gait biomechanics were collected on 30 ACLR individuals (20 females; age, 22.0 ± 4.2 yr; body mass index, 24.0 ± 3.0 kg·m−2) at their habitual speed and at 1.3 m·s−1, a speed similar to controls, and 30 uninjured matched-controls (age: 21.9 ± 3.8, body mass index: 23.6 ± 2.5) at their habitual speed. Functional waveform analyses compared biomechanics between: i) walking at habitual speed vs 1.3 m·s−1 in ACLR individuals; and ii) ACLR individuals at 1.3 m·s−1 vs controls. Results: In the ACLR group, there were no statistically significant biomechanical differences between walking at habitual speed (1.18 ± 0.12 m·s−1) and 1.3 m·s−1 (1.29 ± 0.05 m·s−1). Compared with controls (habitual speed: 1.34 ± 0.12 m·s−1), the ACLR group while walking at 1.3 m·s−1 exhibited smaller vertical ground reaction force (vGRF) during early and late stance (13–28, 78–90% stance phase), greater midstance vGRF (47–61%), smaller early-to-midstance knee flexion angle (KFA; 1–44%), greater mid-to-late stance KFA (68–73, 96–101%), greater internal knee abduction moment (69–101%), and smaller internal knee extension moment (4–51, 88–96%). Conclusions: Increasing walking speed to a speed similar to uninjured controls did not elicit significant changes to gait biomechanics, and ACLR individuals continued to demonstrate biomechanical profiles that are associated with PTOA development and differ from controls. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to assess the effects of leg length discrepancy on paraspinal muscle activity and kinematic variables during gait. Design: Thirty-nine healthy participants aged 5–12 yrs performed the 10-m walk test using the surface electromyography and G-walk sensor for the following conditions: (1) non–leg length discrepancy condition (leg length discrepancy 0 cm) and (2) leg length discrepancy condition with an insole on the right leg at three different heights (leg length discrepancy 0.5 cm, 1.0 cm, and 1.5 cm). The root mean square was normalized using maximal voluntary contraction and reference voluntary contraction methods (RMS_MVC and RMS_ref) and compared between the sides. Results: The mean RMS_MVC of the 12th thoracic erector spinae on the right side was significantly higher at a leg length discrepancy 0.5 cm and 1 cm. Regarding the 3rd lumbar multifidus, the mean RMS_MVC on the right side was significantly higher at a leg length discrepancy 1.5 cm. The mean RMS_ref exhibited similar patterns. Pelvic obliquity and rotation showed asymmetry at a leg length discrepancy 1.5 cm compared with a leg length discrepancy 0 cm. Conclusions: A small leg length discrepancy significantly affected the asymmetric hyperactivation of the 3rd lumbar multifidus and 12th thoracic erector spinae muscles during gait. Considering the action of these muscles, asymmetric hyperactivation might result in rotation and bending of the lumbar spine and the bending of the thoracolumbar spine. [ABSTRACT FROM AUTHOR]

Horsley, BJ, Tofari, PJ, Halson, SL, Kemp, JG, Chalkley, D, Cole, MH, Johnston, RD, and Cormack, SJ. Validity and reliability of thoracic-mounted inertial measurement units to derive gait characteristics during running. J Strength Cond Res 38(2): 274-282, 2024--Inertial measurement units (IMUs) attached to the tibia or lumbar spine can be used to analyze running gait but, with teamsports, are often contained in global navigation satellite system (GNSS) units worn on the thoracic spine. We assessed the validity and reliability of thoracic-mounted IMUs to derive gait characteristics, including peak vertical ground reaction force (vGRFpeak) and vertical stiffness (Kvert). Sixteen recreationally active subjects performed 40 m run throughs at 3-4, 5-6, and 7-8 m·s21. Inertial measurement units were attached to the tibia, lumbar, and thoracic spine, whereas 2 GNSS units were also worn on the thoracic spine. Initial contact (IC) from a validated algorithm was evaluated with F1 score and agreement (mean difference 6SD) of gait data with the tibia and lumbar spine using nonparametric limits of agreement (LoA). Test-retest error {coefficient of variation, CV (95% confidence interval [CI])} established reliability. Thoracic IMUs detected a nearly perfect proportion (F1 $ 0.95) of IC events compared with tibia and lumbar sites. Step length had the strongest agreement (0 6 0.04 m) at 3-4 m·s21, whereas contact time improved from 3 to 4 (20.02860.018 second) to 7-8m·s21 (20.00460.013 second). All values for Kvert fell within the LoA at 7-8 m·s21. Test-retest error was #12.8% for all gait characteristics obtained from GNSS units, where Kvert was most reliable at 3-4 m·s21 (6.8% [5.2, 9.6]) and vGRFpeak at 7-8m·s21 (3.7% [2.5, 5.2]). The thoracic-spine site is suitable to derive gait characteristics, including Kvert, from IMUs within GNSS units, eliminating the need for additional sensors to analyze running gait. [ABSTRACT FROM AUTHOR]

The article focuses on the prevention and management of falls in older adults in primary care settings. Topics include the importance of screening for fall risk using validated tools such as Stay Independent and the Three Key Questions, assessing modifiable risk factors such as medication use and orthostatic blood pressure, and implementing interventions recommended by the Centers for Disease Control and Prevention (CDC)'s STEADI initiative to reduce fall risks among older adults.

Comparative Analysis of ActiGraph Step Counting Methods in Adults: A Systematic Literature Review and Meta-Analysis. Med. Sci. Sports Exerc., Vol. 56, No. 1, pp. 53-62, 2024. Purpose: The primary aim of this study was to compare steps per day across ActiGraph models, wear locations, and filtering methods. A secondary aim was to compare ActiGraph steps per day to those estimated by the ankle-worn StepWatch. Methods: We conducted a systematic literature review to identify studies of adults published before May 12, 2022, that compared free-living steps per day of ActiGraph step counting methods and studies that compared ActiGraph to StepWatch. Random-effects meta-analysis compared ActiGraph models, wear locations, filter mechanisms, and ActiGraph to StepWatch steps per day. A sensitivity analysis of wear location by younger and older age was included. Results: Twelve studies, with 46 comparisons, were identified.When worn on the hip, the AM-7164 recorded 123% of the GT series steps (no low-frequency extension (no LFE) or default filter). However, the AM-7164 recorded 72% of the GT series steps when the LFE was enabled. Independent of the filter used (i.e., LFE, no LFE), ActiGraph GT series monitors captured more steps on the wrist than on the hip, especially among older adults. Enabling the LFE on the GT series monitors consistently recorded more steps, regardless of wear location. When using the default filter (no LFE), ActiGraph recorded fewer steps than StepWatch (ActiGraph on hip 73% and ActiGraph on wrist 97% of StepWatch steps). When LFE was enabled, ActiGraph recorded more steps than StepWatch (ActiGraph on the hip, 132%; ActiGraph on the wrist, 178% of StepWatch steps). Conclusions: The choice of ActiGraph model, wear location, and filter all impacted steps per day in adults. These can markedly alter the steps recorded compared with a criterion method (StepWatch). This review provides critical insights for comparing studies using different ActiGraph step counting methods. [ABSTRACT FROM AUTHOR]

The Effect of Exercise on a Novel Dual-Task Assessment for Sport Concussion. Med. Sci. Sports Exerc., Vol. 56, No. 1, pp. 22-28, 2024. Purpose: This study aimed to determine the effect of exercise on cognitive and motor performance and the subsequent test–retest reliability of a novel dual-task (DT) assessment in nonconcussed college students. Methods: Sixty nonconcussed college students (53.3% female) with an average age (±SD) of 20.5 ± 1.34 yr, height of 171.7 ± 9.33 cm, and massof 69.3 ± 12.23 kg were included in the study. Participants were assigned to an exercise (n = 30) or rest (n = 30) intervention group and completed two study visits that were separated by a 2-wk test–retest interval. At each visit, participants completed a novel DT assessment that consisted of the concurrent administration of the Standardized Assessment of Concussion (SAC) and tandem gait (TG) before the exercise or rest intervention. After the DT assessment at the first visit, participants in the exercise group performed moderate-intensity exercise, whereas the rest group sat quietly for 30 min. After the intervention, both groups were readministered the DT assessment. At the second visit, the same procedures were followed, except that each group was administered the opposite intervention (e.g., the exercise group completed the rest intervention). A composite TG (cTG) score was calculated by summing the average time to complete the TG pattern during each SAC domain (immediate memory, digits backwards, months in reverse order, delayed recall). An ANCOVA was conducted to assess postintervention differences while controlling for preintervention performance. Test–retest reliability was assessed using intraclass correlation coefficients (ICC3,2) with 95% confidence intervals, with all analyses performed with α = 0.05. Results: SAC and cTG performance was similar (P values > 0.05) from preintervention to postintervention for the rest or exercise protocols. Good (rest: ICC = 0.77 (0.62–0.87); exercise: ICC = 0.84 (0.73–0.90)) and excellent (rest: ICC = 0.97 (0.94–0.98); exercise: ICC = 0.93 (0.88–0.96)) test–retest reliabilities were observed for the SAC composite score and cTG score, respectively. Conclusions: Our DT assessment was robust to the influence of moderate-intensity exercise and demonstrated good-to-excellent test–retest reliability in a healthy collegiate sample. [ABSTRACT FROM AUTHOR]

Introduction: Ankle-foot orthosis (AFO) and functional electrical stimulation (FES) are commonly used interventions for patients with foot drop caused by a central neurological origin. The aimof this systematic review is to analyze the available evidence on the improvement of gait endurance in people with foot drop caused by a central neurological origin when comparing effectiveness of AFO and FES. The secondary aim is to evaluate the available evidence for the difference between the use of FES and AFO on perception of walking function. Methods: A literature search was conducted using MEDLINE/PubMed, Cochrane, JBI, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, Scopus, and Web of Science. All articles published through July 2020 were included in this review. Randomized control trials or crossover trials addressing the comparison of AFO to FES in people with foot drop of central neurological origin on gait endurance and perception of improvement in walking function were assessed. PEDro scale was used to assess methodological quality. Two independent reviewers screened titles, abstracts, and full articles, and a third reviewer resolved any disagreements. Results: Twenty-five records were screened with 16 full-text articles assessed for eligibility using the PEDro score. Eleven final studies (PEDro scores range from 5 to 7) were included in qualitative analysis. Only two of the nine studies that evaluated gait endurance reported significant improvement in gait endurance in favor of FES. Seven of the eight studies evaluated the participant preference of device for various walking functions, which showed significance in favor of the use of FES. Conclusions: Our review reveals inconclusive evidence to support the use of FES compared with AFO for improving gait endurance. However, qualitative analysis of device preference for walking by participants reveals that FES was the preferred device in this population compared with AFO. Clinical Relevance: For patients with foot drop of central nervous system pathology, FES or AFO can be used to improve gait endurance. However, FES may be the preferred device by participants for their walking function. [ABSTRACT FROM AUTHOR]

Improving independent mobility in people with various gait abnormalities is a major goal of rehabilitation therapy. While quantitative gait assessment is crucial to provide meaningful feedback on each treatment, many gait wearables have been validated with the standard method. However, none of the studies focused on validation of gait characterization in different classes of the pathological population compared with the control population. Hence, a novel wearable device called Gait Watch, worn on both the lower limbs, to estimate spatiotemporal and kinematic parameters of heterogeneous gait-impaired groups has been evaluated and its outcomes have been statistically analyzed. This article presents a statistical validation of gait dynamics of the control group and patients diagnosed with cerebral vascular accident, traumatic brain injury, peripheral nervous system, psychiatric issues, and seizures. Using the preliminary analysis results, a set of descriptive variables that allow for disease differentiation was selected to provide appropriate treatment to patients with various ailments and enhance their gait quality. The extraction of clinically significant gait parameters of interest using proposed Gait Watch would ascertain various neurological conditions as well as accurately quantify the extent of the difference in various gait parameters in subjects with different gait conditions when compared with the control group. [ABSTRACT FROM AUTHOR]

Frailty, a geriatric syndrome of growing importance in recent years, has been shown to be associated with increased risk of disability and adverse health and socioeconomic outcomes. Therefore, there is a need for new educational strategies for physical medicine and rehabilitation residents to promote greater geriatric competencies, with a focus on developing customized evaluation and management plans. With this article, the aim is offering a quick reference tool summarizing the latest evidence on the rehabilitative management of frailty. Indeed, a comprehensive geriatric evaluation is needed before developing an evidence-based and individually tailored rehabilitation program including physical activity, educative strategies, nutritional interventions, and proposals for social reintegration. in the future, appropriate educational training may allow a more careful management of these patients, with consequent improvements in quality of life and functionality. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore correlations between spasticity and motor impairments in the upper and lower limbs in ambulatory chronic stroke survivors. Design: We performed clinical assessments in 28 ambulatory chronic stroke survivors with spastic hemiplegia (female: 12; male: 16; mean ages = 57.8 ±11.8 yrs; 76 ± 45 mos after stroke). Results: In the upper limb, spasticity index and Fugl-Meyer Motor Assessment showed a significant correlation. spasticity index for the upper limb showed a significant negative correlation with handgrip strength of the affected side (r = -0.4, P = 0.035) while Fugl-Meyer Motor Assessment for the upper limb had a significant positive correlation (r = 0.77, P < 0.001). In the LL, no correlation was found between SI&lowbar;LL and FMA&lowbar;LL. There was a significant and high correlation between timed up and go test and gait speed (r = 0.93, P < 0.001). Gait speed was positively correlated with Spasticity index for the lower limb (r = 0.48, P = 0.01), and negatively correlated with Fugl-Meyer Motor Assessment for the lower limb (r = -0.57, P = 0.002). Age and time since stroke showed no association in analyses for both upper limb and lower limb. Conclusions: Spasticity has a negative correlation on motor impairment in the upper limb but not in the lower limb. Motor impairment was significantly correlated with grip strength in the upper limb and gait performance in the lower limb of ambulatory stroke survivors. [ABSTRACT FROM AUTHOR]

Introduction: Flexible flatfeet are commonly treated with functional foot orthoses (FFOs) and University of California Berkeley Laboratory (UCBL) designs. This study sought to evaluate the immediate effects of low-profile FFOs and high-profile UCBL orthoses on Foot Posture Index (FPI), spatiotemportalmeasures of gait, and perceived comfort and compliance in adults with flexible flatfeet. Materials and Methods: Fourteen individuals with self-reported asymptomatic flexible flatfeet participated in this randomized cross-sectional study. Custom FFOs and UCBL orthoses were fabricated for each participant, who then walked at a self-selected speed in each condition on a Zeno Mat. Foot Posture Index, perceived comfort and compliance, and spatiotemporal parameters were collected across conditions. Results: There were no significant differences in velocity, cadence, step length, stride width, toe-in/toe-out, or stance center of pressure distance percentage. Stance phase duration significantly increased from baseline to UCBL condition. There was a statistically significant decrease bilaterally in FPI from baseline to FFO and from baseline to UCBL orthosis, but not between FFO and UCBL orthosis. There were no significant differences in comfort and compliance ratings between FFOs and UCBL orthoses. Conclusions:With regard to immediate effects, both the UCBL and FFO designs improve foot posture without significant impact on spatiotemporal gait patterns or perceived comfort and compliance. Additional research is needed to determine the longevity of these effects. Clinical Relevance: The results of this study support the use of both FFOs and UCBL orthoses when trying to provide foot posture correction for adults with asymptomatic flexible flatfeet. [ABSTRACT FROM AUTHOR]

Introduction: This article systematically reviews the reliability and validity of balance and gait outcome measures obtained by teleassessment in older adults. Methods: Two reviewers searched electronic databases for articles published from 2010 to 2022. Included studies were appraised for quality. Results: Six articles were reviewed. Reliability was found to be low to good, and validity was acceptable, with some concerns with bias during testing. Discussion: There is evidence to support the use of certain balance and gait outcome measures in teleassessment of the older adult population if the individuals have appropriate electronic devices for telecommunication, good Internet connectivity, and adequate technological knowledge. [ABSTRACT FROM AUTHOR]

Purpose: Exercise and physical activity are recommended to reduce pain and improve joint function in patients with knee osteoarthritis (OA). However, exercise has dose effects, with excessive exercise accelerating OA development and sedentary behaviors also promoting OA development. Prior work evaluating exercise in preclinical models has typically used prescribed exercise regimens; however, in-cage voluntary wheel running creates opportunities to evaluate how OA progression affects self-selected physical activity levels. This study aimed to evaluate how voluntary wheel running after a surgically induced meniscal injury affects gait characteristics and joint remodeling in C57Bl/6 mice. We hypothesize that injured mice will reduce physical activity levels as OA develops after meniscal injury and will engage in wheel running to a lesser extent than the uninjured animals. Methods: Seventy-two C57Bl/6 mice were divided into experimental groups based on sex, lifestyle (physically active vs sedentary), and surgery (meniscal injury or sham control). Voluntary wheel running data were continuously collected throughout the study, and gait data were collected at 3, 7, 11, and 15 wk after surgery. At end point, joints were processed for histology to assess cartilage damage. Results: After meniscal injury, physically active mice showed more severe joint damage relative to sedentary mice. Nevertheless, injured mice engaged in voluntary wheel running at the same rates and distances as mice with sham surgery. In addition, physically active mice and sedentary mice both developed a limp as meniscal injury progressed, yet exercise did not further exacerbate gait changes in the physically active mice, despite worsened joint damage. Conclusions: Taken together, these data indicate a discordance between structural joint damage and joint function. Although wheel running after meniscal injury did worsen OA-related joint damage, physical activity did not necessarily inhibit or worsen OA-related joint dysfunction or pain in mice. [ABSTRACT FROM AUTHOR]

Purpose: Patellofemoral pain syndrome and patellar tendinopathy are important running-related overuse injuries. This study investigated the interaction of running speed and step frequency alterations on peak and cumulative patellofemoral joint stress (PFJS) and patellar tendon force (PTF) parameters. Methods: Twelve healthy individuals completed an incremental running speed protocol on a treadmill at habitual, increased and decreased step frequency. Peak PFJS and PTF, peak rate of PFJS and PTF development, and PFJS and PTF impulse per kilometer (km) were calculated using musculoskeletal modeling. Results: With increasing running speed, peak PFJS (P < 0.001) and PTF (P < 0.001) and peak rate of PFJS (P < 0.001) and PTF (P < 0.001) development increased, whereas PFJS (P < 0.001) and PTF (P < 0.001) impulse per km decreased. While increasing step frequency by 10%, the peak PFJS (P < 0.001) and PTF (P < 0.001) and the PFJS (P < 0.001) and PTF (P < 0.001) impulse per kilometer decreased. No significant effect of step frequency alteration was found for the peak rate of PFJS (P = 0.008) and PTF (P = 0.213) development. A significant interaction effect was found for PFJS (P <0.001) and PTF (P <0.001) impulse per km, suggesting that step frequency alteration was more effective at low running speed. Conclusions: The effectiveness of step frequency alteration on PFJS and PTF impulse per km is dependent on the running speed. With regard to peak PFJS and PTF, step frequency alteration is equally effective at low and high running speeds. Step frequency alteration was not effective for peak rate of PFJS and PTF development. These findings can assist the optimization of patellofemoral joint and patellar tendon load management strategies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to determine the effects of bilateral trunk support during walking on trunk and leg kinematics and neuromuscular responses in children with cerebral palsy. Design: Fourteen children with spastic cerebral palsy (Gross Motor Function Classification System level I to III) participated in this study. Children walked on a treadmill under four different conditions, that is, without support (Baseline), with bilateral support applied to the upper trunk (upper trunk support), the lower trunk (lower trunk support), and combined upper and lower trunk (combined trunk support). The trunk and leg kinematics and muscle activity were recorded. Results: Providing bilateral support to the trunk had a significant impact on the displacement of the pelvis and trunk (P < 0.003) during walking. Children's weaker leg showed greater step length (P = 0.032) and step height (P = 0.012) in combined trunk support compared with baseline and greater step length in upper trunk support (P = 0.02) and combined trunk support (P = 0.022) compared with lower trunk support. Changes in soleus electromyographic activity during stance phase of gait mirrored the changes in step length across all conditions. Conclusions: Providing bilateral upper or combined upper and lower trunk support during walking may induce improvements in gait performance, whichmay be due to improved pelvis kinematics. Improving trunk postural control may facilitate walking in children with cerebral palsy. [ABSTRACT FROM AUTHOR]

Introduction: Aberrant gait variability has been observed after anterior cruciate ligament reconstruction (ACLR), yet it remains unknown if gait variability is associated with early changes in cartilage composition linked to osteoarthritis development. Our purpose was to determine the association between femoral articular cartilage T1ρ magnetic resonance imaging relaxation times and gait variability. Methods: T1ρ magnetic resonance imaging and gait kinematics were collected in 22 ACLR participants (13 women; 21 ± 4 yr old; 7.52 ± 1.43 months post-ACLR). Femoral articular cartilage from the ACLR and uninjured limbs were segmented into anterior, central, and posterior regions from the weight-bearing portions of the medial and lateral condyles. Mean T1ρ relaxation times were extracted fromeach region and interlimb ratios (ILR) were calculated (i.e.,ACLR/uninjured limb). Greater T1ρ ILR values were interpreted as less proteoglycan density (worse cartilage composition) in the injured limb compared with the uninjured limb. Knee kinematics were collected at a self-selected comfortable walking speed on a treadmill with an eight-camera three-dimensional motion capture system. Frontal and sagittal plane kinematics were extracted, and sample entropy was used to calculate kinematic variability structure (KVstructure). Pearson's product-moment correlations were conducted to determine the associations between T1ρ and KVstructure variables. Results: Lesser frontal plane KVstructure was associated with greater mean T1ρ ILR in the anterior lateral (r = -0.44, P = 0.04) and anterior medial condyles (r = -0.47, P = 0.03). Lesser sagittal plane KVstructure was associated with greater mean T1ρ ILR in the anterior lateral condyle (r = -0.47, P = 0.03). Conclusions: The association between less KVstructure and worse femoral articular cartilage proteoglycan density suggests a link between less variable knee kinematics and deleterious changes joint tissue changes. The findings suggest that less knee kinematic variability structure is a mechanism linking aberrant gait to early osteoarthritis development. [ABSTRACT FROM AUTHOR]

Purpose: In a cross-sectional sample of US Hispanic/Latino adults, we aimed to describe step-based metric distributions, estimate their associations with activity counts and self-report, and calibrate step-based translations of current (2018) US physical activity (PA) guidelines, that is, ≥150 min·wk-1 moderate-to-vigorous PA (MVPA) from accelerometer counts and self-report. Methods: The Hispanic Community Health Study/Study of Latinos enrolled 16,415 Hispanic/Latino adults 18-74 yr from four US cities (2008-2011). Participants completed the Global PA Questionnaire and 1 wk of Actical accelerometer wear (n = 12,528). Weighted medians were used to describe step-based metrics, and Spearman correlations estimated their relationships with count-based and self-reported PA indicators. Receiver operator characteristic curve analyses were used to examine the ability of each step-basedmetric to classify participantsmeeting PAguidelines. Results: Overall, US Hispanic/Latino adults accumulated medians of 6770 steps per day and 6, 18, 236, and 630 min·d-1 at ≥100, ≥70, 1-69, and 0 steps perminute, respectively. Count-based time inMVPA, light PA, and sedentary behavior weremost strongly correlated (rs = 0.79-0.85) with times ≥70, 1-69, and 0 steps perminute, respectively,whereas self-reported MVPA had similar correlations with steps per day and times ≥40 and ≥70 steps per minute (rs = 0.28-0.29). Time ≥70 steps per minute had the greatest capacity to classify participants meeting PA guidelines with both measures of MVPA. Conclusions: This study provides the first normative values (based on percentiles) of step-based metrics for US Hispanic/Latino adults, which can facilitate surveillance, program planning, research, and data interpretation. Our finding that PA guidelines corresponded to 6000-7000 steps per day or ~20 min·d-1 at ≥70 steps per minute with an Actical accelerometer can be considered alongside dose-response relationships with health outcomes to develop step-based recommendations that are consistent with and better communicate PA guidelines. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed the effects of the COVID-19 pandemic restrictions/lockdowns on physical activity levels, bodymass, quadriceps strength, and gait biomechanics over 18 months. Methods: Ten healthy men were assessed at baseline (~14 wk before first lockdown) and 17.9 ± 0.3 months later (<1 wk after second lockdown). At both times, physical activity levels, body mass, and quadriceps strength were acquired using the International Physical Activity Questionnaire, a force plate, and a dynamometer, respectively. Gait data were also acquired using a motion capture system and force plates during self-paced walking, from which spatiotemporal parameters, knee angles, and externalmoments were computed. Baseline and follow-upmeasurements were compared using two-tailed paired t-tests (a = 0.05). Results: At follow-up, participants spent less time doing vigorous physical activity (Δ = -76 ± 157 min·wk-1, P = 0.048), exhibited a tendency toward increased sedentary time (Δ = +120 ± 162 min·d-1, P = 0.056), weighedmore (Δ = +2.5 ± 2.8 kg, P = 0.021), and showed a trend toward reduced quadriceps strength (Δ = -0.29 ± 0.45 (N·m)·kg-1, P = 0.071) compared with baseline. At follow-up, participants walked slower (Δ = -0.09 ± 0.07 m·s-1, P = 0.005), had greater knee flexion angles at heel strike (Δ = +2.2° ± 1.8°, P = 0.004) and during late stance (Δ = +2.2° ± 1.8°, P = 0.004), had reduced knee extension moments (Δ = -0.09 ± 0.09 (N·m)·kg-1, P = 0.012) and knee internal rotationmoments (Δ = -0.02 ± 0.02 (N·m)·kg-1, P = 0.012) during late stance. Conclusions: Healthymen exhibited reduced physical activity levels, increased body weight, a tendency toward reduced quadriceps strength, and altered gait biomechanics over the initial 18months of the COVID-19 pandemic--alterations that could have far-reaching health consequences. [ABSTRACT FROM AUTHOR]

Task-specific gait training is recommended to improve locomotor function after stroke. Our objective was to determine the effects of a forced-rate aerobic exercise intervention on gait velocity and biomechanics in the absence of task-specific gait training. Individuals with chronic stroke (N = 14) underwent 24 sessions of forced-rate aerobic exercise, at a targeted aerobic intensity of 60%–80% of their heart rate reserve. Change in comfortable walking speed in addition to spatiotemporal, kinematic, and kinetic variables were measured using three-dimensional motion capture. Overground walking capacity was measured by the 6-min walk test. To determine gait biomechanics associated with increased walking speed, spatiotemporal, kinematic, and kinetic variables were analyzed separately for those who met the minimal clinically important difference for change in gait velocity compared with those who did not. Participants demonstrated a significant increase in gait velocity from 0.61 to 0.70 m/sec (P = 0.004) and 6-min walk test distance from 272.1 to 325.1 meters (P < 0.001). Those who met the minimal clinically important difference for change in gait velocity demonstrated significantly greater improvements in spatiotemporal parameters (P = 0.041), ground reaction forces (P = 0.047), and power generation (P = 0.007) compared with those who did not. Improvements in gait velocity were accompanied by normalization of gait biomechanics. [ABSTRACT FROM AUTHOR]

The purpose of this study was to clarify what percentage of maximum speed is associated with various running gaits. Fifteen amateur field sport athletes (age = 23 ± 3.6 years) participated in a series of 55-meter running trials. The speed of each trial was determined by instructions relating to 5 previously identified gait patterns (jog, run, stride, near maximum sprint, and sprint). Each trial was filmed in slow motion (240 fps), whereas running speed was obtained using Global Positioning Systems. Contact time, stride angle, and midstance free-leg knee angle were determined from video footage. Running gaits corresponded with the following running speeds, jogging = 4.51 m·s-1, 56%Vmax, running = 5.41 m·s-1, 66%Vmax, striding = 6.37 m·s-1, 78%Vmax, near maximum sprinting = 7.08 m·s-1, 87%Vmax, and sprinting = 8.15 m·s-1, 100%Vmax. Significant (p < 0.05) increases in stride angle were observed as running speed increased. Significant (p < 0.05) decreases were observed in contact time and midstance free-leg knee angle as running speed increased. These findings suggest currently used thresholds for high-speed running (HSR) and sprinting most likely correspond with jogging and striding, which likely underestimates the true HSR demands. Therefore, a higher relative speed could be used to describe HSR and sprinting more accurately in field sports. [ABSTRACT FROM AUTHOR]

Introduction: Poliomyelitis has been considered a statutory notifiable infectious disease in Hong Kong since 1948. Approximately 15% to 80% of patients suffer from post-polio syndrome (PPS) with an increased risk of falling and chronic pain. Most of them relied on the use of knee lock-type orthoses as aids. This study aimed to evaluate the effect of using a custom-fit knee robotic orthosis on their gait performance. Materials and Methods: A case series report was used for this study on a group of individuals suffering from chronic PPS who used orthoses and had a history of falling. A knee robotic orthosis was custom-fit for eight sessions of walking practice. Assessments included laboratory gait analysis, functional measures, and subjective ratings of exertional level. Pain responses were recorded to evaluate the effect of using the knee robotic orthosis on participants' gait performance. Results: Five participants completed the study in using the knee robotic orthosis. All achieved reduction in shoulder tilting and trunk swaying movement on walking at the anterior-posterior and the medial-lateral direction. A total of 80% of the study participants achieved reduction in trunk rotation movement, lower-limb circumduction, and hip hiking movement on the affected side on walking. All study participants were able to demonstrate improvement in their gait symmetry after using the knee robotic orthosis as reflected by the symmetric index improvement of kinematics. The rate of perceived exertion and the visual analog scale of pain in all study participants were reported lower when they used the knee robotic orthosis. However, the 10-m walking time achieved was longer. Conclusions: The knee robotic orthosis had a positive effect on remediating the abnormal kinematics of PPS patients using conventional lock-knee orthosis after eight sessions of training practice. Reduction in the limping gait pattern and improvement in gait symmetry was achieved in using a knee robotic orthosis for walking. The chronic pain response and the physical exertional level on walking were also reduced. However, the walking speed achieved was slower. Clinical Relevance: The application of the knee robotic orthosis for walking assist is new to most of the PPS patients. The positive outcomes achieved merit further research for future clinical practice. [ABSTRACT FROM AUTHOR]

Background: Falls are the leading cause of injury-related death and disability in community-dwelling older adults. Local Problem: Evidence-based fall prevention activities in primary care, including nurse-facilitated wellness visits, have been limited. Barriers including patient engagement and adherence exist. Method: A quality improvement project integrating components of the Centers for Disease Control and Prevention's Stopping Elder Accidents, Deaths & Injury (STEADI) was introduced by registered nurses during older adult annual wellness visits. Intervention: Nurses assessed risk and implemented patient-centered fall prevention plans including follow-up. Results: A total of 522 patients were screened, with 21% (n = 111) having increased fall risk. Of these, 78% (n = 87) engaged in home safety, gait, strength, and balance assessments and the majority (n = 83; 95%) participated in fall prevention plans of care. At 2-week follow-up, patients' self-reported adherence was 74% for gait/strength/balance and 67% for home safety. Conclusion: An expanded primary care team model shows promise for promoting fall prevention behaviors. [ABSTRACT FROM AUTHOR]

Background: This article identifies the independent predictors of falls in an implementation study of Tai Ji Quan: Moving for Better Balance® (TJQMBB) in older adults in rural West Virginia churches. Methods: Falls and injuries were identified via calendars, questionnaire, and verbal reports. Results: Fall predictors were gait speed (odds ratio [OR]: 0.27; 95% confidence interval [CI]: 0.08-0.90); low back pain (OR: 8.04; 95% CI: 1.71-37.79); and pain, stiffness, or swelling limiting activity (OR: 2.44; 95% CI: 1.09-5.45). Conclusions: Determining differences between fallers and nonfallers may identify people with different fall risk profiles and ultimately better tailor fall prevention programming to individual needs. [ABSTRACT FROM AUTHOR]

Study Design.: Prospective cohort. Objective.: Determine if total hip arthroplasty (THA) changes lumbar spine kinematics during gait in a manner that explains the improvements in back pain seen in patients with hip-spine syndrome. Summary of Background Data.: For patients with hip-spine syndrome, improvements in both hip and back pain have been demonstrated after THA; however, the exact mechanism of improvement in back pain remains unknown, as no corresponding changes in lumbar spine static radiographic parameters have been identified. Methods.: Thirteen patients with severe, unilateral hip osteoarthritis scheduled to undergo THA with concomitant back pain and disability were tested at baseline and 6 months after THA. Harris Hip Score (HHS) and Oswestry Disability Index questionnaires were completed; the static orientation of the spine and pelvis were measured on standing radiographs, and lumbar spine kinematics were measured during treadmill walking using a validated measurement system that matched subject-specific bone models created from CT scans to dynamic biplane radiographs. Results.: After THA, both the Oswestry Disability Index (36.3–11.3, P <0.001) and Harris Hip Score (55.7–77.9, P <0.001) improved; however, there were no changes in static intervertebral or pelvis orientation. During gait after THA, the overall lumbar spine (L1 to L5) was less lordotic from heel strike to contralateral toe off (P <0.001), the L4 and L5 vertebra were less anteriorly tilted by 3.9° (P =0.038) from midstance to contralateral heel strike and by 3.9° (P =0.001) during stance, respectively. Conclusion: The decreased anterior tilt of the 2 lowest lumbar vertebrae and the corresponding loss of lumbar lordosis may reduce facet loading during the stance phase of gait after THA. This change in lumbar spine kinematics during gait is a potential mechanism to explain the observed improvements in back pain and disability after THA. Level of Evidence.: 4. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to determine the effects of motor imagery training associated with conventional rehabilitation therapies on lower limb motor function recovery in poststroke patients. Design: Comprehensive literature searches were performed to identify studies published before June 5, 2022. RevMan 5.3 software was used for meta-analysis. The quality of the included studies was assessed using the Cochrane risk-of-bias tool and the modified Jadad scale. The certainty of the evidence was evaluated with the Grading of Recommendations, Assessment, Development and Evaluations system. Result: Twenty-three trials and/or 1109 participants with motor imagery training ability were included in this review. Motor imagery training combined with conventional rehabilitation therapies versus conventional rehabilitation therapies demonstrated significant benefits in motor function, balance function, temporospatial gait variables (walking speed, stride length, and cadence) and activities of daily living. Subgroup analysis demonstrated that motor imagery training–conventional rehabilitation therapies had a better effect on improvement in motor function and activities of daily living in the acute phase and had a greater benefit on walking speed in the chronic phase. In addition, motor imagery training–conventional rehabilitation therapies resulted in greater improvements in stride length, cadence, walking ability, and balance function in the subacute phase. Conclusions: Motor imagery training–conventional rehabilitation therapies have better effects on the recovery of lower limb motor function in poststroke patients than conventional rehabilitation therapies, which may be most beneficial for lower extremity motor function recovery in the first 7 days to 6 mos. [ABSTRACT FROM AUTHOR]

Introduction: Patellofemoral pain (PFP) is a common overuse injury associated with physical activity, including walking. The risk for PFP may increase if walking biomechanics change during a bout of walking. Because walking for exercise is often recommended to previously sedentary adults, this would be a cause for concern. The purpose of this study was to determine any differences in walking biomechanics associated with PFP between sedentary and active young women initially and after 30 min of walking for exercise. Methods: Fifteen sedentary and 15 active young women walked overground for five trials of three-dimensional gait analysis before and after a 30-min treadmill walk. Peak knee flexion angle and extensor moment were compared between groups and before and after the 30-min walk. Results: Comparing groups at baseline, peak knee flexion angle and peak knee extensor moment were not statistically significantly different between groups. After the 30-min walk, peak knee flexion angle and extensor moment increased slightly in both groups. Conclusions: Smaller, not larger, peak knee flexion angle and extensor moment during walking have been associated with increased risk of PFP. Therefore, sedentary and active young women can walk for 30 min without further detrimental changes to walking biomechanics that may increase their risk of PFP. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the effect of walking cadence on knee flexion angular impulse and peak external flexion moment in patients with patellofemoral osteoarthritis (OA). Methods: Forty-eight patients with patellofemoral OA underwent repeated quantitative gait analyses on an instrumented treadmill using a randomized crossover design. Walking trials were conducted at a fixed gait speed, under three cadence conditions: (i) preferred cadence, (ii) +10% increased cadence, and (iii) −10% decreased cadence, completed in random order. Using a linear mixed model, we tested the association of cadence conditions with surrogate measures of patellofemoral load (primary outcome measure: knee flexion angular impulse) while controlling for body mass. We then repeated the analyses while sequentially replacing the dependent variable with secondary outcome measures. Results: Walking with increased cadence decreased (adjusted mean difference [95% confidence interval]) the knee flexion angular impulse (−0.85 N·m·s−1 [−1.52 to −0.18], d = 0.20) and peak knee flexion moment (−4.11 N·m [−7.35 to −0.86], d = 0.24), whereas walking with decreased cadence increased the knee flexion angular impulse (1.83 N·m·s−1 [1.15 to 2.49], d = 0.42) and peak knee flexion moment (3.55 N·m [0.30 to 6.78], d = 0.21). Similar decreases and increases were observed for secondary outcome measures. Conclusions: Walking with increased cadence, while maintaining a fixed gait speed, reduces knee flexion angular impulse as well as other surrogate measures of knee loading in patients with patellofemoral OA. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to systematically review the effects of leg-driven treadmill-based exoskeleton robot training on balance and walking ability in poststroke patients. Design: The PubMed, Cochrane Library, Embase, Web of Science, Medline, CNKI, VIP, and Wanfang databases were searched from inception to August 2021. The literature quality was evaluated using Cochrane Handbook. Primary outcomes include the Functional Ambulation Category Scale and Berg Balance Scale, and secondary outcomes include the 10 meter walk test, 6 minute walk test, and gait assessment cadence were analyzed. Results: Seventeen randomized controlled trials were included in the systematic review, 15 studies in meta-analysis. Primary outcomes showed no significant difference in the Functional Ambulation Category Scale score; subgroup with the exoskeleton robot + conventional therapy of the Berg Balance Scale score was significantly increased; secondary outcomes showed no significance in 6 minute walk test or 10 meter walk test. The cadence score increased for the subgroup with an onset of more than 6 mos in the treatment group. The control group performed better than the subgroup with an onset of less than 6 mos. Conclusions: Leg-driven treadmill-based exoskeleton robot training can improve balance function in poststroke patients and is beneficial for patients with an onset of greater than 6 mos. However, there is no evidence to support the efficacy of walking ability. [ABSTRACT FROM AUTHOR]

Introduction: The functional goal for unilateral transfemoral prosthesis users during ambulation is to restore the proper biomechanics and minimize the compensatory actions caused by limb asymmetries. These goals can often lead to embedded design elements that assume the prosthetic limb to look and move like the intact limb. An unconventional artificial limb design can transfer the focus from mimicking the skeletal structure to producing functional symmetry between limbs. In this pilot study, we introduce a length-actuated prosthesis design with the goal of functional biomimicry and collect qualitative feedback from two prosthesis users. Materials and Methods: The length-actuated apparatus is attached to the distal end of a transfemoral prosthetic socket and consists of an external motor and a cam and Bowden cable system for powering and dynamically adjusting the prosthesis' length in synchronization with the gait cycle. Two transfemoral prosthesis users ambulated on a treadmill with the length-actuated prosthesis and gave anecdotal feedback. Results: The prosthesis was able to support the patient's full weight and adjust to the lengths needed during the gait cycle, including toe clearance. The overall response to the prosthesis and concept was positive; prosthesis users stated that the prosthesis and the action of the knee seemed "comfortable," and physicians concluded a sufficient and confident ambulation by the prosthesis users. The next iteration will address specific concerns of the prosthesis users by incorporating a more compact electromechanical system with sensors. This will aid in matching and continuously adjusting the prosthesis' length change timing with the cadence of the user's ambulation. Conclusions: Overall, the prototype and study proved that linear motion could replace the leg shortening functions of lower-joint rotations, with anecdotal improvements in kinematics and comfort. Future work will consist of a quantitative evaluation of center of gravity displacement, ground reaction forces, toe clearance distance, and the possibilities of knee buckling. Clinical Relevance: There are no commercially available lower-limb prostheses that control leg length with dynamic linear motion rather than user flexion and extension of a knee joint. Possible benefits that may come from a length-actuated prosthesis include improved loading symmetry and balance, as well as decreased muscle activity. [ABSTRACT FROM AUTHOR]

Introduction: Treadmills have been widely used for training and performance testing during which the treadmill grade is usually set to 0%–2% grade. The purpose of our study was to compare the level of activation of lower body muscles when running at two speeds in an overground condition and on a treadmill at 0%, 1%, and 2% grades. Methods: We recorded EMG data of eight lower body muscles from 13 recreationally active individuals during overground and treadmill running at 2.92 and 4.58 m·s−1. Maximal voluntary contraction (MVC) tests were performed (3 × 6 s) to identify maximal torque and EMG values. The stride cycles, from one foot strike to the next, were identified using a pair of triaxial accelerometers. A two-way repeated-measures ANOVA was used to examine the differences in EMG activity across running conditions and speeds. Cohen's d effect size was calculated to indicate the difference between the overground and the treadmill running conditions. Results: The effect sizes were moderate to negligible for differences between the EMG integral values for overground running and the three treadmill grades. The coefficient of variation for stride time during overground running was significantly larger than that of the treadmill running at 4.58 m·s−1. Conclusions: The results showed that the overall EMG profiles of the thigh and shank muscles were similar for the overground and treadmill conditions, but the similarity was greatest for thigh muscles when running on the treadmill at 1% grade and for shank muscles at 2% grade. The variability in stride time was greater during overground running than when running on a treadmill and was associated with elevated EMG activity of some muscles. [ABSTRACT FROM AUTHOR]

Objective: Lower limb stiffness strategies and work mode changes between young and older adults during stair descent are unclear. This study investigated the effect of aging on the lower limb stiffness, moments, and joint work mode during stair descent. Design: Twenty young adults and 20 older adults were recruited from the local community for stair descent test. Kinematics and kinetics data were collected by Vicon system and Kistler force plate. The lower limb stiffness, moments, and work mode were calculated and assess between groups. Results: No significant differences in gait parameters were detected between groups. Compared with young adults, older adults have decreased leg stiffness, knee and ankle stiffness, increased peak hip extension moment, hip stiffness, and ankle work contribution. Conclusions: The older adults actively reduce the lower limb stiffness to reduce the risk of injury during stair descent. The hip joint strategy reduces the risk of forwarding falls and ankle joint compensation work mode to make up for the lack of knee extension strength. This provides a reference for the focus of exercise intervention and rehabilitation strategies for older adults. [ABSTRACT FROM AUTHOR]