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Background: Children with cerebral palsy (CP) often have altered gait patterns compared to their typically developing peers. These gait patterns are characterized based on sagittal plane kinematic deviations; however, many children with CP also walk with altered transverse plane kinematics., Research Question: How do both altered skeletal alignment and kinematic deviations affect muscles' capacity to accelerate the body during gait?, Methods: A three-dimensional gait analysis was completed for 18 children with spastic CP (12.5 ± 2.9 years; GMFCS level II). Musculoskeletal models were developed for each participant, and tibial torsion, measured during a static standing trial and assessed using motion capture, was incorporated. An induced acceleration analysis was performed to evaluate the capacity of muscles to accelerate the body center of mass throughout stance. Differences between the root-mean-square muscle capacity for children with CP walking with internally rotated, standard, and externally rotated postures were evaluated., Results: Externally rotated postures resulted in a lower capacity to accelerate the body center of mass compared with internally rotated postures. Both changes in skeletal alignment and kinematics contributed to changes in muscle capacity to accelerate the body., Significance: Altered transverse plane skeletal alignment and compensatory kinematics should both be considered in surgical treatment of children with CP., Competing Interests: Declaration of Competing Interest There was no conflict of interest in the preparation or publication of this work., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Cerebral palsy (CP) is a neurological disorder that results in life-long mobility impairments. Musculoskeletal models used to investigate mobility deficits for children with CP often lack subject-specific characteristics such as altered muscle strength, despite a high prevalence of muscle weakness in this population. We hypothesized that incorporating subject-specific strength scaling within musculoskeletal models of children with CP would improve accuracy of muscle excitation predictions in walking simulations. Ten children (13.5 ± 3.3 years; GMFCS level II) with spastic CP participated in a gait analysis session where lower-limb kinematics, ground reaction forces, and bilateral electromyography (EMG) of five lower-limb muscles were collected. Isometric strength was measured for each child using handheld dynamometry. Three musculoskeletal models were generated for each child including a 'Default' model with the generic musculoskeletal model's muscle strength, a 'Uniform' model with muscle strength scaled allometrically, and a 'Custom' model with muscle strength scaled based on handheld dynamometry strength measures. Muscle-driven gait simulations were generated using each model for each child. Simulation accuracy was evaluated by comparing predicted muscle excitations and measured EMG signals, both in the duration of muscle activity and the root-mean-square difference (RMSD) between signals. Improved agreement with EMG were found in both the 'Custom' and 'Uniform' models compared to the 'Default' model indicated by improvement in RMSD summed across all muscles, as well as RMSD and duration of activity for individual muscles. Incorporating strength scaling into musculoskeletal models can improve the accuracy of walking simulations for children with CP., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Strength training is often prescribed for children with cerebral palsy (CP); however, links between strength gains and mobility are unclear. Nine children (age 14 ± 3 years; GMFCS I-III) with spastic CP completed a 6-week strength-training program. Musculoskeletal gait simulations were generated for four children to assess training effects on muscle forces and function. There were increases in isometric joint strength, but no statistical changes in fast-as-possible walking speed or endurance after training. The walking simulations revealed changes in muscle forces and contributions to body center of mass acceleration, with greater forces from the hip muscles during walking most commonly observed. A progressive strength-training program can result in isometric and dynamic strength gains in children with CP, associated with variable mobility outcomes.

Musculoskeletal modeling and simulation techniques have been used to gain insights into movement disabilities for many populations, such as ambulatory children with cerebral palsy (CP). The individuals who can benefit from these techniques are often limited to those who can walk without assistive devices, due to challenges in accurately modeling these devices. Specifically, many children with CP require the use of ankle-foot orthoses (AFOs) to improve their walking ability, and modeling these devices is important to understand their role in walking mechanics. The purpose of this study was to quantify the effects of AFO mechanical property assumptions, including rotational stiffness, damping, and equilibrium angle of the ankle and subtalar joints, on the estimation of lower-limb muscle forces during stance for children with CP. We analyzed two walking gait cycles for two children with CP while they were wearing their own prescribed AFOs. We generated 1000-trial Monte Carlo simulations for each of the walking gait cycles, resulting in a total of 4000 walking simulations. We found that AFO mechanical property assumptions influenced the force estimates for all the muscles in the model, with the ankle muscles having the largest resulting variability. Muscle forces were most sensitive to assumptions of AFO ankle and subtalar stiffness, which should therefore be measured when possible. Muscle force estimates were less sensitive to estimates of damping and equilibrium angle. When stiffness measurements are not available, limitations on the accuracy of muscle force estimates for all the muscles in the model, especially the ankle muscles, should be acknowledged.

Background: Individuals with multiple sclerosis (MS) often have limited mobility that is thought to be due to the neuromuscular impairments of the ankle. Greater isometric motor control of the ankle has been associated with better standing postural balance but its relationship to mobility is less understood. The objectives of this investigation were to quantify the motor control of the ankle plantarflexors of individuals with MS during a dynamic isometric motor task, and explore the relationship between the ankle force control and gait alterations., Methods: Fifteen individuals with MS and 15 healthy adults participated in both a dynamic isometric ankle plantarflexion force matching task and a biomechanical gait analysis., Findings: Our results displayed that the subjects with MS had a greater amount of error in their dynamic isometric force production, were weaker, walked with altered spatiotemporal kinematics, and had reduced maximal ankle moment at toe-off than the control group. The greater amount of error in the dynamic force production was related to the decreases in strength, step length, walking velocity, and maximal ankle moment during walking., Interpretation: Altogether these results imply that errors in the ankle plantarflexion force production may be a limiting factor in the mobility of individuals with MS., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Individuals with multiple sclerosis (MS) typically walk slower, have reduced cadences and shorter step lengths. While these spatiotemporal gait alterations have been thought to be due to decreased power generation at the ankle, the distribution of mechanical work across the ankle, knee and hip joints during walking is not well understood. By quantifying the mechanical work at each joint, the compensatory mechanisms utilized by individuals with MS to maintain gait speed may be better understood. Fifteen subjects with MS (EDSS: 4.4±1.0) and fifteen healthy age-matched control subjects completed a three-dimensional gait analysis. The net mechanical work at the ankle, knee and hip joints was quantified for the stance phase of gait. Our results found that the less impaired leg of the subjects with MS generated a similar amount of mechanical work as the control group; however, the ankle joint produced less positive mechanical work, and the hip joint generated more positive mechanical work. Additionally, the less impaired leg of the subjects with MS and the leg of the control group generated more positive work than the more impaired leg of the subjects with MS. These outcomes suggest that individuals with MS may adopt a hip compensatory strategy with their less impaired leg during gait due to the limited amount of mechanical work generated at the ankle., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: To quantify the precision of the steady-state isometric control of the ankle plantarflexors musculature of individuals with multiple sclerosis (MS), and to evaluate if the precision is related to the mobility impairments., Methods: Individuals with MS and healthy adults performed a submaximal steady-state isometric contraction with the ankle plantarflexors. The coefficient of variation was used to assess the amount of variability or error in the precision of the torques generated by the ankle plantarflexor musculature. The participants also walked across a digital mat at their preferred and fast-as-possible walking speeds, which recorded their spatiotemporal gait kinematics., Results: The individuals with MS: (1) had reduced maximal voluntary torques at the ankle, (2) a greater amount of variability in the precision of the isometric ankle torques, (3) altered and more variable spatiotemporal gait kinematics, and (4) a greater amount of variability in the isometric ankle torques were related to a slower walking speed and cadence, shorter step length and a greater amount of gait variability., Conclusions: These results further fuels the impression that a reduction in control of the ankle joint musculature may be a key factor in the mobility and balance impairments seen in individuals with MS., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The aim of this investigation was to determine if body-weight-supported (BWS) overground gait training has the potential to improve the walking abilities of children and youth with childhood onset motor impairments and intellectual disabilities. Eight participants (mean age of 16.3 years) completed 12 weeks of BWS overground gait training that was performed two times a week. BWS was provided during the training sessions by an overhead harness system that rolls overground. There was a significant improvement in the preferred walking speed after the training (p < .01; pre = 0.51 ± 0.2 m/s; post = 0.67 ± 0.3 m/s; Cohen's d = 0.80) and cadence (p = .04; pre = 37 ± 7 steps/min; post = 43 ± 8 steps/min; Cohen's d = 0.94). Our results indicate that overground BWS gait training may be an effective treatment strategy for improving the preferred walking speed of children and youth with motor impairments.

The aim of this investigation was to evaluate the differences in the dynamic gait stability of children with cerebral palsy (CP) and typically developing (TD) children. The participants walked on a treadmill for 2 min as a motion capture system assessed the walking kinematics. Floquet analysis was used to quantify the rate of dissipation of disturbances that were present in the walking kinematics, and the variability measures were used to assess the magnitude of the disturbances present in the step length and width. The Floquet multipliers, step width and length values were correlated with Sections D and E of the Gross Motor Function Measure (GMFM). The children with CP had a larger Floquet multiplier and used a wider step width than the TD children. The magnitude of the maximum Floquet multiplier was positively correlated with the step width. Furthermore, the magnitude of the maximum Floquet multiplier and the step width were negatively correlated with the score on Section E of the GMFM. Lastly, the children with CP used a more variable step length than the TD children. These results suggest that children with CP have poor dynamic gait stability because they require more strides to dissipate the disturbances that are present in their walking pattern. In effort to stabilize these disturbances, the children with CP appear to utilize a wider step width and modulate their step length. Overall the inability to effectively dissipate the gait disturbances may be correlated with the child's ability to perform a wide range of gross motor skills (e.g., step over obstacles, jump, walk up stairs)., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The time it takes between consecutive foot contacts from the same leg is referred to as the stride-time interval. Several investigations have shown that the variations that are present in the stride time intervals are linked to walking balance. In this study, functional near infrared spectroscopy (fNIRS) was utilized to evaluate whether activation in the medial sensorimotor cortices reflects the amount of variations seen in the stride-time intervals. Thirteen healthy adults (Age=23.7 ± 1.4 yrs.) walked forwards and backwards on a programmable treadmill. Each walking condition consisted of two sessions, with each being comprised of five alternating blocks of standing still or walking at 0.45 m/s. Activation in the medial sensorimotor cortices was measured using an fNIRS system, which consisted of a 4 × 4 grid of infrared optode emitter/detector pairs. The optodes were positioned on the participant's head using the International 10/20 system with Cz located beneath the center of the front two rows of optodes. We evaluated the block-wise changes in the amount of oxygenated (oxyHb) and deoxygenated hemoglobin (deoxyHb) in the channels that were located over the supplementary motor area, pre-central gyrus, post-central gyrus and superior parietal lobule. Throughout the experiment, a footswitch system was used to concurrently measure the amount of variation present in the stride-time intervals. Our results showed that oxyHb was greater in the supplementary motor area, pre-central gyrus, and superior parietal lobule when participants walked backwards rather than forwards, which suggests that backward walking presents more of a challenge to the nervous system as it controls the stepping pattern. Additionally, there was a significant decrease in the amount of deoxyHb present in the supplementary motor area while walking backward. Consistent with previous investigations, we noted that the amount of variability present in the stride-time intervals was greater during backward walking compared to forward walking. In addition, the amount of variation in the stride-time intervals while walking forward was positively correlated with the maximum oxyHb response found in the pre-central gyrus and supplementary motor area, which has not been previously shown. This neurobehavioral relationship supports the notion that the subtle variations found in the stride-time intervals are partly associated with processing demands by the motor cortices for regulating the forward temporal kinematics., (Copyright © 2011 Elsevier Inc. All rights reserved.)

This study investigated the nature of the structural variations found in the motor output of individuals with Parkinson's disease (PD). Young (n = 21; 19.9 ± 1.3 yrs.), aged (n = 9; 74.8 ± 6.8 yrs.) and individuals with PD (n = 9; 73.4 ± 6.6 yrs.) swung their leg at a pendular frequency and frequencies that were 20% faster and slower. This study had three key findings. First, individuals with PD have greater variability in the leg swing angular kinematics and swing times. These variations appear to be related to the 0-15 Hz band of the of angular displacement power spectrum. Second, changes in the structural variations appear to not be derived from a stochastic source. Third, the magnitude of the variations and the structure of the variations are influenced by the frequency that the leg is swung. These results are consistent with the viewpoint that changes in the magnitude of the variations and the regularity of the structural variations are dependent upon health and adaptability to the task dynamics.

Objective: To examine if body weight supported treadmill training (BWSTT) improves the regularity of stepping kinematics in children with cerebral palsy (CP)., Methods: Twelve children with CP who had Gross Motor Function Classification Scores that ranged from II-IV participated in 12 weeks of body weight supported treadmill training that was performed 2 days a week. The primary outcome measure was the regularity of the stepping kinematics, which was assessed with Fourier analysis methods. The secondary measures were the preferred walking speed, step length, lower extremity strength and section E of the GMFM., Results: BWSTT improved the rhythmical control of the stepping kinematics, preferred walking speed, step length and GMFM score. The improvements in the regularity of the stepping kinematics were strongly correlated with changes in the preferred walking speed, step length and GMFM score., Conclusion: BWSTT can improve the motor control of the walk performance of children with CP.

With human exploration of the moon and Mars on the horizon, research considerations for space suit redesign have surfaced. The portable life support system (PLSS) used in conjunction with the space suit during the Apollo missions may have influenced the dynamic balance of the gait pattern. This investigation explored potential issues with the PLSS design that may arise during the Mars exploration. A better understanding of how the location of the PLSS load influences the dynamic stability of the gait pattern may provide insight, such that space missions may have more productive missions with a smaller risk of injury and damaging equipment while falling. We explored the influence the PLSS load position had on the dynamic stability of the walking pattern. While walking, participants wore a device built to simulate possible PLSS load configurations. Floquet and Lyapunov analysis techniques were used to quantify the dynamic stability of the gait pattern. The dynamic stability of the gait pattern was influenced by the position of load. PLSS loads that are placed high and forward on the torso resulted in less dynamically stable walking patterns than loads placed evenly and low on the torso. Furthermore, the kinematic results demonstrated that all joints of the lower extremity may be important for adjusting to different load placements and maintaining dynamic stability. Space scientists and engineers may want to consider PLSS designs that distribute loads evenly and low, and space suit designs that will not limit the sagittal plane range of motion at the lower extremity joints.

Purpose: We used methods from dynamical system analysis to investigate the effect of carrying external loads on the stability of the locomotive system and sagittal plane kinematics. We hypothesized that carrying an additional load at the waist would 1) decrease the dynamic stability of the locomotive system and 2) cause changes in the location of the Poincaré map's equilibrium point for the hip, the knee, and the ankle joint kinematics., Methods: Lower extremity kinematics were recorded for 23 subjects as they walked on a treadmill at their preferred speed while carrying external loads of 10%, 20%, and 30% of their body weight around their waist. Gait stability was evaluated by computing the eigenvalues of the locomotive system at the instance of heel contact and midswing. Changes in the hip, the knee, and the ankle's equilibrium point of the Poincaré sections were used to determine whether there were changes in the joint kinematics while carrying external loads., Results: No significant differences in sagittal plane stability were found between the respective load carrying conditions (P > 0.05). Significant changes (P < 0.05) in the equilibrium points of the hip and the knee were found at heel contact and midswing., Conclusions: The data suggest that humans are capable of maintaining sagittal plane stability while carrying loads up to 30% of their body weight.

Background: Aging leads to increases in gait variability which may explain the large incidence of falls in the elderly. Body weight support training may be utilized to improve gait in the elderly and minimize falls. However, before initiating rehabilitation protocols, baseline studies are needed to identify the effect of body weight support on elderly gait variability. Our purpose was to determine the kinematic variability of the lower extremities in young and elderly healthy females at changing levels of body weight support during walking., Methods: Ten young and ten elderly females walked on a treadmill for two minutes with a body weight support (BWS) system under four different conditions: 1 g, 0.9 g, 0.8 g, and 0.7 g. Three-dimensional kinematics was captured at 60 Hz with a Peak Performance high speed video system. Magnitude and structure of variability of the sagittal plane angular kinematics of the right lower extremity was analyzed using both linear (magnitude; standard deviations and coefficient of variations) and nonlinear (structure; Lyapunov exponents) measures. A two way mixed ANOVA was used to evaluate the effect of age and BWS on variability., Results: Linear analysis showed that the elderly presented significantly more variability at the hip and knee joint than the young females. Moreover, higher levels of BWS presented increased variability at all joints as found in both the linear and nonlinear measures utilized., Conclusion: Increased levels of BWS increased lower extremity kinematic variability. If the intent of BWS training is to decrease variability in gait patterns, this did not occur based on our results. However, we did not perform a training study. Thus, it is possible that after several weeks of training and increased habituation, these initial increased variability values will decrease. This assumption needs to be addressed in future investigation with both "healthy" elderly and elderly fallers. In addition, it is possible that BWS training can have a positive transfer effect by bringing overground kinematic variability to healthy normative levels, which also needs to be explored in future studies.

Previous research has indicated that the sagittal plane gait dynamics of humans are more stable and less dependent on active neural control, while the frontal plane dynamics are less stable and require greater neural control. The higher neural demands of the frontal plane dynamics are reflected in a more variable step width than step length. Greater variability in the step width occurs because humans modulate their foot placement for each step to ensure stability and prevent falls. Compared to other terrestrial animals, penguins appear to have excessive amount of frontal plane motion in their gait that is characterized as waddling. If excessive frontal plane motion requires additional neural control and is associated with falls, it would seem that evolutionary pressures would have eliminated such locomotive strategies. Here we measured the step length and width variability to determine if waddling results in a less stable gait. Remarkably, the variability of the step width was less than the variability of the step length. These results are directly opposite of what has been reported for humans. Hence, our data indicate that waddling may be an effective strategy for ensuring stability in the frontal plane dynamics.

There is a growing body of evidence that the step-to-step variations present in human walking are related to the biomechanics of the locomotive system. However, we still have limited understanding of what biomechanical variables influence the observed nonlinear gait variations. It is necessary to develop reliable models that closely resemble the nonlinear gait dynamics in order to advance our knowledge in this scientific field. Previously, Goswami et al. [1998. A study of the passive gait of a compass-like biped robot: symmetry and chaos. International Journal of Robotic Research 17(12)] and Garcia et al. [1998. The simplest walking model: stability, complexity, and scaling. Journal of Biomechanical Engineering 120(2), 281-288] have demonstrated that passive dynamic walking computer models can exhibit a cascade of bifurcations in their gait pattern that lead to a deterministic nonlinear gait pattern. These computer models suggest that the intrinsic mechanical dynamics may be at least partially responsible for the deterministic nonlinear gait pattern; however, this has not been shown for a physical walking robot. Here we use the largest Laypunov exponent and a surrogation analysis method to confirm and extend Garcia et al.'s and Goswami et al.'s original results to a physical passive dynamic walking robot. Experimental outcomes from our walking robot further support the notion that the deterministic nonlinear step-to-step variations present in gait may be partly governed by the intrinsic mechanical dynamics of the locomotive system. Furthermore the nonlinear analysis techniques used in this investigation offer novel methods for quantifying the nature of the step-to-step variations found in human and robotic gait.

The purpose of this investigation was to determine if a chronic Parkinson's disease mouse model will display less certainty in its gait pattern due to basal ganglia dysfunction. A chronic Parkinson's disease mouse model was induced by injecting male C57/BL mice with 10 doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (25mg/kg) (MPTP) and probenecid (250 mg/kg) (P) over 5 weeks. This chronic model produces a severe and persistent loss of nigrostriatal neurons resulting in dopamine depletion and locomotor impairment. The control mice were treated with probenecid alone. Fifteen weeks after the last MPTP/P treatment, the mice were videotaped in the sagittal plane with a digital camera (60 Hz) as they ran on a motorized treadmill at a speed of 10 m/min. The indices of gait and gait variability were calculated. Stride length was significantly (p=0.016) more variable in the chronic MPTP/P mice. Additionally, the chronic MPTP/P mice had a statistically less certain gait pattern when compared to the control mice (p=0.02). These results suggest that variability in the gait pattern can be used to evaluate changes in neural function. Additionally, our results imply that disorder of the basal ganglia results in less certainty in modulating the descending motor command that controls the gait pattern.

Background: Several investigations have suggested that changes in the nonlinear gait dynamics are related to the neural control of locomotion. However, no investigations have provided insight on how neural control of the locomotive pattern may be directly reflected in changes in the nonlinear gait dynamics. Our simulations with a passive dynamic walking model predicted that toe-off impulses that assist the forward motion of the center of mass influence the nonlinear gait dynamics. Here we tested this prediction in humans as they walked on the treadmill while the forward progression of the center of mass was assisted by a custom built mechanical horizontal actuator., Methods: Nineteen participants walked for two minutes on a motorized treadmill as a horizontal actuator assisted the forward translation of the center of mass during the stance phase. All subjects walked at a self-select speed that had a medium-high velocity. The actuator provided assistive forces equal to 0, 3, 6 and 9 percent of the participant's body weight. The largest Lyapunov exponent, which measures the nonlinear structure, was calculated for the hip, knee and ankle joint time series. A repeated measures one-way analysis of variance with a t-test post hoc was used to determine significant differences in the nonlinear gait dynamics., Results: The magnitude of the largest Lyapunov exponent systematically increased as the percent assistance provided by the mechanical actuator was increased., Conclusion: These results support our model's prediction that control of the forward progression of the center of mass influences the nonlinear gait dynamics. The inability to control the forward progression of the center of mass during the stance phase may be the reason the nonlinear gait dynamics are altered in pathological populations. However, these conclusions need to be further explored at a range of walking speeds.

This investigation utilized a Markov model to investigate the relationship of correlated lower extremity joint fluctuations and the selection of a steady state gait pattern in the young and elderly. Our model simulated the neuromuscular system by predicting the behavior of the joints for the next gait cycle based on the behavior exhibited in the preceding gait cycles. Such dependencies in the joint fluctuations have been noted previously in the literature. We speculated that compared to the young model, the characteristics of the correlated fluctuations in the elderly model would result in the selection of a different steady state gait pattern. The results of our simulation support the notion that correlated fluctuations in the joint kinematics influence the selection of a steady state gait pattern. The steady state gait pattern for the elderly model was dependent the ankle and hip. Conversely, the steady state gait pattern for the young control model was dependent on the behavior of the knee and hip. Based on our model, we suggested that the altered steady state gait patterns observed in the elderly may be due to an altered neuromuscular memory of prior joint behaviors.

It has been suggested that the intercycle variability present in the time series of biomechanical gait data is of chaotic nature. However, the proper methodology for the correct determination of whether intercycle fluctuations in the data are deterministic chaos or random noise has not been identified. Our goal was to evaluate the pseudoperiodic surrogation (PPS) [Small et al., 2001. Surrogate test for pseudoperiodic time series data. Physical Review Letters 87(18), 188,101-188,104], and the surrogation algorithms of Theiler et al. [1992. Testing for nonlinearity in time series: the method of surrogate data. Physica D 58(1-4), 77-94] and of Theiler and Rapp [1996. Re-examination of the evidence for low-dimensional, nonlinear structure in the human electroencephalogram. Electroencephalography and Clinical Neurophysiology 98, 213-222], to determine which is the more robust procedure for the verification of the presence of chaos in gait time series. The knee angle kinematic time series from six healthy subjects, generated from a 2-min walk, were processed with both algorithms. The Lyapunov exponent (LyE) and the approximate entropy (ApEn) were calculated from the original data and both surrogates. Paired t-tests that compared the LyE and the ApEn values revealed significant differences between both surrogated time series and the original data, indicating the presence of deterministic chaos in the original data. However, the Theiler algorithm affected the intracycle dynamics of the gait time series by changing their overall shape. This resulted in significantly higher LyE and ApEn values for the Theiler-surrogated data when compared with both the original and the PPS-generated data. Thus, the discovery of significant differences was a false positive because it was not based on differences in the intercycle dynamics but rather on the fact that the time series was of a completely different shape. The PPS algorithm, on the other hand, preserved the intracycle dynamics of the original time series, making it more suitable for the investigation of the intercycle dynamics and the identification of the presence of chaos in the gait time series.

This investigation quantitatively characterized the certainty of the aging neuromuscular system in selecting a joint range of motion during gait based on the statistical concept of entropy. Elderly and young control groups walked on a treadmill at a self-selected pace. Joint angles were calculated for the ankle, knee and hip. We hypothesized that the aging group would exhibit less certainty in selecting a joint range of motion during gait. Our results supported this hypothesis, and indicated that aged individuals demonstrated statistically less certainty for the knee (16.8%) and hip (24.6%). We suggest that neurophysiological changes associated with aging may result in less certainty of the neuromuscular system in selecting a stable gait.

Objective: To investigate the nature of variability present in time series generated from gait parameters of two different age groups via a nonlinear analysis., Design: Measures of nonlinear dynamics were used to compare kinematic parameters between elderly and young females., Background: Aging may lead to changes in motor variability during walking, which may explain the large incidence of falls in the elderly., Methods: Twenty females, 10 younger (20-37 yr) and 10 older (71-79 yr) walked on a treadmill for 30 consecutive gait cycles. Time series from selected kinematic parameters of the right lower extremity were analyzed using nonlinear dynamics. The largest Lyapunov exponent and the correlation dimension of all time series, and the largest Lyapunov exponent of the original time series surrogated were calculated. Standard deviations and coefficient of variations were also calculated for selected discrete points from each gait cycle. Independent t-tests were used for statistical comparisons., Results: The Lyapunov exponents were found to be significantly different from their surrogate counterparts. This indicates that the fluctuations observed in the time series may reflect deterministic processes by the neuromuscular system. The elderly exhibited significantly larger Lyapunov exponents and correlation dimensions for all parameters evaluated indicating local instability. The linear measures indicated that the elderly demonstrated significantly higher variability., Conclusions: The nonlinear analysis revealed that fluctuations in the time series of certain gait parameters are not random but display a deterministic behavior. This behavior may degrade with physiologic aging resulting in local instability., Relevance: Elderly show increased local instability or inability to compensate to the natural stride-to-stride variations present during locomotion. We hypothesized that this may be the one of the reasons for the increases in falling due to aging. Future efforts should attempt to evaluate this hypothesis by making comparisons to pathological subjects (i.e. elderly fallers), and examine the sensitivity and specificity of the nonlinear methods used in this study to aid clinical assessment.

This study investigated intralimb coordination during walking in young and elderly women using the theoretical model of dynamical systems. 20 women, 10 Young (M age=24.6 yr., SD= 3.2 yr.) and 10 Elderly (M age=73.7 yr., SD=4.9 yr.), were videotaped during free speed gait and gait perturbed by an ankle weight. Two parameters, one describing the phasing relationship between segments (mean absolute relative phase) and the other the variability of this relationship (deviation in phase), were calculated from the kinematics. Two-way analysis of variance (age and weight) with repeated measures on weight indicated that during the braking period the weight increased the mean absolute relative phase between the shank and the thigh and decreased it between the foot and the shank. The Elderly women had significant smaller values for the mean absolute relative phase between the shank and the thigh during the braking period. For the same period, deviation in phase increased for the segmental 'relationship between the shank and the thigh. The findings suggest that changes in intralimb coordination take place with asymmetrical weighting and the aging process. These changes are most clearly present during the braking period.

• Total brainstem, pons, and midbrain volumes are decreased in people with cerebral palsy (CP). • The reduced brainstem volumes are associated with reduced gait velocity and step length. • Structural changes within the brainstem may contribute to clinical mobility impairments in people with CP. Persons with cerebral palsy (CP) have impaired mobility that has been attributed to changes in structure and function within the nervous system. The brainstem is a region that plays a critical role in mobility by connecting the cortex and cerebellum to the spinal cord, yet this region has been largely unstudied in persons with CP. We used high-resolution structural MRI and biomechanical analyses to examine whether the volume of the whole brainstem and its constituent elements are altered in CP and if these alterations relate to the mobility impairments within this population. A cohort study was conducted to assess the volume of the whole brainstem, pons, midbrain, medulla, and superior cerebellar peduncle in a cohort of persons with CP (N = 26; Age = 16.3 ± 1.0 years; GMFCS levels I-IV, Females = 12) and a cohort of neurotypical (NT) controls (N = 38; Age = 14.3 ± 0.4 years, Females = 14) using structural MR imaging of the brainstem. Outside the scanner, a digital mat was used to quantify the spatiotemporal gait biomechanics of these individuals. We found a significant decrease in volume of the total brainstem, midbrain, and pons in persons with CP in comparison to the NT controls. Furthermore, we found that the altered volumes were related to reduced gait velocity and step length. The structural changes in the brainstems of persons with CP may contribute to the mobility impairments that are ubiquitous within this population. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to evaluate the effect of a lower body positive pressure support system on the joint kinematics and activity of the lower extremity antigravity musculature of adults and children during walking. Adults (age = 25 ± 4 years) and children (age = 13 ± 2 years) walked at a preferred speed and a speed that was based on the Froude number, while 0-80% of their body weight was supported. Electrogoniometers were used to monitor knee and ankle joint kinematics. Surface electromyography was used to quantify the magnitude of the vastus lateralis and gastrocnemius muscle activity. There were three key findings: (1) The lower extremity joint angles and activity of the lower extremity antigravity muscles of children did not differ from those of adults. (2) The magnitude of the changes in the lower extremity joint motion and antigravity muscle activity was dependent upon an interaction between body weight support and walking speed. (3) Lower body positive pressure support resulted in reduced activation of the antigravity musculature, and reduced range of motion of the knee and ankle joints. [ABSTRACT FROM AUTHOR]

Objective To evaluate the mobility and postural balance improvements that could be achieved in a cohort of persons with multiple sclerosis (MS) who participated in a motor adaptation protocol and a cohort of persons with MS who participated in a therapeutic exercise protocol. Design A cohort design, where subjects were evaluated before and after a 6-week intervention period. Setting Clinical laboratory setting. Participants Individuals (N=42) with relapsing-remitting or secondary progressive MS (Expanded Disability Status Scale [EDSS] scores, 3.0–6.5) were initially screened for eligibility for participation in the study, from which those who fit the inclusion criteria (n=32) were enrolled in the study. Subjects were pseudorandomly assigned to a treatment group and matched based on EDSS scores. Fourteen individuals in the motor adaptation cohort (MAC) (mean age ± SD, 52.6±9y; mean EDSS score ± SD, 5.5±0.9) and 13 individuals in the therapeutic exercise cohort (TEC) (mean age ± SD, 54.0±9y; mean EDSS score ± SD, 5.3±0.9) completed the entire duration of their respective programs. Interventions Both cohorts completed their therapy twice a day, 5 days each week, for 6 weeks. Each session of the MAC program consisted of balance and gait training that encouraged new ways to adapt to challenging task demands. The TEC program was similar to a traditional exercise program. Main Outcome Measures The Sensory Organization Test, 6-minute walk test, and gait spatiotemporal kinematics. Results Collectively, both treatment groups had improvements in postural balance ( P =.001), walking endurance ( P =.002), walking speed ( P =.004), and step length ( P <.001) after therapy. However, there were no statistical differences between the 2 treatment groups for any of the outcome variables ( P values >.01). Conclusions Our exploratory results suggest that a high frequency of physical therapy rather than a specific activity focus might be an important parameter for persons with MS. [ABSTRACT FROM AUTHOR]

Observational research suggests that in children with cerebral palsy, the altered arm swing is linked to instability during walking. Therefore, the current study investigates whether children with cerebral palsy use their arms more than typically developing children, to enhance gait stability. Evidence also suggests an influence of walking speed on gait stability. Moreover, previous research highlighted a link between walking speed and arm swing. Hence, the experiment aimed to explore differences between typically developing children and children with cerebral palsy taking into account the combined influence of restricting arm swing and increasing walking speed on gait stability. Spatiotemporal gait characteristics, trunk movement parameters and margins of stability were obtained using three dimensional gait analysis to assess gait stability of 26 children with cerebral palsy and 24 typically developing children. Four walking conditions were evaluated: (i) free arm swing and preferred walking speed; (ii) restricted arm swing and preferred walking speed; (iii) free arm swing and high walking speed; and (iv) restricted arm swing and high walking speed. Double support time and trunk acceleration variability increased more when arm swing was restricted in children with bilateral cerebral palsy compared to typically developing children and children with unilateral cerebral palsy. Trunk sway velocity increased more when walking speed was increased in children with unilateral cerebral palsy compared to children with bilateral cerebral palsy and typically developing children and in children with bilateral cerebral palsy compared to typically developing children. Trunk sway velocity increased more when both arm swing was restricted and walking speed was increased in children with bilateral cerebral palsy compared to typically developing children. It is proposed that facilitating arm swing during gait rehabilitation can improve gait stability and decrease trunk movements in children with cerebral palsy. The current results thereby partly support the suggestion that facilitating arm swing in specific situations possibly enhances safety and reduces the risk of falling in children with cerebral palsy. [ABSTRACT FROM AUTHOR]

Purpose: Children with cerebral palsy (CP) often use a crouch gait pattern that has disturbances in the knee joint kinematics. Although the length and rate of lengthening of the hamstring musculature have been speculated to be the reason that these disturbances are not adequately dissipated, this relationship has not been adequately explored. The purpose of this exploratory investigation was to use simulations of a musculoskeletal model and Floquet analysis to evaluate how the performance of hamstrings musculature during gait may be related to the knee joint instabilities seen in children with CP. Methods: Children with CP and typically developing (TD) children walked on a treadmill as a motion capture system assessed the knee joint kinematics. Floquet analysis was used to quantify the rate that disturbances present at the knee joint were dissipated, and simulations of a musculoskeletal model were used to estimate the in vivo length and velocity of the hamstrings. Pearson correlation coefficients were calculated to determine if there was a relationship between the rate that the disturbances were dissipated and the performance of the hamstring musculature. Results: The children with CP had hamstrings that lengthened more slowly than TD children, and required more strides to dissipate disturbances in the knee joint kinematics. There was negative correlation between the rate that the hamstrings lengthened and the rate that the knee joint disturbances were dissipated. Conclusions: Our results suggest that the ability of children with CP to dissipate the knee joint disturbances may be related to the inability to properly control the hamstring musculature. [ABSTRACT FROM AUTHOR]

Background and Purpose: The neuromuscular impairments seen in the ankle plantarflexors have been identified as a primary factor that limits the mobility and standing postural balance of individuals with multiple sclerosis (MS). However, few efforts have been made to find effective treatment strategies that will improve the ankle plantarflexor control. Our objective was to determine whether an intensive 14week neurorehabilitation protocol has the potential to improve the ankle plantarflexor control of individuals with MS. The secondary objectiveswere to determinewhether the protocolwould also improve postural control, plantarflexion strength, and mobility. Methods: Fifteen individuals withMSparticipated in a 14-week neurorehabilitation protocol, and 20 healthy adults served as a comparison group. The primary measure was the amount of variability in the submaximal steady-state isometric torque, which assessed plantarflexor control. Secondary measures were the Sensory Organization Test composite score, maximum plantarflexion torque, and the spatiotemporal gait kinematics. Results: There was less variability in the plantarflexion torques after the neurorehabilitation protocol (preintervention, 4.15% ± 0.5%; postintervention, 2.27%±0.3%). In addition, therewere less postural sway (preintervention, 51.87 ± 0.2 points; postintervention, 67.8 ± 0.5 points), greater plantarflexion strength (preintervention, 0.46 ± 0.04 Nm/kg; postintervention, 0.57 ± 0.05 Nm/kg), and faster walking speeds (preferred preintervention, 0.71 ± 0.05 m/s; preferred postintervention, 0.81 ± 0.05 m/s; fast-as-possible preintervention, 0.95 ± 0.06 m/s; postintervention, 1.11 ± 0.07 m/s). All of the outcome variables matched or trended toward those seen in the controls. Discussion and Conclusions: The outcomes of this exploratory study suggest that the neurorehabilitation protocol employed in this investigation has the potential to promote clinically relevant improvements in the ankle plantarflexor control, standing postural balance, ankle plantarflexion strength, and the mobility of individuals with MS. [ABSTRACT FROM AUTHOR]

The noted disruption of thalamocortical connections and abnormalities in tactile sensory function has resulted in a new definition of cerebral palsy (CP) that recognizes the sensorimotor integration process as central to the motor impairments seen in these children. Despite this updated definition, the connection between a child's motor impairments and somatosensory processing remains almost entirely unknown. In this investigation, we explored the relationship between the magnitude of neural activity within the somatosensory cortices, the strength of the ankle plantarflexors, and the gait spatiotemporal kinematics of a group of children with CP and a typically developing matched cohort. Our results revealed that the magnitude of somatosensory cortical activity in children with CP had a strong positive relationship with the ankle strength, step length, and walking speed. These results suggest that stronger activity within the somatosensory cortices in response to foot somatosensations was related to enhanced ankle plantarflexor strength and improved mobility in the children with CP. These results provide further support for the notion that children with CP exhibit, not only musculoskeletal deficits, but also somatosensory deficits that potentially contribute to their overall functional mobility and strength limitations. [ABSTRACT FROM AUTHOR]

Individuals with Parkinson's disease and the aged have a high prevalence of falls. Since an increase in the number of falls is associated with physical and psychological harm, ills prudent that biomechanical metrics be established that will accurately assess an individual's walking balance. In this investigation, we initially used a simple bipedal walking computer model to theoretically establish the relationship between attractor divergence and walking balance. The Lyapunov exponent was used to quantify the amount of divergence present in the walking attractor. Simulations from our model indicated that attractors that have a greater amount of divergence are more susceptible to falls from external perturbations. Based on the results of our simulations, we conducted an initial experiment to explore of the young, aged and individuals with Parkinson's disease have different degrees of attractor divergence. Our results indicate that individuals with Parkinson's disease and aged have walking patterns with a greater amount of attractor divergence. Based on the results of our simulations, we infer that these participants may have a higher probability of losing their balance. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this investigation was to evaluate the work performed on the center of mass by the legs of children with cerebral palsy. 10 children that were diagnosed as having cerebral palsy with spastic diplegia (Age=9.1±2 years), and 10 healthy children with no walking disabilities participated (Age=9.4±2 years). We collected individual leg ground reaction forces from four force platforms, and calculated the mechanical work performed on the center of mass by the lead and trail legs. The normalized walking speeds were not significantly (p =0.33) different between the children with cerebral palsy (0.26±0.07) and the controls (0.28±0.06). The children with cerebral palsy performed significantly more negative work by the lead leg during double support (p =0.0004), and significantly less positive work by the trail leg (p <0.00001). During single support, the children with cerebral palsy performed significantly more positive work on the center of mass (p <0.00001). No significant differences were found for the amount of negative work performed by the leg in single support (p =0.84). Children with spastic diplegic cerebral palsy show a diminished ability to appropriately perform mechanical work by the legs to lift and redirect the center of mass. The altered mechanical work performed by the legs on the center of mass may play a role in the higher metabolic cost for walking noted in children with cerebral palsy. [Copyright &y& Elsevier]

This study investigated the independent effect of added mass on the stability of the leg kinematics during human walking. We reasoned that adding mass would influence the body's inertial state and thus challenge the ability of the leg to redirect and accelerate the total mass of the body while walking. We hypothesized that walking with added mass would reduce the stability of the leg kinematics. Lower extremity sagittal plane joint kinematics were recorded for 23 subjects as they walked on a treadmill at their preferred speed with and without added mass. The total mass of each subject was manipulated with combinations of simulated reduced gravity and added load. The stability of the leg kinematics was evaluated by computing the eigenvalues of the Poincaré map (i.e. Floquet analysis) that defined the position and velocity of the right hip, knee and ankle at heel-contact and mid- swing. Significant differences in stability were found between the various added mass conditions (P=0.040) and instant in the gait cycle (P=0.001). Post-hoc analysis revealed that walking with 30% added mass compromised the stability of the leg kinematics compared with walking without additional mass (P=0.031). In addition, greater instability was detected at the instance of heel-contact compared with mid-swing (P=0.001). Our results reveal that walking with added mass gives rise to greater disturbances in the leg kinematics, and may be related to the redirection and acceleration of the body throughout the gait cycle. Walking with added mass reduces the stability of the leg kinematics and possibly the overall balance of the walking pattern. [ABSTRACT FROM AUTHOR]

Abstract: With human exploration of the Moon and Mars on the horizon, research considerations for space suit redesign have surfaced. Review of Apollo mission videos revealed repeated instance of falling during extravehicular activities. A better understanding of how suit weight influences the sagittal dynamic stability of the gait pattern may provide insight for new suit design such that space missions may have more productive extravehicular activities and smaller risk of falls that may cause injuries and damage equipment. Participants walked for 4min in simulated Martian gravity with additional loads of 0%, 15%, 30% and 45% of their body weight. Floquet and Lyapunov analysis techniques were used to quantify the dynamic stability of the sagittal plane gait pattern. Additionally, sagittal plane joint kinematics were evaluated to determine if any modification occurred. Results indicated that weight (i.e., added load) had little effect on the sagittal dynamic stability or joint kinematics while in simulated Martian gravity. Potentially, suit weight may not be a priority for space suit redesign. [Copyright &y& Elsevier]

• EEG is used to quantify the strength of somatosensory cortical oscillations. • Theta-alpha oscillations did not differ between sitting, standing, or walking. • Gamma oscillations were similar while sitting and standing. • Gamma oscillations were markedly attenuated while walking. It is well appreciated that processing of peripheral feedback by the somatosensory cortices plays a prominent role in the control of human motor actions like walking. However, very few studies have actually quantified the somatosensory cortical activity during walking. In this investigation, we used electroencephalography (EEG) and beamforming source reconstruction methods to quantify the frequency specific neural oscillations that are induced by an electrical stimulation that is applied to the right tibial nerve under the following experimental conditions: 1) sitting, 2) standing in place, and 3) treadmill walking. Our experimental results revealed that the peripheral stimulation induced a transient increase in theta-alpha (4−12 Hz; 50−350 ms) and gamma (40−80 Hz; 40−100 ms) activity in the leg region of the contralateral somatosensory cortices. The strength of the gamma oscillations were similar while sitting and standing, but were markedly attenuated while walking. Conversely, the strength of the theta-alpha oscillations were not different across the respective experimental conditions. Prior research suggests the afferent feedback from the Ia sensory fibers are likely attenuated during walking, while afferent feedback from the β polysynaptic sensory fibers are not. We suggest that the attenuated gamma oscillations seen during walking reflect the gating of the Ia afferents, while the similarity of theta-alpha oscillations across the experimental conditions is associated with the afferent information from the type II (Aα and β) polysynaptic sensory fibers. [ABSTRACT FROM AUTHOR]