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Step cadence‐based and machine‐learning (ML) methods have been used to classify physical activity (PA) intensity in health‐related research. This study examined the association of intensity‐specific PA duration with all‐cause (ACM) and CVD mortality using the cadence‐based and ML methods in 68 561 UK Biobank participants wearing wrist‐worn accelerometers. The two‐stage‐ML method categorized activity type and then intensity. The one‐level‐cadence‐method (1LC) derived intensity‐specific duration using all detected steps (including standing utilitarian steps) and cadence thresholds of ≥100 steps/min (moderate intensity) and ≥130 steps/min (vigorous intensity). The two‐level‐cadence‐method (2LC) detected ambulatory steps (i.e., walking and running) and then applied the same cadence thresholds. The 2LC exhibited the most pronounced association at the lower end of duration spectrum. For example, the 2LC showed the smallest minimum moderate‐to‐vigorous‐PA (MVPA) duration (amount associated with 50% of optimal risk reduction) with similar corresponding ACM hazard ratio (HR) to other methods (2LC: 2.8 min/day [95% CI: 2.6, 2.8], HR: 0.83 [95% CI: 0.78, 0.88]; 1LC, 11.1[10.8, 11.4], 0.80 [0.76, 0.85]; ML, 14.9 [14.6, 15.2], 0.82 [0.76, 0.87]). The ML elicited the greatest mortality risk reduction. For example, the medians and corresponding HR in VPA‐ACM association: 2LC, 2.0 min/day [95% CI: 2.0, 2.0], HR, 0.69 [95% CI: 0.61, 0.79]; 1LC, 6.9 [6.9, 7.0], 0.68 [0.60, 0.77]; ML, 3.2 [3.2, 3.2], 0.53 [0.44, 0.64]. After standardizing durations, the ML exhibited the most pronounced associations. For example, the standardized minimum durations in MPA‐CVD mortality association were: 2LC, −0.77; 1LC, −0.85; ML, −0.94; with corresponding HR of 0.82 [0.72, 0.92], 0.79 [0.69, 0.90], and 0.77 [0.69, 0.85], respectively. The 2LC exhibited the most pronounced association with all‐cause and CVD mortality at the lower end of the duration spectrum. The ML method provided the most pronounced association with all‐cause and CVD mortality, thus might be appropriate for estimating health benefits of moderate and vigorous intensity PA in observational studies. [ABSTRACT FROM AUTHOR]

Athletes use either a seven-step or eight-step strategy to reach the first hurdle in the 110 m hurdle event. This study investigated the effect of step strategy on the start position, the block exit and the first four approach steps. Two-dimensional video data were collected in the sagittal plane from 12 male sprinters, grouped as seven-step (n = 6) or eight-step (n = 6) strategists. Mean block spacing was 0.08 m further apart, block contact time 0.06s longer, first step 0.25 m longer and first ground contact 0.03s longer for seven-step athletes compared with eight-step athletes. There was also a greater vertical displacement of the centre of mass (CoM) (0.04 m) for the seven-step athletes compared with the eight-step athletes. Additionally, the front hip mean angular acceleration was 197°/s2 slower for the seven-step athletes than the eight-step athletes. There was limited difference between groups for mean horizontal velocity at the moment of block exit (0.14 m/s). These technical alterations provide an important first insight into start kinematics. The findings of this study identify the position in the starting blocks, and the key parameters which pertain to the initial phases for a successful seven-step approach strategy to be employed. [ABSTRACT FROM AUTHOR]

A middle-aged Asian man had gait difficulty progressing over several years. His speech had gradually become slurred with involuntary tongue biting. He was the product of a consanguineous marriage with no other relevant family history. MR scan of brain showed bilateral caudate atrophy. Nerve conduction studies showed a predominantly sensory peripheral neuropathy. Serum creatine kinase was slightly elevated but electromyography showed no evidence of myopathy. Three consecutive peripheral blood films were negative for acanthocytes. Whole-genome sequencing confirmed a mutation in VPS13A gene, consistent with autosomal recessive chorea-acanthocytosis. [ABSTRACT FROM AUTHOR]

Introduction: Frailty is conventionally diagnosed using clinical tests and self-reported assessments. However, digital health technologies (DHTs), such as wearable accelerometers, can capture physical activity and gait during daily life, enabling more objective assessments. In this study, we assess the feasibility of deploying DHTs in community-dwelling older individuals, and investigate the relationship between digital measurements of physical activity and gait in naturalistic environments and participants' frailty status, as measured by conventional assessments. Methods: Fried Frailty Score (FFS) was used to classify fifty healthy individuals as non-frail (FFS = 0, n/female = 21/11, mean ± SD age: 71.10 ± 3.59 years), pre-frail (FFS = 1–2, n/female = 23/9, age: 73.74 ± 5.52 years), or frail (FFS = 3+, n/female = 6/6, age: 70.70 ± 6.53 years). Participants wore wrist-worn and lumbar-worn GENEActiv accelerometers (Activinsights Ltd., Kimbolton, UK) during three in-laboratory visits, and at-home for 2 weeks, to measure physical activity and gait. After this period, they completed a comfort and usability questionnaire. Compliant days at-home were defined as follows: those with ≥18 h of wear time, for the wrist-worn accelerometer, and those with ≥1 detected walking bout, for the lumbar-worn accelerometer. For each at-home measurement, a group analysis was performed using a linear regression model followed by ANOVA, to investigate the effect of frailty on physical activity and gait. Correlation between at-home digital measurements and conventional in-laboratory assessments was also investigated. Results: Participants were highly compliant in wearing the accelerometers, as 94% indicated willingness to wear the wrist device, and 66% the lumbar device, for at least 1 week. Time spent in sedentary activity and time spent in moderate activity as measured from the wrist device, as well as average gait speed and its 95th percentile from the lumbar device were significantly different between frailty groups. Moderate correlations between digital measurements and self-reported physical activity were found. Conclusions: This work highlights the feasibility of deploying DHTs in studies involving older individuals. The potential of digital measurements in distinguishing frailty phenotypes, while unobtrusively collecting unbiased data, thus minimizing participants' travels to sites, will be further assessed in a follow-up study. [ABSTRACT FROM AUTHOR]

Wearable inertial measurement units (IMUs) are being used to quantify gait characteristics that are associated with increased fall risk, but the current limitation is the lack of contextual information that would clarify IMU data. Use of wearable video-based cameras would provide a comprehensive understanding of an individual's habitual fall risk, adding context to clarify abnormal IMU data. Generally, there is taboo when suggesting the use of wearable cameras to capture real-world video, clinical and patient apprehension due to ethical and privacy concerns. This perspective proposes that routine use of wearable cameras could be realized within digital medicine through AI-based computer vision models to obfuscate/blur/shade sensitive information while preserving helpful contextual information for a comprehensive patient assessment. Specifically, no person sees the raw video data to understand context, rather AI interprets the raw video data first to blur sensitive objects and uphold privacy. That may be more routinely achieved than one imagines as contemporary resources exist. Here, to showcase/display the potential an exemplar model is suggested via off-the-shelf methods to detect and blur sensitive objects (e.g., people) with an accuracy of 88%. Here, the benefit of the proposed approach includes a more comprehensive understanding of an individual's free-living fall risk (from free-living IMU-based gait) without compromising privacy. More generally, the video and AI approach could be used beyond fall risk to better inform habitual experiences and challenges across a range of clinical cohorts. Medicine is becoming more receptive to wearables as a helpful toolbox, camera-based devices should be plausible instruments. [ABSTRACT FROM AUTHOR]

Objective: To develop an early economics evaluation (EEE) to assess the cost‐effectiveness of the GS in reducing the RoF and FoF. Methods: A cost‐effectiveness analysis (CEA) with a return on investment (RoI) estimation was performed. CEA used the most relevant parameters, such as increased gait speed and decreased FoF, to estimate the reduction in the RoF, the impact on health care resources used and financial implications for the National Health System in the United Kingdom. Outcomes were measured as incremental cost‐effectiveness ratio per quality‐adjusted life years (QALYs) gained based on the reduction of the RoF and FoF. Uncertainties around the main parameters used were evaluated by probabilistic sensitivity analysis. Results: The CEA results showed that the GS is a dominant strategy over the standard of care to improve the movements of older persons who have suffered a fall or are afraid of falling (incremental QALYs based on FoF = 0.77 and QALYs based on RoF = 1.07, cost of FoF = ‐£4479.57 and cost of RoF = ‐£2901.79). By implementing the GS, the ROI results suggest that every pound invested in the GS could result in cost savings of £1.85/patient based on the RoF reduction and £11.16/patient based on the FoF reduction. The probability of being cost saving based on the number of iterations were 79.4 percent (based on FoF) and 100 percent (based on RoF). Conclusion: The EEE supports the main hypothesis that the GS is an effective intervention to avoid falls and is potentially cost saving. [ABSTRACT FROM AUTHOR]

Static assessment and grouping of riders by competition level are prevalent in equestrian coaching practice and research. This study explored sagittal pelvic tilt in 35 competitive dressage riders to analyse the relationship between static and dynamic postures and assess the interaction of competition level. Riders were assessed using optical motion capture on a riding simulator at halt and in walk, trot, and left and right canter. Mean, minimum and maximum pelvic tilt, and range of motion (ROM) were measured as the pitch rotation of a rigid body formed by markers placed on the rider's left/right anterior and posterior superior iliac spines and sacrum, averaged over six time-normalised strides. Three key results emerged: (1) there are correlations between the rider's mean pelvic tilt in simulated walk, trot and canter, but not at halt; (2) mean pelvic tilt values are not significantly influenced by competition level (p = 0.233); and (3) the minimum and maximum pelvic tilt values illustrate individual strategies between gaits. Therefore, results from static assessment and grouping of riders by competition level should be interpreted with caution. Riders should be assessed as individuals, during dynamic riding-specific tasks, to understand their postural strategies. [ABSTRACT FROM AUTHOR]

Objectives To determine whether digital gait biomarkers captured by a wrist-worn device can predict injurious falls in older people and to develop a multivariable injurious fall prediction model. Design Population-based longitudinal cohort study. Setting and participants Community-dwelling participants of the UK Biobank study aged 65 and older (n  = 32,619) in the United Kingdom. Methods Participants were assessed at baseline on daily-life walking speed, quality, quantity and distribution using wrist-worn accelerometers for up to 7 days. Univariable and multivariable Cox proportional hazard regression models were used to analyse the associations between these parameters and injurious falls for up to 9 years. Results Five percent of the participants (n  = 1,627) experienced at least one fall requiring medical attention over a mean of 7.0 ± 1.1 years. Daily-life walking speed, gait quality, quantity of walking and distribution of daily walking were all significantly associated with the incidence of injurious falls (P  < 0.05). After adjusting for sociodemographics, lifestyle factors, comorbidities, handgrip strength and reaction time; running duration, total step counts and usual walking speed were identified as independent and significant predictors of falls (P  < 0.01). These associations were consistent in those without a history of previous fall injuries. In contrast, step regularity was the only risk factor for those with a previous fall history after adjusting for covariates. Conclusions Daily-life gait speed, quantity and quality, derived from wrist-worn sensors, are significant predictors of injurious falls in older people. These digital gait biomarkers could potentially be used to identify fall risk in screening programs and integrated into fall prevention strategies. [ABSTRACT FROM AUTHOR]

Objectives: There is no standardisation of tasks or measures for evaluation of freezing of gait severity in people with Parkinson's disease. This study aimed to develop a clinician-rated tool for freezing of gait severity (i.e. Freezing of Gait Severity Tool), through determining clinicians' ratings of the most important triggering circumstances to be examined and aspects of freezing of gait to be measured. Design: A three-round, web-based Delphi study. Participants: Healthcare professionals, with at least five years' experience in managing freezing of gait in people with Parkinson. Main outcome measures: Round 1 required participants (n = 28) to rate items on a 5-point Likert scale, based on priority for inclusion in the Freezing of Gait Severity Tool. In Round 2, participants (n = 18) ranked the items based on priority for inclusion. In Round 3, participants (n = 18) confirmed or rejected the shortlisted items by judging their ability, on a binary scale, to screen for freezing of gait, detect changes in freezing severity, and discriminate between degrees of severity. Results: Participants agreed with the triggering circumstances of turning hesitation, narrow space hesitation, start hesitation, cognitive dual-tasking, and open space hesitation should be assessed; and the aspects of gait freezing to be measured included freezing type, number of freezing episodes during a task, and average duration of freezing episodes. Conclusions: This study attained a consensus for the items to be included in a clinician-rated tool for freezing of gait severity. Future studies should investigate psychometric properties and clinical feasibility of the Freezing of Gait Severity Tool. [ABSTRACT FROM AUTHOR]

Background: Gait impairment limiting mobility and restricting activities is common after stroke. Auditory rhythmical cueing (ARC) uses a metronome beat delivered during exercise to train stepping and early work reports gait improvements. This study aimed to establish the feasibility of a full scale multicentre randomised controlled trial to evaluate an ARC gait and balance training programme for use by stroke survivors in the home and outdoors. Methods: A parallel-group observer-blind pilot randomised controlled trial was conducted. Adults within 2 years of stroke with a gait-related mobility impairment were recruited from four NHS stroke services and randomised to an ARC gait and balance training programme (intervention) or the training programme without ARC (control). Both programmes consisted of 3x30 min sessions per week for 6 weeks undertaken at home/nearby outdoor community. One session per week was supervised and the remainder self-managed. Gait and balance performance assessments were undertaken at baseline, 6 and 10 weeks. Key trial outcomes included recruitment and retention rates, programme adherence, assessment data completeness and safety. Results: Between November 2018 and February 2020, 59 participants were randomised (intervention n=30, control n=29), mean recruitment rate 4/month. At baseline, 6 weeks and 10 weeks, research assessments were conducted for 59/59 (100%), 47/59 (80%) and 42/59 (71%) participants, respectively. Missing assessments were largely due to discontinuation of data collection from mid-March 2020 because of the UK COVID-19 pandemic lockdown. The proportion of participants with complete data for each individual performance assessment ranged from 100% at baseline to 68% at 10 weeks. In the intervention group, 433/540 (80%) total programme exercise sessions were undertaken, in the control group, 390/522 (75%). Falls were reported by five participants in the intervention group, six in the control group. Three serious adverse events occurred, all unrelated to the study. Conclusion: We believe that a definitive multicentre RCT to evaluate the ARC gait and balance training programme is feasible. Recruitment, programme adherence and safety were all acceptable. Although we consider that the retention rate and assessment data completeness were not sufficient for a future trial, this was largely due to the UK COVID-19 pandemic lockdown. Trial registration: ISRCTN, ISRCTN10874601, Registered on 05/03/2018, [ABSTRACT FROM AUTHOR]

Context: In sprint events, the first 2 steps are used to accelerate the center of mass horizontally and vertically. Amputee athletes cannot actively generate energy with their running-specific prosthesis. It is likely that sprint acceleration mechanics, including step asymmetry, are altered compared with able-bodied athletes. Purpose: To investigate spatiotemporal and kinetic variables of amputee compared with able-bodied sprinters. Methods: Kinematic and kinetic data of the first and second stance were collected from 15 able-bodied and 7 amputee sprinters (2 unilateral transfemoral, 4 unilateral transtibial, and 1 bilateral transtibial) with a motion-capture system (250 Hz) and 2 force plates (1000 Hz). In addition, bilateral asymmetry was quantified and compared between groups. Results: Compared with able-bodied athletes, amputee athletes demonstrated significantly lower performance values for 5- and 10-m times. Step length, step velocity, and step frequency were decreased and contact times increased. Peak horizontal force and relative change of horizontal velocity were decreased in both stances. Peak vertical force and relative change of vertical velocity were lower for the amputee than the able-bodied group during the first stance but significantly higher during the second stance. During the first stance, able-bodied and amputee sprinters displayed a similar orientation of the ground-reaction-force vector, which became more vertically orientated in the amputee group during second stance. Amputee sprinters showed significantly greater asymmetry magnitudes for vertical force kinetics compared with able-bodietd athletes. Conclusion: A running-specific prosthesis does not replicate the function of the biological limb well in the early acceleration phase. [ABSTRACT FROM AUTHOR]

Digital gait biomarkers (including walking speed) indicate functional decline and predict hospitalization and mortality. However, waist or lower-limb devices often used are not designed for continuous life-long use. While wrist devices are ubiquitous and many large research repositories include wrist-sensor data, widely accepted and validated digital gait biomarkers derived from wrist-worn accelerometers are not available yet. Here we describe the development of advanced signal processing algorithms that extract digital gait biomarkers from wrist-worn devices and validation using 1-week data from 78,822 UK Biobank participants. Our gait biomarkers demonstrate good test–retest-reliability, strong agreement with electronic walkway measurements of gait speed and self-reported pace and significantly discriminate individuals with poor self-reported health. With the almost universal uptake of smart-watches, our algorithms offer a new approach to remotely monitor life-long population level walking speed, quality, quantity and distribution, evaluate disease progression, predict risk of adverse events and provide digital gait endpoints for clinical trials. [ABSTRACT FROM AUTHOR]

The neuromuscular system responds to perturbation and increasing locomotor task difficulty by altering the stability of neuromuscular output signals. The purpose of this study was to determine the effects of two different military load carriage systems on the dynamic stability of gait and muscle activation signals. 14 army office cadets (20 ± 1 years) performed 4-minute treadmill walking trials on level (0%) and uphill (10%) gradients while unloaded, and with 11 kg backpack and 11 kg webbing loads while the activity of 6 leg and trunk muscles and the motion of the centre of mass (COM) were recorded. Loaded and uphill walking decreased stability and increased magnitude of muscle activations compared to loaded and level gradient walking. Backpack loads increased the medio-lateral stability of COM and uphill walking decreased stability of vertical COM motion and increased stride time variability. However, there was no difference between the two load carriage systems for any variable. The reduced stability of muscle activations in loaded and uphill conditions indicates an impaired ability of the neuromuscular control systems to accommodate perturbations in these conditions which may have implications on the operational performance of military personnel. However, improved medio-lateral stability in backpack conditions may indicate that participants were able to compensate for the loads used in this study, despite the decreased vertical stability and increased stride time variability evident in uphill walking. This study did not find differences between load carriage systems however, specific load carriage system effects may be elicited by greater load carriage masses. [ABSTRACT FROM AUTHOR]

To contain the recent COVID‐19 outbreak, restrictions have been imposed, which has limited outdoor activity. These physical behavior changes can have serious health implications, but there is little objective information quantifying these changes. This study aimed to estimate the change in physical behavior levels during full lockdown conditions using objective data collected from a thigh‐worn activity monitor. Data used were from 6492 individuals in the 1970 British Cohort Study, collected between 2016 and 2018. Using walking bout characteristics, days were classified as either "indoor only" (n = 861), "indoor and exercise" (n = 167), and "outdoor active" (n = 31 934). When compared to "outdoor active" days, "indoor only" days had 6590 fewer steps per day (2320 vs 8876, p < 0.001), a longer sedentary time (1.5 h, p < 0.001), longer lying time (1.4 h, p < 0.001) and shorter standing (1.9 h, p < 0.001) and stepping (1.3 h, p < 0.001) times. The "indoor and exercise" days had a smaller number of steps compared to "outdoor active" (7932 vs 8876, p < 0.05). There is a strong relationship between reduced daily stepping, and increased sedentary time, with a range of poor health outcomes. This has important implications for public health policy and messaging during pandemics. [ABSTRACT FROM AUTHOR]

Objective: To test the extent to which initial walking speed influences dual-task performance after walking intervention, hypothesising that slow walking speed affects automatic gait control, limiting executive resource availability. Design: A secondary analysis of a trial of dual-task (DT) and single-task (ST) walking interventions comparing those with good (walking speed ⩾0.8 m s−1, n = 21) and limited (walking speed <0.79 m s−1, n = 24) capacity at baseline. Setting: Community. Subjects: Adults six-months post stroke with walking impairment. Interventions: Twenty sessions of 30 minutes treadmill walking over 10 weeks with (DT) or without (ST) cognitive distraction. Good and limited groups were formed regardless of intervention received. Main measures: A two-minute walk with (DT) and without (ST) a cognitive distraction assessed walking. f NIRS measured prefrontal cortex activation during treadmill walking with (DT) and without (ST) Stroop and planning tasks and an f MRI sub-study used ankle-dorsiflexion to simulate walking. Results: ST walking improved in both groups (∆baseline: Good = 8.9 ± 13.4 m, limited = 5.3±8.9 m, Group × time = P < 0.151) but only the good walkers improved DT walking (∆baseline: Good = 10.4 ± 13.9 m, limited = 1.3 ± 7.7 m, Group × time = P < 0.025). f NIRS indicated increased ispilesional prefrontal cortex activation during DT walking following intervention (P = 0.021). f MRI revealed greater DT cost activation for limited walkers, and increased resting state connectivity of contralesional M1 with cortical areas associated with conscious gait control at baseline. After the intervention, resting state connectivity between ipsilesional M1 and bilateral superior parietal lobe, involved in integrating sensory and motor signals, increased in the good walkers compared with limited walkers. Conclusion: In individual who walk slowly it may be difficult to improve dual-task walking ability. Registration: ISRCTN50586966 [ABSTRACT FROM AUTHOR]

The Burden of Wounds Study estimated the cost of wound care across the UK to be £5.3 billion, with £3 billion associated with hard-to-heal wounds. This article looks at potential cost savings of managing hard-to-heal leg ulcers in a specialist wound care service using a multidisciplinary team (MDT) approach. This unique approach includes: a consultant dermatologist; a podiatrist specialising in mobility and gait; a clinical psychologist; clinical nurse specialists; and allied health professionals from tissue viability and lymphoedema services. Bringing together specialists from supporting disciplines provides a one-stop service for the patient. We conducted a retrospective analysis (over 365 days) of wound healing in patients attending the service for management of leg ulcers with differing aetiologies, including venous and atypical leg ulceration. Many of the patients referred to the service had a long wound history, between two and nine years, with a duration up to 25 years in the most complex cases. Within this complex cohort of patients, higher levels of focused compression was required (Accelerate Strapping, Accelerate, UK) for retromalleolar ulceration and management of foot oedema needing toe bandaging or garments. Wound healing was achieved in 72% of patients across all wound aetiologies, demonstrating the impact that a specialist MDT team can have on positive healing outcomes, and which can result in cost savings to the health economy and an improved quality of life for the patient. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the prevalence of fear of falling (FOF) and fear‐related activity restriction (FAR) and their association with frailty, sarcopenia, gait speed and grip strength, cognitive impairment, depression, social isolation, self‐perceived health, and vision. DESIGN: Observational cross‐sectional study. SETTING: Community. PARTICIPANTS: A total of 493 community‐dwelling older adults, 60 years and older. MEASURES: FOF and FAR were assessed using validated single closed‐ended questions. Questionnaire was administered to evaluate frailty (FRAIL scale ‐ Fatigue, Resistance, Aerobic, Illness, and Loss of Weight), sarcopenia (SARC‐F ‐ lifting and carrying 10 pounds, walking across a room, transferring from bed/chair, climbing a flight of 10 stairs, and frequency of falls in the past 1 year), social isolation (six‐item Lubben Social Network Scale), depression (Even Briefer Assessment Scale), cognition (Chinese Mini‐Mental State Examination), and perceived general health and pain (The EuroQol‐5 Dimension (EQ‐5D)and EQ visual analogue scale (EQ VAS)). Binary logistic regression was performed to determine the influence of sociodemographic, medical, functional, and cognitive variables on FOF with/without FAR. RESULTS: Prevalence of FOF was 69.2%, and among them, 38.4% had FAR. Prevalence of FOF with or without FAR in those with sarcopenia was 93.3% and in prefrail/frail was 76.6%. FOF was significantly associated with prefrail/frail (odds ratio (OR) = 2.17; 95% confidence interval (CI) = 1.26–3.73), depression (OR = 4.90; 95% CI = 1.06–22.67), number of medications (OR = 1.28; 95% CI = 1.03–1.59), and female sex (OR = 3.54; 95% CI = 1.82–6.90). FOF + FAR was associated with depression (OR = 5.17; 95% CI = 1.84–14.54) and sarcopenia (OR = 8.13; 95% CI = 1.52–43.41). CONCLUSION: FOF with/without FAR is highly prevalent among community‐dwelling older adults, especially in those with sarcopenia, prefrailty, and frailty, with significant negative impact on function, quality of life, social network, and mental health. Further research is needed to investigate the value of population‐level screening, causal relationship, and efficacy of comprehensive intervention strategies. [ABSTRACT FROM AUTHOR]

High rates of occupational training-related lower-limb musculoskeletal (MSK) overuse injuries are reported for British Army recruits during basic training. Foot drill is a repetitive impact loading occupational activity and involves striking the ground violently with an extended-knee (straight-leg) landing. Foot drill produces vertical ground reaction force (vGRF) equal to or greater than those reported for high-level plyometric exercises/activities. Shock absorbing footwear aid in the attenuation of the magnitude of vGRF, resulting in a reduced risk of lower-limb MSK overuse injury when running. The potential shock absorbing characteristics of standard issue British Army footwear on the magnitude of vGRF and temporal parameters of foot drill are scant. Therefore, this study sought to determine the magnitude of and examine changes in vGRF and temporal parameters of foot drill across 3 types of British Army footwear. Sampled at 1,000 Hz, the mean of 8 trials from 15 recreationally active men were collected from 4 foot drills; stand-at-ease, stand-at-attention, quick-march (QM), and halt. Analysis of a normal walk was included to act as a comparison with QM. Significant main effects (P ≤ 0.05) were observed between footwear and foot drill. The training shoe (TR) demonstrated significantly greater shock absorbing capabilities when compared with the combat boot and ammunition boot. Foot drill produced peak vGRF and peak vertical rate of force development in excess of 5 bw, and 350 bw·s, respectively. Time to peak vGRF ranged from 0.016 to 0.036 ms across foot drills, indicating that passive vGRF may not be under neuromuscular control. The marginal reductions in the magnitude of vGRF and temporal parameters in foot drill associated with the TR may act to reduce the accumulative impact loading forces experienced by recruits, subsequently minimizing the severity and rates of lower-limb MSK overuse injuries and recruit medical discharges during basic training. [ABSTRACT FROM AUTHOR]

Trabecular bone structure in adulthood is a product of a process of modelling during ontogeny and remodelling throughout life. Insight into ontogeny is essential to understand the functional significance of trabecular bone structural variation observed in adults. The complex shape and loading of the human calcaneus provides a natural experiment to test the relationship between trabecular morphology and locomotor development. We investigated the relationship between calcaneal trabecular bone structure and predicted changes in loading related to development of gait and body size in growing children. We sampled three main trabecular regions of the calcanei using micro‐computed tomography scans of 35 individuals aged between neonate to adult from the Norris Farms #36 site (1300 AD, USA) and from Cambridge (1200–1500 AD, UK). Trabecular properties were calculated in volumes of interest placed beneath the calcaneocuboid joint, plantar ligaments, and posterior talar facet. At birth, thin trabecular struts are arranged in a dense and relatively isotropic structure. Bone volume fraction strongly decreases in the first year of life, whereas anisotropy and mean trabecular thickness increase. Dorsal compressive trabecular bands appear around the onset of bipedal walking, although plantar tensile bands develop prior to predicted propulsive toe‐off. Bone volume fraction and anisotropy increase until the age of 8, when gait has largely matured. Connectivity density gradually reduces, whereas trabeculae gradually thicken from birth until adulthood. This study demonstrates that three different regions of the calcaneus develop into distinct adult morphologies through varying developmental trajectories. These results are similar to previous reports of ontogeny in human long bones and are suggestive of a relationship between the mechanical environment and trabecular bone architecture in the human calcaneus during growth. However, controlled experiments combined with more detailed biomechanical models of gait maturation are necessary to establish skeletal markers linking growth to loading. This has the potential to be a novel source of information for understanding loading levels, activity patterns, and perhaps life history in the fossil record. [ABSTRACT FROM AUTHOR]

Background Exposure to higher magnitude vertical impacts is thought to benefit bone health. The correlates of this high-impact physical activity (PA) in later life are unknown. Methods Participants were from the Cohort for Skeletal Health in Bristol and Avon, Hertfordshire Cohort Study and MRC National Survey of Health and Development. Associations of demographic, behavioural, physiological and psychological factors with vertical acceleration peaks ≥1.5 g (i.e. high-impact PA) from 7-day hip-worn accelerometer recordings were examined using linear regression. Results A total of 1187 participants (mean age = 72.7 years, 66.6% females) were included. Age, sex, education, active transport, self-reported higher impact PA, walking speed and self-rated health were independently associated with high-impact PA whereas BMI and sleep quality showed borderline independent associations. For example, differences in log-high-impact counts were 0.50 (P < 0.001) for men versus women and −0.56 (P < 0.001) for worst versus best self-rated health. Our final model explained 23% of between-participant variance in high impacts. Other correlates were not associated with high-impact activity after adjustment. Conclusions Besides age and sex, several factors were associated with higher impact PA in later life. Our findings help identify characteristics of older people that might benefit from interventions designed to promote osteogenic PA. [ABSTRACT FROM AUTHOR]

To determine if digital gait biomarkers captured by a wrist-worn device can predict the incidence of depressive episodes in middle-age and older people. Longitudinal cohort study. A total of 72,359 participants recruited in the United Kingdom. Participants were assessed at baseline on gait quantity, speed, intensity, quality, walk length distribution, and walk-related arm movement proportions using wrist-worn accelerometers for up to 7 days. Univariable and multivariable Cox proportional-hazard regression models were used to analyze the associations between these parameters and diagnosed incident depressive episodes for up to 9 years. A total of 1332 participants (1.8%) had incident depressive episodes over a mean of 7.4 ± 1.1 years. All gait variables, except some walk-related arm movement proportions, were significantly associated with the incidence of depressive episodes (P <.05). After adjusting for sociodemographic, lifestyle, and comorbidity covariates; daily running duration, steps per day, and step regularity were identified as independent and significant predictors (P <.001). These associations held consistent in subgroup analysis of older people and individuals with serious medical conditions. The study findings indicate digital gait quality and quantity biomarkers derived from wrist-worn sensors are important predictors of incident depression in middle-aged and older people. These gait biomarkers may facilitate screening programs for at-risk individuals and the early implementation of preventive measures. [ABSTRACT FROM AUTHOR]

Foot drop is a common gait impairment in people with MS (pwMS) but in some foot drop may only occur after a period of prolonged walking and may be a sign of motor fatigability. The purpose of the study was to explore whether, for pwMS, an adapted six-minute walk test (6minWT) would result in an increase in foot drop as measured using electrogoniometry. Sagittal ankle kinematics were recorded for fifteen participants (10 females and 5 males, aged 37-64) with MS (EDSS 4-6) throughout the 6minWT. Ankle kinematics and temporal stride parameters were compared between the first and last 10 gait cycles of the 6minWT. Peak dorsiflexion in swing was significantly reduced at the end of the 6minWT compared to the start, with six of the fifteen participants having a decrease of two degrees or more. Statistically significant changes in temporal stride parameters suggested a decrease in walking speed. Our results suggest that with the protocol used in this study it is feasible to identify patients who experience increased foot drop as a result of a prolonged exercise task. [ABSTRACT FROM AUTHOR]

Background Frailty is a state of increased vulnerability to disability, falls, and mortality. The Fried frailty phenotype includes assessments of grip strength and gait speed, which are complex or require objective measurements and are challenging in routine primary care practice. In this study, we aimed to develop a simple assessment tool based on self-reported information on the 5 Fried frailty components to identify older people at risk of incident disability, falls, and mortality. Methods Analyses are based on a prospective cohort comprising older British men aged 71–92 years in 2010–2012. A follow-up questionnaire was completed in 2014. The discriminatory power for incident disability and falls was compared with the Fried frailty phenotype using receiver operating characteristic-area under the curve (ROC-AUC); for incident falls it was additionally compared with the FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight). Predictive ability for mortality was assessed using age-adjusted Cox proportional hazard models. Results A model including self-reported measures of slow walking speed, low physical activity, and exhaustion had a significantly increased ROC-AUC [0.68, 95% confidence interval (CI) 0.63–0.72] for incident disability compared with the Fried frailty phenotype (0.63, 95% CI 0.59–0.68; P value of ΔAUC = .003). A second model including self-reported measures of slow walking speed, low physical activity, and weight loss had a higher ROC-AUC (0.64, 95% CI 0.59–0.68) for incident falls compared with the Fried frailty phenotype (0.57, 95% CI 0.53–0.61; P value of ΔAUC < .001) and the FRAIL scale (0.56, 95% CI 0.52–0.61; P value of ΔAUC = .001). This model was also associated with an increased risk of mortality (Harrell's C = 0.73, Somer's D = 0.45; linear trend P < .001) compared with the Fried phenotype (Harrell's C = 0.71; Somer's D = 0.42; linear trend P < .001) and the FRAIL scale (Harrell's C = 0.71, Somer's D = 0.42; linear trend P < .001). Conclusions Self-reported information on the Fried frailty components had superior discriminatory and predictive ability compared with the Fried frailty phenotype for all the adverse outcomes considered and with the FRAIL scale for incident falls and mortality. These findings have important implications for developing interventions and health care policies as they offer a simple way to identify older people at risk of adverse outcomes associated with frailty. [ABSTRACT FROM AUTHOR]

Background Ankle inversion injuries are one of the most common and burdensome injuries in athletic populations. Research that prospectively identifies characteristics associated with this injury is lacking. This prospective study compared baseline anthropometric and biomechanical gait characteristics of military recruits who sustained an ankle inversion injury during training, with those who remained injury-free. Methods Bilateral plantar pressure and three-dimensional lower limb kinematics were recorded in 1065 male, injury-free military recruits, during barefoot running. Injuries that occurred during the 32-week recruit training programme were subsequently recorded. Data were compared between recruits who sustained an ankle inversion injury during training (n = 27) and a sample (n = 120) of those who completed training injury-free. A logistic regression analysis was used to identify risk factors for this injury. Findings A narrower bimalleolar width and an earlier peak pressure under the fifth metatarsal were predictors of ankle inversion injury. Those who sustained an ankle inversion injury also had a lower body mass, body mass index, and a smaller calf girth than those who completed training injury-free. Interpretation Anthropometric and dynamic gait characteristics have been identified that may predispose recruits to an ankle inversion injury during Royal Marine recruit training, allowing identification of recruits at higher risk at the start of training. [ABSTRACT FROM AUTHOR]

The number of people living into older age (>65 years) is rising rapidly. Older people are more likely to fall and this has adverse consequences for their quality of life and that of their families. Falls also pose a substantial financial burden on healthcare systems. Extensive research from systematic reviews and meta-analyses has established effective approaches for reducing falls among older people, although uncertainties and controversy remain. The evidence suggests that exercise based and tailored interventions are the most effective way to reduce falls and associated healthcare costs among older people in the community. This review integrates current knowledge on assessment and management strategies to prevent falls in older people living in the community. It summarizes known risk factors for falls in this population and presents assessment strategies that can be used to assess the risk of falls. It discusses the management of risks and interventions to reduce falls among older people in the community, as well as future directions and promising approaches. [ABSTRACT FROM AUTHOR]

Objectives. We investigated associations between having a bus pass, enabling free local bus travel across the United Kingdom for state pension-aged people, and physical activity, gait speed, and adiposity. Methods. We used data on 4650 bus pass-eligible people (aged ≥ 62 years) at wave 6 (2012-2013) of the English Longitudinal Study of Ageing in regression analyses. Results. Bus pass holders were more likely to be female (odds ratio [OR] = 1.67; 95% confidence interval [CI] = 1.38, 2.02; P<.001), retired (OR = 2.65; 95% CI = 2.10, 3.35; P< .001), without access to a car (OR = 2.78; 95% CI = 1.83, 4.21; P< .001), to use public transportation (OR =10.26; 95% CI = 8.33, 12.64; P<.001), and to be physically active (OR =1.43; 95% CI = 1.12, 1.84; P=.004). Female pass holders had faster gait speed (b = 0.06 meters per second; 95% CI = 0.02, 0.09; P = .001), a body mass index 1 kilogram per meter squared lower (b = -1.20; 95% CI =-1.93, -0.46; P=.001), and waist circumference 3 centimeters smaller (b = -3.32; 95% CI =-5.02, -1.62; P<.001) than women without a pass. Conclusions. Free bus travel for older people helps make transportation universally accessible, including for those at risk for social isolation. Those with a bus pass are more physically active. Among women in particular, the bus pass is associated with healthier aging. [ABSTRACT FROM AUTHOR]

Frailty is a clinical syndrome that focuses on loss of reserve, energy and wellbeing. Older people with frailty tend to present late and often in crisis to health and care services so their care may be hospital-based, episodic and unplanned. Frailty should be reframed as a long-term condition that can be managed proactively in primary and community settings by supported self-management and person-centred care. Nurses play a vital role as key workers, care co-ordinators and supporters to patients and their carers at all stages of the frailty trajectory. [ABSTRACT FROM AUTHOR]

Older people are majority users of health and social care services in the UK and internationally. Many older people who access these services have frailty, which is a state of vulnerability to adverse outcomes. The existing health care response to frailty is mainly secondary care-based and reactive to the acute health crises of falls, delirium and immobility. A more proactive, integrated, person-centred and community-based response to frailty is required.The British Geriatrics Society Fit for Frailty guideline is consensus best practice guidance for the management of frailty in community and outpatient settings.Recognition of frailtyThe BGS recommends that all encounters between health and social care staff and older people in community and outpatient settings should include an assessment for frailty. A gait speed <0.8m/s; a timed-up-and-go test >10s; and a score of ≥3 on the PRISMA 7 questionnaire can indicate frailty. The common clinical presentations of frailty (falls, delirium, sudden immobility) can also be used to indicate the possible presence of frailty.Management of frailty The BGS recommends an holistic medical review based on the principles of comprehensive geriatric assessment (CGA) for all older people identified with frailty. This will: diagnose medical illnesses to optimise treatment; apply evidence-based medication review checklists (e.g. STOPP/START criteria); include discussion with older people and carers to define the impact of illness; work with the older person to create an individualised care and support plan.Screening for frailtyThe BGS does not recommend population screening for frailty using currently available instruments. [ABSTRACT FROM AUTHOR]

Objectives: Apert syndrome affects the craniofacial structures resulting in craniosynostosis, craniofacial anomalies and syndactyly. Although many characteristic features are recognized, vestibular dysfunction is a little known feature that can often be present. This can cause a delay in the attainment of gross motor milestones and impair motor function. We aimed to examine this cohort to review the incidence of vestibular hypofunction and to assess the effect on motor function. Study design: We performed a retrospective analysis of 55 Apert syndrome patients who had undergone audiological review at Great Ormond Street Hospital for Children. Results: 50.9% of patients experienced balance difficulties; 18.1% of patients (all of whom had delayed motor milestones) underwent clinical examination and vestibular assessment. Results showed only 20% of patients had bilateral vestibular function present; 30% of patients had unilateral and 50% bilateral vestibular hypofunction. Two patients who initially presented with imbalance and vestibular hypofunction experienced significant improvement in symptoms on re-examination following vestibular physiotherapy. Conclusion: Vestibular dysfunction is a feature of Apert syndrome. Although the imbalance may be attributable to mechanical problems arising from syndactyly, it is important to recognize that a vestibular component can coexist. This is not well recognized, poorly understood and scarcely treated. We aim to increase awareness of vestibular dysfunction in Apert syndrome and advocate a high index of suspicion, particularly in the presence of motor milestone delay. Early detection, thorough vestibular assessment and prompt initiation of vestibular physiotherapy can aid vestibular compensation, rehabilitating patients and maximizing their functional attainment. [ABSTRACT FROM AUTHOR]

Objective. Osteoarthritis (OA) is a common chronic disease for which disease-modifying therapies are not currently available. Studies to seek new targets for slowing the progress of OA rely on mouse models, but these do not allow for longitudinal monitoring of disease development. This study was undertaken to determine whether gait can be used to measure disease severity in the STR/Ort mouse model of spontaneous OA and whether gait changes are related to OA joint pain. Methods. Gait was monitored using a treadmillbased video system. Correlations between OA severity and gait at 3 treadmill speeds were assessed in STR/Ort mice. Gait and pain behaviors of STR/Ort mice and control CBA mice were analyzed longitudinally, with monthly assessments. Results. The best speed to identify paw area changes associated with OA severity in STR/Ort mice was found to be 17 cm. seconds-1. Paw area was modified with age in CBA and STR/Ort mice, but this began earlier in STR/Ort mice and correlated with the onset of OA at 20 weeks of age. In addition, task noncompliance appeared at 20 weeks. Surprisingly, STR/Ort mice did not show any signs of pain with OA development, even when treated with the opioid antagonist naloxone, but did exhibit normal pain behaviors in response to complete Freund's adjuvant-induced arthritis. Conclusion. The present results identify an animal model in which OA severity and OA pain can be studied in isolation from one another. The findings suggest that paw area and treadmill noncompliance may be useful tools to longitudinally monitor nonpainful OA development in STR/Ort mice. This will help in providing a noninvasive means of assessing new therapies to slow the progression of OA. [ABSTRACT FROM AUTHOR]

Objective The external knee adduction moment (EAM) is often considered a surrogate measure of the distribution of loads across the tibiofemoral joint during walking. This study was undertaken to quantify the relationship between the EAM and directly measured medial tibiofemoral contact forces (Fmed) in a sample of subjects across a spectrum of activities. Methods The EAM for 9 patients who underwent total knee replacement was calculated using inverse dynamics analysis, while telemetric implants provided Fmed for multiple repetitions of 10 activities, including walking, stair negotiation, sit-to-stand activities, and squatting. The effects of the factors 'subject' and 'activity' on the relationships between Fmed and EAM were quantified using mixed-effects regression analyses in terms of the root mean square error (RMSE) and the slope of the regression. Results Across subjects and activities a good correlation between peak EAM and Fmed values was observed, with an overall R2 value of 0.88. However, the slope of the linear regressions varied between subjects by up to a factor of 2. At peak EAM and Fmed, the RMSE of the regression across all subjects was 35% body weight (%BW), while the maximum error was 127 %BW. Conclusion The relationship between EAM and Fmed is generally good but varies considerably across subjects and activities. These findings emphasize the limitation of relying solely on the EAM to infer medial joint loading when excessive directed cocontraction of muscles exists and call for further investigations into the soft tissue-related mechanisms that modulate the internal forces at the knee. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to measure changes in gait parameters over the course of a 10 kilometer treadmill run. Researchers evaluated 15 competitive male runners. They found that while foot contact time decreased and flight time increased over the course of the run no other gait variables changed.

Background: vestibular disorders are common in the general population, increasing with age. However, it is unknown whether older adults who fall have a higher proportion of vestibular impairment compared with age-matched older adult non-fallers.Objective: to identify whether a greater proportion of older adult fallers have a peripheral vestibular impairment compared with age-matched healthy controls.Design: case-controlled study.Setting: tertiary falls and neuro-otology clinics and local community centres, London, UK.Participants and methods: community-dwelling older adults experiencing: (i) ≥2 unexplained falls within the previous 12-months (Group F, n = 25), (ii) a confirmed peripheral vestibular disorder (Group PV, n = 15) and (iii) healthy non-fallers (Group H, n = 16). All the participants completed quantitative vestibular function tests, the functional gait assessment (FGA), physiological profile assessment (PPA) and subjective measures for common vestibular symptoms (i.e. giddiness), balance confidence during daily activities and psychological state.Results: a clinically significant vestibular impairment was noted for 80% (20/25) of Group F compared with 18.75% (3/16) for Group H (P < 0.01). Group F performed less well in complex gait tasks (FGA), and reported a greater number of falls than both Groups H and PV (P < 0.05). Vestibular symptom scores showed no significant difference between Groups F and PV.Conclusion: vestibular dysfunction is significantly more prevalent in older adult fallers versus non-fallers. Individuals referred to a falls clinic are older, more impaired and report more falls than those referred to a neuro-otology department. A greater awareness of vestibular impairments may lead to more effective management and treatment for older adult fallers. [ABSTRACT FROM PUBLISHER]

Background and Purpose Ankle foot orthoses (AFOs) are commonly prescribed for people with Charcot-Marie-Tooth (CMT) disease. Scant evidence exists to guide the type and timing of orthotic prescription. This study explores the latter issue by investigating the differences in presentation and gait function of people with CMT disease who wore AFOs for daily mobility ( n = 11) and a group who did not ( n = 21). The aim was to see if there was a difference in the characteristics in people who regularly wear AFOs. Methods Primary measures of gait function were a 10-m timed walk (comfortable and maximum speed) and a 6-minute walk test. Means of the variables were compared using independent t-tests. Secondary measures included disease severity, lower limb muscle strength, sensory impairment, walking effort, fatigue severity and perceived walking ability. Results AFO wearers walked slower with higher effort. They also had greater disease severity, weaker leg muscles and perceived greater walking difficulty. Subjects not wearing AFOs showed significant relationships between gait variables and muscle strength, whereas AFO wearers showed significant relationships between gait variables and perceived walking ability, fatigue severity and effort. Conclusions People who regularly wore AFOs were more severely affected, had a slower maximum walking speed, higher energy cost of walking and worse perceived walking ability. Walking ability in this group was related to fatigue, perceived exertion during walking and perceived walking ability. Gait function of people not using AFOs was determined by lower limb muscle function. People prescribed AFOs, those who do not wear them and those not prescribed AFOs were similar in presentation, suggesting that people choose to wear orthoses when their condition becomes sufficiently severe. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Limb stiffness or musculotendinous stiffness (MTS) has previously been examined in relation to performance and characterized using a number of different methods. However, the fact that MTS shows only low to moderate correlations to performances may indicate a lack of understanding of this parameter. In addition to this, variation is seen between studies examining the same factors. To date, our understanding of MTS and its components are not complete and thus it is unclear which characteristic value represents the ideal index of stiffness as it relates to performance. Moreover, it is uncertain how MTS stiffness as a functional measure relates to performance, and also if there is an optimal amount of MTS stiffness for specific functions or tasks. The knowledge of the interplay of MTU stiffness as it relates to performance and injury risk is also poorly understood in that there is likely a disparity between levels of stiffness required to optimize performance and those required to minimize injury risk. The aim of this article is to review the literature as it describes the components of MTS and to discuss these in terms of their relationship to functional performance; consider adaptations of the MTU with training along with associated performance changes; highlight and discuss how stiffness may affect loading of the soft and bony tissues in terms of the MTU components and gender, with respect to risk of injury; discuss the apparent differences in the literature regarding associations of the various forms of stiffness index to function; suggest recommendations for training in light of adaptation of the muscle and tendon and injury risk in context of gender; and, finally, to highlight potential limitations of current methodologies and suggest further work to gain insight into the mechanisms of stiffness. It is hoped that by suggesting future work, a more detailed and comprehensive understanding of MTS will be gained, thus enabling appropriate interventions to optimally modify this parameter for specific requirements. [ABSTRACT FROM AUTHOR]

Background and Purpose Despite the finding that 40% to 60% of stroke patients suffer from knee joint hyperextension during gait, there is a lack of agreement of the possible causes of this problem. The aim of this study was to determine whether there is a relationship between lower limb muscle weakness and knee joint hyperextension in hemiparetic stroke patients. Methods This is a cross-sectional observational comparison study. Twenty patients (mean age 66 years) who had suffered a single hemiparetic stroke and were ambulant with no major lower limb joint pathology participated. Muscle strength of the hip extensors, hip flexors, hip abductors, knee extensors, knee flexors, ankle plantarflexors and ankle dorsiflexors of both limbs was measured using a hand-held dynamometer. Computerized and visual gait analysis identified subjects with and without knee hyperextension in loading response and midstance. Subjects were categorized as having weakness of a particular muscle group if the difference in strength between the paretic and non-paretic muscle was greater than 50%. The Pearson's chi-squared test was used to evaluate the association between weakness and knee hyperextension. Results A strong relationship was found between ankle plantarflexor weakness and knee hyperextension during midstance ( p = 0.044). No relationship was found between lower limb muscle weakness and knee hyperextension during loading response ( p > 0.05). No relationship was found between any other lower limb muscle groups and knee hyperextension in midstance ( p > 0.05). Conclusions Weak ankle plantarflexors, in particular gastrocnemius, may have an important role in the presence of knee hyperextension. The results of this study did not support a role for weak hamstrings or quadriceps in knee hyperextension during gait. Further research is needed to clarify the role of gastrocnemius during the stance phase and to determine if strengthening weak gastrocnemius reduces knee hyperextension. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Advances in the management of Achilles tendon rupture have led to the development of immediate weightbearing protocols. These vary regarding which ankle-foot orthoses (AFOs) are used and the number of inserted heel wedges used within them.Purpose: This study was conducted to evaluate plantar pressure measurements and temporal gait parameters within different AFOs, using different numbers of heel wedges.Study Design: Controlled laboratory study.Methods: Fifteen healthy participants were evaluated using 3 different AFOs, with 4 different levels of inserted heel wedges. Therefore, a total of 12 conditions were evaluated, in a sequence that was randomly allocated to each participant. Pressure and temporal gait parameters were measured using an in-shoe F-Scan pressure system, and range of movement was measured using an electrogoniometer.Results: Ankle-foot orthoses that were restrictive in design, combined with a higher number of inserted heel wedges, reduced forefoot pressures, increased heel pressures, and decreased the amount of time spent in the terminal stance and preswing phase of the gait cycle (P = .029, .002, and .001).Conclusion: The choice of AFO design and the number of inserted heel wedges have a significant effect on plantar pressure measurements and temporal gait parameters. The implications of these changes need to be applied to the clinical management of acute Achilles tendon ruptures. This clinical management requires a balance between protected weightbearing and functional loading, requiring further research within a clinical context.Clinical Relevance: The biomechanical data from this research imply that a carbon-fiber AFO, with 1 heel raise, protects against excessive dorsiflexion while facilitating the restoration of near-normal gait parameters. This could lead to an accelerated return to function, avoiding the effects of disuse atrophy. This is in contrast to the rigid rocker-bottom AFO design with a greater number of heel-wedge inserts. However, research within a clinical context would be required to ascertain if these biomechanical advantages translate into a functional benefit for patients. The results should also be considered in relation to the amount of force a healing Achilles tendon can withstand. [ABSTRACT FROM AUTHOR]

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Objective: To assess the effect of a slider shoe on the gait speed and energy efficiency of hemiplegic gait. Design: A-B-A single-case design to compare walking with and without the slider shoe. Results were assessed graphically using the 2SD method. Setting: Stroke unit of an NHS general hospital in the UK. Subjects: Four acute stroke patients undergoing gait rehabilitation. Intervention: Walking practice with and without a slider shoe worn over the real shoe of the weak leg. Main outcome measures: Gait speed (10-m walk test) and energy efficiency (Physiological Cost Index). Results: All subjects showed an improvement in speed and efficiency when wearing the slider shoe compared with the baseline phase (A1). Three subjects showed a sustained improvement in efficiency and two showed a sustained improvement in speed in the second baseline phase (A2). Conclusion: A slider shoe may improve the speed and efficiency of hemiplegic gait for people in the early stages of gait rehabilitation. Further investigation is warranted. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of different aids on the amount of support hemiplegic subjects took from them. The relationship between the amount of support, severity of hemiplegia and walking ability were also assessed. Design: Hemiplegic subjects’ gait and the amount of support they took from the aid were measured as they walked with a normal height stick, a high stick and a tripod. Subjects: Fifteen subjects with a hemiplegia of more than three months’ duration who could walk independently were recruited. Outcome measures: Velocity, the gross function section of the Rivermead Motor Assessment, percentage bodyweight taken through the aid, the aid contact time, the placement of the aid, and the lateral shift of the pelvis when weight bearing were assessed. Results: No differences in the amount of support or walking ability were found with the different aids. There was a significant relationship between severity of hemiplegia and the percentage of bodyweight taken through the aid (r &equals; -0.67), between aid contact time and severity of hemiplegia (-0.53) and between aid contact time and walking ability (-0.53). No relationship between walking ability and other measures of the amount of support was found. Conclusions: Different types of aid did not influence the amount of support taken by hemiplegic subjects. These results contradict the beliefs of many neurological physiotherapists in Britain and the clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Background/Aims: Peak hip adduction and knee flexion during running are associated with patellofemoral pain persistence, representing treatment targets. Clinical practice is lacking a validated, reliable tool with which to measure these kinematics. This study aimed to determine the accuracy of clinical gait analysis, by investigating concurrent validity, intra- and inter-rater reliability of two-dimensional video. Methods: A total of 21 participants with patellofemoral pain were recruited (10 males, 11 females). Synchronised three-dimensional and two-dimensional kinematic data were collected during over-groundrunning. Two-dimensional videos were analysed with the Hudl Technique application using a commercially available tablet (iPad). Single measure intraclass coreelation coefficients (ICCs) were calculated using a two-way mixed effects model with absolute agreement. Three-dimensional peak hip internal rotation was investigated as a covariate with backward linear regression, using the F change statistic. Results: There was poor agreement between three-dimensional and two-dimensional measurement of peak hip adduction (ICC 0.06) and peak knee flexion (ICC 0.42). Moderate intra-rater reliability was identified for both variables (ICC 0.61–0.65). Inter-rater reliability for peak knee flexion was moderate (ICC 0.71), but was poor for peak hip adduction (ICC 0.31). Three-dimensional peak hip internal rotation did not significantly explain the identified poor agreement for either variable. Conclusions: Poor agreement between three-dimensional kinematics and two-dimensional video was identified for both variables in runners with patellofemoral pain, despite acceptable intra-rater reliability. Investigation of software with increased precision is warranted, to improve the accuracy of two-dimensional video predicting three-dimensional kinematics in the clinical setting. Clinical gait analysis using the Hudl Technique application is not currently advocated. [ABSTRACT FROM AUTHOR]

The article focuses on a 12-week pedometer-based intervention, delivered in primary care, produces long-term gains in physical activity. It mentions study illuminate the potential of pragmatic, pedometer-based interventions to impact on activity levels over more extended time frames; and also mentions the natural overlap between rehabilitation and physical activity presents an opportunity for physiotherapists to respond to major public health issue.

The article focuses on a 12-week pedometer-based intervention, delivered in primary care, produces long-term gains in physical activity. It mentions the multi-component intervention included a pedometer, keeping a step-count diary, 12 weeks of goal setting, and a handbook that included behaviour change techniques; and also mentions participants in the control group were provided with a pedometer and instructions with no further support.

Purpose This study aimed to investigate whether textured insoles can improve gait in people with multiple sclerosis (MS). Relevance Previous studies have shown that footwear, including textured insoles, may improve postural stability in healthy young and older adults (Palluel et al., 2008; Hatton et al., 2009; Hatton et al., 2011), and there is some evidence to show that footwear interventions may be beneficial for people with MS (Ramdharry et al., 2006; Kelleher et al., 2010). Participants Forty-six people with MS (34 women), mean age (SD) 49 years (7), who reported that they were able to walk 100 m with or without resting with the use of one stick or crutch, participated in the study. Methods Ethical approval was granted by the Local Research Ethics Committee. Participants were randomized to one of two textured insole groups: texture A (Algeos UK Ltd, Liverpool, UK), which was used in our previous studies (Hatton et al., 2009; Hatton et al., 2011), or texture B, a commercial insole (Crocs™, Den Haag, The Netherlands). Participants conducted baseline walking tests at their preferred speed along an instrumented walkway (GAITRite) in a laboratory setting, and temporal-spatial gait parameters were extracted. Participants then wore the insoles for two weeks and returned for repeat testing. Analysis Paired t-tests were used to evaluate changes between baseline and follow-up. Results Stride length increased between baseline and follow-up in both legs in group A (left p = 0.01, right p = 0.02) and group B (left p = 0.02, right p = 0.02). Velocity and cadence did not change significantly in either group. Discussion This finding that textured insoles can produce improvements in stride length requires further investigation. It is consistent with research on foot orthoses in MS showing an improvement in balance after four weeks of wear (Ramdharry et al., 2006). Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]