Christopher P. Hurt

An apparent contradiction: increasing variability to achieve greater precision?

To understand the relationship between variability of foot placement in the frontal plane and stability of gait patterns, we explored how constraining mediolateral foot placement during walking affects the structure of kinematic variance in the lower-limb configuration space during the swing phase of gait. Ten young subjects walked under three conditions: (1) unconstrained (normal walking), (2) constrained (walking overground with visual guides for foot placement to achieve the measured unconstrained step width) and, (3) beam (walking on elevated beams spaced to achieve the measured unconstrained step width). The uncontrolled manifold analysis of the joint configuration variance was used to quantify two variance components, one that did not affect the mediolateral trajectory of the foot in the frontal plane (“good variance”) and one that affected this trajectory (“bad variance”). Based on recent studies, we hypothesized that across conditions (1) the index of the synergy stabilizing the mediolateral trajectory of the foot (the normalized difference between the “good variance” and “bad variance”) would systematically increase and (2) the changes in the synergy index would be associated with a disproportionate increase in the “good variance.” Both hypotheses were confirmed. We conclude that an increase in the “good variance” component of the joint configuration variance may be an effective method of ensuring high stability of gait patterns during conditions requiring increased control of foot placement, particularly if a postural threat is present. Ultimately, designing interventions that encourage a larger amount of “good variance” may be a promising method of improving stability of gait patterns in populations such as older adults and neurological patients.

Challenging gait leads to stronger lower-limb kinematic synergies: The effects of walking within a more narrow pathway.

Previous studies using the uncontrolled manifold (UCM) analysis demonstrated that during the swing phase of gait, multi-joint kinematic synergies act to stabilize, i.e., minimize the variance of, the mediolateral trajectory of the swinging limb. Importantly, these synergies are strongest during midswing, suggesting that during gait, individuals may employ strategies to avoid collisions between the limbs at this instance. The purpose of the current study was to test this hypothesis by quantifying whether the synergy index (ΔV) during the middle period of the swing phase of treadmill walking was affected when the width of the treadmill belt was narrowed, a task expected to increase the risk of limb collisions. Eleven healthy young adults walked on a dual-belt treadmill under two conditions: (1) dual-belt - both belts of the treadmill moved at 1.2 m/s (total width: 62.5 cm) and the subject walked with one foot on each of the moving belts and (2) single-belt - one treadmill belt moved at 1.2m/s while the other belt remained stationary and the subject walked with both feet on the moving belt (total width: 30.5 cm). During both conditions, motion capture recorded the positions of 22 passive reflective markers from which UCM analysis was used to quantify ΔV in the joint configuration space. Results indicate that ΔV during the middle-third of swing phase significantly increased by 20% during single-belt walking (p<.01). We interpret this as evidence that the stronger synergies at midswing are needed to stabilize the limb trajectory in order to reduce the risk of between-limb collisions during a period when the lower limbs are nearest each other in the frontal plane.

Effect of progressive horizontal resistive force on the comfortable walking speed of individuals post-stroke

BackgroundIndividuals post-stroke select slow comfortable walking speeds (CWS) and the major factors used to select their CWS is unknown.ObjectiveTo determine the extent to which slow CWS post-stroke is achieved through matching a relative force output or targeting a particular walking speed.MethodsTen neurologically nonimpaired individuals and fourteen chronic stroke survivors with hemiplegia were recruited. Participants were instructed to “walk at the speed that feels most comfortable” on a treadmill against 12 progressively increasing horizontal resistive force levels applied at the pelvis using a robotic system that allowed participant to self-select their walking speed. We compared slope coefficients of the simple linear regressions between the observed normalized force vs. normalized speed relationship in each group to a slope of -1.0 (i.e. ideal slope for a constant relative force output) and 0.0 (i.e. ideal slope for a constant relative speed). We also compared slope coefficients between groups.ResultsThe slope coefficients were significantly greater than -1.0 (p < 0.001 for both) and significantly less than 0 (p < 0.001 for both). However, compared with nonimpaired individuals, people post-stroke were less able to maintain their walking speed (p = 0.003).ConclusionsThe results of this study provide evidence for a complex interaction between the regulation of relative force output and intention to move at a particular speed in the selection of the CWS for individuals post-stroke. This would suggest that therapeutic interventions should not only focus on task specific lower-limb strengthening exercises (e.g. walking against resistance), but should also focus on increasing the range of speeds at which people can safely walk.

Limb contribution to increased self-selected walking speeds during body weight support in individuals poststroke

Individuals poststroke walk at faster self-selected speeds under some nominal level of body weight support (BWS) whereas nonimpaired individuals walk slower after adding BWS. The purpose of this study was to determine whether increases in self-selected overground walking speed under BWS conditions of individuals poststroke can be explained by changes in their paretic and nonparetic ground reaction forces (GRF). We hypothesize that increased self-selected walking speed, recorded at some nominal level of BWS, will relate to decreased braking GRFs by the paretic limb. We recruited 10 chronic (>12 months post-ictus, 57.5±9.6 y.o.) individuals poststroke and eleven nonimpaired participants (53.3±4.1 y.o.). Participants walked overground in a robotic device, the KineAssist Walking and Balance Training System that provided varying degrees of BWS (0-20% in 5% increments) while individuals self-selected their walking speed. Self-selected walking speed and braking and propulsive GRF impulses were quantified. Out of 10 poststroke individuals, 8 increased their walking speed 13% (p=0.004) under some level of BWS (5% n=2, 10% n=3, 20% n=3) whereas nonimpaired controls did not change speed (p=0.470). In individuals poststroke, changes to self-selected walking speed were correlated with changes in paretic propulsive impulses (r=0.68, p=0.003) and nonparetic braking impulses (r=-0.80, p=0.006), but were not correlated with decreased paretic braking impulses (r=0.50 p=0.14). This investigation demonstrates that when individuals poststroke are provided with BWS and allowed to self-select their overground walking speed, they are capable of achieving faster speeds by modulating braking impulses on the nonparetic limb and propulsive impulses of the paretic limb.

Characteristics of horizontal force generation for individuals post-stroke walking against progressive resistive forces.

BACKGROUND Walking, while experiencing horizontal resistive forces, can allow researchers to assess characteristics of force generation in a task specific manner for individuals post-stroke. METHODS Ten neurologically nonimpaired individuals (mean age 52 years) and fourteen chronic stroke survivors (mean age 54 years) with hemiparesis walked in the treadmill-based KineAssist Walking and Balance System, while experiencing twelve progressive horizontal resistive forces at their comfortable walking speed. Slope coefficients of the observed force-velocity relationship were quantified and submitted to an iterative k-means cluster analysis to test for subgroups within the post-stroke sample. Extrapolated force values for individuals were quantified by extrapolating the line of best fit of the force-velocity relationship to the x-intercept. FINDINGS Within the post-stroke group, six individuals were clustered into a high sensitivity group, i.e., large reduction in speed with resistance, and eight were clustered into a low sensitive group, i.e., small reduction in speed with resistance. The low sensitivity group was similar to non-impaired individual. The extrapolated force was significantly higher for non-impaired individuals compared to individuals post-stroke in either the high or low sensitivity group. The differences between low and high sensitivity group suggest that high sensitivity of walking speed to applied resistive force is indicative of overall weakness. INTERPRETATION Individuals with high sensitivity to horizontal resistive force may be walking at or near their maximum force generating capacity when at comfortable walking speed, while low sensitivity individuals may have greater reserve force generating capacity when walking at a particular comfortable walking speed.

Step-by-step variability of swing phase trajectory area during steady state walking at a range of speeds

Background Step kinematic variability has been characterized during gait using spatial and temporal kinematic characteristics. However, people can adopt different trajectory paths both between individuals and even within individuals at different speeds. Single point measures such as minimum toe clearance (MTC) and step length (SL) do not necessarily account for the multiple paths that the foot may take during the swing phase to reach the same foot fall endpoint. The purpose of this study was to test a step-by-step foot trajectory area (SBS-FTA) variability measure that is able to characterize sagittal plane foot trajectories of varying areas, and compare this measure against MTC and SL variability at different speeds. We hypothesize that the SBS-FTA variability would demonstrate increased variability with speed. Second, we hypothesize that SBS-FTA would have a stronger curvilinear fit compared with the CV and SD of SL and MTC. Third, we hypothesize SBS-FTA would be more responsive to change in the foot trajectory at a given speed compared to SL and MTC. Fourth, SBS-FTA variability would not strongly co-vary with SL and MTC variability measures since it represents a different construct related to foot trajectory area variability. Methods We studied 15 nonimpaired individuals during walking at progressively faster speeds. We calculated SL, MTC, and SBS-FTA area. Results SBS-FTA variability increased with speed, had a stronger curvilinear fit compared with the CV and SD of SL and MTC, was more responsive at a given speed, and did not strongly co-vary with SL and MTC variability measures. Conclusion SBS foot trajectory area variability was sensitive to change with faster speeds, captured a relationship that the majority of the other measures did not demonstrate, and did not co-vary strongly with other measures that are also components of the trajectory.

Altered joint kinetic strategies of healthy older adults and individuals with Parkinson’s disease to walk at faster speeds

Individuals with Parkinsons disease (PD) exhibit poorer walking performance compared to healthy, age-matched adults. Lower extremity joint kinetics may provide insight into this performance deficit but are currently lacking in the PD literature, especially across multiple speeds. The primary purpose of this study was to compare joint kinetics between individuals with PD and healthy older adults at both comfortable and maximal walking speeds. Secondarily, we quantified relationships between joint kinetics and walking speeds within each group. Biomechanical gait analyses were conducted for 13 individuals with PD and 12 age-matched controls during comfortable (CWS) and maximal (MWS) speed walking. Relative contributions to total positive work from the hip, knee, and ankle were compared across groups and speeds. Within each group, relationships between relative joint work and CWS and MWS were also quantified. Significant group by speed interactions indicated that healthy older adults increased hip and decreased ankle relative work at MWS compared to CWS whereas relative work at all joints in PD group remained stable across speeds. In the older group, positive relationships were observed between relative hip work and MWS. In the PD group, negative relationships were observed between relative hip work and CWS and MWS. Healthy older adults disproportionately increased mechanical contributions from the hip at MWS compared to CWS. Individuals with PD did not exhibit similar disproportionate scaling of joint kinetics across speed conditions. Inability to appropriately scale joint kinetics in PD may represent an inflexible neuromuscular system in PD, which may limit walking performance in this population.