François Prince

Symmetry and limb dominance in able-bodied gait: a review

As one of the most universal of all human activities, gait in the able-bodied has received considerable attention, but many aspects still need to be clarified. Symmetry or asymmetry in the actions of the lower extremities during walking and the possible effect of laterality on gait are two prevalent and controversial issues. The purpose of this study was to review the work done over the last few decades in demonstrating: (a) whether or not the lower limbs behave symmetrically during able-bodied gait; and (b) how limb dominance affects the symmetrical or asymmetrical behavior of the lower extremities. The literature reviewed shows that gait symmetry has often been assumed, to simplify data collection and analysis. In contrast, asymmetrical behavior of the lower limbs during able-bodied ambulation was addressed in numerous investigations and was found to reflect natural functional differences between the lower extremities. These functional differences were probably related to the contribution of each limb in carrying out the tasks of propulsion and control during able-bodied walking. In current debates on gait symmetry in able-bodied subjects, laterality has been cited as an explanation for the existence of functional differences between the lower extremities, although a number of studies do not support the hypothesis of a relationship between gait symmetry and laterality. Further investigation is needed to demonstrate functional gait asymmetry and its relationship to laterality, taking into consideration the biomechanical aspects of gait.

Gait in the elderly

Abstract Walking is one of the most common of all human movements. It exists to transport the body safely and efficiently across ground level, uphill or downhill. Walking is learned during the first year of life and reaches maturity around 7 until 60 years. Elderly walking performance then starts to decline and the elderly slow down gradually. Falls are a major cause of morbidity in the elderly and in almost all incidences of falls, some aspects of locomotion have been implicated. With the increased life expectancy of the elderly and their more active lifestyle there is now an emphasis on determining any changes that occur in their gait patterns in order to reduce the frequency of falls, to identify diagnostic measures that are reliable predictors of fall-prone elderly and finally to develop programs for preventing such falls. This review addresses the gait related changes in the elderly in order to pinpoint the effect of normal aging for comparison with different gait deviations related to some pathologies. Spatio-temporal, kinematics, kinetics and EMG data will be reviewed as well as the physiological changes associated with gait and aging. Finally, the selection criteria will be reviewed and recommendation on the urgent need of a valid healthy elderly database will be addressed.

Screening older adults at risk of falling with the Tinetti balance scale

In a prospective study of 225 community dwelling people 75 years and older, we tested the validity of the Tinetti balance scale to predict individuals who will fall at least once during the following year. A score of 36 or less identified 7 of 10 fallers with 70% sensitivity and 52% specificity. With this cut-off score, 53% of the individuals were screened positive and presented a two-fold risk of falling. These characteristics support the use of this test to screen older people at risk of falling in order to include them in a preventive intervention.

Effect of ageing and vision on limb load asymmetry during quiet stance

Although the identification and characterization of limb load asymmetries during quiet standing has not received much research attention, they may greatly extend our understanding of the upright stance stability control. It seems that the limb load asymmetry factor may serve as a veridical measure of postural stability and thus it can be used for early diagnostic of the age-related decline in balance control. The effects of ageing and of vision on limb load asymmetry (LLA) during quiet stance were studied in 43 healthy subjects (22 elderly, mean age 72.3+/-4.0 yr, and 21 young, mean age 23.9+/-4.8 yr). Postural sway and body weight distribution were recorded while the subject was standing on two adjacent force platforms during two 120 s trials: one trial was performed with the eyes open (EO), while the other trial was with the eyes closed (EC). The results indicate that LLA was greater in the old adults when compared with the young control subjects. The LLA values were correlated with the postural sway magnitudes especially in the anteroposterior direction. Eyes closure which destabilized posture resulted in a significant increase of body weight distribution asymmetry in the elderly but not in the young persons. The limb load difference between EO and EC conditions showed a significantly greater effect of vision on LLA in the elderly compared to the young subjects. The observed differences in the LLA may be attributed to the decline of postural stability control in the elderly. Ageing results in the progressive decline of postural control and usually the nervous system requires more time to complete a balance recovery action. To compensate for such a deficiency, different compensatory strategies are developed. One of them, as evidenced in our study, is preparatory limb unload strategy (a stance asymmetry strategy) which could significantly shorten reaction time in balance recovery.

Locomotor strategies in obese and non-obese children.

Objective: The constant strain in obese children may increase the risks of articular problems in adulthood. In the short term, obesity in children could lead to modifications of the gait pattern. The purpose of this study was to compare biomechanical parameters between obese and non‐obese children during self‐paced walking.

Gait Patterns After Total Hip Arthroplasty and Surface Replacement Arthroplasty

OBJECTIVE To compare gait patterns in patients with total hip arthroplasty (THA) and surface hip arthroplasty. DESIGN Observational study. SETTING Outpatient biomechanical laboratory. PARTICIPANTS Two groups of 10 surface hip arthroplasty and THA patients and 10 control subjects participated in the study (N=30). The patients were volunteers recruited from a larger randomized study. INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Gait patterns, hip abductor muscle strength, clinical outcomes, and radiographic analyses were compared between groups. RESULTS In the sagittal plane, the THA group showed a larger flexor moment and larger mechanical work in H2S and K3S power bursts compared with surface hip arthroplasty and control subjects. In the frontal plane, both THA and surface hip arthroplasty patients had smaller hip abductor muscles energy generation (H3F) than the control group. No difference was found for the hip abductor muscles strength. CONCLUSIONS In the THA group, the larger energy absorption in H2S and K3S would be a cost-effective mechanical adaptation to increase stability. The surface hip arthroplasty characteristics could allow the return to a more normative gait pattern compared with THA. The modification in the frontal plane in surface hip arthroplasty and THA would be related to the hip abductor muscles strength.

Functional roles of ankle and hip sagittal muscle moments in able-bodied gait.

OBJECTIVE The main objectives of this study on able-bodied gait were (a) to identify the main functions of the ankle and hip muscle moments and their contribution to support and propulsion tasks, and (b) to illustrate the interaction between the ankle and hip moment activities. DESIGN Twenty young, able-bodied male subjects walked along a 13 m path at a freely chosen speed. BACKGROUND Functional contributions of the ankle and hip muscles and their interactions in achieving support and propulsion tasks during gait are still subject to controversy. METHODS Principal component analysis was applied as a curve structure detection method to identify the main functional characteristics of the ankle and hip muscle moments. The first two principal components which contained over 70% and 85%, respectively, of the information in the ankle and hip moment curves revealed their functional tasks. Ankle versus hip moment plots was used to illustrate the interactions between muscles acting at the hip and ankle in the sagittal plane. Correlation coefficient and covariance calculations quantified the interaction between the ankle and hip moments. RESULTS The first principal component revealed that the main role of the ankle and hip is to keep the body from collapsing. The second principal component is associated with the functional contribution of both ankle plantarflexors and hip flexors during the propulsion phase (50-60% of the gait cycle). High coordination (r=0.82) between the ankle and hip moments was observed. CONCLUSION Maintaining body support against gravity was identified as the first functional task of the ankle plantarflexors and hip extensors, while contribution to propulsion was recognised as the second major role for the ankle plantarflexors and hip flexors. RELEVANCE Identifying the main roles of the muscles acting at the hip and ankle during able-bodied walking provides better insight into how pathological gait should be evaluated.

Reduction of gait data variability using curve registration

Timing in peak gait values shifts slightly between gait trials. When averaged, the standard deviation (S.D.) in gait data may increase due to this inter-trial variability unless normalization is carried out beforehand. The objective of this study was to determine how curve registration, an alignment technique, can reduce inter-subject variability in gait data without perturbing the curve characteristics. Twenty young, healthy men participated in this study each providing a single gait trial. Gait was assessed by means of a four-camera high-speed video system synchronized to a force plate. A rigid body three-segment model was used in an inverse dynamic approach to calculate three-dimensional muscle powers at the hip, knee and ankle. Curve registration was applied to each of the 20 gait trials to align the peak powers. The mean registered peak powers increased by an average of 0.10 +/- 0.13 W/kg with the highest increases in the sagittal plane at push-off. After performing curve registration, the RMS values decreased by 13.6% and the greatest reduction occurred at the hip and knee, both in the sagittal plane. No important discontinuities were reported in the first and second derivatives of the unregistered and registered curves. Curve registration did not have much effect on the harmonic content. This would be an appropriate technique for application prior to any statistical analysis using able-bodied gait patterns.

Principal component analysis of the power developed in the flexion/extension muscles of the hip in able-bodied gait.

This study was undertaken to demonstrate how principal component analysis (PCA) can be used: (a) to detect the main functional structure of actions taken by hip extensors and flexors during two consecutive gait cycles of able-bodied subjects, and (b) to determine whether or not symmetrical behaviour exists between right and left hip muscle power activity. Twenty young, healthy male subjects walked along a 13 m path at a freely-chosen speed. Applying curve structure detection methods such as PCA to walking patterns can provide insight into the functional tasks accomplished by the lower limbs of able-bodied and disabled subjects. PCA was applied as a classification and curve structure detection method to hip sagittal muscle power calculated for the right and left lower limbs. Over 70% of the information provided by the first four principal components (PCs) was chosen for further biomechanical interpretation. PC1 for both right and left sides mainly described the action taken by the hip extensors/flexors corresponding to the vertical component of ground force on the respective limbs during mid-stance. Propulsion and limb preparation were identified as the second and third tasks attributed to right hip muscle power, while between limb co-ordination was recognised as the second and third functional tasks of the left hip extensors/flexors. Balance was identified as the fourth main functional contribution of the hip extensors/flexors at the right limb while for the left limb, these muscles were mainly responsible for preparing the limb to enter into new gait cycle. PCA was able to identify the four main functional contributions of hip sagittal muscle power during able-bodied gait. PCA was also able to examine the existence of functional asymmetry in gait by highlighting different task priorities at the hip level for the right and left lower limbs.

Physical Activity and Obesity: Biomechanical and Physiological Key Concepts

Overweight (OW) and obesity (OB) are often associated with low levels of physical activity. Physical activity is recommended to reduce excess body weight, prevent body weight regain, and decrease the subsequent risks of developing metabolic and orthopedic conditions. However, the impact of OW and OB on motor function and daily living activities must be taken into account. OW and OB are associated with musculoskeletal structure changes, decreased mobility, modification of the gait pattern, and changes in the absolute and relative energy expenditures for a given activity. While changes in the gait pattern have been reported at the ankle, knee, and hip, modifications at the knee level might be the most challenging for articular integrity. This review of the literature combines concepts and aims to provide insights into the prescription of physical activity for this population. Topics covered include the repercussions of OW and OB on biomechanical and physiological responses associated with the musculoskeletal system and daily physical activity. Special attention is given to the effect of OW and OB in youth during postural (standing) and various locomotor (walking, running, and cycling) activities.