Pieter Meyns

The how and why of arm swing during human walking.

Humans walk bipedally, and thus, it is unclear why they swing their arms. In this paper, we will review the mechanisms and functions of arm swinging in human gait. First, we discuss the potential advantages of having swinging arms. Second, we go into the detail on the debate whether arm swing is arising actively or passively, where we will conclude that while a large part of arm swinging is mechanically passive, there is an active contribution of muscles (i.e. an activity that is not merely caused by stretch reflexes). Third, we describe the possible function of the active muscular contribution to arm swinging in normal gait, and discuss the possibility that a Central Pattern Generator (CPG) generates this activity. Fourth, we discuss examples from pathological cases, in which arm swinging is affected. Moreover, using the ideas presented, we suggest ways in which arm swing may be used as a therapeutic aid. We conclude that (1) arm swing should be seen as an integral part of human bipedal gait, arising mostly from passive movements, which are stabilized by active muscle control, which mostly originates from locomotor circuits in the central nervous system (2) arm swinging during normal bipedal gait most likely serves to reduce energy expenditure and (3) arm swinging may be of therapeutic value.

Action and emotion recognition from point light displays: an investigation of gender differences.

Folk psychology advocates the existence of gender differences in socio-cognitive functions such as ‘reading’ the mental states of others or discerning subtle differences in body-language. A female advantage has been demonstrated for emotion recognition from facial expressions, but virtually nothing is known about gender differences in recognizing bodily stimuli or body language. The aim of the present study was to investigate potential gender differences in a series of tasks, involving the recognition of distinct features from point light displays (PLDs) depicting bodily movements of a male and female actor. Although recognition scores were considerably high at the overall group level, female participants were more accurate than males in recognizing the depicted actions from PLDs. Response times were significantly higher for males compared to females on PLD recognition tasks involving (i) the general recognition of ‘biological motion’ versus ‘non-biological’ (or ‘scrambled’ motion); or (ii) the recognition of the ‘emotional state’ of the PLD-figures. No gender differences were revealed for a control test (involving the identification of a color change in one of the dots) and for recognizing the gender of the PLD-figure. In addition, previous findings of a female advantage on a facial emotion recognition test (the ‘Reading the Mind in the Eyes Test’ (Baron-Cohen, 2001)) were replicated in this study. Interestingly, a strong correlation was revealed between emotion recognition from bodily PLDs versus facial cues. This relationship indicates that inter-individual or gender-dependent differences in recognizing emotions are relatively generalized across facial and bodily emotion perception. Moreover, the tight correlation between a subjects ability to discern subtle emotional cues from PLDs and the subjects ability to basically discriminate biological from non-biological motion provides indications that differences in emotion recognition may - at least to some degree – be related to more basic differences in processing biological motion per se.

Turning and unilateral cueing in Parkinson's disease patients with and without freezing of gait.

BACKGROUND Freezing of gait (FOG) is one of the most disabling symptoms in Parkinsons disease (PD), and cueing has been reported to improve FOG during straight-line walking. Studies on how cueing affects FOG during turning are lacking. Given the asymmetrical nature of turning and the asymmetrical disease expression, we aimed to gain a new perspective on how unilateral cueing may alleviate FOG. OBJECTIVE To explore disease dominance and turning side as contributing factors to turning problems and FOG and to investigate the effect of unilateral cueing. METHODS In the first study, 13 PD patients with FOG (freezers) and 13 without FOG (nonfreezers) turned toward their disease-dominant and nondominant side (off medication). During the second study, 16 freezers and 14 nonfreezers turned with and without a unilateral auditory cue at -10% of preferred cadence. Total number of steps, turn duration, cadence, and FOG episodes were measured using VICON. RESULTS Cadence, but not FOG frequency, was higher when turning toward the disease-dominant side. FOG started more frequently (64.9%) on the inner side of the turning cycle. Unilateral cueing seemed to prevent FOG in most patients, irrespective of the side at which the cue was offered. A carryover effect was found for cadence during turning, but the effect on FOG disappeared when the cue was removed. CONCLUSIONS The occurrence of FOG is not influenced by turning toward the disease-dominant or nondominant side, which is confirmed by the fact that it does not make a difference at which side unilateral cueing is applied. Cueing reduces FOG during turning, but these effects disappear dramatically after cue removal. This raises further questions as to the influence of training on cue dependency and on the feasibility of either continuous application of cues or using cognitive strategies as an alternative.

Is interlimb coordination during walking preserved in children with cerebral palsy

Arm movements during gait in children with cerebral palsy (CP) are altered compared to typically developing children (TD). We investigated whether these changes in arm movements alter interlimb coordination in CP gait. 3D gait analysis was performed in CP (diplegia [DI]: N = 15 and hemiplegia [HE]: N = 11) and TD (N = 24) children at preferred and fast walking speeds. Mean Relative Phase (MRP, i.e. mean over the gait cycle of the Continuous Relative Phase or CRP) was calculated as a measure of coordination, standard deviation of CRP was used as a measure of coordinative stability, and the sign of MRP indicated which limb was leading (for all pair combinations of the four limbs). In HE, coordination was significantly altered, less stable and a different leading limb was found compared to TD whenever the most affected arm was included in the studied limb pair. In DI, coordination deteriorated significantly when any of the two legs was included in the studied limb pair, and coordinative stability was significantly affected when any of the two arms was included. In almost all limb pair combinations, a different limb was leading in DI compared to TD. Increasing walking speed significantly improved coordination and coordinative stability of several limb pairs in DI. Coordination and limb-leading deficits were mostly linked to the affected limb. The compensating (non-affected) arm primarily affected coordinative stability, which underlines the importance of active arm movements in HE. Increasing walking speed may be used to improve interlimb coordination in DI.

Three-dimensional head and trunk movement characteristics during gait in children with spastic diplegia

This study uses a recently developed trunk model to determine which head and trunk kinematic parameters differentiate children with spastic diplegia from typically developing (TD) children while walking. Differences in head and trunk parameters in relation to the severity of the motor involvement (GMFCS levels) were additionally examined. The trunk model consisted of five segments (pelvis, thorax, head, shoulder line, spine). Discrete kinematic parameters (ROM, mean position) and angular waveforms were compared between 20 children with spastic diplegia (age 9.8 years±2.9 years; GMFCS I: n=10, GMFCS II: n=10) and 20 individually age-matched TD children (9.7 years±3 years). A new measure for overall trunk pathology, the trunk profile score (TPS), was proposed and included in the comparative analysis. Compared to TD children, children with GMFCS II showed a significantly higher TPS and increased ROM for pelvis tilt, for thorax and head in nearly all planes, and the angle of kyphosis. In children with GMFCS I, only ROM of thorax lateral bending was significantly increased. Sagittal ROM differentiated best between GMFCS levels, with higher ROM found in children with GMFCS II. Current results provide new insights into head and trunk kinematics during gait in children with spastic diplegia.

Control of angular momentum during walking in children with cerebral palsy

Children with hemiparetic Cerebral Palsy (CP) walk with marked asymmetries. For instance, we have recently shown that they have less arm swing on the affected side, and more arm swing at the unaffected side. Such an increase in arm swing at the unaffected side may be aimed at controlling total body angular momentum about the vertical axis, although it was never investigated in this respect. In the current study, we thus investigated if participants with hemiparetic CP control angular momentum by compensatory movements of the unaffected arm. We measured gait kinematics of 11 CP children, and 24 age matched typically developing (TD) children, walking at both self-selected and fast walking speeds, and calculated angular momenta. We found that children with hemiparetic CP did not have a reduced angular momentum of the affected arm. However, they showed substantial increases in angular momentum generated by the legs, which were compensated by increased angular momentum of the unaffected arm. As a result, there were no differences in total body angular momentum between TD and CP children. Moreover, walking speed had no effect on total body angular momentum in both groups. These findings support the idea that angular momentum during walking is a controlled variable, even in children with hemiplegic CP.

Steps forward in understanding backward gait: from basic circuits to rehabilitation

Backward locomotion is used increasingly in sports and rehabilitation. However, it is unclear whether training effects of backward walking (BW)/backward running (BR) can be transferred simply to forward walking (FW)/forward running (FR). This touches on the question whether the same neural substrate can generate FW and BW. The available evidence suggests that BW uses the same rhythm circuitry but additionally requires specialized control circuits.

Gait stability in children with Cerebral Palsy

Children with unilateral Cerebral Palsy (CP) have several gait impairments, amongst which impaired gait stability may be one. We tested whether a newly developed stability measure (the foot placement estimator, FPE) which does not require long data series, can be used to asses gait stability in typically developing (TD) children as well as children with CP. In doing so, we tested the FPEs sensitivity to the assumptions needed to calculate this measure, as well as the ability of the FPE to detect differences in stability between children with CP and TD children, and differences in walking speed. Participants were asked to walk at two different speeds, while gait kinematics were recorded. From these data, the FPE, as well as the error that violations of assumptions of the FPE could have caused were calculated. The results showed that children with CP walked with marked instabilities in anterior-posterior and mediolateral directions. Furthermore, errors caused by violations of assumptions in calculation of FPE were only small (≈ 1.5 cm), while effects of walking speed (≈ 20 cm per m/s increase in walking speed) and group (≈ 5 cm) were much larger. These results suggest that the FPE may be used to quantify gait stability in TD children and children with CP.

Interlimb coordination during forward walking is largely preserved in backward walking in children with cerebral palsy

OBJECTIVE Limb kinematics in backward walking (BW) are essentially those of forward walking (FW) in reverse. It has been argued that subcortical mechanisms could underlie both walking modes. METHODS Therefore, we tested whether participants with supraspinal/cortical deficits (i.e. cerebral palsy) show the kinematic reversal from FW to BW. 3D gait analysis was performed in 15 children with diplegia and 11 children with hemiplegia to record elevation angles of upper arm, lower arm, upper leg, lower leg, and foot, and were compared to those of 23 control subjects. Coordination patterns were compared between FW and BW, and elevation angle traces of BW were reversed in time (revBW) and correlated to FW traces. RESULTS The interlimb coordination pattern during BW was largely preserved for all groups. The kinematic reversal of the limbs was also present in children with cerebral palsy (represented by high correlation coefficients between FW and revBW kinematics). CONCLUSIONS The neural control mechanism of FW leading to BW, is preserved in persons with cortical deficits (as in cerebral palsy). SIGNIFICANCE The current results support previous evidence suggesting that interlimb locomotor coordination depends mostly on the coupling between spinal pattern generators, coordinated by brainstem mechanisms, rather than primarily on cortical structures.

To what extent is mean EMG frequency during gait a reflection of functional muscle strength in children with cerebral palsy

The aim of the current paper was to analyze the potential of the mean EMG frequency, recorded during 3D gait analysis (3DGA), for the evaluation of functional muscle strength in children with cerebral palsy (CP). As walking velocity is known to also influence EMG frequency, it was investigated to which extent the mean EMG frequency is a reflection of underlying muscle strength and/or the applied walking velocity. Surface EMG data of the lateral gastrocnemius (LGAS) and medial hamstrings (MEH) were collected during 3DGA. For each muscle, 20 CP children characterized by a weak and 20 characterized by a strong muscle (LGAS or MEH) were selected. A weak muscle was defined as a manual muscle testing score <3; a strong muscle was defined as a manual muscle testing score ≥4. Patient selection was based on the following inclusion criteria: (a) predominantly spastic type of CP (3-15 years old), (b) either (near) normal muscle strength or muscle weakness in at least one of the studied lower limb muscles, (c) no lower limb Botulinum Toxin-A treatment within 6 months prior to the 3DGA, (d) no history of lower limb surgery, and (e) high-quality noise-free EMG-data. For each muscle, twenty age-related typically developing (TD) children were included as controls. In both muscles a consistent pattern of increasing mean EMG frequency with decreasing muscle strength was observed. This was significant in the LGAS (TD versus weak CP). Walking velocity also had a significant effect on mean EMG frequency in the LGAS. Furthermore, based on R(2) and partial correlations, it could be concluded that both walking velocity and muscle strength have an impact on EMG, but the contribution of muscle strength was always higher. These findings underscore the potential of the mean EMG frequency recorded during 3DGA, for the evaluation of functional muscle strength in children with CP.