Descending stairs: Good or bad task to discriminate women with patellofemoral pain?

Publication date: September 2018

Source: Gait & Posture, Volume 65

Author(s): Aline de Almeida Novello, Silvio Garbelotti, Nayra Deise dos Anjos Rabelo, André Nogueira Ferraz, André Serra Bley, João Carlos Ferrari Correa, Fabiano Politti, Paulo Roberto Garcia Lucareli

Abstract

Background

There is no consensus on kinematics alterations during descending stairs in females with patellofemoral pain (PFP). In addition, there are no studies that have evaluated the three dimensional kinematics of the trunk, pelvis, hip, knee, and ankle using a multi-segmental model of the foot simultaneously during this task in patients with PFP and evaluated the subphases of stair descent. The objectives of this study were to compare the three dimensional kinematics of the trunk, pelvis, and lower limbs during different subphases of stair descent and identify the discriminatory capacity of the kinematic variables among women with PFP and healthy women.

Methods

In this cross-sectional study, thirty-four women with PFP and thirty-four pain free women between 18 and 35 years-old were submitted to three-dimensional kinematic evaluation during stair descent.

Results

It was observed that kinematic differences between the groups occurred in the first double support phase of the stair descent, with the variables of internal rotation of the hindfoot in relation to the tibia in the initial contact (2.1°; sensitivity = 68.6%, specificity = 61.8%) and contralateral pelvic drop in load response (1.3°, sensitivity = 65.7%, specificity = 63.7%) presenting the best ability to discriminate women with and without PFP.

Conclusion

Our results suggest that kinematic changes during stair descent should be used with caution during the evaluation and decision-making process in women with PFP.

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Graded forward and backward walking at a matched intensity on cardiorespiratory responses and postural control

Publication date: September 2018

Source: Gait & Posture, Volume 65

Author(s): Kathleen S. Thomas, Macon Hammond, Meir Magal

Abstract

Background

While several studies compare backward walking (BW) and forward walking (FW) in terms of heart rate (HR) and rating of perceived exertion (RPE), workload (VO₂) was not matched to control for intensity levels (Hooper et al. [1]). Moreover, acute effects of inclined BW on postural control and ankle musculature has not been investigated. This study was designed to compare cardiovascular, metabolic and perceptual responses, changes in center of pressure (COP) motion, and muscle activation of tibialis anterior (TA) and gastrocnemius (GM) to control quiet stance posture immediately following inclined BW and FW at a matched intensity.

Methods

Seventeen healthy young adults completed three lab sessions 7–14 days apart. Session one, maximal oxygen consumption (VO_2max) was measured using open-circuit spirometry for each participant. Session two, participants performed BW for 15-min. Session three, participants performed FW for 15-min at matched intensity of BW. Surface electromyography (SEMG) measured the muscular activity of the TA and GM during bilateral stance on a force plate for 30 s prior to and immediately following BW and FW under both eyes open (EO), and eyes closed (EC) conditions.

Results

HR, VCO₂, RER and RPE were significantly greater during BW compared to FW. Increased muscle activation and COP motion was elicited immediately following BW compared to FW under EO and EC.

Conclusion

Results of this study indicate BW requires greater cardiovascular, metabolic, perceptual and neuromuscular demands than FW, which may cause postural instability particularly to those with compromised balance. While there are benefits to BW in rehabilitation settings, these factors should be considered when prescribing BW for training and/or rehabilitation exercise program (Duffell et al. [2], Warnica et al. [3]).

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Effect of force magnitude of touch on the components of postural sway

Publication date: September 2018

Source: Gait & Posture, Volume 65

Author(s): Janina Manzieri Prado-Rico, Sandra Regina Alouche, Ariani Cardoso Sodré, Rafaela Barroso de Souza Costa Garbus, Sandra Maria Sbeghen Ferreira de Freitas

Abstract

Background

Lightly touching the tip of the index finger on an external surface reduces the postural sway during upright standing due to the additional somatosensory information provided by the touch to the postural control system. But when the individuals apply more force, it provides more mechanical support. However, because most of the studies investigated only two levels of force, whether the control mechanisms of postural sway are affected by the different force levels was unknown.

Research question

To examine the influence of the magnitude of force (up to 1, 2, 4, 6 or 8 N) applied to the touch bar on the mechanisms used to control the postural sway during quiet standing with eyes open or closed.

Methods

Ten young right-handed adults stood for 35 s on a force platform, with feet apart, while touched a rigid bar with different force levels with eyes open or closed. The amplitude and velocity of the center of pressure and its components, Rambling and Trembling trajectories, respectively, related to more supraspinal and spinal control mechanisms, were assessed.

Results

The touch reduced all trajectories, mainly of the Rambling component and with closed eyes. There was a floor effect of the touch force as amplitudes and velocities were minimal at 4 N of force.

Significance

The component of postural sway under the supraspinal neural control is more affected by different force magnitudes applied to the touch bar.

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Walking combined with reach-to-grasp while crossing obstacles at different distances

Publication date: September 2018

Source: Gait & Posture, Volume 65

Author(s): Natalia Madalena Rinaldi, Jongil Lim, Joseph Hamill, Richard Van Emmerik, Renato Moraes

Abstract

Background

Obstacle avoidance and object prehension occur regularly in real-world environments (walking up/down steps and opening a door). However, it is not known how walking and prehension change when there is an increase in the level of difficulty of the walking task.

Research question

We investigated the changes in walking and reach-tograsp when performing these two motor skills concomitantly in the presence of an obstacle on the ground positioned in different locations in relation to the object-to-be-grasped.

Methods

Fifteen young adults walked and grasped a dowel placed on a support with the obstacle positioned at the step before (N-1), during (N) and after (N + 1) the prehension task.

Results

The prehension task did not affect leading limb obstacle negotiation. Toe clearance and maximum toe elevation were lesser at obstacle position N + 1 than at obstacle position N-1 when combining grasping and obstacle-crossing task for the trailing limb. Step width increased in the presence of the obstacle-crossing task independent of obstacle location. The correlation between foot position before the obstacle and toe clearance revealed that the addition of the prehension task disrupted the relationship between these variables for the trailing limb. Foot placement and limb elevation were unaffected by the prehension task. The reaching component was unaffected by the increased level of difficulty of the walking task. The grasping component was affected by the increased level of difficulty of the walking task, as the time to peak grip aperture occurred earlier in the presence of the obstacle at position N, and may indicate a cautious strategy to grasp the dowel successfully.

Significance

Our results showed that prospective control is affected after the prehension since the attention to grasping may have impaired the acquisition of visual information for planning the trailing limb elevation.

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Carrying asymmetric loads while walking on an uneven surface

Publication date: September 2018

Source: Gait & Posture, Volume 65

Author(s): Junsig Wang, Jason C. Gillette

Abstract

Background

Individuals often carry asymmetric loads over challenging surfaces such as uneven or irregular terrain, which may require a higher demand for postural control than walking on an even surface.

Research Question

The purpose of this study was to assess postural stability in the medial-lateral (ML) direction while carrying unilateral versus bilateral loads when walking on even versus uneven surfaces.

Methods

Nineteen healthy young adults walked on even and uneven surface treadmills under three load conditions: no load, 20% body weight (BW) bilateral load, and 20% BW unilateral load. A Pedar in-shoe pressure system (Novel, Munich, Germany) was used to evaluate center of pressure (COP)-based parameters.

Results

Carrying 20% BW bilateral or unilateral loads significantly increased double support ratio. In addition, carrying a 20% BW unilateral load significantly increased coefficient of variation (CV) of double support ratio, CV of ML COP excursion, and CV of ML COP velocity. Walking on an uneven surface significantly increased double support ratio, ML COP excursion, ML COP velocity, and CV of double support ratio. When carrying a 20% BW unilateral load, unloaded limb stance had significantly increased double support ratio and ML COP velocity, although it appears that the loaded limb may be used to make step-by-step adjustments as evidenced by the higher CV of ML COP velocity.

Significance

Unilateral load carriage, walking on uneven surfaces, and unloaded leg stance are of particular concern when considering postural stability.

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Fear of falling, not falls, impacts leisure-time physical activity in people with multiple sclerosis

Publication date: September 2018

Source: Gait & Posture, Volume 65

Author(s): Alon Kalron, Roy Aloni, Uri Givon, Shay Menascu

Abstract

Background

There is a consensus that physical activity is imperative for people with MS (PwMS). However, regardless of the benefits, many PwMS do not participate in any meaningful physical activity.

Aim

To examine the relationship between leisure-time physical activity with clinical characteristics and common symptoms in PwMS.

Methods

The sample included 190 PwMS (107 women), mean age 40.8 (S.D = 13.1) and mean disease duration of 6.4 (SD = 8.3) years since diagnosis. Outcome measures included the Godin Leisure-Time Exercise Questionnaire (GLTEQ), Four Square Step Test (FSST), 2-Minute Walk test (2 mWT), Timed Up and Go test (TUG), Timed 25-Foot Walk test (T25FW), fall status, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), walking speed and the Multiple Sclerosis Walking Scale self-reported questionnaire (MSWS-12).

Results

Eighty-six PwMS were classified as active (GLTEQ = 31.6 (S.D = 16.7); 104 were insufficiently active (GLTEQ = 3.0 (S.D = 4.3). Insufficiently active PwMS demonstrated a slower walking speed, elevated fatigue, more concerns of falling and additional walking difficulties compared to active PwMS. Non-significant differences between groups were observed in the TUG, 2 mWT, FSST, T25FWT and fall status. According to the linear regression, by utilizing the FES-I we observed a 12.2% variance related to leisure-time physical activity. The independent variables: EDSS, MSWS-12, fatigue and walking speed were non-significant.

Significance

The present findings highlight the impact of concern of falling on physical activity in PwMS. This knowledge may represent an opportunity to improve care and enhance physical activity in the MS population.

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P 020 - Is gait asymmetry correlated to anatomic leg length discrepancy when abnormal clinical findings are also present?

Publication date: Available online 4 July 2018

Source: Gait & Posture

Author(s): S. Khamis, B. Danino, E. Carmeli

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