Psychophysical Boundary for Categorization of Voiced–Voiceless Stop Consonants in Native Japanese Speakers

Purpose

The purpose of this study was to investigate the psychophysical boundary used for categorization of voiced–voiceless stop consonants in native Japanese speakers.

Method

Twelve native Japanese speakers participated in the experiment. The stimuli were synthetic stop consonant–vowel stimuli varying in voice onset time (VOT) with manipulation of the amplitude of the initial noise portion and the first formant (F1) frequency of the periodic portion. There were 3 tasks, namely, speech identification to either /d/ or /t/, detection of the noise portion, and simultaneity judgment of onsets of the noise and periodic portions.

Results

The VOT boundaries of /d/–/t/ were close to the shortest VOT values that allowed for detection of the noise portion but not to those for perceived nonsimultaneity of the noise and periodic portions. The slopes of noise detection functions along VOT were as sharp as those of voiced–voiceless identification functions. In addition, the effects of manipulating the amplitude of the noise portion and the F1 frequency of the periodic portion on the detection of the noise portion were similar to those on voiced–voiceless identification.

Conclusion

The psychophysical boundary of perception of the initial noise portion masked by the following periodic portion may be used for voiced–voiceless categorization by Japanese speakers.

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Psychophysical Boundary for Categorization of Voiced–Voiceless Stop Consonants in Native Japanese Speakers

Purpose

The purpose of this study was to investigate the psychophysical boundary used for categorization of voiced–voiceless stop consonants in native Japanese speakers.

Method

Twelve native Japanese speakers participated in the experiment. The stimuli were synthetic stop consonant–vowel stimuli varying in voice onset time (VOT) with manipulation of the amplitude of the initial noise portion and the first formant (F1) frequency of the periodic portion. There were 3 tasks, namely, speech identification to either /d/ or /t/, detection of the noise portion, and simultaneity judgment of onsets of the noise and periodic portions.

Results

The VOT boundaries of /d/–/t/ were close to the shortest VOT values that allowed for detection of the noise portion but not to those for perceived nonsimultaneity of the noise and periodic portions. The slopes of noise detection functions along VOT were as sharp as those of voiced–voiceless identification functions. In addition, the effects of manipulating the amplitude of the noise portion and the F1 frequency of the periodic portion on the detection of the noise portion were similar to those on voiced–voiceless identification.

Conclusion

The psychophysical boundary of perception of the initial noise portion masked by the following periodic portion may be used for voiced–voiceless categorization by Japanese speakers.

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Psychophysical Boundary for Categorization of Voiced–Voiceless Stop Consonants in Native Japanese Speakers

Purpose

The purpose of this study was to investigate the psychophysical boundary used for categorization of voiced–voiceless stop consonants in native Japanese speakers.

Method

Twelve native Japanese speakers participated in the experiment. The stimuli were synthetic stop consonant–vowel stimuli varying in voice onset time (VOT) with manipulation of the amplitude of the initial noise portion and the first formant (F1) frequency of the periodic portion. There were 3 tasks, namely, speech identification to either /d/ or /t/, detection of the noise portion, and simultaneity judgment of onsets of the noise and periodic portions.

Results

The VOT boundaries of /d/–/t/ were close to the shortest VOT values that allowed for detection of the noise portion but not to those for perceived nonsimultaneity of the noise and periodic portions. The slopes of noise detection functions along VOT were as sharp as those of voiced–voiceless identification functions. In addition, the effects of manipulating the amplitude of the noise portion and the F1 frequency of the periodic portion on the detection of the noise portion were similar to those on voiced–voiceless identification.

Conclusion

The psychophysical boundary of perception of the initial noise portion masked by the following periodic portion may be used for voiced–voiceless categorization by Japanese speakers.

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The Impact of Vocal and Laryngeal Pathologies Among Professional Singers: A Meta-analysis

Publication date: Available online 6 March 2018
Source:Journal of Voice
Author(s): Michelle Kwok, Guy D. Eslick
ObjectiveProfessional singers are more likely to develop laryngeal pathologies and symptoms associated with misuse and overuse of the voice. However, different studies have shown conflicting evidence. We aim to perform a systematic review and quantitative meta-analysis to determine the prevalence and risk of laryngeal pathologies and symptoms among professional singers.MethodsFour electronic databases (MEDLINE, PubMed, EMBASE, and CINAHL) were searched, with no language restrictions. From 3368 potential studies, a total of 21 studies met our inclusion criteria. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All cohort, case-control, or cross-sectional studies that reported the risk of laryngeal pathologies in singers were included. Data were pooled by a random effects model and the pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.ResultsThere was a positive relationship between singing and laryngeal pathologies. There was an increased risk of hoarseness (OR: 2.00, 95% CI: 1.61–2.49), gastroesophageal reflux disease (GERD) (OR: 1.45, 95% CI: 1.19–1.77), Reinke edema (OR: 2.15, 95% CI: 1.08–4.30), and polyps (OR: 2.10, 95% CI: 1.06–4.14) in professional singers.ConclusionProfessional singers are at an increased risk of laryngeal pathologies and symptoms associated with vocal misuse and overuse, particularly hoarseness, GERD, edema, and polyps.



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Vowel and tone recognition in quiet and in noise among Mandarin-speaking amusics

Publication date: Available online 6 March 2018
Source:Hearing Research
Author(s): Wei Tang, Xi-jian Wang, Jia-qi Li, Chang Liu, Qi Dong, Yun Nan
Music and language are two intricately linked communication modalities in humans. A deficit in music pitch processing as manifested in the condition of congenital amusia has been related to difficulties in lexical tone processing for both tone and non-tonal languages. However, it is still unclear whether amusia also affects the perception of vowel phonemes in quiet and in noise. In this study, we examined vowel-plus-tone identification in quiet and noise conditions among Mandarin-speaking amusics with and without speech tone difficulties (tone agnosics and pure amusics, respectively), and IQ- and age-matched controls. Overall, pure amusics showed vowel and tone identification comparable to the controls in both quiet and noise conditions. Compared to amusics and controls, tone agnosics showed deficits in tone perception in both quiet and noise conditions. More importantly, their vowel perception was lower than pure amusics and controls in noise conditions, e.g., at a signal-to-noise ratio of −4 dB, although they showed normal-like performance in quiet and at a signal-to-noise ratio of −8 dB. These results suggest that when amusia affected speech tone processing (e.g., tone agnosics), it could also compromise vowel processing in noise. However, amusia alone does not affect tone or vowel perceptions in Mandarin Chinese either in quiet or in noise. Overall, the current study highlights the necessity of taking heterogeneity within the amusic group into account when considering the related speech deficits in this group.



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Fetal auditory evoked responses to onset of amplitude modulated sounds. A fetal magnetoencephalography (fMEG) study

Publication date: Available online 6 March 2018
Source:Hearing Research
Author(s): R. Draganova, A. Schollbach, F. Schleger, J. Braendle, S. Brucker, H. Abele, K.O. Kagan, D. Wallwiener, A. Fritsche, H. Eswaran, H. Preissl
The human fetal auditory system is functional around the 25th week of gestational age when the thalamocortical connections are established. Fetal magnetoencephalography (fMEG) provides evidence for fetal auditory brain responses to pure tones and syllables. Fifty-five pregnant women between 31 and 40 weeks of gestation were included in the study. Fetal MEG was recorded during the presentation of an amplitude modulated tone (AM) with a carrier frequency of 500 Hz to the maternal abdomen modulated by low modulation rates (MRs) - 2/s and 4/s, middle MR - 8/s and high MRs - 27/s, 42/s, 78/s and 91/s. The aim was to determine whether the fetal brain responds differently to envelope slopes and intensity change at the onset of the AM sounds.A significant decrease of the response latencies of transient event-related responses (ERR) to high and middle MRs in comparison to the low MRs was observed. The highest fetal response rate was achieved by modulation rates of 2/s, 4/s and 27/s (70%, 57%, and 86%, respectively). Additionally, a maturation effect of the ERR (response latency vs. gestational age) was observed only for 4/s MR.The significant difference between the response latencies to low, middle, and high MRs suggests that still before birth the fetal brain processes the sound slopes at the onset in different integration time-windows, depending on the time for the intensity increase or stimulus power density at the onset, which is a prerequisite for language acquisition.



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Vowel and tone recognition in quiet and in noise among Mandarin-speaking amusics

Publication date: Available online 6 March 2018
Source:Hearing Research
Author(s): Wei Tang, Xi-jian Wang, Jia-qi Li, Chang Liu, Qi Dong, Yun Nan
Music and language are two intricately linked communication modalities in humans. A deficit in music pitch processing as manifested in the condition of congenital amusia has been related to difficulties in lexical tone processing for both tone and non-tonal languages. However, it is still unclear whether amusia also affects the perception of vowel phonemes in quiet and in noise. In this study, we examined vowel-plus-tone identification in quiet and noise conditions among Mandarin-speaking amusics with and without speech tone difficulties (tone agnosics and pure amusics, respectively), and IQ- and age-matched controls. Overall, pure amusics showed vowel and tone identification comparable to the controls in both quiet and noise conditions. Compared to amusics and controls, tone agnosics showed deficits in tone perception in both quiet and noise conditions. More importantly, their vowel perception was lower than pure amusics and controls in noise conditions, e.g., at a signal-to-noise ratio of −4 dB, although they showed normal-like performance in quiet and at a signal-to-noise ratio of −8 dB. These results suggest that when amusia affected speech tone processing (e.g., tone agnosics), it could also compromise vowel processing in noise. However, amusia alone does not affect tone or vowel perceptions in Mandarin Chinese either in quiet or in noise. Overall, the current study highlights the necessity of taking heterogeneity within the amusic group into account when considering the related speech deficits in this group.



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Fetal auditory evoked responses to onset of amplitude modulated sounds. A fetal magnetoencephalography (fMEG) study

Publication date: Available online 6 March 2018
Source:Hearing Research
Author(s): R. Draganova, A. Schollbach, F. Schleger, J. Braendle, S. Brucker, H. Abele, K.O. Kagan, D. Wallwiener, A. Fritsche, H. Eswaran, H. Preissl
The human fetal auditory system is functional around the 25th week of gestational age when the thalamocortical connections are established. Fetal magnetoencephalography (fMEG) provides evidence for fetal auditory brain responses to pure tones and syllables. Fifty-five pregnant women between 31 and 40 weeks of gestation were included in the study. Fetal MEG was recorded during the presentation of an amplitude modulated tone (AM) with a carrier frequency of 500 Hz to the maternal abdomen modulated by low modulation rates (MRs) - 2/s and 4/s, middle MR - 8/s and high MRs - 27/s, 42/s, 78/s and 91/s. The aim was to determine whether the fetal brain responds differently to envelope slopes and intensity change at the onset of the AM sounds.A significant decrease of the response latencies of transient event-related responses (ERR) to high and middle MRs in comparison to the low MRs was observed. The highest fetal response rate was achieved by modulation rates of 2/s, 4/s and 27/s (70%, 57%, and 86%, respectively). Additionally, a maturation effect of the ERR (response latency vs. gestational age) was observed only for 4/s MR.The significant difference between the response latencies to low, middle, and high MRs suggests that still before birth the fetal brain processes the sound slopes at the onset in different integration time-windows, depending on the time for the intensity increase or stimulus power density at the onset, which is a prerequisite for language acquisition.



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Vowel and tone recognition in quiet and in noise among Mandarin-speaking amusics

Publication date: Available online 6 March 2018
Source:Hearing Research
Author(s): Wei Tang, Xi-jian Wang, Jia-qi Li, Chang Liu, Qi Dong, Yun Nan
Music and language are two intricately linked communication modalities in humans. A deficit in music pitch processing as manifested in the condition of congenital amusia has been related to difficulties in lexical tone processing for both tone and non-tonal languages. However, it is still unclear whether amusia also affects the perception of vowel phonemes in quiet and in noise. In this study, we examined vowel-plus-tone identification in quiet and noise conditions among Mandarin-speaking amusics with and without speech tone difficulties (tone agnosics and pure amusics, respectively), and IQ- and age-matched controls. Overall, pure amusics showed vowel and tone identification comparable to the controls in both quiet and noise conditions. Compared to amusics and controls, tone agnosics showed deficits in tone perception in both quiet and noise conditions. More importantly, their vowel perception was lower than pure amusics and controls in noise conditions, e.g., at a signal-to-noise ratio of −4 dB, although they showed normal-like performance in quiet and at a signal-to-noise ratio of −8 dB. These results suggest that when amusia affected speech tone processing (e.g., tone agnosics), it could also compromise vowel processing in noise. However, amusia alone does not affect tone or vowel perceptions in Mandarin Chinese either in quiet or in noise. Overall, the current study highlights the necessity of taking heterogeneity within the amusic group into account when considering the related speech deficits in this group.



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Fetal auditory evoked responses to onset of amplitude modulated sounds. A fetal magnetoencephalography (fMEG) study

Publication date: Available online 6 March 2018
Source:Hearing Research
Author(s): R. Draganova, A. Schollbach, F. Schleger, J. Braendle, S. Brucker, H. Abele, K.O. Kagan, D. Wallwiener, A. Fritsche, H. Eswaran, H. Preissl
The human fetal auditory system is functional around the 25th week of gestational age when the thalamocortical connections are established. Fetal magnetoencephalography (fMEG) provides evidence for fetal auditory brain responses to pure tones and syllables. Fifty-five pregnant women between 31 and 40 weeks of gestation were included in the study. Fetal MEG was recorded during the presentation of an amplitude modulated tone (AM) with a carrier frequency of 500 Hz to the maternal abdomen modulated by low modulation rates (MRs) - 2/s and 4/s, middle MR - 8/s and high MRs - 27/s, 42/s, 78/s and 91/s. The aim was to determine whether the fetal brain responds differently to envelope slopes and intensity change at the onset of the AM sounds.A significant decrease of the response latencies of transient event-related responses (ERR) to high and middle MRs in comparison to the low MRs was observed. The highest fetal response rate was achieved by modulation rates of 2/s, 4/s and 27/s (70%, 57%, and 86%, respectively). Additionally, a maturation effect of the ERR (response latency vs. gestational age) was observed only for 4/s MR.The significant difference between the response latencies to low, middle, and high MRs suggests that still before birth the fetal brain processes the sound slopes at the onset in different integration time-windows, depending on the time for the intensity increase or stimulus power density at the onset, which is a prerequisite for language acquisition.



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Development of a Diagnostic Prediction Model for Conductive Conditions in Neonates Using Wideband Acoustic Immittance

Objectives: Wideband acoustic immittance (WAI) is an emerging test of middle-ear function with potential applications for neonates in screening and diagnostic settings. Previous large-scale diagnostic accuracy studies have assessed the performance of WAI against evoked otoacoustic emissions, but further research is needed using a more stringent reference standard. Research into suitable quantitative techniques to analyze the large volume of data produced by WAI is still in its infancy. Prediction models are an attractive method for analysis of multivariate data because they provide individualized probabilities that a subject has the condition. A clinically useful prediction model must accurately discriminate between normal and abnormal cases and be well calibrated (i.e., give accurate predictions). The present study aimed to develop a diagnostic prediction model for detecting conductive conditions in neonates using WAI. A stringent reference standard was created by combining results of high-frequency tympanometry and distortion product otoacoustic emissions. Design: High-frequency tympanometry and distortion product otoacoustic emissions were performed on both ears of 629 healthy neonates to assess outer- and middle-ear function. Wideband absorbance and complex admittance (magnitude and phase) were measured at frequencies ranging from 226 to 8000 Hz in each neonate at ambient pressure using a click stimulus. Results from one ear of each neonate were used to develop the prediction model. WAI results were used as logistic regression predictors to model the probability that an ear had outer/middle-ear dysfunction. WAI variables were modeled both linearly and nonlinearly, to test whether allowing nonlinearity improved model fit and thus calibration. The best-fitting model was validated using the opposite ears and with bootstrap resampling. Results: The best-fitting model used absorbance at 1000 and 2000 Hz, admittance magnitude at 1000 and 2000 Hz, and admittance phase at 1000 and 4000 Hz modeled as nonlinear variables. The model accurately discriminated between normal and abnormal ears, with an area under the receiver-operating characteristic curve (AUC) of 0.88. It effectively generalized to the opposite ears (AUC = 0.90) and with bootstrap resampling (AUC = 0.85). The model was well calibrated, with predicted probabilities aligning closely to observed results. Conclusions: The developed prediction model accurately discriminated between normal and dysfunctional ears and was well calibrated. The model has potential applications in screening or diagnostic contexts. In a screening context, probabilities could be used to set a referral threshold that is intuitive, easy to apply, and sensitive to the costs associated with true- and false-positive referrals. In a clinical setting, using predicted probabilities in conjunction with graphical displays of WAI could be used for individualized diagnoses. Future research investigating the use of the model in diagnostic or screening settings is warranted. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors thank the Surgical Services and Health and Wellbeing Service Groups of the Townsville Hospital and Health Service for supporting the study; the Healthy Hearing Team at Townsville Hospital for recruiting participants; Karen Nielsen from the Audiology Department at Townsville Hospital for administrative support; and Interacoustics A/S (Denmark) for loan of equipment for the study. This study was supported by a grant from the Australian National Health and Medical Research Council (NHMRC, APP1046477), an award from the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS) funded by the Commonwealth Department of Health, and an Australian Government Research Training Program Scholarship. The views expressed in this publication do not necessarily represent those of the NHMRC; the NAHSSS or its Administrator, Services for Australian Rural and Remote Allied Health; or the Commonwealth Department of Health. The authors declare no conflict of interest. Address for correspondence: Joshua Myers, Department of Audiology, IMB 79, Townsville Hospital, PO Box 670, Townsville, Queensland 4810, Australia. E-mail: myers.josh@gmail.com Received February 23, 2017; accepted January 23, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Development of a Diagnostic Prediction Model for Conductive Conditions in Neonates Using Wideband Acoustic Immittance

Objectives: Wideband acoustic immittance (WAI) is an emerging test of middle-ear function with potential applications for neonates in screening and diagnostic settings. Previous large-scale diagnostic accuracy studies have assessed the performance of WAI against evoked otoacoustic emissions, but further research is needed using a more stringent reference standard. Research into suitable quantitative techniques to analyze the large volume of data produced by WAI is still in its infancy. Prediction models are an attractive method for analysis of multivariate data because they provide individualized probabilities that a subject has the condition. A clinically useful prediction model must accurately discriminate between normal and abnormal cases and be well calibrated (i.e., give accurate predictions). The present study aimed to develop a diagnostic prediction model for detecting conductive conditions in neonates using WAI. A stringent reference standard was created by combining results of high-frequency tympanometry and distortion product otoacoustic emissions. Design: High-frequency tympanometry and distortion product otoacoustic emissions were performed on both ears of 629 healthy neonates to assess outer- and middle-ear function. Wideband absorbance and complex admittance (magnitude and phase) were measured at frequencies ranging from 226 to 8000 Hz in each neonate at ambient pressure using a click stimulus. Results from one ear of each neonate were used to develop the prediction model. WAI results were used as logistic regression predictors to model the probability that an ear had outer/middle-ear dysfunction. WAI variables were modeled both linearly and nonlinearly, to test whether allowing nonlinearity improved model fit and thus calibration. The best-fitting model was validated using the opposite ears and with bootstrap resampling. Results: The best-fitting model used absorbance at 1000 and 2000 Hz, admittance magnitude at 1000 and 2000 Hz, and admittance phase at 1000 and 4000 Hz modeled as nonlinear variables. The model accurately discriminated between normal and abnormal ears, with an area under the receiver-operating characteristic curve (AUC) of 0.88. It effectively generalized to the opposite ears (AUC = 0.90) and with bootstrap resampling (AUC = 0.85). The model was well calibrated, with predicted probabilities aligning closely to observed results. Conclusions: The developed prediction model accurately discriminated between normal and dysfunctional ears and was well calibrated. The model has potential applications in screening or diagnostic contexts. In a screening context, probabilities could be used to set a referral threshold that is intuitive, easy to apply, and sensitive to the costs associated with true- and false-positive referrals. In a clinical setting, using predicted probabilities in conjunction with graphical displays of WAI could be used for individualized diagnoses. Future research investigating the use of the model in diagnostic or screening settings is warranted. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors thank the Surgical Services and Health and Wellbeing Service Groups of the Townsville Hospital and Health Service for supporting the study; the Healthy Hearing Team at Townsville Hospital for recruiting participants; Karen Nielsen from the Audiology Department at Townsville Hospital for administrative support; and Interacoustics A/S (Denmark) for loan of equipment for the study. This study was supported by a grant from the Australian National Health and Medical Research Council (NHMRC, APP1046477), an award from the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS) funded by the Commonwealth Department of Health, and an Australian Government Research Training Program Scholarship. The views expressed in this publication do not necessarily represent those of the NHMRC; the NAHSSS or its Administrator, Services for Australian Rural and Remote Allied Health; or the Commonwealth Department of Health. The authors declare no conflict of interest. Address for correspondence: Joshua Myers, Department of Audiology, IMB 79, Townsville Hospital, PO Box 670, Townsville, Queensland 4810, Australia. E-mail: myers.josh@gmail.com Received February 23, 2017; accepted January 23, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Development of a Diagnostic Prediction Model for Conductive Conditions in Neonates Using Wideband Acoustic Immittance

Objectives: Wideband acoustic immittance (WAI) is an emerging test of middle-ear function with potential applications for neonates in screening and diagnostic settings. Previous large-scale diagnostic accuracy studies have assessed the performance of WAI against evoked otoacoustic emissions, but further research is needed using a more stringent reference standard. Research into suitable quantitative techniques to analyze the large volume of data produced by WAI is still in its infancy. Prediction models are an attractive method for analysis of multivariate data because they provide individualized probabilities that a subject has the condition. A clinically useful prediction model must accurately discriminate between normal and abnormal cases and be well calibrated (i.e., give accurate predictions). The present study aimed to develop a diagnostic prediction model for detecting conductive conditions in neonates using WAI. A stringent reference standard was created by combining results of high-frequency tympanometry and distortion product otoacoustic emissions. Design: High-frequency tympanometry and distortion product otoacoustic emissions were performed on both ears of 629 healthy neonates to assess outer- and middle-ear function. Wideband absorbance and complex admittance (magnitude and phase) were measured at frequencies ranging from 226 to 8000 Hz in each neonate at ambient pressure using a click stimulus. Results from one ear of each neonate were used to develop the prediction model. WAI results were used as logistic regression predictors to model the probability that an ear had outer/middle-ear dysfunction. WAI variables were modeled both linearly and nonlinearly, to test whether allowing nonlinearity improved model fit and thus calibration. The best-fitting model was validated using the opposite ears and with bootstrap resampling. Results: The best-fitting model used absorbance at 1000 and 2000 Hz, admittance magnitude at 1000 and 2000 Hz, and admittance phase at 1000 and 4000 Hz modeled as nonlinear variables. The model accurately discriminated between normal and abnormal ears, with an area under the receiver-operating characteristic curve (AUC) of 0.88. It effectively generalized to the opposite ears (AUC = 0.90) and with bootstrap resampling (AUC = 0.85). The model was well calibrated, with predicted probabilities aligning closely to observed results. Conclusions: The developed prediction model accurately discriminated between normal and dysfunctional ears and was well calibrated. The model has potential applications in screening or diagnostic contexts. In a screening context, probabilities could be used to set a referral threshold that is intuitive, easy to apply, and sensitive to the costs associated with true- and false-positive referrals. In a clinical setting, using predicted probabilities in conjunction with graphical displays of WAI could be used for individualized diagnoses. Future research investigating the use of the model in diagnostic or screening settings is warranted. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGMENTS: The authors thank the Surgical Services and Health and Wellbeing Service Groups of the Townsville Hospital and Health Service for supporting the study; the Healthy Hearing Team at Townsville Hospital for recruiting participants; Karen Nielsen from the Audiology Department at Townsville Hospital for administrative support; and Interacoustics A/S (Denmark) for loan of equipment for the study. This study was supported by a grant from the Australian National Health and Medical Research Council (NHMRC, APP1046477), an award from the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS) funded by the Commonwealth Department of Health, and an Australian Government Research Training Program Scholarship. The views expressed in this publication do not necessarily represent those of the NHMRC; the NAHSSS or its Administrator, Services for Australian Rural and Remote Allied Health; or the Commonwealth Department of Health. The authors declare no conflict of interest. Address for correspondence: Joshua Myers, Department of Audiology, IMB 79, Townsville Hospital, PO Box 670, Townsville, Queensland 4810, Australia. E-mail: myers.josh@gmail.com Received February 23, 2017; accepted January 23, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Trunk involvement in performing upper extremity activities while seated in neurological patients with a flaccid trunk – A review

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): Laura H.C. Peeters, Imelda J.M. de Groot, Alexander C.H. Geurts
BackgroundTrunk control is essential during seated activities. The trunk interacts with the upper extremities (UE) and head by being part of a kinematic chain and by providing a stable basis. When trunk control becomes impaired, it may have consequences for the execution of UE tasks.AimTo review trunk involvement in body movement and stability when performing seated activities and its relation with UE and head movements in neurological patients with a flaccid trunk, with a focus on childhood and development with age.Methods and proceduresA search using PubMed was conducted and 32 out of 188 potentially eligible articles were included.Outcomes and resultsPatients with a flaccid trunk (e.g. with spinal cord injury or cerebral palsy) tend to involve the trunk earlier while reaching than healthy persons. Different balance strategies are observed in different types of patients, like using the contralateral arm as counterweight, eliminating degrees of freedom, or reducing movement speed.Conclusions and implicationsThe key role of the trunk in performing activities should be kept in mind when developing interventions to improve seated task performance in neurological patients with a flaccid trunk.



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Impaired set shifting is associated with previous falls in individuals with and without Parkinson’s disease

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): J. Lucas McKay, Kimberly C. Lang, Lena H. Ting, Madeleine E. Hackney
BackgroundIndividuals with Parkinson’s disease (PD) are at increased risk for falls, which lead to substantial morbidity and mortality. Understanding the motor and non-motor impairments associated with falls in PD is critical to informing prevention strategies. In addition to motor symptoms, individuals with PD exhibit non-motor deficits, including impaired set shifting, an aspect of executive function related to cognitive flexibility that can be measured quickly with the Trailmaking Test.Research questionTo determine whether impaired set shifting is associated with fall history in people with and without PD.MethodsWe examined associations between set shifting, PD status, and fall history (≥1 falls in the previous 6 months) in data from PD patients (n = 65) with and without freezing of gait (FOG) and community-dwelling neurologically-normal older adults (NON-PD) (n = 73) who had participated in our rehabilitation studies.ResultsImpaired set shifting was associated with previous falls after controlling for age, sex, overall cognitive function, PD status, FOG, and PD disease duration (OR = 1.29 [1.03–1.60]; P = 0.02). Consistent with literature, PD and FOG were also independently associated with increased fall prevalence (PD OR = 4.15 [95% CI 1.65–10.44], P < 0.01; FOG OR = 3.63 [1.22–10.80], P = 0.02). Although the strongest associations between set shifting and falling were observed among PD without FOG (OR = 2.11) compared to HOA (OR = 1.14) and PD with FOG (OR = 1.46), no statistically-significant differences were observed across groups. SIGNIFICANCE. Impaired set shifting is associated with previous falls in older adults with and without PD. Set shifting may be useful to include in fall risk assessments, particularly when global cognitive measures are within reference limits.



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A comparison of gait one year post operation in an RCT of robotic UKA versus traditional Oxford UKA

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): Arman Motesharei, Philip Rowe, Mark Blyth, Bryn Jones, Angus Maclean
Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant alignment. However, little work has been done to ascertain if this improvement results in a measureable improvement in knee function post operatively and a more normal gait.The kinematics of 70 knees were assessed using motion analysis in an RCT (31 receiving robotic-assisted surgery, and 39 receiving traditional manual surgery) and compared to healthy knees. Significant kinematic differences were seen between the two surgical groups from foot-strike to mid-stance. The robotic-assisted group achieved a higher knee excursion (18.0°, SD 4.9°) compared to the manual group (15.7°, SD 4.1°). There was no significant difference between the healthy group and the roboticassisted group, however there was a significant difference between the healthy group and the manual group (p < 0.001). Hence robotically-assisted knee replacement with Mako Restoris Implants appears to lead not only to better implant alignment but also kinematic benefits to the user during gait.



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Partitioning ground reaction forces for multi-segment foot joint kinetics

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): Dustin A. Bruening, Kota Z. Takahashi
BackgroundKinematic multi-segment foot models have been increasingly used to study foot function. The addition of kinetics to these models may enhance their utility; however, this been hindered by limitations in measuring ground reaction forces (GRFs) under individual foot segments.PurposeTo determine the accuracy of partitioning segment GRFs from a single force platform on foot joint kinetics.MethodsTwo potential partitioning methods were applied to a previously published three-segment kinetic foot model. The first method calculated joint kinetics only when the center of pressure crossed anterior to a joint (CPcross). The second method utilized a virtual pressure mat and a proportionality assumption to partition GRFs from the force platform (PRESS). Accuracy was assessed by comparing joint moments and powers obtained from each partitioning method to those obtained from a dual force plate approach that isolated forces under two segments at a time (2Plate). Thirteen healthy pediatric subjects walked in a controlled manner so as to isolate the kinetics acting at the metatarsophalangeal (MTP) joint and, subsequently, the midtarsal joint.ResultsThe PRESS method was generally more accurate than the CPcross method, and both methods were more accurate at the midtarsal joint than at the MTP joint. At the MTP joint, sagittal plane moment peaks, power peaks, and work done were slightly overestimated, more so by CPcross than PRESS. At the midtarsal joint, sagittal plane moments were captured well by PRESS, while CPcross missed the early portion of the moment, but both methods captured power profiles fairly accurately.SignificanceAnalysis of kinetics in multi-segment foot models may provide insight into foot function, pathologies, and interventions. Partitioning accuracy and generalizability is promising for analysis of the midtarsal joints but has limitations at the MTP joint.



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Dynamic stability during split-belt walking and the relationship with step length symmetry

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Benjamin J. Darter, Bethany A. Labrecque, Robert A. Perera
IntroductionWalking instability is a contributor to falls and other undesired changes in walking performance. We investigated the effect of split-belt treadmill based perturbations on dynamic stability. Furthermore, we examined the relationships for dynamic stability and symmetry during unperturbed and perturbed walking.MethodTwenty healthy young adults completed unperturbed and perturbed walking conditions on a split-belt treadmill. The continuous perturbation involved moving the parallel belts at unequal speeds (1.5 m/s: 0.5 m/s). Margins of stability (MoS) and step length symmetry (SYM) were assessed.ResultsStability and symmetry measures each decreased at the onset of the split walking perturbation. Only anterior-posterior (AP) MoS and SYM exhibited adaptive changes. Associations were found primarily for AP MoS with immediate changes in SYM at the onset of split walking, and over the duration of the split walking condition.DiscussionOur findings suggest walking strategies were adapted to maintain dynamic stability when faced with a continuous perturbation. Additionally, dynamic stability was associated with symmetry during perturbed walking.



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Over-focused? The relation between patients’ inclination for conscious control and single- and dual-task motor performance after stroke

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): R.P.M. Denneman, E.C. Kal, H. Houdijk, J.van der Kamp
BackgroundMany stroke patients are inclined to consciously control their movements. This is thought to negatively affect patients’ motor performance, as it disrupts movement automaticity. However, it has also been argued that conscious control may sometimes benefit motor performance, depending on the task or patientś motor or cognitive capacity.AimTo assess whether stroke patients’ inclination for conscious control is associated with motor performance, and explore whether the putative association differs as a function of task (single- vs dual) or patientś motor and cognitive capacity.MethodsUnivariate and multivariate linear regression analysis were used to assess associations between patients’ disposition to conscious control (i.e., Conscious Motor Processing subscale of Movement-Specific Reinvestment Scale; MSRS-CMP) and single-task (Timed-up-and-go test; TuG) and motor dual-task costs (TuG while tone counting; motor DTC%). We determined whether these associations were influenced by patients’ walking speed (i.e., 10-meter-walk test) and cognitive capacity (i.e., working memory, attention, executive function).ResultsSeventy-eight clinical stroke patients (<6 months post-stroke) participated. Patients’ conscious control inclination was not associated with single-task TuG performance. However, patients with a strong inclination for conscious control showed higher motor DTC%. These associations were irrespective of patients’ motor and cognitive abilities.ConclusionPatients’ disposition for conscious control was not associated with single task motor performance, but was associated with higher motor dual task costs, regardless of patients’ motor or cognitive abilities.Clinical RelevanceTherapists should be aware that patients’ conscious control inclination can influence their dual-task performance while moving. Longitudinal studies are required to test whether reducing patients’ disposition for conscious control would improve dual-tasking post-stroke.



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Sit-to-stand ground reaction force characteristics in blind and sighted female children

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Mozhgan Faraji Aylar, Amir Ali Jafarnezhadgero, Fatemeh Salari Esker
BackgroundThe association between visual sensory and sit-to-stand ground reaction force characteristics is not clear. Impulse is the amount of force applied over a period of time. Also, free moment represents the vertical moment applied in the center of pressure (COP). Research question: How the ground reaction force components, vertical loading rate, impulses and free moment respond to long and short term restricted visual information?MethodsFifteen female children with congenital blindness and 45 healthy girls with no visual impairments participated in this study. The girls with congenital blindness were placed in one group and the 45 girls with no visual impairments were randomly divided into three groups of 15; eyes open, permanently eyes closed, and temporary eyes closed. The participants in the permanently eyes closed group closed their eyes for 20 minutes before the test, whereas temporary eyes closed group did tests with their eyes closed throughout, and those in the eyes open group kept their eyes open.ResultsCongenital blindness was associated with increased vertical loading rate, range of motion of knee and hip in the medio-lateral plane. Also, medio-lateral and vertical ground reaction force impulses. Similar peak negative and positive free moments were observed in three groups. Significance: In conclusion, the results reveal that sit-to-stand ground reaction force components in blind children may have clinical importance for improvement of balance control of these individuals.



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Does local dynamic stability during unperturbed walking predict the response to balance perturbations? An examination across age and falls history

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Mu Qiao, Kinh N. Truong, Jason R. Franz
BackgroundOlder adults are at an exceptionally high risk of falls, and most falls occur during locomotor activities such as walking. Reduced local dynamic stability in old age is often interpreted to suggest a lessened capacity to respond to more significant balance challenges encountered during walking and future falls risk. However, it remains unclear whether local dynamic stability during normal, unperturbed walking predicts the response to larger external balance disturbances.Research questionWe tested the hypothesis that larger values of local dynamic instability during unperturbed walking would positively correlate with larger changes thereof due to optical flow balance perturbations.MethodsWe used trunk kinematics collected in subjects across a spectrum of walking balance integrity – young adults, older non-fallers, and older fallers – during walking with and without mediolateral optical flow perturbations of four different amplitudes.ResultsWe first found evidence that optical flow perturbations of sufficient amplitude appear capable of revealing independent effects of aging and falls history that are not otherwise apparent during normal, unperturbed walking. We also reject our primary hypothesis; a significant negative correlation only in young adults indicated that individuals with more local dynamic instability during normal, unperturbed walking exhibited smaller responses to optical flow perturbations. In contrast, most prominently in older fallers, the response to optical flow perturbations appeared independent of their baseline level of dynamic instability.SignificanceWe propose that predicting the response to balance perturbations in older fallers, at least that measured using local dynamic stability, likely requires measuring that response directly.



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Short-term functional assessment of gait, plantarflexor strength, and tendon properties after Achilles tendon rupture

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Alison N. Agres, Tobias J. Gehlen, Adamantios Arampatzis, William R. Taylor, Georg N. Duda, Sebastian Manegold
BackgroundAlthough early functional rehabilitation (EFR) has been suggested to yield rapid functional recovery after Achilles tendon rupture (ATR) compared to conventional rehabilitation (CR), most quantitative assessments occur long after rehabilitation has been completed. Few data exist regarding the short-term functional gains during the healing period post-ATR. It remains unclear if EFR allows for an objectively faster return to function. The aim of this study was to examine EFR's effect on gait, plantarflexor strength, and tendon properties in early post-operative follow-ups.MethodsFourteen patients received either EFR (n = 6) or CR (n = 8) after percutaneous ATR repair. Functional gait analysis, maximal voluntary isometric contractions (MVICs), and Achilles tendon properties were assessed at 8 and 12 weeks post-op.ResultsComparison of EFR against CR yielded no statistically significant differences in ankle kinematics or kinetics, Achilles tendon properties or MVICs on the injured ankle at either time point. CR patients demonstrated lower plantarflexion moments on the injured limb at 8 weeks (0.817 ± 0.151 N·m/kg vs. 1.172 ± 0.177 N·m/kg, p = 0.002). On INJ, all patients exhibited deficits in plantarflexor moment at 8 weeks and eversion moment at 12 weeks that were clinically significant compared to CON. Significance: ATR patients, regardless of rehabilitation, exhibit deficits in gait, AT properties, and single-limb strength at 8 weeks. Though AT properties and single-limb plantarflexor isometric strength remain at a deficit at 12 weeks, bipedal plantarflexion moments are comparable between INJ and CON. Though effect size calculations suggested clinically significant differences, clear benefits of EFR compared to CR were not found.SignificanceATR patients, regardless of rehabilitation, exhibit deficits in gait, AT properties, and single-limb strength at 8 weeks. Though AT properties and single-limb plantarflexor isometric strength remain at a deficit at 12 weeks, bipedal plantarflexion moments are comparable between INJ and CON. Though effect size calculations suggested clinically significant differences, clear benefits of EFR compared to CR were not found.



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Foot posture is associated with plantar pressure during gait: a comparison of normal, planus and cavus feet

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Andrew K. Buldt, Saeed Forghany, Karl B. Landorf, Pazit Levinger, George S. Murley, Hylton B. Menz
BackgroundVariations in foot posture, such as pes planus (low medial longitudinal arch) or pes cavus (high medial longitudinal arch) are associated with some lower limb injuries. However, the mechanism that links foot posture to injury is not clear. Research question The aim of this study was to compare plantar pressure between healthy individuals with normal, planus or cavus feet.MethodsNinety-two healthy volunteers (aged 18 to 45) were classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on the Foot Posture Index, Arch Index and normalised navicular height truncated. Barefoot walking trials were conducted using an emed^®-x400 plantar pressure system (Novel GmbH, Munich, Germany). An 11 region mask was used that included the medial heel, lateral heel, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsophalangeal joints, hallux, 2nd toe, and the 3rd, 4th and 5th toes. Peak pressure, pressure-time integral, maximum force, force-time integral and contact area were calculated for each region. One way analyses of variance and effect sizes were used to compare the three foot posture groups.ResultsOverall, the largest differences were between the planus and cavus foot groups in forefoot pressure and force. In particular, peak pressures at the 4th and 5th MTPJs in the planus foot group were lower compared to the normal and cavus foot groups, and displayed the largest effect sizes. Significance This study confirms that foot posture does influence plantar pressures, and that each foot posture classification displays unique plantar pressure characteristics.



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Trunk involvement in performing upper extremity activities while seated in neurological patients with a flaccid trunk – A review

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): Laura H.C. Peeters, Imelda J.M. de Groot, Alexander C.H. Geurts
BackgroundTrunk control is essential during seated activities. The trunk interacts with the upper extremities (UE) and head by being part of a kinematic chain and by providing a stable basis. When trunk control becomes impaired, it may have consequences for the execution of UE tasks.AimTo review trunk involvement in body movement and stability when performing seated activities and its relation with UE and head movements in neurological patients with a flaccid trunk, with a focus on childhood and development with age.Methods and proceduresA search using PubMed was conducted and 32 out of 188 potentially eligible articles were included.Outcomes and resultsPatients with a flaccid trunk (e.g. with spinal cord injury or cerebral palsy) tend to involve the trunk earlier while reaching than healthy persons. Different balance strategies are observed in different types of patients, like using the contralateral arm as counterweight, eliminating degrees of freedom, or reducing movement speed.Conclusions and implicationsThe key role of the trunk in performing activities should be kept in mind when developing interventions to improve seated task performance in neurological patients with a flaccid trunk.



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Impaired set shifting is associated with previous falls in individuals with and without Parkinson’s disease

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): J. Lucas McKay, Kimberly C. Lang, Lena H. Ting, Madeleine E. Hackney
BackgroundIndividuals with Parkinson’s disease (PD) are at increased risk for falls, which lead to substantial morbidity and mortality. Understanding the motor and non-motor impairments associated with falls in PD is critical to informing prevention strategies. In addition to motor symptoms, individuals with PD exhibit non-motor deficits, including impaired set shifting, an aspect of executive function related to cognitive flexibility that can be measured quickly with the Trailmaking Test.Research questionTo determine whether impaired set shifting is associated with fall history in people with and without PD.MethodsWe examined associations between set shifting, PD status, and fall history (≥1 falls in the previous 6 months) in data from PD patients (n = 65) with and without freezing of gait (FOG) and community-dwelling neurologically-normal older adults (NON-PD) (n = 73) who had participated in our rehabilitation studies.ResultsImpaired set shifting was associated with previous falls after controlling for age, sex, overall cognitive function, PD status, FOG, and PD disease duration (OR = 1.29 [1.03–1.60]; P = 0.02). Consistent with literature, PD and FOG were also independently associated with increased fall prevalence (PD OR = 4.15 [95% CI 1.65–10.44], P < 0.01; FOG OR = 3.63 [1.22–10.80], P = 0.02). Although the strongest associations between set shifting and falling were observed among PD without FOG (OR = 2.11) compared to HOA (OR = 1.14) and PD with FOG (OR = 1.46), no statistically-significant differences were observed across groups. SIGNIFICANCE. Impaired set shifting is associated with previous falls in older adults with and without PD. Set shifting may be useful to include in fall risk assessments, particularly when global cognitive measures are within reference limits.



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A comparison of gait one year post operation in an RCT of robotic UKA versus traditional Oxford UKA

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): Arman Motesharei, Philip Rowe, Mark Blyth, Bryn Jones, Angus Maclean
Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant alignment. However, little work has been done to ascertain if this improvement results in a measureable improvement in knee function post operatively and a more normal gait.The kinematics of 70 knees were assessed using motion analysis in an RCT (31 receiving robotic-assisted surgery, and 39 receiving traditional manual surgery) and compared to healthy knees. Significant kinematic differences were seen between the two surgical groups from foot-strike to mid-stance. The robotic-assisted group achieved a higher knee excursion (18.0°, SD 4.9°) compared to the manual group (15.7°, SD 4.1°). There was no significant difference between the healthy group and the roboticassisted group, however there was a significant difference between the healthy group and the manual group (p < 0.001). Hence robotically-assisted knee replacement with Mako Restoris Implants appears to lead not only to better implant alignment but also kinematic benefits to the user during gait.



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Partitioning ground reaction forces for multi-segment foot joint kinetics

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): Dustin A. Bruening, Kota Z. Takahashi
BackgroundKinematic multi-segment foot models have been increasingly used to study foot function. The addition of kinetics to these models may enhance their utility; however, this been hindered by limitations in measuring ground reaction forces (GRFs) under individual foot segments.PurposeTo determine the accuracy of partitioning segment GRFs from a single force platform on foot joint kinetics.MethodsTwo potential partitioning methods were applied to a previously published three-segment kinetic foot model. The first method calculated joint kinetics only when the center of pressure crossed anterior to a joint (CPcross). The second method utilized a virtual pressure mat and a proportionality assumption to partition GRFs from the force platform (PRESS). Accuracy was assessed by comparing joint moments and powers obtained from each partitioning method to those obtained from a dual force plate approach that isolated forces under two segments at a time (2Plate). Thirteen healthy pediatric subjects walked in a controlled manner so as to isolate the kinetics acting at the metatarsophalangeal (MTP) joint and, subsequently, the midtarsal joint.ResultsThe PRESS method was generally more accurate than the CPcross method, and both methods were more accurate at the midtarsal joint than at the MTP joint. At the MTP joint, sagittal plane moment peaks, power peaks, and work done were slightly overestimated, more so by CPcross than PRESS. At the midtarsal joint, sagittal plane moments were captured well by PRESS, while CPcross missed the early portion of the moment, but both methods captured power profiles fairly accurately.SignificanceAnalysis of kinetics in multi-segment foot models may provide insight into foot function, pathologies, and interventions. Partitioning accuracy and generalizability is promising for analysis of the midtarsal joints but has limitations at the MTP joint.



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Dynamic stability during split-belt walking and the relationship with step length symmetry

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Benjamin J. Darter, Bethany A. Labrecque, Robert A. Perera
IntroductionWalking instability is a contributor to falls and other undesired changes in walking performance. We investigated the effect of split-belt treadmill based perturbations on dynamic stability. Furthermore, we examined the relationships for dynamic stability and symmetry during unperturbed and perturbed walking.MethodTwenty healthy young adults completed unperturbed and perturbed walking conditions on a split-belt treadmill. The continuous perturbation involved moving the parallel belts at unequal speeds (1.5 m/s: 0.5 m/s). Margins of stability (MoS) and step length symmetry (SYM) were assessed.ResultsStability and symmetry measures each decreased at the onset of the split walking perturbation. Only anterior-posterior (AP) MoS and SYM exhibited adaptive changes. Associations were found primarily for AP MoS with immediate changes in SYM at the onset of split walking, and over the duration of the split walking condition.DiscussionOur findings suggest walking strategies were adapted to maintain dynamic stability when faced with a continuous perturbation. Additionally, dynamic stability was associated with symmetry during perturbed walking.



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Over-focused? The relation between patients’ inclination for conscious control and single- and dual-task motor performance after stroke

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): R.P.M. Denneman, E.C. Kal, H. Houdijk, J.van der Kamp
BackgroundMany stroke patients are inclined to consciously control their movements. This is thought to negatively affect patients’ motor performance, as it disrupts movement automaticity. However, it has also been argued that conscious control may sometimes benefit motor performance, depending on the task or patientś motor or cognitive capacity.AimTo assess whether stroke patients’ inclination for conscious control is associated with motor performance, and explore whether the putative association differs as a function of task (single- vs dual) or patientś motor and cognitive capacity.MethodsUnivariate and multivariate linear regression analysis were used to assess associations between patients’ disposition to conscious control (i.e., Conscious Motor Processing subscale of Movement-Specific Reinvestment Scale; MSRS-CMP) and single-task (Timed-up-and-go test; TuG) and motor dual-task costs (TuG while tone counting; motor DTC%). We determined whether these associations were influenced by patients’ walking speed (i.e., 10-meter-walk test) and cognitive capacity (i.e., working memory, attention, executive function).ResultsSeventy-eight clinical stroke patients (<6 months post-stroke) participated. Patients’ conscious control inclination was not associated with single-task TuG performance. However, patients with a strong inclination for conscious control showed higher motor DTC%. These associations were irrespective of patients’ motor and cognitive abilities.ConclusionPatients’ disposition for conscious control was not associated with single task motor performance, but was associated with higher motor dual task costs, regardless of patients’ motor or cognitive abilities.Clinical RelevanceTherapists should be aware that patients’ conscious control inclination can influence their dual-task performance while moving. Longitudinal studies are required to test whether reducing patients’ disposition for conscious control would improve dual-tasking post-stroke.



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Sit-to-stand ground reaction force characteristics in blind and sighted female children

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Mozhgan Faraji Aylar, Amir Ali Jafarnezhadgero, Fatemeh Salari Esker
BackgroundThe association between visual sensory and sit-to-stand ground reaction force characteristics is not clear. Impulse is the amount of force applied over a period of time. Also, free moment represents the vertical moment applied in the center of pressure (COP). Research question: How the ground reaction force components, vertical loading rate, impulses and free moment respond to long and short term restricted visual information?MethodsFifteen female children with congenital blindness and 45 healthy girls with no visual impairments participated in this study. The girls with congenital blindness were placed in one group and the 45 girls with no visual impairments were randomly divided into three groups of 15; eyes open, permanently eyes closed, and temporary eyes closed. The participants in the permanently eyes closed group closed their eyes for 20 minutes before the test, whereas temporary eyes closed group did tests with their eyes closed throughout, and those in the eyes open group kept their eyes open.ResultsCongenital blindness was associated with increased vertical loading rate, range of motion of knee and hip in the medio-lateral plane. Also, medio-lateral and vertical ground reaction force impulses. Similar peak negative and positive free moments were observed in three groups. Significance: In conclusion, the results reveal that sit-to-stand ground reaction force components in blind children may have clinical importance for improvement of balance control of these individuals.



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Does local dynamic stability during unperturbed walking predict the response to balance perturbations? An examination across age and falls history

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Mu Qiao, Kinh N. Truong, Jason R. Franz
BackgroundOlder adults are at an exceptionally high risk of falls, and most falls occur during locomotor activities such as walking. Reduced local dynamic stability in old age is often interpreted to suggest a lessened capacity to respond to more significant balance challenges encountered during walking and future falls risk. However, it remains unclear whether local dynamic stability during normal, unperturbed walking predicts the response to larger external balance disturbances.Research questionWe tested the hypothesis that larger values of local dynamic instability during unperturbed walking would positively correlate with larger changes thereof due to optical flow balance perturbations.MethodsWe used trunk kinematics collected in subjects across a spectrum of walking balance integrity – young adults, older non-fallers, and older fallers – during walking with and without mediolateral optical flow perturbations of four different amplitudes.ResultsWe first found evidence that optical flow perturbations of sufficient amplitude appear capable of revealing independent effects of aging and falls history that are not otherwise apparent during normal, unperturbed walking. We also reject our primary hypothesis; a significant negative correlation only in young adults indicated that individuals with more local dynamic instability during normal, unperturbed walking exhibited smaller responses to optical flow perturbations. In contrast, most prominently in older fallers, the response to optical flow perturbations appeared independent of their baseline level of dynamic instability.SignificanceWe propose that predicting the response to balance perturbations in older fallers, at least that measured using local dynamic stability, likely requires measuring that response directly.



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Short-term functional assessment of gait, plantarflexor strength, and tendon properties after Achilles tendon rupture

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Alison N. Agres, Tobias J. Gehlen, Adamantios Arampatzis, William R. Taylor, Georg N. Duda, Sebastian Manegold
BackgroundAlthough early functional rehabilitation (EFR) has been suggested to yield rapid functional recovery after Achilles tendon rupture (ATR) compared to conventional rehabilitation (CR), most quantitative assessments occur long after rehabilitation has been completed. Few data exist regarding the short-term functional gains during the healing period post-ATR. It remains unclear if EFR allows for an objectively faster return to function. The aim of this study was to examine EFR's effect on gait, plantarflexor strength, and tendon properties in early post-operative follow-ups.MethodsFourteen patients received either EFR (n = 6) or CR (n = 8) after percutaneous ATR repair. Functional gait analysis, maximal voluntary isometric contractions (MVICs), and Achilles tendon properties were assessed at 8 and 12 weeks post-op.ResultsComparison of EFR against CR yielded no statistically significant differences in ankle kinematics or kinetics, Achilles tendon properties or MVICs on the injured ankle at either time point. CR patients demonstrated lower plantarflexion moments on the injured limb at 8 weeks (0.817 ± 0.151 N·m/kg vs. 1.172 ± 0.177 N·m/kg, p = 0.002). On INJ, all patients exhibited deficits in plantarflexor moment at 8 weeks and eversion moment at 12 weeks that were clinically significant compared to CON. Significance: ATR patients, regardless of rehabilitation, exhibit deficits in gait, AT properties, and single-limb strength at 8 weeks. Though AT properties and single-limb plantarflexor isometric strength remain at a deficit at 12 weeks, bipedal plantarflexion moments are comparable between INJ and CON. Though effect size calculations suggested clinically significant differences, clear benefits of EFR compared to CR were not found.SignificanceATR patients, regardless of rehabilitation, exhibit deficits in gait, AT properties, and single-limb strength at 8 weeks. Though AT properties and single-limb plantarflexor isometric strength remain at a deficit at 12 weeks, bipedal plantarflexion moments are comparable between INJ and CON. Though effect size calculations suggested clinically significant differences, clear benefits of EFR compared to CR were not found.



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Foot posture is associated with plantar pressure during gait: a comparison of normal, planus and cavus feet

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Andrew K. Buldt, Saeed Forghany, Karl B. Landorf, Pazit Levinger, George S. Murley, Hylton B. Menz
BackgroundVariations in foot posture, such as pes planus (low medial longitudinal arch) or pes cavus (high medial longitudinal arch) are associated with some lower limb injuries. However, the mechanism that links foot posture to injury is not clear. Research question The aim of this study was to compare plantar pressure between healthy individuals with normal, planus or cavus feet.MethodsNinety-two healthy volunteers (aged 18 to 45) were classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on the Foot Posture Index, Arch Index and normalised navicular height truncated. Barefoot walking trials were conducted using an emed^®-x400 plantar pressure system (Novel GmbH, Munich, Germany). An 11 region mask was used that included the medial heel, lateral heel, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsophalangeal joints, hallux, 2nd toe, and the 3rd, 4th and 5th toes. Peak pressure, pressure-time integral, maximum force, force-time integral and contact area were calculated for each region. One way analyses of variance and effect sizes were used to compare the three foot posture groups.ResultsOverall, the largest differences were between the planus and cavus foot groups in forefoot pressure and force. In particular, peak pressures at the 4th and 5th MTPJs in the planus foot group were lower compared to the normal and cavus foot groups, and displayed the largest effect sizes. Significance This study confirms that foot posture does influence plantar pressures, and that each foot posture classification displays unique plantar pressure characteristics.



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Trunk involvement in performing upper extremity activities while seated in neurological patients with a flaccid trunk – A review

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): Laura H.C. Peeters, Imelda J.M. de Groot, Alexander C.H. Geurts
BackgroundTrunk control is essential during seated activities. The trunk interacts with the upper extremities (UE) and head by being part of a kinematic chain and by providing a stable basis. When trunk control becomes impaired, it may have consequences for the execution of UE tasks.AimTo review trunk involvement in body movement and stability when performing seated activities and its relation with UE and head movements in neurological patients with a flaccid trunk, with a focus on childhood and development with age.Methods and proceduresA search using PubMed was conducted and 32 out of 188 potentially eligible articles were included.Outcomes and resultsPatients with a flaccid trunk (e.g. with spinal cord injury or cerebral palsy) tend to involve the trunk earlier while reaching than healthy persons. Different balance strategies are observed in different types of patients, like using the contralateral arm as counterweight, eliminating degrees of freedom, or reducing movement speed.Conclusions and implicationsThe key role of the trunk in performing activities should be kept in mind when developing interventions to improve seated task performance in neurological patients with a flaccid trunk.



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Impaired set shifting is associated with previous falls in individuals with and without Parkinson’s disease

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): J. Lucas McKay, Kimberly C. Lang, Lena H. Ting, Madeleine E. Hackney
BackgroundIndividuals with Parkinson’s disease (PD) are at increased risk for falls, which lead to substantial morbidity and mortality. Understanding the motor and non-motor impairments associated with falls in PD is critical to informing prevention strategies. In addition to motor symptoms, individuals with PD exhibit non-motor deficits, including impaired set shifting, an aspect of executive function related to cognitive flexibility that can be measured quickly with the Trailmaking Test.Research questionTo determine whether impaired set shifting is associated with fall history in people with and without PD.MethodsWe examined associations between set shifting, PD status, and fall history (≥1 falls in the previous 6 months) in data from PD patients (n = 65) with and without freezing of gait (FOG) and community-dwelling neurologically-normal older adults (NON-PD) (n = 73) who had participated in our rehabilitation studies.ResultsImpaired set shifting was associated with previous falls after controlling for age, sex, overall cognitive function, PD status, FOG, and PD disease duration (OR = 1.29 [1.03–1.60]; P = 0.02). Consistent with literature, PD and FOG were also independently associated with increased fall prevalence (PD OR = 4.15 [95% CI 1.65–10.44], P < 0.01; FOG OR = 3.63 [1.22–10.80], P = 0.02). Although the strongest associations between set shifting and falling were observed among PD without FOG (OR = 2.11) compared to HOA (OR = 1.14) and PD with FOG (OR = 1.46), no statistically-significant differences were observed across groups. SIGNIFICANCE. Impaired set shifting is associated with previous falls in older adults with and without PD. Set shifting may be useful to include in fall risk assessments, particularly when global cognitive measures are within reference limits.



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A comparison of gait one year post operation in an RCT of robotic UKA versus traditional Oxford UKA

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): Arman Motesharei, Philip Rowe, Mark Blyth, Bryn Jones, Angus Maclean
Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant alignment. However, little work has been done to ascertain if this improvement results in a measureable improvement in knee function post operatively and a more normal gait.The kinematics of 70 knees were assessed using motion analysis in an RCT (31 receiving robotic-assisted surgery, and 39 receiving traditional manual surgery) and compared to healthy knees. Significant kinematic differences were seen between the two surgical groups from foot-strike to mid-stance. The robotic-assisted group achieved a higher knee excursion (18.0°, SD 4.9°) compared to the manual group (15.7°, SD 4.1°). There was no significant difference between the healthy group and the roboticassisted group, however there was a significant difference between the healthy group and the manual group (p < 0.001). Hence robotically-assisted knee replacement with Mako Restoris Implants appears to lead not only to better implant alignment but also kinematic benefits to the user during gait.



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Partitioning ground reaction forces for multi-segment foot joint kinetics

Publication date: Available online 6 March 2018
Source:Gait & Posture
Author(s): Dustin A. Bruening, Kota Z. Takahashi
BackgroundKinematic multi-segment foot models have been increasingly used to study foot function. The addition of kinetics to these models may enhance their utility; however, this been hindered by limitations in measuring ground reaction forces (GRFs) under individual foot segments.PurposeTo determine the accuracy of partitioning segment GRFs from a single force platform on foot joint kinetics.MethodsTwo potential partitioning methods were applied to a previously published three-segment kinetic foot model. The first method calculated joint kinetics only when the center of pressure crossed anterior to a joint (CPcross). The second method utilized a virtual pressure mat and a proportionality assumption to partition GRFs from the force platform (PRESS). Accuracy was assessed by comparing joint moments and powers obtained from each partitioning method to those obtained from a dual force plate approach that isolated forces under two segments at a time (2Plate). Thirteen healthy pediatric subjects walked in a controlled manner so as to isolate the kinetics acting at the metatarsophalangeal (MTP) joint and, subsequently, the midtarsal joint.ResultsThe PRESS method was generally more accurate than the CPcross method, and both methods were more accurate at the midtarsal joint than at the MTP joint. At the MTP joint, sagittal plane moment peaks, power peaks, and work done were slightly overestimated, more so by CPcross than PRESS. At the midtarsal joint, sagittal plane moments were captured well by PRESS, while CPcross missed the early portion of the moment, but both methods captured power profiles fairly accurately.SignificanceAnalysis of kinetics in multi-segment foot models may provide insight into foot function, pathologies, and interventions. Partitioning accuracy and generalizability is promising for analysis of the midtarsal joints but has limitations at the MTP joint.



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Dynamic stability during split-belt walking and the relationship with step length symmetry

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Benjamin J. Darter, Bethany A. Labrecque, Robert A. Perera
IntroductionWalking instability is a contributor to falls and other undesired changes in walking performance. We investigated the effect of split-belt treadmill based perturbations on dynamic stability. Furthermore, we examined the relationships for dynamic stability and symmetry during unperturbed and perturbed walking.MethodTwenty healthy young adults completed unperturbed and perturbed walking conditions on a split-belt treadmill. The continuous perturbation involved moving the parallel belts at unequal speeds (1.5 m/s: 0.5 m/s). Margins of stability (MoS) and step length symmetry (SYM) were assessed.ResultsStability and symmetry measures each decreased at the onset of the split walking perturbation. Only anterior-posterior (AP) MoS and SYM exhibited adaptive changes. Associations were found primarily for AP MoS with immediate changes in SYM at the onset of split walking, and over the duration of the split walking condition.DiscussionOur findings suggest walking strategies were adapted to maintain dynamic stability when faced with a continuous perturbation. Additionally, dynamic stability was associated with symmetry during perturbed walking.



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Over-focused? The relation between patients’ inclination for conscious control and single- and dual-task motor performance after stroke

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): R.P.M. Denneman, E.C. Kal, H. Houdijk, J.van der Kamp
BackgroundMany stroke patients are inclined to consciously control their movements. This is thought to negatively affect patients’ motor performance, as it disrupts movement automaticity. However, it has also been argued that conscious control may sometimes benefit motor performance, depending on the task or patientś motor or cognitive capacity.AimTo assess whether stroke patients’ inclination for conscious control is associated with motor performance, and explore whether the putative association differs as a function of task (single- vs dual) or patientś motor and cognitive capacity.MethodsUnivariate and multivariate linear regression analysis were used to assess associations between patients’ disposition to conscious control (i.e., Conscious Motor Processing subscale of Movement-Specific Reinvestment Scale; MSRS-CMP) and single-task (Timed-up-and-go test; TuG) and motor dual-task costs (TuG while tone counting; motor DTC%). We determined whether these associations were influenced by patients’ walking speed (i.e., 10-meter-walk test) and cognitive capacity (i.e., working memory, attention, executive function).ResultsSeventy-eight clinical stroke patients (<6 months post-stroke) participated. Patients’ conscious control inclination was not associated with single-task TuG performance. However, patients with a strong inclination for conscious control showed higher motor DTC%. These associations were irrespective of patients’ motor and cognitive abilities.ConclusionPatients’ disposition for conscious control was not associated with single task motor performance, but was associated with higher motor dual task costs, regardless of patients’ motor or cognitive abilities.Clinical RelevanceTherapists should be aware that patients’ conscious control inclination can influence their dual-task performance while moving. Longitudinal studies are required to test whether reducing patients’ disposition for conscious control would improve dual-tasking post-stroke.



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Sit-to-stand ground reaction force characteristics in blind and sighted female children

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Mozhgan Faraji Aylar, Amir Ali Jafarnezhadgero, Fatemeh Salari Esker
BackgroundThe association between visual sensory and sit-to-stand ground reaction force characteristics is not clear. Impulse is the amount of force applied over a period of time. Also, free moment represents the vertical moment applied in the center of pressure (COP). Research question: How the ground reaction force components, vertical loading rate, impulses and free moment respond to long and short term restricted visual information?MethodsFifteen female children with congenital blindness and 45 healthy girls with no visual impairments participated in this study. The girls with congenital blindness were placed in one group and the 45 girls with no visual impairments were randomly divided into three groups of 15; eyes open, permanently eyes closed, and temporary eyes closed. The participants in the permanently eyes closed group closed their eyes for 20 minutes before the test, whereas temporary eyes closed group did tests with their eyes closed throughout, and those in the eyes open group kept their eyes open.ResultsCongenital blindness was associated with increased vertical loading rate, range of motion of knee and hip in the medio-lateral plane. Also, medio-lateral and vertical ground reaction force impulses. Similar peak negative and positive free moments were observed in three groups. Significance: In conclusion, the results reveal that sit-to-stand ground reaction force components in blind children may have clinical importance for improvement of balance control of these individuals.



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Does local dynamic stability during unperturbed walking predict the response to balance perturbations? An examination across age and falls history

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Mu Qiao, Kinh N. Truong, Jason R. Franz
BackgroundOlder adults are at an exceptionally high risk of falls, and most falls occur during locomotor activities such as walking. Reduced local dynamic stability in old age is often interpreted to suggest a lessened capacity to respond to more significant balance challenges encountered during walking and future falls risk. However, it remains unclear whether local dynamic stability during normal, unperturbed walking predicts the response to larger external balance disturbances.Research questionWe tested the hypothesis that larger values of local dynamic instability during unperturbed walking would positively correlate with larger changes thereof due to optical flow balance perturbations.MethodsWe used trunk kinematics collected in subjects across a spectrum of walking balance integrity – young adults, older non-fallers, and older fallers – during walking with and without mediolateral optical flow perturbations of four different amplitudes.ResultsWe first found evidence that optical flow perturbations of sufficient amplitude appear capable of revealing independent effects of aging and falls history that are not otherwise apparent during normal, unperturbed walking. We also reject our primary hypothesis; a significant negative correlation only in young adults indicated that individuals with more local dynamic instability during normal, unperturbed walking exhibited smaller responses to optical flow perturbations. In contrast, most prominently in older fallers, the response to optical flow perturbations appeared independent of their baseline level of dynamic instability.SignificanceWe propose that predicting the response to balance perturbations in older fallers, at least that measured using local dynamic stability, likely requires measuring that response directly.



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Short-term functional assessment of gait, plantarflexor strength, and tendon properties after Achilles tendon rupture

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Alison N. Agres, Tobias J. Gehlen, Adamantios Arampatzis, William R. Taylor, Georg N. Duda, Sebastian Manegold
BackgroundAlthough early functional rehabilitation (EFR) has been suggested to yield rapid functional recovery after Achilles tendon rupture (ATR) compared to conventional rehabilitation (CR), most quantitative assessments occur long after rehabilitation has been completed. Few data exist regarding the short-term functional gains during the healing period post-ATR. It remains unclear if EFR allows for an objectively faster return to function. The aim of this study was to examine EFR's effect on gait, plantarflexor strength, and tendon properties in early post-operative follow-ups.MethodsFourteen patients received either EFR (n = 6) or CR (n = 8) after percutaneous ATR repair. Functional gait analysis, maximal voluntary isometric contractions (MVICs), and Achilles tendon properties were assessed at 8 and 12 weeks post-op.ResultsComparison of EFR against CR yielded no statistically significant differences in ankle kinematics or kinetics, Achilles tendon properties or MVICs on the injured ankle at either time point. CR patients demonstrated lower plantarflexion moments on the injured limb at 8 weeks (0.817 ± 0.151 N·m/kg vs. 1.172 ± 0.177 N·m/kg, p = 0.002). On INJ, all patients exhibited deficits in plantarflexor moment at 8 weeks and eversion moment at 12 weeks that were clinically significant compared to CON. Significance: ATR patients, regardless of rehabilitation, exhibit deficits in gait, AT properties, and single-limb strength at 8 weeks. Though AT properties and single-limb plantarflexor isometric strength remain at a deficit at 12 weeks, bipedal plantarflexion moments are comparable between INJ and CON. Though effect size calculations suggested clinically significant differences, clear benefits of EFR compared to CR were not found.SignificanceATR patients, regardless of rehabilitation, exhibit deficits in gait, AT properties, and single-limb strength at 8 weeks. Though AT properties and single-limb plantarflexor isometric strength remain at a deficit at 12 weeks, bipedal plantarflexion moments are comparable between INJ and CON. Though effect size calculations suggested clinically significant differences, clear benefits of EFR compared to CR were not found.



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Foot posture is associated with plantar pressure during gait: a comparison of normal, planus and cavus feet

Publication date: Available online 5 March 2018
Source:Gait & Posture
Author(s): Andrew K. Buldt, Saeed Forghany, Karl B. Landorf, Pazit Levinger, George S. Murley, Hylton B. Menz
BackgroundVariations in foot posture, such as pes planus (low medial longitudinal arch) or pes cavus (high medial longitudinal arch) are associated with some lower limb injuries. However, the mechanism that links foot posture to injury is not clear. Research question The aim of this study was to compare plantar pressure between healthy individuals with normal, planus or cavus feet.MethodsNinety-two healthy volunteers (aged 18 to 45) were classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on the Foot Posture Index, Arch Index and normalised navicular height truncated. Barefoot walking trials were conducted using an emed^®-x400 plantar pressure system (Novel GmbH, Munich, Germany). An 11 region mask was used that included the medial heel, lateral heel, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsophalangeal joints, hallux, 2nd toe, and the 3rd, 4th and 5th toes. Peak pressure, pressure-time integral, maximum force, force-time integral and contact area were calculated for each region. One way analyses of variance and effect sizes were used to compare the three foot posture groups.ResultsOverall, the largest differences were between the planus and cavus foot groups in forefoot pressure and force. In particular, peak pressures at the 4th and 5th MTPJs in the planus foot group were lower compared to the normal and cavus foot groups, and displayed the largest effect sizes. Significance This study confirms that foot posture does influence plantar pressures, and that each foot posture classification displays unique plantar pressure characteristics.



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