Safe and Sound

Over time, automobiles have become ever safer. Airbags all around us protect us against impact and crumple zones keep the impact away from the people in the cabin. In more modern developments, automobiles are surrounded by sensors and even cameras to warn the driver about nearby objects and even drifts across traffic lanes. And today’s post-modern vehicles will even apply the brakes upon sensing danger. Even after all of these advancements, accidents happen.

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Evidence of compensatory joint kinetics during stair ascent and descent in Parkinson’s disease

Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Zachary J. Conway, Peter A. Silburn, Tim D. Blackmore, Michael H. Cole
BackgroundStair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson’s disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk.ObjectiveTo investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body’s support in people with PD.MethodsTwelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated.ResultsLinear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients.ConclusionsDespite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks.



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Under Water Gait Analysis in Parkinson’s disease

Publication date: Available online 10 November 2016
Source:Gait & Posture
Author(s): Daniele Volpe, Davide Pavan, Meg Morris, Annamaria Guiotto, Robert Iansek, Sofia Fortuna, Giuseppe Frazzitta, Zimi Sawacha
Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.



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Muscle Activation Patterns of the Lumbo-Pelvic-Hip Complex During Walking Gait Before and After Exercise

Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Mihyang Chang, Lindsay V. Slater, Revay O. Corbett, Joseph M. Hart, Jay Hertel
The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.



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Evidence of compensatory joint kinetics during stair ascent and descent in Parkinson’s disease

Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Zachary J. Conway, Peter A. Silburn, Tim D. Blackmore, Michael H. Cole
BackgroundStair ambulation is a challenging activity of daily life that requires larger joint moments than walking. Stabilisation of the body and prevention of lower limb collapse during this task depends upon adequately-sized hip, knee and ankle extensor moments. However, people with Parkinson’s disease (PD) often present with strength deficits that may impair their capacity to control the lower limbs and ultimately increase their falls risk.ObjectiveTo investigate hip, knee and ankle joint moments during stair ascent and descent and determine the contribution of these joints to the body’s support in people with PD.MethodsTwelve PD patients and twelve age-matched controls performed stair ascent and descent trials. Data from an instrumented staircase and a three-dimensional motion analysis system were used to derive sagittal hip, knee and ankle moments. Support moment impulses were calculated by summing all extensor moment impulses and the relative contribution of each joint was calculated.ResultsLinear mixed model analyses indicated that PD patients walked slower and had a reduced cadence relative to controls. Although support moment impulses were typically not different between groups during stair ascent or descent, a reduced contribution by the ankle joint required an increased knee joint contribution for the PD patients.ConclusionsDespite having poorer knee extensor strength, people with PD rely more heavily on these muscles during stair walking. This adaptation could possibly be driven by the somewhat restricted mobility of this joint, which may provide these individuals with an increased sense of stability during these tasks.



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Under Water Gait Analysis in Parkinson’s disease

Publication date: Available online 10 November 2016
Source:Gait & Posture
Author(s): Daniele Volpe, Davide Pavan, Meg Morris, Annamaria Guiotto, Robert Iansek, Sofia Fortuna, Giuseppe Frazzitta, Zimi Sawacha
Although hydrotherapy is one of the physical therapies adopted to optimize gait rehabilitation in people with Parkinson disease, the quantitative measurement of gait-related outcomes has not been provided yet. This work aims to document the gait improvements in a group of parkinsonians after a hydrotherapy program through 2D and 3D underwater and on land gait analysis. Thirty-four parkinsonians and twenty-two controls were enrolled, divided into two different cohorts. In the first one, 2 groups of patients underwent underwater or land based walking training; controls underwent underwater walking training. Hence pre-treatment 2D underwater and on land gait analysis were performed, together with post-treatment on land gait analysis. Considering that current literature documented a reduced movement amplitude in parkinsonians across all lower limb joints in all movement planes, 3D underwater and on land gait analysis were performed on a second cohort of subjects (10 parkinsonians and 10 controls) who underwent underwater gait training. Baseline land 2D and 3D gait analysis in parkinsonians showed shorter stride length and slower speed than controls, in agreement with previous findings. Comparison between underwater and on land gait analysis showed reduction in stride length, cadence and speed on both parkinsonians and controls. Although patients who underwent underwater treatment exhibited significant changes on spatiotemporal parameters and sagittal plane lower limb kinematics, 3D gait analysis documented a significant (p<0.05) improvement in all movement planes. These data deserve attention for research directions promoting the optimal recovery and maintenance of walking ability.



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Muscle Activation Patterns of the Lumbo-Pelvic-Hip Complex During Walking Gait Before and After Exercise

Publication date: Available online 9 November 2016
Source:Gait & Posture
Author(s): Mihyang Chang, Lindsay V. Slater, Revay O. Corbett, Joseph M. Hart, Jay Hertel
The lumbo-pelvic-hip core complex consists of musculoskeletal structures that stabilize the spine and pelvis, however fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy inidviduals. Means and 95% confidence intervals for muscle amplitude, muscle onsent and kinematics for 0-100% of the gait cycle were compared before and after exercise. Mean differences (MD) and standard deviations were calculated for all significant differences. The amplitude increased in the rectus abdominis during loading (MD=0.67±0.11), midstance (MD=0.75±0.04), terminal stance (MD=0.58±0.04), and late swing (MD=0.75±0.07) after exercise. Amplitude also increased during swing phase in the erector spinae (MD=0.92±0.11), vastus lateralis (MD=1.12±0.30), and vastus medialis (MD=1.80±0.19) after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload.



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