Design characteristics and inclusion of evidence-based exercise recommendation in fall prevention community exercise programs for older adults in Canada: a national descriptive self-report study.

BACKGROUND: Training balance through exercise is an effective strategy to reduce falls in community-dwelling older adults. Evidence-based fall prevention exercise recommendations have been proposed, specifying that exercise programs should: (1) provide a high challenge to balance, (2) be offered for a least three hours per week, (3) be provided on an ongoing basis. Community exercise programs have the potential to deliver effective fall prevention exercise; however, current design characteristics and whether they include the recommendations is not known. This study described design characteristics of fall prevention community exercise programs for older adults (50 years and older) across Canada, and explored whether these programs included the three evidence-based exercise recommendations. METHODS: Instructors of fall prevention community exercise programs completed electronic self-report questionnaires following a modified Dillman recruitment approach. Questions explored program characteristics, exercise content, target population, and program and instructor demographic information. Using a previously developed coding scheme based on recommendations, exercises were coded for balance challenge. RESULTS: One hundred fourty completed eligible questionnaires were analyzed (74% response rate). One hundred thirty-three programs (95%) included the challenge recommendation by prescribing mostly moderate or high challenge balance exercises, 16 programs (11%) included at least three hours of exercise a week, and 59 programs (42%) were offered on an ongoing basis. Eight programs (6%) included all three recommendations. CONCLUSIONS: Most programs included at least one recommendation for effective fall prevention exercise. Future studies should examine organizational barriers and facilitators to incorporating evidence-based exercise recommendations and explore the use of mixed home/in-class strategies to include the recommendations.

The effects of light touch on gait and dynamic balance during normal and tandem walking in individuals with an incomplete spinal cord injury.

STUDY DESIGN: Prospective cross-sectional study OBJECTIVES: To investigate the effect of adding haptic input during walking in individuals with incomplete spinal cord injury (iSCI). SETTING: Research laboratory. METHODS: Participants with iSCI and age- and sex-matched able-bodied (AB) individuals walked normally (SCI n = 18, AB n = 17) and in tandem (SCI n = 12, AB n = 17). Haptic input was added through light touch on a railing. Step parameters, and mediolateral and anterior-posterior margins of stability (means and standard deviations) were calculated. Surface electromyography data were collected bilaterally from the tibialis anterior (TA), soleus (SOL), and gluteus medius (GMED) and integrated over a stride. Repeated measures ANOVAs examined within- and between-group differences (α = 0.05). Cutaneous and proprioceptive sensation of individuals with iSCI were correlated to changes in outcome measures that were affected by haptic input. RESULTS: When walking normally, adding haptic input decreased stride velocity, step width, stride length, MOSML, MOSML_SD, MOSAP, and MOSAP_SD, and increased GMED activity on the limb opposite the railing. During tandem walking, haptic input had no effect; however, individuals with iSCI had a larger step width SD and MOSML_SD compared with the AB group. Sensory abilities of individuals with iSCI were not correlated to any of the outcome measures that significantly changed with added haptic input. CONCLUSIONS: Added haptic input improved balance control during normal but not in tandem walking. Sensory abilities did not impact the use of added haptic input during walking.

Adding Light Touch While Walking in Older Adults: Biomechanical and Neuromotor Effects.

Adding haptic input may improve balance control and help prevent falls in older adults. This study examined the effects of added haptic input via light touch on a railing while walking. Participants (N = 53, 75.9 ± 7.9 years) walked normally or in tandem (heel to toe) with and without haptic input. During normal walking, adding haptic input resulted in a more cautious and variable gait pattern, reduced variability of center of mass acceleration and margin of stability, and increased muscle activity. During tandem walking, haptic input had minimal effect on step parameters, decreased lower limb muscle activity, and increased cocontraction at the ankle closest to the railing. Age was correlated with step width variability, stride length variability, stride velocity, variability of medial-lateral center of mass acceleration, and margin of stability for tandem walking. This complex picture of sensorimotor integration in older adults warrants further exploration into added haptic input during walking.

To what extent do older adult community exercise programs in Winnipeg, Canada address balance and include effective fall prevention exercise? A descriptive self-report study.

BACKGROUND: Effective fall prevention exercise for community-dwelling older adults requires (i) challenging balance exercise, (ii) offered at least 3 hrs/ week, and (iii) on an ongoing basis, to reduce falls. Community exercise programs are a potential implementation strategy for fall prevention exercise; however, the extent to which they address balance and include effective fall prevention exercise is unknown. Study objectives were to describe program delivery, exercise design, and assessment characteristics of older adult community exercise programs in Winnipeg, Canada; determine if they included effective fall prevention exercise; determine the balance challenge and components of postural control addressed in the most- and least-frequently reported exercises. METHODS: A public inventory of older adult community exercise programs served as the sampling frame for cross-sectional telephone questionnaires exploring program, exercise, and assessment characteristics. Exercises were coded independently by two investigators for balance challenge level and components of postural control. Programs were categorized by number of effective fall prevention exercise components established by evidence-based recommendations. Descriptive statistics were calculated. RESULTS: Thirty-three eligible programs were identified and nine individuals participated. Most programs (n = 5, 56%) identified as general exercise, and two (22%) as fall prevention exercise. Most programs (n = 5, 56%) were offered two or more times/ week and reported exercise intensity as somewhat challenging. Exercise time offered ranged between 1 and 3 h/ week. Assessments were conducted in two programs (22%). Only one program (general exercise) included all components of effective fall prevention exercise. Two programs (22%) included the component of being offered at least 3 hrs/ week. Three programs (33%) included the component of being offered on an ongoing basis. Seven programs (78%) prescribed mostly moderate challenge balance exercise, and one program (11%) prescribed mostly high challenge exercise. Most of the 19 most-frequently prescribed exercises (n = 17, 89%) targeted static stability and none targeted reactive postural control. CONCLUSIONS: Most of the older adult community exercise programs participating in this study did not focus on fall prevention, and did not include all components of effective fall prevention exercise. Future studies should focus on fall prevention programs and explore factors influencing implementation of effective fall prevention exercise components to facilitate planning.

Different haptic tools reduce trunk velocity in the frontal plane during walking, but haptic anchors have advantages over lightly touching a railing.

There are different ways to add haptic input during walking which may affect walking balance. This study compared the use of two different haptic tools (rigid railing and haptic anchors) and investigated whether any effects on walking were the result of the added sensory input and/or the posture generated when using those tools. Data from 28 young healthy adults were collected using the Mobility Lab inertial sensor system (APDM, Oregon, USA). Participants walked with and without both haptic tools and while pretending to use both haptic tools (placebo trials), with eyes opened and eyes closed. Using the tools or pretending to use both tools decreased normalized stride velocity (p < .001-0.008) and peak medial-lateral (ML) trunk velocity (p < .001-0.001). Normalized stride velocity was slower when actually using the railing compared to placebo railing trials (p = .006). Using the anchors resulted in lower peak ML trunk velocity than the railing (p = .002). The anchors had lower peak ML trunk velocity than placebo anchors (p < .001), but there was no difference between railing and placebo railing (p > .999). These findings highlight a difference in the type of tool used to add haptic input and suggest that changes in balance control strategy resulting from using the railing are based on arm placement, where it is the posture combined with added sensory input that affects balance control strategies with the haptic anchors. These findings provide a strong framework for additional research to be conducted on the effects of haptic input on walking in populations known to have decreased walking balance.

Spatiotemporal walking performance in different settings: effects of walking speed and sex.

Background: Understanding the factors that influence walking is important as quantitative walking assessments have potential to inform health risk assessments. Wearable technology innovation has enabled quantitative walking assessments to be conducted in different settings. Understanding how different settings influence quantitative walking performance is required to better utilize the health-related potential of quantitative walking assessments. Research question: How does spatiotemporal walking performance differ during walking in different settings at different speeds for young adults? Methods: Forty-two young adults [21 male (23 ± 4 years), 21 female (24 ± 5 years)] walked in two laboratory settings (overground, treadmill) and three non-laboratory settings (hallway, indoor open, outdoor pathway) at three self-selected speeds (slow, preferred, fast) following verbal instructions. Six walking trials of each condition (10 m in laboratory overground, 20 m in other settings) were completed. Participants wore 17 inertial sensors (Xsens Awinda, Movella, Henderson, NV) and spatiotemporal parameters were computed from sensor-derived kinematics. Setting × speed × sex repeated measures analysis of variance were used for statistical analysis. Results: Regardless of the speed condition, participants walked faster overground when compared to while on the treadmill and walked faster in the indoor open and outdoor pathway settings when compared to the laboratory overground setting. At slow speeds, participants also walked faster in the hallway when compared to the laboratory overground setting. Females had greater cadence when compared to males, independent of settings and speed conditions. Significance: Particularly at slow speeds, spatiotemporal walking performance was different between the settings, suggesting that setting characteristics such as walkway boundary definition may significantly influence spatiotemporal walking performance.

Walking balance control in different settings: Effects of walking speed and biological sex.

BACKGROUND: Previous research has suggested that spatiotemporal step parameters differ between settings; however, it remains unclear how different settings influence walking balance control. RESEARCH QUESTION: How do settings and sex influence walking balance control during walking at different speeds for young adults? METHODS: Forty-two adults (21 male (23 ± 4 years), 21 female (24 ± 5 years)) completed overground walking trials in four settings: laboratory (10 m), hallway, indoor open, and outdoor pathway (all 20 m) at three self-selected speeds (slow, preferred, fast) following verbal instructions. Participants wore 17 inertial sensors (Xsens Awinda, Movella, Henderson, NV) to capture total body kinematics. The number of included strides was matched across all conditions, with six strides included in each condition for all participants. Medial-lateral and anterior-posterior total body angular momentum range over each stride was calculated (HML range and HAP range). Setting × speed × sex mixed factorial analysis of variance with repeated measures on setting and speed were used for statistical analysis (α =.05). RESULTS: Significant setting × speed interactions (p <.001) were present for both outcomes. HML range was greater in the laboratory and hallway compared to the indoor open and outdoor pathway settings for slow walking speed only. HAP range was lower in the outdoor pathway compared to all indoor settings at slow and preferred walking speeds. Differences in HAP range between settings was more pronounced at the slow speed condition. Across setting and speed conditions, HML range was greater for males compared to females. SIGNIFICANCE: Young adults may alter their balance control strategy depending on the setting (laboratory, indoor open and outdoor pathway), particularly at slow speeds. Researchers and clinicians are cautioned not to assume walking in laboratory settings reflects walking in all settings nor that males and females can be examined as a single group.

Don't get tripped up: Haptic modalities alter gait characteristics during obstacle crossing.

The attentional capacity required of haptic modalities while obstacle crossing may limit their effectiveness. Therefore, this study examined the attentional demands of haptic modalities during obstacle crossing. Nineteen healthy young adults walked across a 10 m laboratory floor within two modality blocks using either: 1) light touch on a railing, or 2) pulling haptic anchors. Randomly dispersed within these blocks were trials without added haptic input and verbal reaction time (VRT) tasks. VRT was compared across the three walking conditions. Gait characteristics, obstacle crossing stability, and obstacle toe clearance were compared across the three walking conditions (normal walking, light touch walking, anchored walking) and 2 VRT conditions (absence vs. presence). VRTs did not differ according to walking conditions (p > .05). Step length variability for the normal walking condition was significantly greater than for both the light touch and anchored walking conditions (p = .026). Toe clearance for the trail leg was less during light touch than normal walking (p = .020). The presence of the VRT resulted in greater toe clearance for both lead (p = .018) and trail limbs (F(2,34) = 8.053, p = .011). Neither haptic modality required significantly increased attentional demand; however, light touch walking results in less obstacle toe clearance. Haptic modalities likely provide greater benefit than risk to users during obstacle crossing.

The Associations Among Self-Compassion, Self-Esteem, Self-Criticism, and Concern Over Mistakes in Response to Biomechanical Feedback in Athletes.

Athletes regularly face the possibility of failing to meet expectations in training and competition, and it is essential that they are equipped with strategies to facilitate coping after receiving performance feedback. Self-compassion is a potential resource to help athletes manage the various setbacks that arise in sport over and above other psychological resources. The primary purpose of this research was to explore how athletes respond to objective biomechanical feedback given after a performance. Specifically, we investigated if levels of self-compassion, self-esteem, self-criticism, and concern over mistakes were related to one another before and after a series of sprint tests interspersed with biomechanical feedback, and whether self-compassionate athletes achieved a better sprint performance after receiving and implementing biomechanical feedback. Forty-eight athletes (20 female: M age = 19.8 years, SD = 3.1; 28 male: M age = 23.6 years, SD = 7.8) completed online measures of self-compassion, self-esteem, self-criticism and concern over mistakes before performing four sets of 40-m sprints. Participants received personalized biomechanical feedback after each sprint that compared their performance to gold standard results. Following all sprints, they then completed measures of self-criticism, and reported emotions, thoughts, and reactions. Self-compassion was positively correlated with self-esteem (r = 0.57, p < 0.01) and negatively related to both self-criticism (r = -0.52, p < 0.01) and concern over mistakes (r = -0.69, p < 0.01). We also found that athletes with higher levels of self-compassion prior to sprint performance experienced less self-critical thoughts following biomechanical feedback and subsequent sprint trials (r = -0.38, p < 0.01). Although the results of this study provide some support for the effectiveness of self-compassion in promoting healthy emotions, thoughts, and reactions in response to sprint performance-based biomechanical feedback, a moderated regression analysis between the first and fourth sprint time variables revealed that self-compassion was not a moderator for change in sprint performance (R 2 = 0.64, ΔR 2 = 0.10, p > 0.05). These findings suggest that there are likely longer-term benefits of athletes using self-compassion to cope with biomechanical feedback, but that any benefits might be limited in a short series of sprint trials.

The measurement properties of the Lean-and-Release test in people with incomplete spinal cord injury or disease.

OBJECTIVE: To evaluate test-retest reliability, agreement, and convergent validity of the Lean-and-Release test for the assessment of reactive stepping among individuals with incomplete spinal cord injury or disease (iSCI/D). DESIGN: Multi-center cross-sectional multiple test design. SETTING: SCI/D rehabilitation hospital and biomechanics laboratory. PARTICIPANTS: Individuals with motor incomplete SCI/D (iSCI/D). INTERVENTIONS: None. OUTCOME MEASURES: Twenty-six participants attended two sessions to complete the Lean-and-Release test and a battery of clinical tests. Behavioral (i.e. one-step, multi-step, loss of balance) and temporal (i.e. timing of foot off, foot contact, swing of reactive step) parameters were measured. Test-retest reliability was determined with intraclass correlation coefficients, and agreement was evaluated with Bland-Altman plots. Convergent validity was assessed through correlations with clinical tests. RESULTS: The behavioral responses were reliable for the Lean-and-Release test (ICC = 0.76), but foot contact was the only reliable temporal parameter using data from a single site (ICC = 0.79). All variables showed agreement according to the Bland-Altman plots. The behavioral responses correlated with scores of lower extremity strength (0.54, P<0.01) and balance confidence (0.55, P < 0.01). Swing time of reactive stepping correlated with step time (0.73, P < 0.01) and cadence (-0.73 P < 0.01) of over ground walking. CONCLUSIONS: The behavioral response of the Lean-and-Release test is a reliable and valid measure for people with iSCI/D. Our findings support the use of the behavioral responses to evaluate reactive stepping for research and clinical purposes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02960178.

Haptic input and balance control: An exploratory study examining normative messaging.

This study examined the effect of descriptive norm messaging information on the relationship between haptic input and balance control. Participants were randomly assigned to either a message group where they balanced with haptic input after receiving a descriptive norm message about the positive effect of haptic input or a control group. Findings from an analysis of covariance revealed a significant difference between the two groups. Those in the descriptive norm message group had better balance control than those in the control group. These findings suggest that efforts designed to improve balance control through haptic input may be enhanced through normative messaging.

Investigating proactive balance control in individuals with incomplete spinal cord injury while walking on a known slippery surface.

BACKGROUND: Up to 83 % of individuals with incomplete spinal cord injury (iSCI) experience ≥ 1 fall/year. Individuals with iSCI employ more cautious walking strategies than able-bodied (AB) individuals during normal walking. Whether individuals with iSCI can use proactive balance strategies to adapt to expected slip perturbations/reduce slip severity while walking has not been previously assessed. METHODS: 19 individuals with iSCI (AIS D; 14 males; 61 ± 18 years) and 17 AB individuals (13 males; 61 ± 18 years) completed 3 walking conditions: normal walking trials, an unexpected slip trial, and expected slip trials. Steel rollers induced a slip in the antero-posterior (AP) direction. Outcome variables included step length, center of mass velocity, foot-floor angle, AP margin of stability, and maximum post-slip velocity (PSV). RESULTS: The iSCI group used a greater magnitude of cautious strategies (i.e. walking slower with shorter, flatter steps) than AB individuals in all conditions. However, the lack of significant interaction effects indicate that the proactive adaptations compared to normal walking (i.e. walking slower with shorter, flatter steps, and a more anterior xCOM-position) were similar between the two groups (AB & iSCI). Both groups showed a similar rate of adaptation (after just 1 slip) and these feedforward changes were maintained throughout the remaining slip trials which was effective at reducing maximum PSV. CONCLUSIONS: Individuals with iSCI use proactive balance strategies to adapt to a known slippery surface in a similar manner to AB individuals both in terms of the proportion and timing of adaptation.

Control of dynamic stability during adaptation to gait termination on a slippery surface.

An unexpected slip during gait termination results in a generalised slip response designed to regain stability and prevent a fall. With knowledge of and experience with a slippery surface, locomotor behaviour adapts to proactively diminish the effect of the slip and improve the reactive control during the slip. Our purpose was to examine the organisation of the adaptation to a slippery surface during gait termination. After receiving an unexpected slip during gait termination, participants (N = 8) experienced cued gait termination trials in which they were given knowledge of the surface characteristics (i.e., slippery or non-slippery). The observed strategy used to repeatedly stop on a slippery surface involves proactively diminishing the size of the slip perturbation through a flattened foot at heel contact, anterior shift of the COM, shorter step, stance leg extension and swing limb slowing, as well as improving the reaction to the slippery surface through decreased muscle activity and an appropriate decrease in the braking force generation. The implications of this research are that a combination of knowledge of and experience with a slippery surface enables proactive and reactive adjustments in behaviour to effectively and more safely stop walking on a slippery surface.

Comparing the effect of haptic modalities on walking balance control: Is using one or two arms better?

BACKGROUND: Adding haptic input by lightly touching a railing or using haptic anchors may improve walking balance control. Typical use of the railing(s) and haptic anchors requires the use of one and two arms in an extended position, respectively. It is unclear whether it is arm configuration and/or the number of arms used or the addition of sensory input that affects walking balance control. RESEARCH QUESTION: This study examined whether using one arm or two arms to add haptic input through light touch on a railing or using the haptic anchors affects walking balance control. METHODS: In this study, young adults (n = 24) walked while using (actual use) or pretending to use (pretend use) the railing(s) and haptic anchors with one or two arms. Inertial-based sensors (Mobility Lab, APDM) were used to measure stride velocity, relative time spent in double support (%DS), and peak normalized medio-lateral trunk velocity (pnMLTV). RESULTS: Using two arms lead to a decrease in pnMLTV compared to using one arm and pnMLTV was lower in the actual use trials compared to the pretend use trials for the anchors only. Stride velocity and %DS did not change between trials when one or two arms were used or when participants actually or pretended to use the haptic tools. Participants walked slower when using the railing compared to the anchors. SIGNIFICANCE: The importance of considering the number of arms is highlighted in the improved balance control when using two arms with either tool. The augmented sensory input adds to the stabilizing effect of arm configuration for the anchors but not the railings. These results have implications for future research and rehabilitation efforts emphasizing sensorimotor integration to improve walking balance control.

Are there attentional demands associated with haptic modalities while walking in young, healthy adults?

STUDY DESIGN: A prospective, observational study. OBJECTIVES: To assess the attentional demands of using haptic modalities during walking using a multi-task paradigm in young, healthy adults. SETTING: Biomechanics of Balance and Movement (BBAM) Lab, University of Saskatchewan. METHODS: Twenty-two (12 male) young, healthy adults performed walking trials with and without a verbal reaction time (VRT) task, as well as with and without the use of haptic anchors and light touch on a railing. Walking performance was evaluated using normalized stride velocity and step width, and dynamic stability was evaluated using step width variability and medial-lateral margin of stability (ML MOS) and its variability. RESULTS: There were no significant differences in VRT when walking with and without added haptic input and no interactions between the added VRT task and added haptic input. Step width increased and variability of the ML MOS increased during trials with the VRT task compared to trials without the VRT task. The ML MOS decreased when using both haptic tools with a greater decrease when using light touch on the railing compared to when using the haptic anchors. Normalized stride velocity and step width decreased when using light touch on the railing only. CONCLUSION: Both haptic tools affected stability during walking. Using the railing to add haptic input had a greater effect on walking stability and was the only haptic tool to affect walking performance. Attentional demands should be considered in future research and applications of adding haptic input during walking.

Modulation of the Hoffmann reflex in the tibialis anterior with a change in posture.

Hoffmann (H-) reflex amplitudes in plantar flexor soleus muscle are modulated by posture, yet dorsiflexor tibialis anterior (TA) H-reflex parameters have sparingly been studied. The purpose was to investigate modulation of the TA H-reflex when postural demands are increased from sitting to standing. In this study, data from 18 participants (Age: 25 ± 4 years, Height: 170.9 ± 9.5 cm, Weight: 75.9 ± 17.2 kg) allowed comparison of two experimental conditions involving different postures (i.e. sitting and standing). Maximal amplitude of the TA H-reflex (Hmax ) as a percent of the maximal M-wave amplitude (Mmax ) (Hmax (% Mmax )) during sitting and standing was compared using ANOVA. Modulation of TA H-reflex amplitude was found: Eleven participants showed facilitation and seven showed no change of reflex amplitudes. Only participants in the facilitation group showed modulation related to changes in posture (sitting: 8.7 ± 2.9%; standing: 14.8 ± 6.7%, P = 0.005). These data provide evidence of the sensitivity to posture of TA H-reflexes. As with task-dependent changes in soleus H-reflexes, presynaptic regulation of Ia afferent transmission is a possible mechanism. Further investigations into causes of modulation are warranted.

Control of dynamic stability during gait termination on a slippery surface in Parkinson's disease.

This study investigated how Parkinson's disease (PD) affects the ability to switch from locomotion to gait termination (GT) during planned and cued GT and examined the effect of PD on the integration of a reactive, balance maintenance strategy into voluntary GT. After a series of stops on a stable surface, eight participants with and 10 without PD stopped on a surface, which slid quickly and unexpectedly forward mimicking a slippery surface. PD caused instability during the completely voluntary nonslippery stops (P = 0.012) but not during the slippery stops, which required a reactive movement. The PD group walked slower [0.9-1.0 m/s vs. 1.3 m/s, respectively (P < 0.001)] with shorter steps during the first step of nonslippery GT (P = 0.016) and with wider steps during all steps of nonslippery GT (P

The effects of haptic input on biomechanical and neurophysiological parameters of walking: A scoping review.

Walking is an important component of daily life requiring sensorimotor integration to be successful. Adding haptic input via light touch or anchors has been shown to improve standing balance; however, the effect of adding haptic input on walking is not clear. This scoping review systematically summarizes the current evidence regarding the addition of haptic input on walking in adults. Following an established protocol, relevant studies were identified using indexed data bases (Medline, EMBASE, PsychINFO, Google Scholar) and hand searches of published review articles on related topics. 644 references were identified and screened by a minimum of two independent researchers before data was extracted from 17 studies. A modified TREND tool was used to assess quality of the references which showed that the majority of studies were of moderate or high quality. Results show that adding haptic input changes walking behaviour. In particular, there is an immediate reduction in variability of gait step parameters and whole body stability, as well as a decrease in lower limb muscle activity. The effect of added haptic input on reflex modulation may depend on the limb of interest (i.e., upper or lower limb). Many studies did not clearly describe the amount and/or direction of haptic input applied. This information is needed to replicate and/or advance their results. More investigations into the use and design of the haptic tools, the attentional demands of adding haptic input, and clarity on short-term effects are needed. In addition, more is research needed to determine whether adding haptic input has significant, lasting benefits that may translate to fall prevention efforts.

Validation of a commercial inertial sensor system for spatiotemporal gait measurements in children.

Although inertial sensor systems are becoming a popular tool for gait analysis in both healthy and pathological adult populations, there are currently no data on the validity of these systems for use with children. The purpose of this study was to validate spatiotemporal data from a commercial inertial sensor system (MobilityLab) in typically-developing children. Data from 10 children (5 males; 3.0-8.3 years, mean=5.1) were collected simultaneously from MobilityLab and 3D motion capture during gait at self-selected and fast walking speeds. Spatiotemporal parameters were compared between the two methods using a Bland-Altman method. The results indicate that, while the temporal gait measurements were similar between the two systems, MobilityLab demonstrated a consistent bias with respect to measurement of the spatial data (stride length). This error is likely due to differences in relative leg length and gait characteristics in children compared to the MobilityLab adult reference population used to develop the stride length algorithm. A regression-based equation was developed based on the current data to correct the MobilityLab stride length output. The correction was based on leg length, stride time, and shank range-of-motion, each of which were independently associated with stride length. Once the correction was applied, all of the spatiotemporal parameters evaluated showed good agreement. The results of this study indicate that MobilityLab is a valid tool for gait analysis in typically-developing children. Further research is needed to determine the efficacy of this system for use in children suffering from pathologies that impact gait mechanics.

Measuring balance confidence after spinal cord injury: the reliability and validity of the Activities-specific Balance Confidence Scale.

CONTEXT/OBJECTIVE: The study objectives were to evaluate the test-retest reliability, convergent validity, and discriminative validity of the Activities-specific Balance Confidence (ABC) scale in individuals with incomplete spinal cord injury (iSCI). DESIGN: Prospective, cross-sectional study. SETTING: Laboratory. PARTICIPANTS: Twenty-six community-dwelling individuals with chronic iSCI (20 males, 59.7 + 18.9 years old) and 26 age- and sex-matched able-bodied (AB) individuals participated. INTERVENTIONS: None. OUTCOME MEASURES: Measures of balance and gait were collected over two days. Clinical measures included the ABC scale, Mini-Balance Evaluation System's Test, 10-meter Walk Test, SCI Functional Ambulation Profile, manual muscle testing of lower extremity muscles, and measures of lower extremity proprioception and cutaneous pressure sensitivity. Biomechanical measures included the velocity and sway area of centre of pressure (COP) movement during quiet standing. RESULTS: The ABC scale demonstrated high test-retest reliability (intraclass correlation coefficient = 0.93) among participants with iSCI. The minimal detectable change was 14.87%. ABC scale scores correlated with performance on all clinical measures (ρ=0.60-0.80, P<0.01), with the exception of proprioception and cutaneous pressure sensitivity (P=0.20-0.70), demonstrating convergent validity. ABC scale scores also correlated with overall COP velocity (ρ=-0.69, P<0.001) and COP velocity in the anterior-posterior direction (ρ=-0.71, P<0.001). Participants with iSCI scored significantly lower on the ABC scale than the AB participants (P<0.001), and the area under the receiver operating characteristic curve was 0.95, demonstrating discriminative validity. CONCLUSION: The ABC scale is a reliable and valid measure of balance confidence in community-dwelling, ambulatory individuals with chronic iSCI.