Cautious Gait during Navigational Tasks in People with Hemiparesis: An Observational Study.

Locomotor and balance disorders are major limitations for subjects with hemiparesis. The Timed Up and Go (TUG) test is a complex navigational task involving oriented walking and obstacle circumvention. We hypothesized that subjects with hemiparesis adopt a cautious gait during complex locomotor tasks. The primary aim was to compare spatio-temporal gait parameters, indicators of cautious gait, between the locomotor subtasks of the TUG (Go, Turn, Return) and a Straight-line walk in people with hemiparesis. Our secondary aim was to analyze the relationships between TUG performance and balance measures, compare spatio-temporal gait parameters between fallers and non-fallers, and identify the biomechanical determinants of TUG performance. Biomechanical parameters during the TUG and Straight-line walk were analyzed using a motion capture system. A repeated measures ANOVA and two stepwise ascending multiple regressions (with performance variables and biomechanical variables) were conducted. Gait speed, step length, and % single support phase (SSP) of the 29 participants were reduced during Turn compared to Go and Return and the Straight-line walk, and step width and % double support phase were increased. TUG performance was related to several balance measures. Turn performance (R2 = 63%) and Turn trajectory deviation followed by % SSP on the paretic side and the vertical center of mass velocity during Go (R2 = 71%) determined TUG performance time. People with hemiparesis adopt a cautious gait during complex navigation at the expense of performance.

Short-latency inhibition mitigates the relationship between conscious movement processing and overly cautious gait.

BACKGROUND: Overly cautious gait is common in older adults. This is characterised by excessively slow gait, shortened steps, broadened base of support and increased double limb support. The current study sought to (1) evaluate if overly cautious gait is associated with attempts to consciously process walking movements, and (2) explore whether an individual's ability to rapidly inhibit a dominant motor response serves to mitigate this relationship. METHODS: A total of 50 older adults walked at a self-selected pace on an instrumented walkway containing two raised wooden obstacles (height = 23 cm). Trait conscious movement processing was measured with the Movement-Specific Reinvestment Scale. Short-latency inhibitory function was assessed using a validated electronic go/no-go ruler catch protocol. We used linear regressions to explore the relationship between these variables and gait parameters indicative of overly cautious gait. RESULTS: When controlling for general cognitive function (MoCA), and functional balance (Berg Balance Scale), the interaction between trait conscious movement processing and short-latency inhibition capacity significantly predicted gait velocity, step length and double limb support. Specifically, older adults with higher trait conscious movement processing and poorer inhibition were more likely to exhibit gait characteristics indicative of cautious gait (i.e. reduced velocity, shorter step lengths and increased double limb support). Neither conscious movement processing nor inhibition independently predicted gait performance. CONCLUSION: The combination of excessive movement processing tendencies and poor short-latency inhibitory capacity was associated with dysfunctional or 'overly cautious' gait. It is therefore plausible that improvement in either factor may lead to improved gait and reduced fall risk.

Adaptive gait responses to awareness of an impending slip during treadmill walking.

The awareness of potential slip risk has been shown to cause protective changes to human gait during overground walking. It remains unknown if such adaptations to walking pattern also exist when ambulating on a treadmill. This study sought to determine whether and to what extent individuals, when being aware of a potential slip risk during treadmill walking, could adjust their gait pattern to improve their dynamic stability against backward balance loss in response to the impending slip hazard. Fifty-four healthy young subjects (age: 23.9±4.7years) participated in this study. Subjects' gait pattern was measured under two conditions: walking on a treadmill without (or normal walking) and with (or aware walking) the awareness of the potential slip perturbation. During both walking conditions, subjects' full body kinematics were gathered by using a motion capture system. Spatial gait parameters and the dynamic gait stability against backward balance were compared between the two walking conditions. The results revealed that subjects proactively adopted a "cautious gait" during aware walking compared with the normal walking. The cautious gait, which was achieved by taking a shorter step and a more flatfoot landing, positioned the body center of mass closer to the base of support, improving participants' dynamic stability and increasing their resistance against a possible slip-related fall. The finding from this study could provide insights into the dynamic stability control when individuals anticipate potential slip risk during treadmill walking.