Task specificity impacts dual-task interference in older adults.

BACKGROUND: Task prioritization is an important factor determines the magnitude and direction of dual-task interference in older adults. Greater dual-task cost during walking may lead to falling, sometimes causing lasting effects on mobility. AIMS: We investigated dual-task interference for walking and cognitive performance. METHODS: Twenty healthy, older adults (71 ± 5 years) completed three cognitive tasks: letter fluency, category fluency, and serial subtraction during seated and walking conditions on a self-paced treadmill for 3 min each, in addition to walking only condition. Walking speed, step length and width were measured during walking and each dual-task condition. RESULTS: Comparing the percentage of correct answers in cognitive tasks across single and dual-task conditions, there was a main effect of cognitive task (p = 0.021), showing higher scores during letter fluency compared to serial subtraction (p = 0.011). Step width was significantly wider during dual-task letter fluency compared to walking alone (p = 0.003), category fluency (p = 0.001), and serial subtraction (p = 0.007). DISCUSSION: During both fluency tasks, there was a cost for gait and cognition, with category showing a slightly higher cognitive cost compared to letter fluency. During letter fluency, to maintain cognitive performance, gait was sacrificed by increasing step width. During serial subtraction, there was a cost for gait, yet a benefit for cognitive performance. CONCLUSION: Differential effect of cognitive task on dual-task performance is critical to be understood in designing future research or interventions to improve dual-task performance of most activities of daily living.

COPD Patients Have a Restricted Breathing Pattern That Persists with Increased Metabolic Demands.

A healthy respiratory system has variability from breath-to-breath and patients with COPD (PwCOPD) have abnormal variability in breath cycles. The aim of this study was to determine if interbreath-interval and tidal-volume variability, and airflow regularity change as metabolic demands increase (seated, standing, and walking) in PwCOPD as compared to controls. Sixteen PwCOPD (64.3 ± 7.9 yr, 61.3 ± 44.1% FEV1%predicted) and 21 controls (60.2 ± 6.8 yr, 97.5 ± 16.8% FEV1%predicted) sat, stood, and walked at their preferred-pace for five-minutes each while breathing patterns were recorded. The mean, standard deviation, and coefficient of variation of interbreath-intervals and tidal-volume, and the regularity (sample entropy) of airflow were quantified. Results were subjected to ANOVA analysis. Interbreath-interval means were shorter in PwCOPD compared to controls (p = 0.04) and as metabolic demand increased (p < 0.0001), standard deviation was decreased in PwCOPD compared to controls during each condition (p's < 0.002). Mean tidal-volume did decrease as metabolic demand increased across groups (p < 0.0001). Coefficient of variation findings (p = 0.002) indicated PwCOPD decline in tidal-volume variability from sitting to standing to walking; whereas, controls do not. There was an interaction for airflow (p = 0.02) indicating that although, PwCOPD had a more regular airflow across all conditions, control's airflow became more irregular as metabolic demand increased. PwCOPD's airflow was always more regular compared to controls (p = 0.006); although, airflow became more irregular as metabolic demand increased (p < 0.0001). Healthy respiratory systems have variability and irregularity from breath-to-breath decreases with adaptation to demand. PwCOPD have more regular and restricted breathing pattern that may affect their ability to adjust in demanding situations.

Optic flow improves step width and length in older adults while performing dual task.

BACKGROUND: Dual-task paradigms are used to investigate gait and cognitive declines in older adults (OA). Optic-flow is a virtual reality environment where the scene flows past the subject while walking on a treadmill, mimicking real-life locomotion. AIMS: To investigate cost of environment (no optic-flow v. optic-flow) while completing single- and dual-task walking and dual-task costs (DTC; single- v. dual-task) in optic-flow and no optic-flow environments. METHODS: Twenty OA and seven younger adults (YA) walked on a self-paced treadmill in 3-min segments per task and both environments. Five task conditions included: no task, semantic fluency (category), phonemic fluency (letters), word reading, and serial-subtraction. RESULTS: OAs had a benefit of optic-flow compared to no optic-flow for step width (p = 0.015) and step length (p = 0.045) during letters compared to the YA. During letters, OA experienced improvement in step width DTC; whereas YA had a decrement in step width DTC from no optic-flow to optic-flow (p = 0.038). During serial-subtraction, OA had less step width DTC when compared to YA in both environments (p = 0.02). DISCUSSION: During letters, step width and step length improved in OA while walking in optic-flow. Also, step width DTC differed between the two groups. Sensory information from optic-flow appears to benefit OA. Letters relies more on verbal ability and word knowledge, which are preserved in aging. However, YA use a complex speech style during dual tasking, searching for complex words and an increased speed of speech. CONCLUSIONS: OA can benefit from optic-flow by improving spatial gait parameters, specifically, step width, during dual-task walking.

The Likelihood of Self-reporting Balance Problems in Those With Advanced Chronic Kidney Disease, Slow Gait Speed, or Low Vitamin D.

OBJECTIVE: The purpose of this study was to determine the prevalence of vitamin D (25(OH)D) and balance deficits in persons with chronic kidney disease (CKD) and the likelihood of self-reporting balance and falling problems, measured gait speed in persons with kidney disease, and low levels of vitamin D and albumin. DESIGN: Analysis of the National Health and Nutrition Examination Survey 1999-2004 data set. SUBJECTS: The study included 8,554 subjects aged >40 years who were categorized into CKD stages based on the glomerular filtration rate (normal kidney function and stages 1 and 2 served as the control group, and stages 3 and 4/5 served as the CKD groups). MAIN OUTCOME MEASURES: Measured 25(OH)D levels, timed 20-feet walk, Romberg standing balance task, and self-reported balance and falling issues. RESULTS: The prevalence of balance deficits was found to be high in this CKD sample, with fail rates increasing with kidney disease severity. Similarly, when examining the relationship between CKD stage and the measurement of balance, fail rates (impaired balance) increased and gait speed decreased with kidney disease severity. In addition, the likelihood of self-reporting a balance and falling problem in the past year was higher in persons who had advanced CKD, were of older age, were of female sex, were with former or current smoking status, had lower 25(OH)D levels, and had lower albumin levels. Similarly, the likelihood of having a 20-feet walk time of more than 8 seconds was associated with those who were older, had higher body mass index, and had lower levels of 25(OH)D and albumin. CONCLUSION: The unique finding of this study is that increased reporting of balance and falling issues (both perceived and measured) and slower gait were found in persons with increased CKD severity and lower 25(OH)D status.

Interaction between step-to-step variability and metabolic cost of transport during human walking.

Minimizing the metabolic cost of transport can affect selection of the preferred walking speed. While many factors can affect metabolic cost of transport during human walking, its interaction with step-to-step variability is unclear. Here, we aimed to determine the interaction between metabolic cost of transport and step length variability during human walking at different speeds. In particular, two aspects of step length variability were analyzed: the amount of variations ('variations') and the organization of the step-to-step fluctuations ('fluctuations'). Ten healthy, young participants walked on a treadmill at five speeds, ranging from 0.75 to 1.75 m s-1 Metabolic cost of transport, step length variations (coefficient of variation) and step length fluctuations (quantified via detrended fluctuation analysis) were calculated. A mixed-model ANOVA revealed that variations and walking speed were strong predictors of metabolic cost of transport (R2=0.917, P<0.001), whereas fluctuations were not. Preferred walking speed (1.05±0.20 m s-1) was not significantly different from the speed at which metabolic cost of transport was minimized (1.04±0.05 m s-1; P=0.792), nor from the speed at which fluctuations were most persistent (1.00±0.41 m s-1; P=0.698). The minimization of variations occurred at a faster speed (1.56±0.17 m s-1) than the preferred walking speed (P<0.001). Step length variations likely affect metabolic cost of transport because greater variations are indicative of suboptimal, mechanically inefficient steps. Fluctuations have little or no effect on metabolic cost of transport, but still may relate to preferred walking speed.

On the calculation of sample entropy using continuous and discrete human gait data.

Sample entropy (SE) has relative consistency using biologically-derived, discrete data >500 data points. For certain populations, collecting this quantity is not feasible and continuous data has been used. The effect of using continuous versus discrete data on SE is unknown, nor are the relative effects of sampling rate and input parameters m (comparison vector length) and r (tolerance). Eleven subjects walked for 10-minutes and continuous joint angles (480Hz) were calculated for each lower-extremity joint. Data were downsampled (240, 120, 60Hz) and discrete range-of-motion was calculated. SE was quantified for angles and range-of-motion at all sampling rates and multiple combinations of parameters. A differential relationship between joints was observed between range-of-motion and joint angles. Range-of-motion SE showed no difference; whereas, joint angle SE significantly decreased from ankle to knee to hip. To confirm findings from biological data, continuous signals with manipulations to frequency, amplitude, and both were generated and underwent similar analysis to the biological data. In general, changes to m, r, and sampling rate had a greater effect on continuous compared to discrete data. Discrete data was robust to sampling rate and m. It is recommended that different data types not be compared and discrete data be used for SE.

Gait mechanics in patients with chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by the frequent association of disease outside the lung. The objective of this study was to determine the presence of biomechanical gait abnormalities in COPD patients compared to healthy controls while well rested and without rest. METHODS: Patients with COPD (N = 17) and aged-matched, healthy controls (N = 21) walked at their self-selected pace down a 10-meter walkway while biomechanical gait variables were collected. A one-minute rest was given between each of the five collected trials to prevent tiredness (REST condition). Patients with COPD then walked at a self-selected pace on a treadmill until the onset of self-reported breathlessness or leg tiredness. Subjects immediately underwent gait analysis with no rest between each of the five collected trials (NO REST condition). Statistical models with and without covariates age, gender, and smoking history were used. RESULTS: After adjusting for covariates, COPD patients demonstrated more ankle power absorption in mid-stance (P = 0.006) than controls during both conditions. Both groups during NO REST demonstrated increased gait speed (P = 0.04), stride length (P = 0.03), and peak hip flexion (P = 0.04) with decreased plantarflexion moment (P = 0.04) and increased knee power absorption (P = 0.04) as compared to REST. A significant interaction revealed that peak ankle dorsiflexion moment was maintained from REST to NO REST for COPD but increased for controls (P < 0.01). Stratifying by disease severity did not alter these findings, except that step width decreased in NO REST as compared to REST (P = 0.01). Standardized effect sizes of significant effects varied from 0.5 to 0.98. CONCLUSIONS: Patients with COPD appear to demonstrate biomechanical gait changes at the ankle as compared to healthy controls. This was seen not only in increased peak ankle power absorption during no rest but was also demonstrated by a lack of increase in peak ankle dorsiflexion moment from the REST to the NO REST condition as compared to the healthy controls. Furthermore, a wider step width has been associated with fall risk and this could account for the increased incidence of falls in patients with COPD.

Alterations in stride-to-stride fluctuations in patients with chronic obstructive pulmonary disease during a self-paced treadmill 6-minute walk test.

Evaluating variability and stability using measures for nonlinear dynamics may provide additional insight into the structure of the locomotor system, reflecting the neuromuscular system's organization of gait. This is in particular of interest when this system is affected by a respiratory disease and it's extrapulmonary manifestations. This study assessed stride-to-stride fluctuations and gait stability in patients with chronic obstructive pulmonary disease (COPD) during a self-paced, treadmill 6-minute walk test (6MWT) and its association with clinical outcomes. In this cross-sectional study, eighty patients with COPD (age 62±7y; forced expiratory volume in first second 56±19%predicted) and 39 healthy older adults (62±7y) were analyzed. Gait parameters including stride-to-stride fluctuations (coefficient of variation (CoV), predictability (sample entropy) and stability (Local Divergence Exponent (LDE)) were calculated over spatiotemporal parameters and center of mass velocity. Independent t-test, Mann-Whitney U test and ANCOVA analyses were conducted. Correlations were calculated between gait parameters, functional mobility using Timed Up and Go Test, and quadriceps muscle strength using dynamometry. Patients walked slower than healthy older adults. After correction for Speed, patients demonstrated increased CoV in stride length (F(1,116) = 5.658, p = 0.019), and increased stride length predictability (F(1,116) = 3.959, p = 0.049). Moderate correlations were found between mediolateral center of mass velocity LDE and normalized maximum peak torque (ρ = -0.549). This study showed that patients with COPD demonstrate alterations in stride length fluctuations even when adjusted for walking speed, highlighting the potential of nonlinear measures to detect alterations in gait function in patients with COPD. Association with clinical outcomes were moderate to weak, indicating that these clinical test are less discriminative for gait alterations.

Isometric force complexity may not fully originate from the nervous system.

In humans and animals, spatial and temporal information from the nervous system are translated into muscle force enabling movements of body segments. To gain deeper understanding of this translation of information into movements, we investigated the motor control dynamics of isometric contractions in children, adolescents, young adults and older adults. Twelve children, thirteen adolescents, fourteen young adults, and fifteen older adults completed two minutes of submaximal isometric plantar- and dorsiflexion. Simultaneously, sensorimotor cortex EEG, tibialis anterior and soleus EMG and plantar- and dorsiflexion force was recorded. Surrogate analysis suggested that all signals were from a deterministic origin. Multiscale entropy analysis revealed an inverted U-shape relationship between age and complexity for the force but not for the EEG and EMG signals. This suggests that temporal information in from the nervous system is modulated by the musculoskeletal system during the transmission into force. The entropic half-life analyses indicated that this modulation increases the time scale of the temporal dependency in the force signal compared to the neural signals. Together this indicates that the information embedded in produced force does not exclusively reflect the information embedded in the underlying neural signal.

Calculating sample entropy from isometric torque signals: methodological considerations and recommendations.

We investigated the effect of different sampling frequencies, input parameters and observation times for sample entropy (SaEn) calculated on torque data recorded from a submaximal isometric contraction. Forty-six participants performed sustained isometric knee flexion at 20% of their maximal contraction level and torque data was sampled at 1,000 Hz for 180 s. Power spectral analysis was used to determine the appropriate sampling frequency. The time series were downsampled to 750, 500, 250, 100, 50, and 25 Hz to investigate the effect of different sampling frequency. Relative parameter consistency was investigated using combinations of vector lengths of two and three and tolerance limits of 0.1, 0.15, 0.2, 0.25, 0.3, 0.35, and 0.4, and data lengths between 500 and 18,000 data points. The effect of different observations times was evaluated using Bland-Altman plot for observations times between 5 and 90 s. SaEn increased at sampling frequencies below 100 Hz and was unaltered above 250 Hz. In agreement with the power spectral analysis, this advocates for a sampling frequency between 100 and 250 Hz. Relative consistency was observed across the tested parameters and at least 30 s of observation time was required for a valid calculation of SaEn from torque data.

Pharmacological treatment of intermittent claudication does not have a significant effect on gait impairments during claudication pain.

Peripheral arterial disease (PAD) is a manifestation of atherosclerosis resulting in intermittent claudication (IC) or leg pain during physical activity. Two drugs (cilostazol and pentoxifylline) are approved for treatment of IC. Our previous work has reported no significant differences in gait biomechanics before and after drug interventions when PAD patients walked without pain. However, it is possible that the drugs are more efficacious during gait with pain. Our aim was to use advanced biomechanical analysis to evaluate the effectiveness of these drugs while walking with pain. Initial and absolute claudication distances, joint kinematics, torques, powers, and gait velocity during the presence of pain were measured from 24 patients before and after 12 weeks of treatment with either cilostazol or pentoxifylline. We found no significant improvements after 12 weeks of treatment with either cilostazol or pentoxifylline on the gait biomechanics of PAD patients during pain. Our findings indicate that the medications cilostazol and pentoxifylline have reduced relevance in the care of gait dysfunction even during pain in patients with PAD.

Passive Exoskeleton-Assisted Gait Shows a Unique Interlimb Coordination Signature Without Restricting Regular Walking.

Exoskeleton assistive devices have been developed as a potential approach to solve gait deficits like paretic propulsion and reduced speed. However, it is unclear how these devices affect inter-limb coordination. The duration and the synchrony of gait coordination was assessed during passive exoskeleton-assisted walking in healthy young individuals. It was hypothesized that inter-limb coordination would be reduced in comparison to normal walking without assistance, thus demonstrating gait with exoskeleton to be more explorative and flexible. Eighteen participants were divided into two groups (EXO: n = 9; NO EXO: n = 9) and performed a 5-min walking trial at a preferred walking speed after a familiarization trial. The duration of inter-limb coordination was examined using cross-recurrence quantification analysis and the synchrony was measured using cross sample entropy. There were no significant differences in spatiotemporal measurements between the two groups. However, in comparison to the no exoskeleton group, there was a reduction in the duration of coordination (mean diagonal length: p < 0.01) and the synchrony of coordination (entropy value: p < 0.05) in the exoskeleton group. These results indicate that exoskeletal-assisted gait is characterized by reduced inter-limb coordination possibly for allowing gait patterns to be more explorative and flexible. This is important in rehabilitation of patients who suffer from coordination deficits.

Updated Perspectives on the Role of Biomechanics in COPD: Considerations for the Clinician.

Patients with chronic obstructive pulmonary disease (COPD) demonstrate extra-pulmonary functional decline such as an increased prevalence of falls. Biomechanics offers insight into functional decline by examining mechanics of abnormal movement patterns. This review discusses biomechanics of functional outcomes, muscle mechanics, and breathing mechanics in patients with COPD as well as future directions and clinical perspectives. Patients with COPD demonstrate changes in their postural sway during quiet standing compared to controls, and these deficits are exacerbated when sensory information (eg, eyes closed) is manipulated. If standing balance is disrupted with a perturbation, patients with COPD are slower to return to baseline and their muscle activity is differential from controls. When walking, patients with COPD appear to adopt a gait pattern that may increase stability (eg, shorter and wider steps, decreased gait speed) in addition to altered gait variability. Biomechanical muscle mechanics (ie, tension, extensibility, elasticity, and irritability) alterations with COPD are not well documented, with relatively few articles investigating these properties. On the other hand, dyssynchronous motion of the abdomen and rib cage while breathing is well documented in patients with COPD. Newer biomechanical technologies have allowed for estimation of regional, compartmental, lung volumes during activity such as exercise, as well as respiratory muscle activation during breathing. Future directions of biomechanical analyses in COPD are trending toward wearable sensors, big data, and cloud computing. Each of these offers unique opportunities as well as challenges. Advanced analytics of sensor data can offer insight into the health of a system by quantifying complexity or fluctuations in patterns of movement, as healthy systems demonstrate flexibility and are thus adaptable to changing conditions. Biomechanics may offer clinical utility in prediction of 30-day readmissions, identifying disease severity, and patient monitoring. Biomechanics is complementary to other assessments, capturing what patients do, as well as their capability.

Sampling rate influences the regularity analysis of temporal domain measures of walking more than spatial domain measures.

BACKGROUND: The spatiotemporal dynamics of stepping can provide useful information about walking performance. Most often, the identification of gait motion is performed using 3-D cinematography. The sampling rate of motion capture systems may influence the accuracy of these measures albeit in varying degrees for measures within the spatial versus temporal domain. RESEARCH QUESTION: What are the effects of sampling frequency on common analysis methods of measures within the spatial and temporal domain? METHODS: Specifically, mean, variability (i.e. standard deviation), and regularity (i.e. sample entropy) of step length (i.e. spatial domain) and step time (i.e. temporal domain) measures were assessed following ten minutes of preferred-speed treadmill walking in eleven young adults. RESULTS: The spatiotemporal mean measures were not affected by changing sampling frequencies. Frequencies ≥120 Hz showed consistent results for spatial variability measures, while temporal variability increased due to decreased resolution in capturing variability when data was sampled at 120 Hz or less. In assessing regularity, poor temporal resolution at lower sampling rates led to "binning", limiting the variety of vector patterns. As a result, more vectors were classified as similar, leading to a signal appearing more periodic. For the spatial domain, sample entropy was not affected, indicating the greater sensitivity of step time to sampling rate compared to step length. SIGNIFICANCE: Sampling rate influenced recognition of gait events. By reducing the sampling rate, the time intervals were increased and reduced the resolution leading to less accurate gait event detection in the temporal domain. The sampling rate of 120 Hz is the minimum sampling rate that should be used to calculate spatiotemporal data for variability and sample entropy.

Entropy Analysis in Gait Research: Methodological Considerations and Recommendations.

The usage of entropy analysis in gait research has grown considerably the last two decades. The present paper reviews the application of different entropy analyses in gait research and provides recommendations for future studies. While single-scale entropy analysis such as approximate and sample entropy can be used to quantify regularity/predictability/probability, they do not capture the structural richness and component entanglement characterized by a complex system operating across multiple spatial and temporal scales. Thus, for quantification of complexity, either multiscale entropy or refined composite multiscale entropy is recommended. For both single- and multiscale-scale entropy analyses, care should be made when selecting the input parameters of tolerance window r, vector length m, time series length N and number of scales. This selection should be based on the proposed research question and the type of data collected and not copied from previous studies. Parameter consistency should be investigated and published along with the main results to ensure transparency and enable comparisons between studies. Furthermore, since the interpretation of the absolute size of both single- and multiscale entropy analyses outcomes is not straightforward, comparisons should always be made with a control condition or group.

Margin of Stability May Be Larger and Less Variable during Treadmill Walking Versus Overground.

Margin of stability (MOS) is considered a measure of mechanical gait stability. Due to broad application of treadmills in gait assessment experiments, we aimed to determine if walking on a treadmill vs. overground would affect MOS during three speed-matched conditions. Eight healthy young participants walked on a treadmill and overground at Slow, Preferred, and Fast speed-matched conditions. The mean and variability (standard deviation) of the MOS in anterior-posterior and mediolateral directions at heel contact were calculated. Anterior-posterior and mediolateral mean MOS values decreased with increased speed for both overground and treadmill; although mediolateral mean MOS was always wider on the treadmill compared to overground. Due to lack of optic flow and different proprioceptive inputs during treadmill walking, subjects may employ strategies to increase their lateral stability on treadmill compared to overground. Anterior-posterior MOS variability increased with speed overground, while it did not change on treadmill, which might be due to the fixed speed of treadmill. Whereas, lateral variability on both treadmill and overground was U-shaped. Walking at preferred speed was less variable (may be interpreted as more stable) laterally, compared to fast and slow speeds. Caution should be given when interpreting MOS between modes and speeds of walking. As sagittal plane walking is functionally unstable, this raises the consideration as to the meaningfulness of using MOS as a global measure of gait stability in this direction.

On the application of entropic half-life and statistical persistence decay for quantification of time dependency in human gait.

Entropic half-life (ENT½) and statistical persistence decay (SPD) was recently introduced as measures of time dependency in stride time intervals during walking. The present study investigated the effect of data length on ENT½ and SPD and additionally applied these measures to stride length and stride speed intervals. First, stride times were collected from subjects during one hour of treadmill walking. ENT½ and SPD were calculated from a range of stride numbers between 250 and 2500. Secondly, stride times, stride lengths and stride speeds were collected from subjects during 16 min of treadmill walking. ENT½ and SPD were calculated from the stride times, stride lengths and stride speeds. The ENT½ values reached a plateau between 1000 and 2500 strides whereas the SPD increased linearly with the number of included strides. This suggests that ENT½ can be compared if 1000 strides or more are included, but only SPD obtained from same number of strides should be compared. The ENT½ and SPD of the stride times were significantly longer compared to that of the stride lengths and stride speeds. This indicates that the time dependency is greater in the motor control of stride time compared to that of stride lengths and stride speeds.

Chronic obstructive pulmonary disease patients increase medio-lateral stability and limit changes in antero-posterior stability to curb energy expenditure.

BACKGROUND: A relationship exists between step width and energy expenditure, yet the contribution of dynamic stability to energy expenditure is not completely understood. Chronic obstructive pulmonary disease (COPD) patients' energy expenditure is increased due to airway obstruction. Further, they have a higher prevalence of falls and balance deficits compared to controls. RESEARCH QUESTION: Is dynamic stability different between COPD patients and controls; and is the association between dynamic stability and energy expenditure different between groups? METHODS: Seventeen COPD patients (64.3 ±â€¯7.6years) and 23 controls (59.9 ±â€¯6.6years) walked on a treadmill at three speeds: self-selected walking speed (SSWS), -20%SSWS, and +20%SSWS. Mean and variability (standard deviation) of the anterior-posterior (AP) and medio-lateral (ML) margins of stability (MOS) were compared between groups and speed conditions, while controlling for covariates. Additionally, their association to metabolic power was examined. RESULTS: The association between stability and power did not significantly differ between groups. However, increased metabolic power was associated with decreased MOS AP mean (p < 0.0001), independent of speed. Increased MOS AP variability (p = 0.01) and increased SSWS (p's < 0.05) were associated with increased metabolic power. The MOS ML mean for COPD patients was greater than that of healthy patients (p = 0.02). MOS AP mean decreased as speed increased and differed by group (p = 0.048). For COPD patients, a plateau was observed at SSWS and did not decrease further at +20%SSWS compared to controls. MOS AP variability (p < 0.0001), MOS ML mean (p < 0.0001), and MOS ML variability (p = 0.003) decreased as speed increased and did not differ by group. SIGNIFICANCE: Patients with COPD operate at the upper limit of their metabolic reserve due to an increased cost of breathing. To compensate for their lack of stability, they walked with larger margins of stability in the ML direction, instead of changing the stability margins in the AP direction, due to its association with energy expenditure.

Cognitive Loading Produces Similar Change in Postural Stability in Patients With Chronic Ankle Instability and Controls.

Purpose: While postural stability is compromised in individuals with chronic ankle instability (CAI), few studies have attempted to examine how performing simultaneous cognitive and balancing tasks may alter the complexity of the center of pressure. The purpose of this study was to compare postural stability in patients with CAI to controls during a dual-task condition via sample entropy. Methods: Thirty participants (15 CAI, 15 healthy control) performed 3-trials of single-leg stance for 60-seconds each under two different conditions: single-task and dual-task (serial subtraction). Sample entropy (SampEn), a measure of pattern regularity, was calculated from the center of pressure excursion in the anterio-posterior (AP) and medio-lateral (ML) directions. 2x2 mixed-model ANOVAs determined any differences by task or group (p≤0.05). Results: SampEn-AP decreased in the dual-task condition compared to single-task, single-leg balance across groups (F1,28=8.23, p=0.008, d=0.53). A significant interaction for group by task was found for SampEn-ML (F1,28=4.18, p=0.05), but post hoc testing failed to reveal significant differences. Serial subtraction was completed with significantly fewer errors during dual-task compared to single-task (F1,27=12.75, p=0.001, d=0.66). Conclusions: Patients with CAI do not display differences in regularity of postural stability, even when attention is divided. However, the addition of serial subtraction increased the regularity of AP center-of-pressure motion. Increased regularity may suggest a change in motor control strategy, reducing natural fluctuations and flexibility within movement patterns during more challenging tasks. Clinicians could utilize dual-task situations during rehabilitation of patients with CAI, in order to adequately restore stability and function when attention is divided.