Tandem gait step-width increases more rapidly in more severely affected people with Parkinson's disease.

INTRODUCTION: Tandem gait performance reportedly predicts fall risk in people with Parkinson's disease (PwPD) and help distinguish PwPD from atypical parkinsonism. In a cross-sectional study, we previously showed that tandem gait step-width widens with increasing Hoehn and Yahr (H&Y) staging scores. In this longitudinal study, we aimed to determine if progression in tandem gait deficits is dependent on disease severity in PwPD. METHODS: Participants underwent an instrumented tandem gait measurement every 6 months for at least 2 years. The mean and variability of 4 tandem gait parameters were calculated at each visit: step-width, step-length, step-time, and step-velocity. The change in these parameters over time for 3 H&Y groups (stage 1, 2 and 2.5+) compared to aging controls was determined using a random coefficients regression model. The annual percent change in tandem gait parameters was correlated with initial disease features using Kendall's τB. RESULTS: 66 participants were analyzed (46 PD, 20 controls). Mean step-width increased over time in an H&Y stage-dependent manner, with H&Y 2 and H&Y 2.5+ experiencing increases of 6% and 10% per year (p = 0.001 and 0.024 respectively). Annual percent-change in step-width was correlated with initial motor Unified Parkinson's Disease Rating Scale (UPDRS) scores (Kendall's τB = 0.229), total UPDRS scores (τB = 0.249), H&Y scores (τB = 0.266) and inversely correlated with Montreal Cognitive Assessment (MoCA) scores (τB = -0.209; ps ≤ 0.019). CONCLUSION: Tandem gait step-width widens over time more rapidly in more severely affected PD patients. These results suggest that tandem gait should be routinely clinically evaluated and considered in the management of imbalance in PwPD.

The Biomechanical Influence of Step Width on Typical Locomotor Activities: A Systematic Review.

BACKGROUND: Step width is a spatial variable in the frontal plane, defined as the mediolateral distance between the heel (forefoot during sprinting) of bilateral feet at initial contact. Variations in step width may impact the lower limb biomechanics. This systematic review aimed to synthesize the published findings to determine the influence of acute changes in step width on locomotion biomechanics and provide implications for injury prevention and enhanced sports performance. METHODS: Literature was identified, selected, and appraised in accordance with the methods of a systematic review. Four electronic databases (Web of Science, MEDLINE via PubMed, Scopus, and ScienceDirect) were searched up until May 2023 with the development of inclusion criteria based on the PICO model. Study quality was assessed using the Downs and Black checklist and the measured parameters were summarized. RESULTS: Twenty-three articles and 399 participants were included in the systematic review. The average quality score of the 23 studies included was 9.39 (out of 14). Step width changed the kinematics and kinetics in the sagittal, frontal, and transverse planes of the lower limb, such as peak rearfoot eversion angle and moment, peak hip adduction angle and moment, knee flexion moment, peak knee internal rotation angle, as well as knee external rotation moment. Alteration of step width has the potential to change the stability and posture during locomotion, and evidence exists for the immediate biomechanical effects of variations in step width to alter proximal kinematics and cues to impact loading variables. CONCLUSION: Short-term changes in step width during walking, running, and sprinting influenced multiple lower extremity biomechanics. Narrower step width may result in poor balance and higher impact loading on the lower extremities during walking and running and may limit an athlete's sprint performance. Increasing step width may be beneficial for injury rehabilitation, i.e., for patients with patellofemoral pain syndrome, iliotibial band syndrome or tibial bone stress injury. Wider steps increase the supporting base and typically enhance balance control, which in turn could reduce the risks of falling during daily activities. Altering the step width is thus proposed as a simple and non-invasive treatment method in clinical practice.

The Effect of a Cognitive Dual Task on Gait Parameters among Healthy Young Adults with Good and Poor Sleep Quality: A Cross-Sectional Analysis.

Background: Sleep quality is known to affect automatic and executive brain functions such as gait control and cognitive processing. This study aimed to investigate the effect of dual tasks on gait spatiotemporal parameters among young adults with good and poor sleep quality. Methods: In total, 65 young adults with a mean age of 21.1 ± 2.5 were assessed for gait analysis during single-task and dual-task conditions. The participants' sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and gait was assessed using the BTS Gaitlab System. The participants were asked to walk at natural speed as a single-task condition, followed by walking while performing a cognitive task as a dual-task condition. The parameters assessed included the gait velocity (m/s), cadence (steps/min), step width (m), and stride length (m). The dual-task cost (DTC) on each gait parameter was calculated. The Mann-Whitney U test was used to compare the differences in the DTC on gait variables between the good and poor sleep quality groups and the Spearman correlation test was used to assess the correlation between total PSQI scores and the DTC. Results: At a significance level of p < 0.05, a significant difference in cadence between the two sleep quality groups was observed, in addition to a positive correlation between sleep quality and the DTC effect on gait mean velocity, cadence, and stride length. Our findings also revealed a greater DTC in participants with poorer sleep quality. Conclusions: These findings contribute to our perception of the significance of sleep quality in gait performance while multitasking in younger populations.

Impact of step width on trunk motion and gait adaptation in elderly women with knee osteoarthritis.

BACKGROUND: Step width during walking can provide important information about aging and pathology. Although knee osteoarthritis (OA) is a common disease in elderly women, little is known about how different step widths influence gait parameters in patients with knee OA. OBJECTIVE: To address this, we investigated the differences between narrower and wider step width on the center of mass (CoM) and gait biomechanics of elderly women with knee OA. METHODS: Gait and CoM data were measured using a three-dimensional motion capture system and anthropometric data were acquired via standing full-limb radiography. Thirty elderly women with knee OA were divided into two groups depending on the average step width value (0.16 m). Specifically, the narrower step width group included those with a below average step width (n= 15) and the wider step width group included those with an above average step width (n= 15). The differences between the two groups were analyzed using an independentt-test. RESULTS: Walking speed, step length, knee and ankle sagittal excursion, and medial-lateral CoM range were significantly greater in the narrower group. In contrast, the medial-lateral CoM velocity, medial-lateral ground reaction force (GRF), and foot progression angle were significantly higher in wider group. The external knee adduction moment, vertical GRF, and vertical CoM did not differ between the groups. CONCLUSIONS: Our data indicate that step width in women with knee OA is associated with trunk motion and gait patterns. People with a narrower step might improve their gait function by increasing trunk frontal control to maintain gait stability. In contrast, in those with a wider step, greater toe out angle and shorter step length might be a compensatory adaptation to reduce knee loading.

Dynamic Gait Stability and Spatiotemporal Gait Parameters During Overground Walking in Professional Ballet Dancers.

Introduction: It has been recognized that practicing ballet could strengthen the leg muscles, improve balance, and reduce fall risk. However, few studies have investigated how ballet practice alters a person's gait pattern, and this knowledge gap could present a barrier to designing ballet-based training programs. This study examined dynamic gait stability and spatiotemporal gait parameters among professional ballet dancers during normal level overground walking. Methods: Twenty young adults were recruited: 10 ballet dancers (24.5 ± 4.9 years) and 10 age- and sex-matched non-dancers (22.6 ± 3.4 years). Participants walked on a 10 m linear walkway at their self-selected speed. Dynamic gait stability and common gait parameters (step length, step width, gait speed, and cadence) were determined from the collected kinematic data and compared between groups with a significance level of .05. Results: The results showed that both groups displayed comparable dynamic gait stability at touchdown (P = .140) and liftoff (P = .638). However, ballet dancers walked with a longer (P = .054), narrower (P = .009), and faster step (P = .014) at a marginally quicker speed (P = .063) than non-dancers. Conclusion: Our study suggests that young professional ballet dancers have different gait patterns, but similar dynamic gait stability compared to non-dancers. These findings not only provide insight into the mechanisms of dynamic stability control among young ballet dancers during gait but expand our understanding of the control of dynamic gait balance of human locomotion across a wide variety of populations and walking conditions.

Lower-limb joint quasi-stiffness in the frontal and sagittal planes during walking at different step widths.

Quasi-stiffness describes the intersegmental joint moment-angle relationship throughout the progression of a task. Previous work has explored sagittal-plane ankle quasi-stiffness and its application for the development of powered lower-limb assistive devices. However, frontal-plane quasi-stiffness remains largely unexplored but has important implications for the development of exoskeletons since clinical populations often walk with wider steps and rely on frontal-plane balance recovery strategies at the hip and ankle. This study aimed to characterize frontal-plane hip and ankle quasi-stiffness during walking and determine how step width affects quasi-stiffness in both the frontal and sagittal planes. Kinematic and kinetic data were collected and quasi-stiffness values computed for healthy young adults (n = 15) during treadmill walking across a range of step widths. We identified specific subphases of the gait cycle that exhibit linear and quadratic frontal-plane quasi-stiffness approximations for the hip and ankle, respectively. In addition, we found that at wider step widths, sagittal-plane ankle quasi-stiffness increased during early stance (∼12-35% gait cycle), sagittal-plane hip quasi-stiffness decreased in late stance (∼40-55% gait cycle) and frontal-plane hip quasi-stiffness decreased during terminal stance (∼48-65% gait cycle). These results provide a framework for further exploration of frontal-plane quasi-stiffness, lend insight into how quasi-stiffness may relate to balance control at various step widths, and motivate the development of stiffness-modulating assistive devices to improve balance related outcomes.

Generalizing stepping concepts to non-straight walking.

People rarely walk in straight lines. Instead, we make frequent turns or other maneuvers. Spatiotemporal parameters fundamentally characterize gait. For straight walking, these parameters are well-defined for the task of walking on a straight path. Generalizing these concepts to non-straight walking, however, is not straightforward. People follow non-straight paths imposed by their environment (sidewalk, windy hiking trail, etc.) or choose readily-predictable, stereotypical paths of their own. People actively maintain lateral position to stay on their path and readily adapt their stepping when their path changes. We therefore propose a conceptually coherent convention that defines step lengths and widths relative to predefined walking paths. Our convention simply re-aligns lab-based coordinates to be tangent to a walker's path at the mid-point between the two footsteps that define each step. We hypothesized this would yield results both more correct and more consistent with notions from straight walking. We defined several common non-straight walking tasks: single turns, lateral lane changes, walking on circular paths, and walking on arbitrary curvilinear paths. For each, we simulated idealized step sequences denoting "perfect" performance with known constant step lengths and widths. We compared results to path-independent alternatives. For each, we directly quantified accuracy relative to known true values. Results strongly confirmed our hypothesis. Our convention returned vastly smaller errors and introduced no artificial stepping asymmetries across all tasks. All results for our convention rationally generalized concepts from straight walking. Taking walking paths explicitly into account as important task goals themselves thus resolves conceptual ambiguities of prior approaches.

The influence of step width on balance control and response strategies during perturbed walking in healthy young adults.

Individuals with neuromuscular deficits often walk with wider step widths compared to healthy adults. Wider steps have been linked to a higher destabilizing frontal-plane external moment and greater range of frontal-plane whole-body angular momentum (HR), which is an indicator of decreased balance control. The purpose of this study was to experimentally determine 1) how step width alters balance control during steady-state walking, and 2) if step width changes the balance response strategies following mediolateral surface perturbations in healthy adults. Fifteen healthy young adults (7 male, age: 25 ± 4 years) walked on an instrumented treadmill at narrow, self-selected, wide and extra-wide step widths. During perturbed trials, the treadmill provided random mediolateral surface translations to each foot midway through single-leg-stance. Muscle electromyography, biomechanical measures (HR, frontal-plane external moment and joint moments) and deviations (differences in these measures between the perturbed and unperturbed walking trials) were compared across step widths. During steady state walking, wider steps were associated with decreased balance control. Increasing step widths were also associated with increased gluteus medius activity and reduced hip abduction and ankle inversion moments, which suggests healthy subjects rely more on a lateral ankle strategy to maintain balance at increasing step widths. There was no change in the plantarflexion moment. During perturbed walking, lateral, but not medial, surface translations adversely affected balance control. Further, wider steps did not change the balance response strategies following the perturbations, which suggests healthy individuals have the capacity to respond similarly to the perturbations at different step widths.

Generalizing Stepping Concepts To Non-Straight Walking.

People rarely walk in straight lines. Instead, we make frequent turns or other maneuvers. Spatiotemporal parameters fundamentally characterize gait. For straight walking, these parameters are well-defined for that task of walking on a straight path. Generalizing these concepts to non-straight walking, however, is not straightforward. People also follow non-straight paths imposed by their environment (store aisle, sidewalk, etc.) or choose readily-predictable, stereotypical paths of their own. People actively maintain lateral position to stay on their path and readily adapt their stepping when their path changes. We therefore propose a conceptually coherent convention that defines step lengths and widths relative to known walking paths. Our convention simply re-aligns lab-based coordinates to be tangent to a walker's path at the mid-point between the two footsteps that define each step. We hypothesized this would yield results both more correct and more consistent with notions from straight walking. We defined several common non-straight walking tasks: single turns, lateral lane changes, walking on circular paths, and walking on arbitrary curvilinear paths. For each, we simulated idealized step sequences denoting "perfect" performance with known constant step lengths and widths. We compared results to path- independent alternatives. For each, we directly quantified accuracy relative to known true values. Results strongly confirmed our hypothesis. Our convention returned vastly smaller errors and introduced no artificial stepping asymmetries across all tasks. All results for our convention rationally generalized concepts from straight walking. Taking walking paths explicitly into account as important task goals themselves thus resolves conceptual ambiguities of prior approaches.

Hip adduction angle during wider step-width gait affects hip adduction moment impulse.

BACKGROUND: Decreasing an external hip adduction moment (HAM) impulse during stance is important to prevent the progression of hip osteoarthritis. A hip adduction angle (HAA) during walking influences the HAM impulse. Although a wider step-width (WS) gait is a gait modification to decrease a peak HAM, no study has reported the HAM impulse and HAA. RESEARCH QUESTION: We investigated whether the HAA influences the peak HAM and HAM impulse during WS gait. METHODS: Twenty-six healthy young adults walked with normal step-width (NS) and WS comfortably. They were not instructed about hip adduction motion during gait, and the peak HAM, HAM impulse, HAA, and other gait parameters were evaluated using a 3D motion capture system. The participants were divided into two groups according to the HAA size during WS gait. The percentage reduction of HAM variables (the WS condition relative to the NS condition) and other gait parameters were compared between the groups. RESULTS: No difference in gait parameters was found between the groups. The percentage reduction of the HAM impulse in participants with smaller HAA was significantly higher than that in participants with larger HAA (14.5 % vs. 1.6 %, p < 0.01). Also, during normal step-width gait, the large HAA group showed a significantly larger HAA compared to the small HAA group (about 3°). SIGNIFICANCE: Participants with smaller HAA could decrease the HAM impulse more effectively during WS gait compared with those with larger HAA. Thus, the HAA would influence the HAM impulse reduction effect on the WS gait. We recommend paying attention to the HAA to decrease the HAM with the WS gait.

The influence of altered foot placement and cognitive load on balance control during walking in healthy young adults.

BACKGROUND: Clinical populations often walk with altered foot placement, which can adversely affect balance control. However, it is unknown how balance control during walking is influenced when combining a cognitive load with altered foot placement. RESEARCH QUESTION: Is balance control during walking adversely affected by the combination of a more complex motor task, such as walking with altered foot placements, with a cognitive load? METHODS: Fifteen young healthy adults walked on a treadmill with and without a spelling cognitive load during normal walking, with step width targets (self-selected width, narrow, wide and extra wide), or with step length targets (self-selected length, short and long). RESULTS: Cognitive performance, measured by correct spelling response rate, decreased from self-selected (2.407 ± 0.6 letters/s) to the extra wide width (2.011 ± 0.5 letters/s). The addition of the cognitive load caused a decrease in frontal plane balance control across all step lengths (15% change) and at the wider step widths (16% change), but only caused a slight decrease in the sagittal plane for the short step length (6.8% change). SIGNIFICANCE: These results suggest that when combining a cognitive load with walking at non-self-selected widths, a threshold exists at wider steps where attentional resources become insufficient and balance control and cognitive performance decrease. Because decreased balance control increases the risk of falling, these results have implications for clinical populations who often walk with wider steps. Furthermore, the lack of changes to sagittal plane balance during altered step length dual-tasks further supports that frontal plane balance requires more active control.

Relationship between Muscle Strength and Gait Parameters in Healthy Older Women and Men.

Maintaining sufficient muscle strength is fundamental to prevent a decline in basic physical functions such as gait, and is therefore a prerequisite for a healthy independent life in older people. However, the relationship between gait parameters and the strength of single muscle groups is reported with inconclusive results. The objective of this study was to analyze the relationship of strength of nine single muscle groups of lower and upper leg muscles as well as handgrip strength for gait parameters in older adults. Sixty-nine independently living older adults participated in the study. Maximum ankle plantar- and dorsiflexion, knee flexion and extension, as well as hip abduction, adduction, flexion, and extension strength, were measured using an isokinetic dynamometer. Additionally, hand grip strength measured via a hand dynamometer was obtained. Walking gait parameters were recorded with a 3D motion capture system on an instrumented treadmill. The relationships between multiple strength and gait variables were analyzed by Pearson's correlation coefficient. Linear regression analyses were performed to identify the predictive ability of muscle strength (normalized to body weight) for gait speed, stride time, stance time, stride length and step width. Multiple significant weak to moderate positive ([r = 0.343, p = 0.047]-[r = 0.538, p = 0.002]) and negative ([r = -0.340, p = 0.046]-[r = 0.593, p = 0.001]) correlations that were unequally distributed between both sexes were detected. Significant regression models explained ([r2 = 16.6%, p = 0.015]-[r2 = 44.3 %, p = 0.003]) and ([r2 = 21.8%, p = 0.022]-[r2 = 36.1%, p = 0.044]) of the gait parameter variations for men and women, respectively. The results suggest a sex-specific relevance of single muscle groups for all gait parameters. This may be attributed to anatomical differences and it is important to prevent strength-related changes in gait parameters.

Variability of Spatiotemporal Gait Kinematics During Treadmill Walking: Is There a Hawthorne Effect?

Spatiotemporal gait kinematics and their variability are commonly assessed in clinical and laboratory settings to quantify fall risk. Although the Hawthorne effect, or modifications in participant behavior due to knowledge of being observed, has the potential to impact such assessments, it has received minimal attention in the study of gait-particularly gait variability. The purpose of this study was to quantify the Hawthorne effect on variability and central tendency measures of fall-related spatiotemporal gait parameters. Seventeen healthy young adults walked on a treadmill at a self-selected velocity for 2 minutes under covert evaluation (ie, without awareness of being evaluated) and 2 minutes under overt evaluation. The movement was recorded using motion capture technology, from which we calculated mean value and step-to-step variability (using standard deviation and mean absolute deviation) of step length, step width, percent double support, percent stance phase, and stride time. Although central tendencies were unaffected by evaluation type, four-of-five measures of variability were significantly lower during overt evaluation for at least one-of-two metrics. Our results suggest a Hawthorne effect on locomotor control. Researchers should be aware of this phenomenon when designing research studies and interpreting gait assessments.

Differential effects of ankle constraints on foot placement control between normal and split belt treadmills.

Mediolateral ankle moment control contributes to gait stability. Ankle moments can be constrained by walking with a shoe with a ridge underneath the sole, narrowing the mediolateral support surface. In our previous study, such ankle moment constraints resulted in an increased step width and a decrease in the degree of foot placement control, as defined by the percentage of variance in foot placement that can be explained by CoM state. However, since our previous study was performed on a split-belt treadmill and the narrow ridge could fit inside the gap between the belts, it is not evident whether these effects can be attributed to the constrained ankle moment control or to avoidance of this gap. Therefore, we investigated if the effects of ankle moment constraints are dependent on whether participants walk on a normal treadmill or a split-belt treadmill. We included fourteen healthy young adults. Walking with constrained ankle moment control resulted in a wider step width on both treadmills. Yet, the increase in step width was larger on the split-belt treadmill compared to on the normal treadmill. We only found a decreased degree of foot placement control on the split-belt treadmill, whilst the degree of foot placement control increased on the normal treadmill. We conclude that the effects of ankle moment constraints reported in our previous study were confounded by the use of a split-belt treadmill. For future research, we recommend using a normal treadmill whenever possible, because the gap in a split-belt treadmill might affect gait parameters.

Does the stimulus provoking a stepping reaction correlate with step characteristics and clinical measures of balance and mobility post-stroke?

BACKGROUND: Retraining stepping reactions in people post-stroke is vital. However, the relationship between the stimulus and resulting stepping performance in people post-stroke is unknown. We explored relationships between stepping stimulus and stepping reactions initiated by either paretic or non-paretic legs of people post-stroke and controls. Relationships were examined in the context of clinical measures of balance. METHODS: Centre of mass dynamics were measured during self-initiated destabilizing leaning stimuli that required stepping reactions by paretic and non-paretic legs of people post-stroke (n = 10) and controls (n = 10) to recover balance. Step characteristics of the first two steps of stepping reactions were measured. Correlations were calculated between clinical measures of balance and mobility and the centre of mass and step characteristics. FINDINGS: Steps were shorter and slower with decreased centre of mass fore-aft and downward displacement and velocity when initiated by paretic and non-paretic legs compared with controls. However, increase in centre of mass displacement and velocity in the fore-aft and downward direction tended to be associated with a greater increase in step length and speed when stepping reactions were initiated by the paretic and non-paretic legs compared with controls. Time to step initiation in response to onset of falling stimulus did not differ between groups. Strong positive correlations were found between clinical balance and mobility scores and centre of mass and step dynamics in fore-aft and vertical directions. INTERPRETATION: These results support objective measurement of centre of mass to quantify the stimulus influencing step dynamics and stepping performance during retraining interventions following stroke.

Impact of subject-specific step width modification on the knee and hip adduction moments during gait.

BACKGROUND: Patients with hip osteoarthritis (OA) exhibit an increased step width (SW) during walking before and up to 2 years after total hip arthroplasty. Wider SW is associated with a reduction in the external knee adduction moment (KAM), but there is a lack of research regarding the effect of SW on the hip adduction moment (HAM). RESEARCH QUESTION: Is a wider SW an effective compensatory mechanism to reduce the hip joint loading? We hypothesized that (1) an increased SW reduces, (2) a decreased SW increases the KAM/HAM, and (3) secondary kinematic gait changes have an effect on the KAM/HAM. METHODS: Twenty healthy individuals (24.0 ± 2.5 years of age) underwent instrumented gait analyses with 4 different subject-specific SW modifications (habitual, halved, double, and triple SW). The resulting external KAMs and HAMs were compared using statistical parametric mapping (SPM). RESULTS: Post hoc testing demonstrated significantly lower HAM for both the double (p < 0.001, 15-31 % and 61-98 % of the stance phase) and the triple SW (p < 0.001, 1-36 % and 58-98 %) compared to the habitual SW. The extent of the reduction at the first and second peak was comparable for HAM (15-25 % reduction) and less pronounced at the first peak of KAM (9-11 % reduction) compared to the second peak of KAM (19-28 % reduction). In contrast, halving the SW did not lead to a significant change in KAM or HAM compared to the habitual SW (p > 0.009). SIGNIFICANCE: An increase in SW is an effective and simple gait mechanism to reduce the frontal plane knee and hip joint moments. However, hypothesis 2 could not be confirmed, as halving the SW did not cause a significant change in KAM or HAM. Given the results of the present study, gait retraining with regard to an increased SW may be an adequate, noninvasive option for the treatment of patients with hip OA.

Young adults with recurrent low back pain demonstrate altered trunk coordination during gait independent of pain status and attentional demands.

Pain influences both attention and motor behavior. We used a dual-task interference paradigm to investigate (1) alterations in attentional performance, (2) the ability to switch task prioritization, and (3) the effect of attentional demand on trunk coordination during narrow-based walking in and out of a painful episode in individuals with recurrent low back pain (LBP). We tested twenty young adults with LBP both in and out of a painful episode and compared them to twenty matched back-healthy individuals. Participants simultaneously performed a narrow step width matching task and an arithmetic task, with and without instructions to prioritize either task. A motion capture system was used to record kinematic data, and frontal plane trunk coordination was analyzed using vector coding on the thorax and pelvis angles. Single-task performance, dual-task effect, dual-task performance variability, task prioritization switch, and trunk coordination were analyzed using paired t tests or repeated measures two-way ANOVAs. Results indicated that active pain has a detrimental effect on attentional processes, indicated by poorer single-task performance and increased dual-task performance variability for individuals with recurrent LBP. Individuals with LBP, regardless of pain status, were able to switch task prioritization to a similar degree as their back-healthy counterparts. Compared to the control group, individuals with recurrent LBP exhibited a less in-phase, more pelvis-dominated trunk coordination during narrow-based walking, independent of pain status and regardless of attentional manipulations. Thus, altered trunk coordination in persons with LBP appears to be habitual, automatic, and persists beyond symptom duration.

User-driven treadmill walking promotes healthy step width after stroke.

BACKGROUND: Walking with user-driven treadmill control is believed to be more like overground walking than fixed-speed treadmill walking. Walking speed and ground reaction forces differ between overground and fixed-speed treadmill walking, but not between overground and user-driven treadmill walking in healthy and post-stroke subjects. However, studies assessing spatiotemporal gait parameters during user-driven treadmill walking are limited. This information may help confirm that user-driven treadmill walking is more like overground walking than fixed-speed treadmill walking, as well as inform the development of post-stroke gait rehabilitation programs. RESEARCH QUESTION: How do spatiotemporal gait parameters for individuals post-stroke differ between fixed-speed and user-driven treadmill walking? METHODS: Eighteen subjects (10 M, 8 F; 62 ± 12 years; 1.73 ± 0.12 m; 84.9 ± 12.9 kg; 40 ± 30 months post-stroke) with chronic post-stroke hemiparesis participated in this study. Participants walked on an instrumented treadmill in its fixed-speed and user-driven modes at their self-selected and fastest comfortable walking speeds. Subjects wore retroreflective markers for motion capture. Shapiro-Wilk tests were used to assess for normality and one-way repeated measures ANOVAs were used to compare between conditions with α = 0.05. Bonferroni corrections were used for multiple comparisons. RESULTS: Step width was significantly smaller with user-driven control (13.7 cm, 95 % CI: [0.131, 0.145]) than fixed-speed control (16.8 cm, 95 % CI:[0.160, 0.174]), while step length and step time did not differ across treadmill conditions. Step length and step time differed between self-selected and fast walking speeds, but not treadmill control conditions. SIGNIFICANCE: The results of this study show that user-driven treadmill control encourages healthy gait biomechanics and a greater sense of stability in post-stroke subjects. Individuals post-stroke walked with smaller step width with user-driven treadmill control, which has been associated with increased balance. Post-stroke gait rehabilitation may benefit from programs with user-driven treadmill training paradigms to improve mobility following stroke.

Assay of active pharmaceutical ingredients in drug products based on relative response factors: Instrumentation insights and practical considerations.

Relative Response Factors (RRFs) can be used for quantitation of one compound against another and it is widely used for Impurity analysis of pharmaceutical products; however, the application in potency assay is limited. Through an extensive study shown in this paper, it can be concluded that using the "RRF methodology" for potency assay is much more challenging compared to impurity analysis, due to the much tighter criteria required for potency analysis. The effects of instrument settings, which are rarely discussed or recognized in current HPLC analytical method development and quality release testing, are discussed. These factors impact the RRF just as much as other commonly recognized HPLC parameters. The effects of UV detector settings, i.e. Slit Width, Step Width, Band Width, and Data Collection Module, have been explored. This phenomenon has been demonstrated using three compounds to observe the impact of their quantitation due to the significant RRF variations. Finally, principles to reduce RRF variations have been discussed, and practical considerations of RRF application to method development and method transfer are provided.

Factors Influencing Base of Gait During Running: Consideration of Sex, Speed, Kinematics, and Anthropometrics.

CONTEXT: A narrow base of gait (BOG), the mediolateral distance between the foot and the body's line of gravity at midstance, during running is a suggested cause of injuries such as iliotibial band syndrome and tibial stress injury. However, an understanding of modifiable and nonmodifiable factors that influence BOG is lacking, which limits the development of corrective strategies. OBJECTIVE: To determine if BOG varies by sex and running speed and the influence of running kinematics and anthropometrics on BOG. DESIGN: Cross-sectional study. SETTING: Record review of routinely collected performance data from a National Collegiate Athletic Association Division I intercollegiate athletic program. PATIENTS OR OTHER PARTICIPANTS: A total of 166 Division I collegiate athletes (basketball, cross-country, football, soccer). MAIN OUTCOME MEASURE(S): Running biomechanics (N = 166) and dual-energy x-ray absorptiometry-derived anthropometric data (n = 68) were extracted. Running variables were BOG, step rate, stride length, foot-inclination angle, center-of-mass vertical displacement, heel-to-center of mass anteroposterior distance, and peak stance-phase angles: hip flexion, hip adduction, pelvic drop, knee flexion, and ankle dorsiflexion. Extracted anthropometric variables were height; leg, femur, and tibia length; and anterior-superior iliac spine, hip-joint, and greater trochanter width. We calculated linear mixed-effects models to assess the influence of sex and running speed on BOG and identify the kinematic and anthropometric variables most associated with BOG. RESULTS: A significant interaction between sex and running speed on BOG was observed, with males demonstrating a smaller BOG than females at faster speeds and BOG decreasing overall with speed. The kinematic measures most associated with BOG at preferred running speed were foot-inclination angle at initial contact and peak stance-phase hip adduction and ankle dorsiflexion. Anterior-superior iliac spine width was the anthropometric variable most associated with BOG at preferred running speed. CONCLUSIONS: Sex and running speed must be considered when determining the appropriateness of an individual's BOG. Additionally, BOG was associated with several potentially modifiable kinematic parameters.