Time-integrated propulsive and braking impulses do not depend on walking speed.

BACKGROUND: Enhancing propulsion during walking is often a focus in physical therapy for those with impaired gait. However, there is no consensus in the literature for assessing braking and propulsion. Both are typically measured from the anterior-posterior ground reaction force (AP-GRF). While normalization of AP-GRF force by bodyweight is commonly done in the analysis, different methods for AP-GRF time axis normalization are used. RESEARCH QUESTION: Does walking speed affect propulsion and/or braking, and how do different methods for calculating propulsion and braking impact the conclusion, in both healthy adults and those with lower limb impairment? METHODS: We investigated three different analysis methods for assessing propulsion. 1. BW-TimeIntegration: Bodyweight (BW) normalized time integration of AP-GRF (units of BWs). 2. BW-%StanceIntegration: BW normalized AP-GRF is resampled to percent stance phase prior to integration (units of BW%Stance). 3. BW-Peak: BW normalized peak force (units of BW). We applied these methods to two data sets. One data set included AP-GRFs from trials of slow, self-selected, and fast walking speeds for 203 healthy controls (HCs); a second data set included subjects with lower limb orthopedic injuries. RESULTS: Using the BW-TimeIntegration method, we found no effect of walking speed on propulsion for HCs. Time integration over the longer stance phase of slower walking balanced the lower magnitude AP-GRFs of slower walking, resulting in a time-integrated impulse that was the same regardless of walking speed. In contrast, the other two methods that are not time integration methods found that propulsion increased with walking speed. Similarly, in the gait pathology data set, differences in results were found depending on the analysis method used. SIGNIFICANCE: For many gait studies concerning propulsion and/or braking, the impulse measure used should be related to the body's change of momentum, necessitating an analysis method with a time integration of the AP-GRF.

Constraints on Stance-Phase Force Production during Overground Walking in Persons with Chronic Incomplete Spinal Cord Injury.

Persons with incomplete spinal cord injury (iSCI) face ongoing struggles with walking, including reduced speed and increased reliance on assistive devices (ADs). The forces underlying body weight support and gait, as measured by ground reaction forces (GRFs), are likely altered after iSCI because of weakness and AD dependence but have not been studied. The purpose of this study was to examine GRF production during overground walking after iSCI, because greater insight into GRF constraints is important for refining therapeutic interventions. Because of reduced and discoordinated motor output after iSCI, we hypothesized that persons with iSCI would exert smaller GRFs and altered GRF modifications to increased cadence compared with able-bodied (AB) persons, especially when using an AD. Fifteen persons with chronic iSCI, stratified into no AD (n = 7) and AD (n = 8) groups, walked across an instrumented walkway at self-selected and fast (115% self-selected) cadences. Fifteen age-matched AB controls walked at their own cadences and iSCI-matched conditions (cadence and AD). Results showed fore-aft GRFs are reduced in persons with iSCI compared with AB controls, with reductions greatest in persons dependent on an AD. When controlling for cadence and AD, propulsive forces were still lower in persons with iSCI. Compared with AB controls, persons with iSCI demonstrated altered GRF modifications to increased cadence. Persons with iSCI exhibit different stance-phase forces compared with AB controls, which are impacted further by AD use and slower walking speed. Minimizing AD use and/or providing propulsive biofeedback during walking could enhance GRF production after iSCI.

Interhemispheric interactions between trunk muscle representations of the primary motor cortex.

Unilateral arm movements require trunk stabilization through bilateral contraction of axial muscles. Interhemispheric interactions between primary motor cortices (M1) could enable such coordinated contractions, but these mechanisms are largely unknown. Using transcranial magnetic stimulation (TMS), we characterized interhemispheric interactions between M1 representations of the trunk-stabilizing muscles erector spinae at the first lumbar vertebra (ES L1) during a right isometric shoulder flexion. These interactions were compared with those of the anterior deltoid (AD), the main agonist in this task, and the first dorsal interosseous (FDI). TMS over the right M1 elicited ipsilateral silent periods (iSP) in all three muscles on the right side. In ES L1, but not in AD or FDI, ipsilateral motor evoked potential (iMEP) could precede the iSP or replace it. iMEP amplitude was not significantly different whether ES L1 was used to stabilize the trunk or was voluntarily contracted. TMS at the cervicomedullary junction showed that the size of cervicomedullary evoked potential was unchanged during the iSP but increased during iMEP, suggesting that the iSP, but not the iMEP, is due to intracortical mechanisms. Using a dual-coil paradigm with two coils over the left and right M1, interhemispheric inhibition could be evoked at interstimulus intervals of 6 ms in ES L1 and 8 ms in AD and FDI. Together, these results suggest that interhemispheric inhibition is dominant when axial muscles are involved in a stabilizing task. The ipsilateral facilitation could be evoked by ipsilateral or subcortical pathways and could be used depending on the role axial muscles play in the task.NEW & NOTEWORTHY The mechanisms involved in the bilateral coordination of axial muscles during unilateral arm movement are poorly understood. We thus investigated the nature of interhemispheric interactions in axial muscles during arm motor tasks in healthy subjects. By combining different methodologies, we showed that trunk muscles receive both inhibitory and facilitatory cortical outputs during activation of arm muscles. We propose that inhibition may be conveyed mainly through interhemispheric mechanisms and facilitation by subcortical mechanisms or ipsilateral pathways.

Coactivation of lower leg muscles during body weight-supported treadmill walking decreases with age in adolescents.

The kinematics of children's walking are nearly adult-like by about age 3-4 years, but metabolic efficiency of walking does not reach adult values until late in adolescence or early adulthood, perhaps due to higher coactivation of agonist/antagonist muscle pairs in adolescents. Additionally, it is unknown how use of a body weight-supported treadmill device affects coactivation, but because unloading will alter the activity of anti-gravity muscles, it was hypothesized that muscle coactivation will be altered as well. Muscle coactivation during treadmill walking was evaluated for adolescents (ages 10 to 17 years, M = 13.2, SD = 2.2) and adults (ages 22 to 35 years, M = 25.2, SD = 4.3), for thigh muscles (vastus lateralis/biceps femoris) and lower leg muscles (tibialis anterior/gastrocnemius). Conditions included body weight unloadings from nearly 0% to 80% of body weight, while walking at a preferred speed (self-selected, overground speed) or a reduced speed. Unloading was accomplished using a lower body positive pressure support system. Coactivation was found to be higher in adolescents than in adults, but only for the lower leg muscles.

Influence of lower body pressure support on the walking patterns of healthy children and adults.

The purpose of this investigation was to evaluate the effect of a lower body positive pressure support system on the joint kinematics and activity of the lower extremity antigravity musculature of adults and children during walking. Adults (age = 25 ± 4 years) and children (age = 13 ± 2 years) walked at a preferred speed and a speed that was based on the Froude number, while 0-80% of their body weight was supported. Electrogoniometers were used to monitor knee and ankle joint kinematics. Surface electromyography was used to quantify the magnitude of the vastus lateralis and gastrocnemius muscle activity. There were three key findings: (1) The lower extremity joint angles and activity of the lower extremity antigravity muscles of children did not differ from those of adults. (2) The magnitude of the changes in the lower extremity joint motion and antigravity muscle activity was dependent upon an interaction between body weight support and walking speed. (3) Lower body positive pressure support resulted in reduced activation of the antigravity musculature, and reduced range of motion of the knee and ankle joints.

Sensory information utilization and time delays characterize motor developmental pathology in infant sitting postural control.

Sitting is one of the first developmental milestones that an infant achieves. Thus measurements of sitting posture present an opportunity to assess sensorimotor development at a young age. Sitting postural sway data were collected using a force plate, and the data were used to train a neural network controller of a model of sitting posture. The trained networks were then probed for sensitivity to position, velocity, and acceleration information at various time delays. Infants with typical development developed a higher reliance on velocity information in control in the anterior-posterior axis, and used more types of information in control in the medial-lateral axis. Infants with delayed development, where the developmental delay was due to cerebral palsy for most of the infants in the study, did not develop this reliance on velocity information, and had less reliance on short latency control mechanisms compared with infants with typical development.

Approximate entropy used to assess sitting postural sway of infants with developmental delay.

Infant sitting postural sway provides a window into motor development at an early age. The approximate entropy, a measure of randomness, in the postural sway was used to assess developmental delay, as occurs in cerebral palsy. Parameters used for the calculation of approximate entropy were investigated, and approximate entropy of postural sway in early sitting was found to be lower for infants with developmental delay in the anterior-posterior axis, but not in the medial-lateral axis. Spectral analysis showed higher frequency features in the postural sway of early sitting of infants with typical development, suggesting a faster control mechanism is active in infants with typical development as compared to infants with delayed development, perhaps activated by near-fall events.

Nonlinear detrended fluctuation analysis of sitting center-of-pressure data as an early measure of motor development pathology in infants.

Upright sitting is one of the first motor skills an infant learns, and thus sitting postural control provides an early window into the infant's motor development. Early identification of infants with motor developmental delay, such as infants with cerebral palsy, allows for early therapeutic intervention by physical therapists. Early intervention is thought to produce better outcomes, due to greater neural plasticity in younger infants. Postural sway, as measured by a force plate, can be used to objectively and quantitatively characterize infant motor control during sitting. Pathology, such as cerebral palsy, may alter the fractal properties of motor function. Often physiologic time series data, including infant sitting postural sway data, is mathematically non-stationary. Detrended Fluctuation Analysis (DFA) is useful to characterize the fractal nature of time series data because it is does not assume stationarity of the data. In this study we found that suitable selection of the order of the detrending function improves the performance of the DFA algorithm, with a higher order polynomial detrending better able to distinguish infant sitting posture time series data from Brown noise (random walk), and first order detrending better able to distinguish infants with motor delay (cerebral palsy) from infants with typical development.

Use of information entropy measures of sitting postural sway to quantify developmental delay in infants.

BACKGROUND: By quantifying the information entropy of postural sway data, the complexity of the postural movement of different populations can be assessed, giving insight into pathologic motor control functioning. METHODS: In this study, developmental delay of motor control function in infants was assessed by analysis of sitting postural sway data acquired from force plate center of pressure measurements. Two types of entropy measures were used: symbolic entropy, including a new asymmetric symbolic entropy measure, and approximate entropy, a more widely used entropy measure. For each method of analysis, parameters were adjusted to optimize the separation of the results from the infants with delayed development from infants with typical development. RESULTS: The method that gave the widest separation between the populations was the asymmetric symbolic entropy method, which we developed by modification of the symbolic entropy algorithm. The approximate entropy algorithm also performed well, using parameters optimized for the infant sitting data. The infants with delayed development were found to have less complex patterns of postural sway in the medial-lateral direction, and were found to have different left-right symmetry in their postural sway, as compared to typically developing infants. CONCLUSION: The results of this study indicate that optimization of the entropy algorithm for infant sitting postural sway data can greatly improve the ability to separate the infants with developmental delay from typically developing infants.

Nonlinear analysis of sitting postural sway indicates developmental delay in infants.

BACKGROUND: Upright sitting is one of the first developmental motor milestones achieved by infants, and sitting postural sway provides a window into the developing motor control system. A variety of posture sway measures can be used, but the optimal measures for infant development have not been identified. METHODS: We have collected sitting postural sway data from two groups of infants, one with typical development (n=33), and one with delayed development and either diagnosed with or at risk for cerebral palsy (n=26), when the infants had developed to the point where they could just maintain sitting for about 10s. Postural sway data was collected while infants were sitting on a force platform, and the center of pressure was analyzed using both linear and nonlinear measures. FINDINGS: Our results showed that a nonlinear measure, the largest Lyapunov exponent, was the only parameter of postural sway that revealed significant differences between infants with typical versus delayed development. The largest Lyapunov exponent was found to be higher for typically developing infants, indicating less repeated patterning in their movement coordination. INTERPRETATIONS: A nonlinear measure such as largest Lyapunov exponent may be useful as an identifier of pathology and as a yardstick for the success of therapeutic interventions.

Development of upper body coordination during sitting in typically developing infants.

Our goal was to determine how the actions of the thorax and the pelvis are organized and coordinated to achieve independent sitting posture in typically developing infants. The participants were 10 typically developing infants who were evaluated longitudinally from first onset of sitting until sitting independence. Each infant underwent nine testing sessions. The first session included motor evaluation with the Peabody test. The other eight sessions occurred over a period of 4 mo where sitting behavior was evaluated by angular kinematics of the thorax and the pelvis. A physical therapist evaluated sitting behavior in each session and categorized it according to five stages. The phasing relationship of the thorax and the pelvis was calculated and evaluated longitudinally using a one-way analysis of variance. With development, the infants progressed from an in-phase (moving in the same direction) to an out-of-phase (moving in an opposite direction) coordinative relationship between the thorax and the pelvis segments. This change was significant for both sagittal and frontal planes of motion. Clinically, this relationship is important because it provides a method to quantify infant sitting postural development, and can be used to assess efficacy of early interventions for pediatric populations with developmental motor delays.

Complexity of postural control in infants: linear and nonlinear features revealed by principal component analysis.

Nonlinear analysis of standing postural control in healthy adults reveals a chaotic structure of the center of pressure time series. Independent sitting is the first controlled posture during development, and can also be examined for nonlinear dynamics. We performed a principal component analysis on variables extracted from the center of pressure (COP) time series of infants sitting independently. Our purpose was to describe factors that could be interpreted for clinical use in evaluating postural control for infants, and determine if nonlinear measures provide additional information about postural control not quantified by standard linear measures. Four factors were identified: the area or amount of postural sway and the overall variability of the sway (linear); the complexity of the sway in the anterior-posterior direction (nonlinear); power variability or velocity (linear); and the complexity of the sway in the medial-lateral direction (nonlinear). Nonlinear measures, which are used to examine complexity in many physiological systems, describe the variability of postural control that is not described by linear measures. Nonlinear measures may be critical in determining the developing health of the postural control system in infants, and may be useful in early diagnosis of movement disorders. The measurement of nonlinear dynamics of postural control reveals a chaotic structure of postural control in infancy, which may be an indicator of healthy postural control throughout development.