Self-selected step length asymmetry is not explained by energy cost minimization in individuals with chronic stroke.

BACKGROUND: Asymmetric gait post-stroke is associated with decreased mobility, yet individuals with chronic stroke often self-select an asymmetric gait despite being capable of walking more symmetrically. The purpose of this study was to test whether self-selected asymmetry could be explained by energy cost minimization. We hypothesized that short-term deviations from self-selected asymmetry would result in increased metabolic energy consumption, despite being associated with long-term rehabilitation benefits. Other studies have found no difference in metabolic rate across different levels of enforced asymmetry among individuals with chronic stroke, but used methods that left some uncertainty to be resolved. METHODS: In this study, ten individuals with chronic stroke walked on a treadmill at participant-specific speeds while voluntarily altering step length asymmetry. We included only participants with clinically relevant self-selected asymmetry who were able to significantly alter asymmetry using visual biofeedback. Conditions included targeting zero asymmetry, self-selected asymmetry, and double the self-selected asymmetry. Participants were trained with the biofeedback system in one session, and data were collected in three subsequent sessions with repeated measures. Self-selected asymmetry was consistent across sessions. A similar protocol was conducted among unimpaired participants. RESULTS: Participants with chronic stroke substantially altered step length asymmetry using biofeedback, but this did not affect metabolic rate (ANOVA, p = 0.68). In unimpaired participants, self-selected step length asymmetry was close to zero and corresponded to the lowest metabolic energy cost (ANOVA, p = 6e-4). While the symmetry of unimpaired gait may be the result of energy cost minimization, self-selected step length asymmetry in individuals with chronic stroke cannot be explained by a similar least-effort drive. CONCLUSIONS: Interventions that encourage changes in step length asymmetry by manipulating metabolic energy consumption may be effective because these therapies would not have to overcome a metabolic penalty for altering asymmetry.

Motorized Shoes Induce Robust Sensorimotor Adaptation in Walking.

The motor system has the flexibility to update motor plans according to systematic changes in the environment or the body. This capacity is studied in the laboratory through sensorimotor adaptation paradigms imposing sustained and predictable motor demands specific to the task at hand. However, these studies are tied to the laboratory setting. Thus, we asked if a portable device could be used to elicit locomotor adaptation outside the laboratory. To this end, we tested the extent to which a pair of motorized shoes could induce similar locomotor adaptation to split-belt walking, which is a well-established sensorimotor adaptation paradigm in locomotion. We specifically compared the adaptation effects (i.e. after-effects) between two groups of young, healthy participants walking with the legs moving at different speeds by either a split-belt treadmill or a pair of motorized shoes. The speeds at which the legs moved in the split-belt group was set by the belt speed under each foot, whereas in the motorized shoes group were set by the combined effect of the actuated shoes and the belts' moving at the same speed. We found that the adaptation of joint motions and measures of spatial and temporal asymmetry, which are commonly used to quantify sensorimotor adaptation in locomotion, were indistinguishable between groups. We only found small differences in the joint angle kinematics during baseline walking between the groups - potentially due to the weight and height of the motorized shoes. Our results indicate that robust sensorimotor adaptation in walking can be induced with a paired of motorized shoes, opening the exciting possibility to study sensorimotor adaptation during more realistic situations outside the laboratory.

Three-dimensional intervertebral range of motion in the cervical spine: Does the method of calculation matter?

Intervertebral range of motion (ROM) is commonly calculated using ordered rotations or projection angles. Ordered rotations are sequence-dependent, and projection angles are dependent upon on which orientation vectors are projected. This study assessed the effect of calculation method on intervertebral ROM in the subaxial cervical spine (C3-C7) during in vivo dynamic, three-dimensional, functional movement. Biplane radiographs were collected at 30 images per second while 29 participants performed full ROM flexion/extension, axial rotation and lateral bending movements of their cervical spine. In vivo bone motion was tracked with sub-millimeter accuracy using a validated volumetric model-based tracking technique. Intervertebral rotations were calculated using six Cardan angle sequences and two projection angle combinations. Within-subject comparisons revealed significant differences in intervertebral ROM among calculation methods (all p<0.002). Group mean ROM differences were small, but significantly different among calculation methods (p<0.001). A resampling technique demonstrated that as group size increases, the differences between calculation methods decreases substantially. It is concluded that the method used to calculate intervertebral rotations of the sub-axial cervical spine can significantly affect within-subject and between group comparisons of intervertebral ROM.