Aging and neurological conditions like Multiple Sclerosis (MS) and Parkinson’s disease (PD) make people vulnerable for gait impairments, limit function, and restrict sustained walking needed for health promotion. Walking to meet physical activity guidelines requires adequate cadence which is difficult to achieve for gait vulnerable populations.
OBJECTIVE:
The objective of this study is to estimate, for seniors and people with MS or PD, the extent to which cadence is associated with heel-to-toe stepping pattern (good steps), angular velocity of ankle at heel-strike and its variability.
METHODS:
A cross-sectional regression analysis was performed on data collected during walking tests using the Heel2Toe sensor.
RESULTS:
Health condition (MS = 57, PD = 27, seniors = 56) had an association with cadence, independent of age and sex. Only angular velocity showed a significant relationship with cadence such that every – 50° difference in angular velocity (more negative is better) was associated with a difference of ≈3.5 steps per minute.
CONCLUSION:
Adequate angular velocity occurs with an optimal heel-to-toe movement. This heel-to-toe gait can easily be targeted during therapy but technology would be an asset to sustain the relearned movement during everyday activities, Technology that provides real-time feedback for steps with adequate angular velocity at heel strike could be a valuable therapeutic adjunct.
Abdi, Hervé. (2010). Coefficient of variation. Encyclopedia of Research Design, 1, 169–171.
2.
Afiah, I. N., Nakashima, H., Loh, P. Y., & Muraki, S. (2016). An exploratory investigation of changes in gait parameters with age in elderly Japanese women. Springerplus, 5(1), 1069. doi: 10.1186/s40064-016-2739-7
3.
Alcock, L., Galna, B., Lord, S., & Rochester, L. (2016). Characterisation of foot clearance during gait in people with early Parkinson’s disease: Deficits associated with a dual task. Journal of Biomechanics, 49(13), 2763–2769.
4.
Beauchet, O., Dubost, V., Herrmann, F. R., & Kressig, R. W. (2005). Stride-to-stride variability while backward counting among healthy young adults. J Neuroeng Rehabil, 2, 26. doi: 10.1186/1743-0003-2-26
5.
Benedetti, M. G., Piperno, R., Simoncini, L., Bonato, P., Tonini, A., & Giannini, S. (1999). Gait abnormalities in minimally impaired multiple sclerosis patients. Mult Scler, 5(5), 363–368. doi: 10.1177/135245859900500510
6.
Brach, J. S., Berlin, J. E., VanSwearingen, J. M., Newman, A. B., & Studenski, S. A. (2005). Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed. J Neuroeng Rehabil, 2, 21.
7.
Bryant, M. S., Rintala, D. H., Hou, J. G., Charness, A. L., Fernandez, A. L., Collins, R. L.,… Protas, E. J. (2011). Gait variability in Parkinson’s disease: Influence of walking speed and dopaminergic treatment. Neurol Res, 33(9), 959–964. doi: 10.1179/1743132811y.0000000044
8.
Crenshaw, S. J., Royer, T. D., Richards, J. G., & Hudson, D. J. (2006a). Gait variability in people with multiple sclerosis. Multiple Sclerosis Journal, 12(5), 613–619. doi: 10.1177/1352458505070609
9.
Crenshaw, S. J., Royer, T. D., Richards, J. G., & Hudson, D. J. (2006b). Gait variability in people with multiple sclerosis. Mult Scler, 12(5), 613–619. doi: 10.1177/1352458505070609
10.
Donelan, J. M., Kram, R., & Kuo, A. D. (2001). Mechanical and metabolic determinants of the preferred step width in human walking. Proc Biol Sci, 268(1480),1985–1992. doi: 10.1098/rspb.2001.1761
11.
FigueiredoJ.,
F’ixP.,
CostaL.,
MorenoJ. C., & SantosC. P. (2018). Gait event detection in controlled and real-life situations: Repeated measures from healthy subjects. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 26(10), 1945–1956.
12.
Grieve, D. W., & Gear, Ruth J. (1966). The relationships between length of stride, step frequency, time of swing and speed of walking for children and adults. Ergonomics, 9(5), 379–399.
13.
Hausdorff, J. M., Cudkowicz, M. E., Firtion, R., Wei, J. Y., & Goldberger, A. L. (1998). Gait variability and basal ganglia disorders: Stride-to-stride variations of gait cycle timing in Parkinson’s disease and Huntington's disease. Movement Disorders, 13(3), 428–437.
14.
Heidenfelder, J., Sterzing, T., Bullmann, M., & Milani, T. L. (2008). Heel strike angle and foot angular velocity in the sagittal plane during running in different shoe conditions. Journal of Foot and Ankle Research, 1(Suppl 1), O16. doi: 10.1186/1757-1146-1-S1-O16
15.
Hollman, J. H., Kovash, F. M., Kubik, J. J., & Linbo, R. A. (2007). Age-related differences in spatiotemporal markers of gait stability during dual task walking. Gait & Posture, 26(1), 113–119.
16.
Institute, SAS. (2014). SAS 9.4 Language Reference: Concepts: SAS Institute Inc.
17.
Jacobs, L. D., Beck, R. W., Simon, J. H., Kinkel, R. P., Brownscheidle, C. M., Murray, T. J.,… & Sandrock, A. W. (2000). Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. CHAMPS Study Group. NEngl J Med, 343(13), 898–904. doi: 10.1056/nejm200009283431301
18.
Lajoie, Y., Teasdale, N., Bard, C., & Fleury, M. (1996). Atten-tional Demands for Walking: Age-Related Changes.In FerrandezA.-M.TeasdaleN.(Eds.)Advances in Psychology (Vol. 114, pp. 235–256): North-Holland.
19.
Lamoreux, L. W. (1970). Kinematic measurements in the study of human walking. Bulletin of Prosthetics Research, 10(15), 3–84.
20.
Lamoth, C. J., van Deudekom, F. J., van Campen, J. P., Appels, B. A., de Vries, O. J., & Pijnappels, M. (2011). Gait stability and variability measures show effects of impaired cognition and dual tasking in frail people. Journal of Neuroengineering and Rehabilitation, 8(1), 2.
21.
Marriott, J. J., Miyasaki, J. M., Gronseth, G., & O'Connor, P. W. (2010). Evidence Report: The efficacy and safety of mitoxantrone (Novantrone) in the treatment of multiple sclerosis Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 74(18), 1463–1470.
22.
Martin, C. L., Phillips, B. A., Kilpatrick, T. J., Butzkueven, H., Tubridy, N., McDonald, E., & Galea, M. P. (2006). Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler, 12(5), 620–628. doi: 10.1177/1352458506070658
23.
Matsuda, P. N., Shumway-Cook, A., Bamer, A. M., Johnson, S. L., Amtmann, D., & Kraft, G. H. (2011). Falls in multiple sclerosis. PM R, 3(7), 624–632; quiz 632. doi: 10.1016/j.pmrj.2011.04.015
24.
Mayo, N. E., Bayley, M., Duquette, P., Lapierre, Y., Anderson, R., & Bartlett, S. (2013). The role of exercise in modifying outcomes for people with multiple sclerosis: A randomized trial. BMC Neurol, 13, 69. doi: 10.1186/1471-2377-13-69
25.
Murray, M. P., Kory, R. C., & Clarkson, B. H. (1969). Walking patterns in healthy old men. Journal of Gerontology, 24(2), 169–178.
26.
Owings, T. M., & Grabiner, M. D. (2004). Variability of step kinematics in young and older adults. Gait Posture, 20(1), 26–29. doi: 10.1016/s0966-6362(03)00088-2
27.
Polman, Chris H, O'Connor, Paul W, Havrdova, Eva, Hutchinson, Michael, Kappos, Ludwig, Miller, David H,… Wajgt, Andrzej. (2006). A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. New England Journal of Medicine, 354(9), 899–910.
28.
Schaafsma, Joanna D, Giladi, Nir, Balash, Yacov, Bartels, Anna L, Gurevich, Tanya, & Hausdorff, Jeffrey M. (2003). Gait dynamics in Parkinson's disease: Relationship to Parkinso-nian features, falls and response to levodopa. Journal of the Neurological Sciences, 212(1-2), 47–53.
29.
Schrager, M. A., Kelly, V. E., Price, R., Ferrucci, L., & Shumway-Cook, A. (2008). The effects of age on medio-lateral stability during normal and narrow base walking. Gait Posture, 28(3), 466–471. doi: 10.1016/j.gaitpost.2008.02.009
30.
Schwid, Steven R, Covington, MMSB, Segal, Benjamin M, & Goodman, Andrew D. (2002). Fatigue in multiple sclerosis: Current understanding and future directions. Journal of Rehabilitation Research and Development, 39(2), 211–224.
31.
Scott, S. M., van der Linden, M. L., Hooper, J. E., Cowan, P., & Mercer, T. H. (2013). Quantification of gait kinematics and walking ability of people with multiple sclerosis who are new users of functional electrical stimulation. J Rehabil Med, 45(4), 364–369. doi: 10.2340/16501977-1109
32.
Sheridan, Pamela L, Solomont, Judi, Kowall, Neil, & Hausdorff, Jeffrey M. (2003). Influence of executive function on locomotor function: Divided attention increases gait variability in Alzheimer’s disease. Journal of the American Geriatrics Society, 51(11), 1633–1637.
33.
Socie, M. J., & Sosnoff, J. J. (2013). Gait variability and multiple sclerosis. Mult Scler Int, 2013, 645197. doi: 10.1155/2013/645197
34.
Tudor-Locke, C., & Bassett, D. R., Jr. (2004). How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med, 34(1), 1–8.
35.
Vadnerkar, A., Figueiredo, S., Mayo, N. E., & Kearney, R. E. (2014). Classification of gait quality for biofeedback to improve heel-to-toe gait. Conf Proc IEEE Eng Med Biol Soc, 2014, 3626–3629. doi: 10.1109/embc.2014.6944408
36.
Vadnerkar, A., Figueiredo, S., Mayo, N., & Kearney, R. (2017). Design and Validation of a Biofeedback Device to Improve Heel-to-toe Gait in Seniors. IEEE J Biomed Health Inform. doi: 10.1109/jbhi.2017.2665519
37.
Wheat, J., Milner, C. E., & Bartlett, R. M. (2003). Joint coordination variability during overground and treadmill running. Hip, 22(16.7), 8.5.
