The reliability of plantar pressure assessment during barefoot level walking in children aged 7-11 years

<p>Abstract</p> <p>Background</p> <p>Plantar pressure assessment can provide information pertaining to the dynamic loading of the foot, as well as information specific to each region in contact with the ground. There have been few studies which have considered the reliability of plantar pressure data and therefore the purpose of this study was to investigate the reliability of assessing plantar pressure variables in a group of typically developing children, during barefoot level walking.</p> <p>Methods</p> <p>Forty-five participants, aged 7 to 11 years, were recruited from local primary and secondary schools in East London. Data from three walking trials were collected at both an initial and re-test session, taken one week apart, to determine both the within- and between-session reliability of selected plantar pressure variables. The variables of peak pressure, peak force, pressure-time and force-time integrals were extracted for analysis in the following seven regions of the foot; lateral heel, medial heel, midfoot, 1st metatarsophalangeal joint, 2nd-5th metatarsophalangeal joint, hallux and the lesser toes. Reliability of the data were explored using Intra Class Correlation Coefficients (ICC 3,1 and 3,2) and variability with Coefficients of Variation (CoV's).</p> <p>Results</p> <p>The measurements demonstrated moderate to good levels of within-session reliability across all segments of the foot (0.69-0.93), except the lesser toes, which demonstrated poor reliability (0.17-0.50). CoV's across the three repeated trials ranged from 10.12-19.84% for each of the measured variables across all regions of the foot, except the lesser toes which demonstrated the greatest variability within trials (27.15-56.08%). The between-session results demonstrated good levels of reliability across all foot segments (0.79-0.99) except the lesser toes; with moderate levels of reliability reported at this region of the foot (0.58-0.68). The CoV's between-sessions demonstrated that the midfoot (16.41-36.23%) and lesser toe region (29.64-56.61) demonstrated the greatest levels of variability across all the measured variables.</p> <p>Conclusions</p> <p>These findings indicate that using the reported protocols, reliable plantar pressure data can be collected in children, aged 7 to 11 years in all regions of the foot except the lesser toes which consistently reported poor-to-moderate levels of reliability and increased variability.</p

Big issues for small feet : developmental, biomechanical and clinical narratives on children's footwear

The effects of footwear on the development of children's feet has been debated for many years and recent work from the developmental and biomechanical literature has challenged long-held views about footwear and the impact on foot development. This narrative review draws upon existing studies from developmental, biomechanical and clinical literature to explore the effects of footwear on the development of the foot. The emerging findings from this support the need for progress in [children's] footwear science and advance understanding of the interaction between the foot and shoe. Ensuring clear and credible messages inform practice requires a progressive evidence base but this remains big issue in children's footwear research

Cervical dystonia severity assessment with 3D motion analysis and MRI

This investigation assessed the utility of 3D motion analysis, in conjunction with radiological imaging (MRI, magnetic resonance imaging) and clinical assessment, to objectively measure head/neck motion and tremor in patients with cervical dystonia (CD). It also investigated the relationship between head/neck muscle volume and head/neck motion and posture in patients with CD. Nineteen CD patients participated in this study (age: 56.3 ± 14.4 yrs). Subjects were clinically assessed, completed MRI and 3D movement analysis. The following movements were recorded by a Vicon system (OMG, England) with 8 MX cameras (100 Hz): relaxed posture, and head/neck range of motion in the sagittal (flex/ext), frontal (lateral flex/ext) and transverse planes (rotation). A body builder program was used to extract head/neck motion relative to the thorax and to assess tremor. MRI imaging of the Sternocleidomastoid, Splenius Capitus, Semispinalis Capitus and Levator Scapulae muscles (right and left) were captured and used to estimate muscle volumes based on the principle of summation of truncated cones. Data demonstrates that the Vicon system can record tremor associated with CD. This tremor is in the order of 1 to 2 mm with a dominant frequency at 4 Hz in the sagittal and transverse planes. Data analysis showed that muscle volume asymmetry was not associated or correlated with head-neck posture adopted by the subjects. In conclusion, 3D motion analysis can identify movement abnormality and tremor in CD and may prove valuable in identifying neck musculature for botulinum toxin treatment

Speed Effect on Joint Powers in Aging Gait

Ankle plantar flexor (A2), hip extensor (H1) and hip flexor (H3) joint power generation are important factors in human gait. It is well known gait speed and ageing alters joint kinetics during walking. Ageing gait has been associated with decreased ankle joint function and increased hip muscle activity. However, it is not known whether this effect of speed upon join kinetics is the same for older and young adults. This study investigated the effect of speed on A2, H1 and H3 joint powers in a group of young (YG) and older adults (OG) walking over a range of speeds. Participants walked at seven speed conditions. Peak joint powers were calculated and regressed as a function of gait speed. All joint powers were affected by speed. The OG increased H3 more than the YG, whereas the YG increased more A2 than the OG. At speeds over 1.5 ms-1 the OG increased cadence more than the YG, whereas the YG increased step length more than the OG. This shows that the OG relied more on hip flexor muscles and increases in cadence to reach a maximum walking speed

Gait symmetry in school-aged children and young adults whilst walking at slow, normal and fast speed

This investigation recorded normative or reference gait symmetry data. The gait patterns of a large sample of healthy primary school-aged children and young adults were recorded whilst walking along a level walkway with shoes at varying speed. The effect of age and walking speed on gait symmetry was investigated. A sample of 737 healthy able-bodied children (5 to 13 yrs) and 82 young adults (19.6 ± 1.6 yrs) participated in this study. Each participant wore athletic shoes or runners and completed 6 to 8 walks across a GAITRite mat (80 Hz) at self-selected slow, free and fast speeds. Gait parameters extracted were step and stride length, stance duration, step time, swing time, single support and double support. Temporal measures were normalized to the gait cycle. Symmetry measures were calculated from these gait parameters. Symmetry was found to be unaffected by speed or age. Step and stride symmetry differentials (combining conditions) fell around 0.8 cm, whereas symmetry differentials (combining conditions) for stance duration, step time, swing time, single support and double support fell around 0.7%. This shows that gait is highly symmetrical in healthy children and young adults. This appears to be an invariant quality of human gait but may change with pathology

Relationship between ankle plantar flexor power and EMG muscle activity during gait

It is thought that the A2 ankle power burst observed in human gait is solely generated by rapid concentric contraction of the ankle plantar flexors. Recent work, however, suggests that the return of elastic energy may play a role. This study investigated the temporal relationship between the maximum electromyographic activity (EMG) of the ankle plantar flexors and A2. The natural gait of eight young adults were recorded across level ground. Collectively, the maximum EMG of the Soleus, Gastrocnemius and Peroneus Longus fell 92 ms before A2. The period between maximum EMG and A2 were longer than the electromechanical delay reported in the literature (e.g. 8 to 45 ms). It is reasonable to conclude, therefore, that it may be partly produced by the return of elastic energy stored in the musculotendinous units of the plantar flexors during the A1 absorption period

Stepping responses made by elderly and young female adults to approach and accommodate known surface height changes

Falls on stairs, kerbs and footpaths are a major cause of morbidity in older female adults. This investigation examined the stepping responses made by 48 elderly (mean age 67 years, S.D. 5.4 years) and 48 young (mean age 20 years, S.D. 2.4 years) healthy, communitydwelling adult females to approach and accommodate known surface height changes. The surface was designed to simulate an object like a kerb or step in the walking path. For ascent, the surface was 9 m long (height, 15 cm) with a 13 m ground-level approach. For descent, it was 15 m long (height, 15 cm) with a 7 m ground-level departure. These tasks (particularly descent) perturbed the gait of the elderly more than the young. The elderly exerted more control or were more cautious. They made earlier and larger step adjustments ( p &lt; .05), primarily employed a short step crossing strategy (elderly, 60%; young, 19%), exhibited less footfall variability ( p &lt; .05), moved slower across the step ( p &lt; .001) and spent more time in double foot support while crossing the step. In descent, the elderly preferred to land on the forefoot ( p &lt; .001). In both conditions, the elderly placed the feet closer to the step and cleared it by a lesser margin. Step descent appears to be particularly hazardous for older females since foot clearances were small and foot placement was closer to the step

Obstacle crossing following stroke improves over one month when the unaffected limb leads, but not when the affected limb leads

While it is well established that obstacle crossing is impaired following stroke, it is not known whether obstacle crossing improves as gait improves following stroke. The purpose of this study was to determine whether obstacle crossing changed over a one month time period in people with a recent stroke. Twenty participants receiving rehabilitation following a recent stroke were tested on two occasions one month apart. Participants received usual care rehabilitation, including physiotherapy, between the tests. The main outcome measure was obstacle crossing speed as participants stepped over a 4-cm high obstacle. Secondary measures were spatiotemporal variables. Data were collected via a three dimensional motion analysis system. When leading with the affected limb no changes in obstacle crossing speed or spatiotemporal variables were observed over the one month period. When leading with the unaffected limb, crossing speed significantly increased (p = .002), and affected trail limb swing time (p = .03) and crossing step double support time reduced (p = .016). While not significant, the lead and trail limb pre-obstacle distance increased (p = .08), and lead swing time (p = .052) reduced. Change in obstacle crossing speed did not correlate with change in level gait speed. Obstacle crossing does not necessarily improve over a one month time period in people receiving rehabilitation following stroke. These findings suggest that there may be a need for more targeted training of obstacle crossing, particularly when leading with the affected limb

Basic gait and symmetry measures for primary school-aged children and young adults II: Walking at slow, free and fast speed

This study recorded basic gait data from 656 healthy primary school-aged children (5-13 years) and 81 young adults (18-27 years) whilst walking over-ground across a level walkway at varying speed. It investigated the effect of gait speed and re-examined the issue of gait maturation. Participants completed 6-8 walks at self-selected slow, free and fast speed along a GAITRite walkway whilst wearing athletic shoes. Outcome measures (non-normalized and normalized) were gait speed, cadence, step and stride length, step and stride time, support base, single and double support (%), stance duration (%), foot angle and associated symmetry measures. Compared to free speed, participants walked 24% slower for the slow speed and 30% faster for the fast speed (. p&lt; 0.0001). Both normalized and non-normalized measures of cadence, step and stride length increased with speed (. p&lt; 0.001) whereas step and stride time reduced (. p&lt; 0.001). As a percentage of the gait cycle, single support and stance duration increased with speed (. p&lt; 0.001) whereas double support reduced (. p&lt; 0.001). Foot angle was significantly less (less toe-out) for the fast speed than the free and slow speeds (. p&lt; 0.001) whereas support base was unaffected by speed. Symmetry measures were unaffected by age or speed. Step and stride symmetry differentials (combining conditions) fell around 0.8. cm, whereas symmetry differentials for step and stance time, single and double support fell around 0.7%. This information can be used by clinicians and researchers to assess the gait of children