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Abstract

The extent to which therapeutic, exercise or robotic devices can maximize gait function is a major unresolved issue in neurorehabilitation. Several factors may influence gait outcomes such as similarity of the task to overground walking, degree of coordination within and across limbs, and cycle-to-cycle variability in each device. Our objective was to compare lower extremity kinematics, coordination and variability during four locomotor tasks: overground walking, treadmill walking, elliptical training and stationary cycling in 10 non-disabled adults (6 male; mean age 22.7±2.9 yrs, range 20-29). All first performed four overground walking trials at self-selected speed with mean temporal-spatial data used to pace the other conditions. Joint positions, excursions, and the Gait Deviation Index (GDI) were compared across conditions to evaluate kinematic similarity. Time-series data were correlated within and across limbs to evaluate intralimb and interlimb coordination, respectively. Variability in cadence was quantified to assess how constrained the locomotor rhythm was compared to overground walking. Treadmill walking most closely resembled overground with GDI values nearly overlapping, reinforcing its appropriateness for gait training. Cycling showed the largest GDI difference from overground, with elliptical closer but still a significant distance from all three. Cycling showed greater hip reciprocation Cycling and elliptical showed stronger intralimb synergism at the hip and knee than the other two. Based on kinematics, results suggest that elliptical training may have greater transfer to overground walking than cycling and cycling may be more useful for enhancing reciprocal coordination. Further evaluation of these devices in neurological gait disorders is needed.

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... Characteristics and described results of the 55 included studies are provided in Table 2. Forty-one studies compared treadmill walking to indoor overground walking (Anders et al., 2019;Barela et al., 2019;Bechard et al., 2011;Bizovska et al., 2018;Carpinella et al., 2010;Chockalingam et al., 2006Chockalingam et al., , 2012Cronin & Finni, 2013;Damiano et al., 2011;Das Gupta et al., 2021;Dewig et al., 2022;Dingwell et al., 2001;Dufek & Bates, 1990;Fellin et al., 2016;Galloway et al., 2021;Hall et al., 2004;Hollman et al., 2016aHollman et al., , 2016bHutchinson et al., 2021;Lee & Hidler, 2008;Lim & Lee, 2018;Martin & Li, 2017;Matsas et al., 2000;Montes et al., 2019;Montgomery et al., 2016;Murray et al., 1985;Nagano et al., 2013;Nymark et al., 2005;Park et al., 2022;Parvataneni et al., 2009;Pearce et al., 1983;Prosser et al., 2011;Ralston, 1960;Riley et al., 2007;Ryu et al., 2018;Stolze et al., 1997;Strathy et al., 1983;Strutzenberger et al., 2022;Vickery-Howe et al., 2021;White et al., 1998;Wrightson et al., 2020;Yngve et al., 2003), five studies compared treadmill walking to outdoor overground walking (Barnett et al., 2015;Custance, 1970;Daniels et al., 1953;Shi et al., 2019;Wyndham et al., 1971), and nine studies did not clearly describe the overground surface (Cronin & Finni, 2013;Fallahtafti et al., 2021;Fullenkamp et al., 2018;Hossain et al., 2022;Khademi-Kalantari et al., 2017;Korvas et al., 2013;Mazaheri et al., 2016;Mileti et al., 2020;Tong et al., 2020 Murray et al., 1985;Riley et al., 2007;Stolze et al., 1997;Strutzenberger et al., 2022) and four studies included the addition of carried external load (Custance, 1970;Daniels et al., 1953;Fellin et al., 2016;Vickery-Howe et al., 2021), whereas 15 studies did not report walking speed (Chockalingam et al., 2012;Damiano et al., 2011;Dingwell et al., 2001;Fellin et al., 2016;Hossain et al., 2022;Hutchinson et al., 2021;Khademi-Kalantari et al., 2017;Lee & Hidler, 2008;Lim & Lee, 2018;Mazaheri et al., 2016;Montes et al., 2019;Nymark et al., 2005;Shi et al., 2019;Strathy et al., 1983;Tong et al., 2020). The results of Downs and Black quality assessment scores are presented in Table 3. ...
... Characteristics and described results of the 55 included studies are provided in Table 2. Forty-one studies compared treadmill walking to indoor overground walking (Anders et al., 2019;Barela et al., 2019;Bechard et al., 2011;Bizovska et al., 2018;Carpinella et al., 2010;Chockalingam et al., 2006Chockalingam et al., , 2012Cronin & Finni, 2013;Damiano et al., 2011;Das Gupta et al., 2021;Dewig et al., 2022;Dingwell et al., 2001;Dufek & Bates, 1990;Fellin et al., 2016;Galloway et al., 2021;Hall et al., 2004;Hollman et al., 2016aHollman et al., , 2016bHutchinson et al., 2021;Lee & Hidler, 2008;Lim & Lee, 2018;Martin & Li, 2017;Matsas et al., 2000;Montes et al., 2019;Montgomery et al., 2016;Murray et al., 1985;Nagano et al., 2013;Nymark et al., 2005;Park et al., 2022;Parvataneni et al., 2009;Pearce et al., 1983;Prosser et al., 2011;Ralston, 1960;Riley et al., 2007;Ryu et al., 2018;Stolze et al., 1997;Strathy et al., 1983;Strutzenberger et al., 2022;Vickery-Howe et al., 2021;White et al., 1998;Wrightson et al., 2020;Yngve et al., 2003), five studies compared treadmill walking to outdoor overground walking (Barnett et al., 2015;Custance, 1970;Daniels et al., 1953;Shi et al., 2019;Wyndham et al., 1971), and nine studies did not clearly describe the overground surface (Cronin & Finni, 2013;Fallahtafti et al., 2021;Fullenkamp et al., 2018;Hossain et al., 2022;Khademi-Kalantari et al., 2017;Korvas et al., 2013;Mazaheri et al., 2016;Mileti et al., 2020;Tong et al., 2020 Murray et al., 1985;Riley et al., 2007;Stolze et al., 1997;Strutzenberger et al., 2022) and four studies included the addition of carried external load (Custance, 1970;Daniels et al., 1953;Fellin et al., 2016;Vickery-Howe et al., 2021), whereas 15 studies did not report walking speed (Chockalingam et al., 2012;Damiano et al., 2011;Dingwell et al., 2001;Fellin et al., 2016;Hossain et al., 2022;Hutchinson et al., 2021;Khademi-Kalantari et al., 2017;Lee & Hidler, 2008;Lim & Lee, 2018;Mazaheri et al., 2016;Montes et al., 2019;Nymark et al., 2005;Shi et al., 2019;Strathy et al., 1983;Tong et al., 2020). The results of Downs and Black quality assessment scores are presented in Table 3. ...
... The results of Downs and Black quality assessment scores are presented in Table 3. Of the included 55 studies, 17 were high quality (Barela et al., 2019;Bizovska et al., 2018;Cronin & Finni, 2013;Dewig et al., 2022;Fellin et al., 2016;Galloway et al., 2021;Hall et al., 2004;Hollman et al., 2016aHollman et al., , 2016bHutchinson et al., 2021;Lim & Lee, 2018;Martin & Li, 2017;Parvataneni et al., 2009;Shi et al., 2019;Strutzenberger et al., 2022;Vickery-Howe et al., 2021;Wrightson et al., 2020), 29 were moderate quality (Anders et al., 2019;Barnett et al., 2015;Bechard et al., 2011;Carpinella et al., 2010;Chockalingam et al., 2006Chockalingam et al., , 2012Damiano et al., 2011;Das Gupta et al., 2021;Dufek & Bates, 1990;Fallahtafti et al., 2021;Fullenkamp et al., 2018;Khademi-Kalantari et al., 2017;Lee & Hidler, 2008;Matsas et al., 2000;Mazaheri et al., 2016;Mileti et al., 2020;Montes et al., 2019;Montgomery et al., 2016;Murray et al., 1985;Nagano et al., 2013;Nymark et al., 2005;Park et al., 2022;Prosser et al., 2011;Riley et al., 2007;Ryu et al., 2018;Stolze et al., 1997;Tong et al., 2020;White et al., 1998;Yngve et al., 2003), and 9 were low quality (Custance, 1970;Daniels et al., 1953;Dingwell et al., 2001;Hossain et al., 2022;Korvas et al., 2013;Pearce et al., 1983;Ralston, 1960;Strathy et al., 1983;Wyndham et al., 1971). All included studies reported results that were not based on data dredging. ...
... Seven studies found similarities between the parameters for TW and OW; 4 of these studies were performed with the overground preferred walking speed (O-PWS) for both TW and OW [19,20,23,24], and the other 3 studies had different speed instructions (O-PWS during OW and treadmill preferred walking speed (T-PWS) during TW), though the same speed was ultimately used for both walking conditions [21,22,28]. The remaining 9 studies that found differences in spatiotemporal parameters evaluated those data with the same speed instructions (O-PWS) [26,[29][30][31] or different speed instructions (O-PWS and T-PWS) [6,[32][33][34][35]. At the end, 5 studies must have had the same speed values for both conditions [26,[29][30][31]33], even if actual speed values were not mentioned for 2 of them [26,31]. ...
... The remaining 9 studies that found differences in spatiotemporal parameters evaluated those data with the same speed instructions (O-PWS) [26,[29][30][31] or different speed instructions (O-PWS and T-PWS) [6,[32][33][34][35]. At the end, 5 studies must have had the same speed values for both conditions [26,[29][30][31]33], even if actual speed values were not mentioned for 2 of them [26,31]. When speed values were different between the O-PWS and T-PWS instructions [6,32,34,35], T-PWS was systematically lower than O-PWS, by approximately 1 km/h. ...
... The remaining 9 studies that found differences in spatiotemporal parameters evaluated those data with the same speed instructions (O-PWS) [26,[29][30][31] or different speed instructions (O-PWS and T-PWS) [6,[32][33][34][35]. At the end, 5 studies must have had the same speed values for both conditions [26,[29][30][31]33], even if actual speed values were not mentioned for 2 of them [26,31]. When speed values were different between the O-PWS and T-PWS instructions [6,32,34,35], T-PWS was systematically lower than O-PWS, by approximately 1 km/h. ...
Article
Background The equivalency of treadmill and overground walking has been investigated in a large number of studies. However, no systematic review has been performed on this topic. Research question The aim of this study was to compare the biomechanical, electromyographical and energy consumption outcomes of motorized treadmill and overground walking. Methods Five databases, ScienceDirect, SpringerLink, Web of Science, PubMed, and Scopus, were searched until January 13, 2021. Studies written in English comparing lower limb biomechanics, electromyography and energy consumption during treadmill and overground walking in healthy young adults (20-40 years) were included. Results Twenty-two studies (n=409 participants) were included and evaluated via the Cochrane Collaboration’s tool. These 22 studies showed that some kinematic (reduced pelvic ROM, maximum hip flexion angle for females, maximum knee flexion angle for males and cautious gait pattern), kinetic (sagittal plane joint moments: dorsiflexor moments, knee extensor moments and hip extensor moments and sagittal plane joint powers at the knee and hip joints, peak backwards, lateral and medial COP velocities and propulsive forces during late stance) and electromyographic (lower limbs muscles activities) outcome measures were significantly different for motorized treadmill and overground walking. Significance Spatiotemporal, kinematic, kinetic, electromyographic and energy consumption outcome measures were largely comparable for motorized treadmill and overground walking. However, the differences in kinematic, kinetic and electromyographic parameters should be taken into consideration by clinicians, trainers, and researchers when working on new protocols related to patient rehabilitation, fitness rooms or research as to be as close as possible to the outcome measures of overground walking. The protocol registration number is CRD42021236335 (PROSPERO International Prospective Register of Systematic Reviews).
... Many researchers have analyzed muscle activity during upright cycling, [17][18][19][20][21][22] elliptical cycling, [22][23][24] and recumbent cycling, 19,21,25,26 however few have compared a combination of these exercise devices 18,24 and the methodology has varied across studies. Results of research that has assessed muscle activity among various equipment devices have been difficult to compare as methodologies and equipment design vary widely among the literature. ...
... Many researchers have analyzed muscle activity during upright cycling, [17][18][19][20][21][22] elliptical cycling, [22][23][24] and recumbent cycling, 19,21,25,26 however few have compared a combination of these exercise devices 18,24 and the methodology has varied across studies. Results of research that has assessed muscle activity among various equipment devices have been difficult to compare as methodologies and equipment design vary widely among the literature. ...
... 28 The sample size was determined based on a study with similar independent variables where ten subjects were studied using elliptical training, stationary cycling, treadmill walking and over ground walking. 18 Subjects were recruited using a sample of convenience from the university campus and the study involved a single-session research design. Exclusion criteria consisted of anyone diagnosed with musculoskeletal, cardiovascular, vestibular, visual, neurological, or balance disorders, or have a history musculoskeletal injury requiring medical treatment in the past year. ...
Article
Background: Stationary equipment devices are often used to improve fitness. The ElliptiGO® was recently developed that blends the elements of an elliptical trainer and bicycle, allowing reciprocal lower limb pedaling in an upright position. However, it is unknown whether the muscle activity used for the ElliptiGO® is similar to walking or cycling. To date, there is no information comparing muscle activity for exercise on the treadmill, stationary upright and recumbent bikes, and the ElliptiGO®. Purpose/hypothesis: The purpose of this study was to assess trunk and lower extremity muscle activity among treadmill walking, cycling (recumbent and upright) and the ElliptiGO® cycling. It was hypothesized that the ElliptiGO® and treadmill would elicit similar electromyographic muscle activity responses compared to the stationary bike and recumbent bike during an exercise session. Study design: Cohort, repeated measures. Methods: Twelve recreationally active volunteers participated in the study and were assigned a random order of exercise for each of the four devices (ElliptiGO®, stationary upright cycle ergometer, recumbent ergometer, and a treadmill). Two-dimensional video was used to monitor the start and stop of exercise and surface electromyography (SEMG) were used to assess muscle activity during two minutes of cycling or treadmill walking at 40-50% heart rate reserve (HRR). Eight muscles on the dominant limb were used for analysis: gluteus maximus (Gmax), gluteus medius (Gmed), biceps femoris (BF), lateral head of the gastrocnemius (LG), tibialis anterior (TA), rectus femoris (RF). Two trunk muscles were assessed on the same side; lumbar erector spinae at L3-4 level (LES) and rectus abdominus (RA). Maximal voluntary isometric contractions (MVIC) were determined for each muscle and SEMG data were expressed as %MVIC in order to normalize outputs. Results: The %MVIC for RF during ElliptiGO® cycling was higher than recumbent cycling. The LG muscle activity was highest during upright cycling. The TA was higher during walking compared to recumbent cycling and ElliptiGO® cycling. No differences were found among the the LES and remaining lower limb musculature across devices. Conclusion: ElliptiGO® cycling was found to elicit sufficient muscle activity to provide a strengthening stimulus for the RF muscle. The LES, RA, Gmax, Gmed, and BF activity were similar across all devices and ranged from low to moderate strength levels of muscle activation. The information gained from this study may assist clinicians in developing low to moderate strengthening exercise protocols when using these four devices. Level of evidence: 3.
... Before data collection, the participants were allowed 3 min to become familiar with the self-selected fast speed. They were instructed to 'cycle as fast as possible' [28]. After a 60 s passive rest, the participants cycled for 1 min. ...
... The verbal instructions that they received were 'walk as fast as possible without running'. The participants switched the treadmill on and then gradually increased the speed by 0.5 km/h until their fast walking speed was selected [28]. After 60 s of passive rest, the participants walked on the treadmill for 1 min. ...
Article
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This study investigated the factors that influence core muscle endurance, i.e., the symmetry of frontal core motion during indoor walking and cycling, the symmetry of lateral core muscle endurance, the symmetry of the hip abductor strength, the weekly workout time and fast walking and cycling speeds, while controlling for gender. Seventy-nine healthy young adults participated in this study. In a regression analysis, the core muscle endurance time was the dependent variable. The independent variables were the symmetry of frontal core motion (measured using a wireless earbud sensor during walking and cycling), the symmetry of side plank time and of hip abductor strength, the weekly workout time and fast walking and cycling speeds. In the multiple regression analysis, weekly workout time, fast walking speed, symmetry of frontal core motion during fast cycling and symmetry of lateral side plank time predicted core muscle endurance (adjusted R2 = 0.42). Thus, clinicians and fitness personnel should consider the association of core muscle endurance with the symmetry of frontal core motion during cycling and the symmetry of side plank holding time, as well as with the weekly workout time and a fast walking speed, when designing core muscle exercise programmes.
... Following a 1 s static trial, anatomical markers were removed, and treadmill walking began. Participants walked on a treadmill (Exciteþ Run Now 900, TechnoGym, Fairfield, NJ) [23][24][25][26][27][28] at 1.4 m/s [29,30] for at least 2 min prior to data collection. 3D position data and PP were captured for ten sequential steps. ...
... Thus, the chronic use effects of these orthoses may alter our current findings. Testing was performed during treadmill walking which may have created an artificial walking environment compared to overground walking, although gait kinematics should not have been affected [23][24][25][26][27][28]. Treadmill walking was chosen as the walking modality in order to validly control walking speed during testing. ...
Article
Patients who sustain irreversible cartilage damage or joint instability from ankle injuries are likely to develop ankle osteoarthritis. A Dynamic Ankle Orthosis (DAO) was recently designed with the intent to offload the foot and ankle using a distractive force, allowing more natural sagittal and frontal plane ankle motion during gait. To evaluate its efficacy, the current study compared ankle joint kinematics and plantar pressures among the DAO, standard double upright ankle-foot orthosis (DUAFO), and a non-orthosis control (CON) condition in healthy adults during walking. Ten healthy subjects walked on a treadmill at 1.4m/s in three orthosis conditions: CON, DAO, and DUAFO. Ankle kinematics were assessed using a 3D motion capture system and in-shoe plantar pressures were measured for seven areas of the foot. DAO reduced hallux peak plantar pressures compared to CON and DUAFO. Peak plantar pressures under toes 2-5 were smaller in DAO than DUAFO, but greater in DUAFO compared to CON. Early stance peak plantarflexion angular velocity was smaller in DAO compared to CON and DUAFO. Eversion ROM was much smaller in DUAFO compared to CON and DAO. Early stance peak eversion angular velocity was smaller in DAO and much smaller in DUAFO compared to CON. This study demonstrates the capacity of the DAO to provide offloading during ambulation without greatly affecting kinematic parameters including frontal plane ankle motion compared to CON. Future work will assess the effectiveness of the DAO in a clinical osteoarthritic population.
... Nevertheless, it is challenging for stroke patients with severe motor impairments to support themselves, maintain balance, and walk coordinately. Stationary pedaling might be a suitable alternative as pedaling and walking share similar activation patterns of muscle groups [9]. Synchronized NMES and pedaling have been investigated for stroke survivors. ...
... As stroke survivors cannot perform stable stance or gait activities, stationary pedaling was conducted in the current study, which shares a similar group of muscle activation as waking [9]. Future studies might investigate the cortico-muscular activation of walking or other complex movements with advanced robot-assisted techniques for patients with movement disorders. ...
Article
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Background Neuromuscular electrical stimulation (NMES) is extensively used in stroke motor rehabilitation. How it promotes motor recovery remains only partially understood. NMES could change muscular properties, produce altered sensory inputs, and modulate fluctuations of cortical activities; but the potential contribution from cortico-muscular couplings during NMES synchronized with dynamic movement has rarely been discussed. Method We investigated cortico-muscular interactions during passive, active, and NMES rhythmic pedaling in healthy subjects and chronic stroke survivors. EEG (128 channels), EMG (4 unilateral lower limb muscles) and movement parameters were measured during 3 sessions of constant-speed pedaling. Sensory-level NMES (20 mA) was applied to the muscles, and cyclic stimulation patterns were synchronized with the EMG during pedaling cycles. Adaptive mixture independent component analysis was utilized to determine the movement-related electro-cortical sources and the source dipole clusters. A directed cortico-muscular coupling analysis was conducted between representative source clusters and the EMGs using generalized partial directed coherence (GPDC). The bidirectional GPDC was compared across muscles and pedaling sessions for post-stroke and healthy subjects. Results Directed cortico-muscular coupling of NMES cycling was more similar to that of active pedaling than to that of passive pedaling for the tested muscles. For healthy subjects, sensory-level NMES could modulate GPDC of both ascending and descending pathways. Whereas for stroke survivors, NMES could modulate GPDC of only the ascending pathways. Conclusions By clarifying how NMES influences neuromuscular control during pedaling in healthy and post-stroke subjects, our results indicate the potential limitation of sensory-level NMES in promoting sensorimotor recovery in chronic stroke survivors.
... Treadmills provide a common alternative to overground walking, yet the gait patterns are not entirely similar. Previous literature, focusing on mean kinematic and kinetic variables, has suggested the two walking modes are similar (Damiano et al., 2011;Gates et al., 2012;Lee and Hidler, 2008). Conversely, alterations in walking (Hollman et al., 2016a, b) and running dynamics (Lindsay et al., 2014) on a fixed-speed treadmill (FixedTM), as compared to overground, exist. ...
... We hypothesized that spatiotemporal means would be similar between the two types of treadmills, while spatiotemporal variability would be greater in the FeedbackTM. Based on previous literature (Damiano et al., 2011;Gates et al., 2012;Hollman et al., 2016a, b;Lee and Hidler, 2008;Lindsay et al., 2014), it was anticipated that the gait dynamics -specifically step speed -would be significantly more persistent when using the FeedbackTM compared to the FixedTM. It was also hypothesized that gait dynamics would be significantly reliable between-sessions when walking on a FeedbackTM based on previous findings (Choi et al., 2015). ...
... Treadmill training has shown to be effective for patients with a minimal amount of strength [52,53], but still requires significant effort from the therapist to guide metatarsal trajectories. One study showed that that the mean difference between treadmill walking and overground walking was very small, beating out both cycling and elliptical therapy methods [54]. ...
... Kinematic analyses of elliptical devices show that they do assist in effective gait rehabilitation [67][68][69][70][71][72]. However, as stated earlier, some elliptical devices have shown poorer performance than robotic or treadmill training [60], and their motion does not match normal gait [54]. ...
Article
Gait therapy methodologies were studied and analyzed for their potential for pediatric patients. Using data from heel, metatarsal, and toe trajectories, a nominal gait trajectory was determined using Fourier transforms for each foot point. These average trajectories were used as a basis of evaluating each gait therapy mechanism. An existing gait therapy device (called ICARE) previously designed by researchers, including engineers at the University of Nebraska-Lincoln, was redesigned to accommodate pediatric patients. Unlike many existing designs, the pediatric ICARE did not over- or under-constrain the patient’s leg, allowing for repeated, comfortable, easily-adjusted gait motions. This design was assessed under clinical testing and deemed to be acceptable. A gait rehabilitation device was designed to interface with both pediatric and adult patients and more closely replicate the gait-like metatarsal trajectory compared to an elliptical machine. To accomplish this task, the nominal gait path was adjusted to accommodate for rotation about the toe, which generated a new trajectory that was tangent to itself at the midpoint of the stride. Using knowledge of the bio-mechanics of the foot, the gait path was analyzed for its applicability to the general population. Several trajectory-replication methods were evaluated, and the crank-slider mechanism was chosen for its superior performance and ability to mimic the gait path adequately. Adjustments were made to the gait path to further optimize its realization through the crank-slider mechanism. Two prototypes were constructed according to the slider-crank mechanism to replicate the gait path identified. The first prototype, while more accurately tracing the gait path, showed difficulty in power transmission and excessive cam forces. This prototype was ultimately rejected. The second prototype was significantly more robust. However, it lacked several key aspects of the original design that were important to matching the design goals. Ultimately, the second prototype was recommended for further work in gait-replication research. Advisor: Carl A. Nelson
... However, it is limited to the functional states of stroke survivors, and some patients have difficulty in walking or performing complex lower limb tasks. Upright stationary pedaling training is an alternative to walking tasks for stroke survivors, which shares similar muscular control strategies [22]. Further, both volitional and passive motor tasks might provide information regarding the functional states of the muscular system [23]. ...
Article
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This study examines pedaling asymmetry using the electromyogram (EMG) complexity of six bilateral lower limb muscles for chronic stroke survivors. Fifteen unilateral chronic stroke and twelve healthy participants joined passive and volitional recumbent pedaling tasks using a self-modified stationary bike with a constant speed of 25 revolutions per minute. The fuzzy approximate entropy (fApEn) was adopted in EMG complexity estimation. EMG complexity values of stroke participants during pedaling were smaller than those of healthy participants (p = 0.002). For chronic stroke participants, the complexity of paretic limbs was smaller than that of non-paretic limbs during the passive pedaling task (p = 0.005). Additionally, there was a significant correlation between clinical scores and the paretic EMG complexity during passive pedaling (p = 0.022, p = 0.028), indicating that the paretic EMG complexity during passive movement might serve as an indicator of stroke motor function status. This study suggests that EMG complexity is an appropriate quantitative tool for measuring neuromuscular characteristics in lower limb dynamic movement tasks for chronic stroke survivors.
... musculature, by causing activation of muscles such as vastus intermedius, vastus lateralis, vastus medialis and rectus femoris in the knee extension during descending phase.21 There is evidence that neural circuits are shared in cycling and walking and that both require reciprocal motor coordination,23 encouraging the choice of this equipment in gait rehabilitation.Regarding biofeedback, surprisingly no difference was found in its use in activating the tested muscles.Biofeedback is a technique to support motor learningand has been used in clinical practice. 27 EMG therapy plus biofeedback is based on the improvement of myoelectric signals obtained from the muscles that have been converted into visual signals, with the aim of informing the subject about the activity of the muscles. ...
Article
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Introduction Spinal cord injury generates muscle weakness, impairing orthostatism and gait. The elliptical trainer (ET) and the ergometric bicycle (EB) are rehabilitation options for this subject. Understanding the pattern of muscle activation generated by these methods is important to answer questions arising from clinical practice. Objective To verify muscle activation with ET and EB with and without electromyographic biofeedback in subjects with incomplete spinal cord injury (ISCI). Methods Cross-sectional crossover study, enrolled in Clinical Trials (NCT05118971). Subjects with spinal cord injury (incomplete spinal cord injury group - ISCIG) and without spinal cord injury (reference group - RG) were randomized into four groups: elliptical group (EG), elliptical + biofeedback group (EBG), bicycle group (BG) and bicycle + biofeedback group (BBG). Subjects were assessed for functionality by the Functional Independence Measure, injury classification by the ASIA Scale, muscle tone by the modified Ashworth scale, and muscle activity by electromyography. Results There was greater activation of the tibialis anterior on cycling compared to other modalities in ISCIG. Biofeedback offered no difference in any of the groups. In RG the vastus medialis was the most activated muscle in all modalities, with more expressive activation in the ET. In this same group, the tibialis anterior was more activated on the EB. Conclusion This study showed that both ET and EB are safe and effective in recruiting the muscles investigated, encouraging its use by rehabilitation professionals when the objective is to strength muscles involved in gait.
... Stationary cycling exercise is another form of AE which is regarded as one of the most effective exercises to improve muscular coordination. 50,72 Three fair to good quality RCTs were included in this review that examined the effectiveness of stationary cycling exercise, and outcomes demonstrated that stationary cycling exercise was as effective as walking exercise, and stationary cycling exercise was not inferior to other interventions. 45,50,52 In addition, Chatzitheodorou et al. 56 showed that high-intensity AE, including running, was adequate to improve pain and disability in CLBP patients significantly. ...
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Background: Physical activity, including aerobic exercise, is highly recommended for chronic low back pain (CLBP) patients to improve pain intensity and functional disability. Objectives: To assess the effectiveness of different aerobic exercises to reduce pain intensity and functional disability in patients with CLBP. Methods: A computer-aided search was performed to find Randomised controlled Trials (RCTs) that evaluated the effectiveness of different aerobic exercises in CLBP. Articles published between January 2007 to December 2020 were included in the review. Quality assessment using the PEDro scale, extraction of relevant information, and evaluation of outcomes were done by two reviewers independently. Results: A total of 17 studies were included that involved 1146 participants. Outcomes suggested that aerobic exercise combined with other interventions was more effective than aerobic exercise alone. Aerobic exercise with higher frequency (≥ 5 days/week) and longer duration (≥ 12 weeks) were effective to gain clinically significant (≥ 30%) improvements. Environment and using pedometer did not seem to influence the outcomes. Conclusions: Pain intensity and functional disability in CLBP patients can be minimized by prescribing aerobic exercise. However, to get better improvements, aerobic exercise should be done in combination with other interventions and at optimum frequency and duration. Further studies should emphasize examining the optimal doses and period of different aerobic exercises.
... Although the Fibion monitor does not report stepping data, differentiation between slow walking, fast walking, and high-intensity activity is likely based on stepping frequency or velocity of leg movement (Ayabe et al., 2011), and given the different stride lengths, different movement frequencies/ velocities at a given absolute speed may have contributed to some of the misclassification of slow and fast walking. Cycling and walking bear resemblance in rhythmic leg movement, although biomechanical differences exist that should allow for differentiation between these distinct activities (Damiano et al., 2011). Alternately, both walking and cycling are executed differently when performed on machines (e.g., treadmill, cycle ergometer) compared to when performed outside of a laboratory (Lee & Hidler, 2008) where road vibrations or coasting may increase differences between cycling and walking, so accuracy in differentiating between these activities may be better outside of a laboratory setting. ...
Article
Background : Given the popularity of thigh-worn accelerometers, it is important to understand their reliability and validity. Purpose : Our study evaluated laboratory validity and free-living intermonitor reliability of the Fibion monitor and free-living intermonitor reliability of the activPAL monitor. Free-living comparability of the Fibion and activPAL monitors was also assessed. Methods : Nineteen adult participants wore Fibion monitors on both thighs while performing 11 activities in a laboratory setting. Then, participants wore Fibion and activPAL monitors on both thighs for 3 days during waking hours. Accuracy of the Fibion monitor was determined for recognizing lying/sitting, standing, slow walking, fast walking, jogging, and cycling. For the 3-day free-living wear, outputs from the Fibion monitors were compared, with similar analyses conducted for the activPAL monitors. Finally, free-living comparability of the Fibion and activPAL monitors was determined for nonwear, sitting, standing, stepping, and cycling. Results : The Fibion monitor had an overall accuracy of 85%–89%, with high accuracy (94%–100%) for detecting prone and supine lying, sitting, and standing but some misclassification among ambulatory activities and for left-/right-side lying with standing. Intermonitor reliability was similar for the Fibion and activPAL monitors, with best reliability for sitting but poorer reliability for activities performed least often (e.g., cycling). The Fibion and activPAL monitors were not equivalent for most tested metrics. Conclusion : The Fibion monitor appears suitable for assessment of sedentary and nonsedentary waking postures, and the Fibion and activPAL monitors have comparable intermonitor reliability. However, studies using thigh-worn monitors should use the same monitor brand worn on the same leg to optimize reliability.
... The elliptical trainer is a typical stationary exercise machine that provides upper and lower limb exercises without causing an excessive impact on body joints [1]. It offers efficient training with relatively smaller floor space and lower noise than other equipment options [2]. ...
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This work aims to introduce simple-to-implement modifications to the elliptical trainer device to increase its utility with added new exercise options. The effectiveness of the introduced modifications was assessed on 51 subjects, with effectiveness representing the recruitment of a broader range of muscle groups with desired intensity levels. The improvements include a new in-phase mode, where bilateral body synchronization creates a skiing-like motion, and a variable range of motion through adjusting the stride length of a rotating-link mechanism. The impact of these modifications on muscle recruitment was assessed by recording surface electromyogram (sEMG) from eleven major muscles while performing a total of six exercise routines. The routines have various combinations of mode and intensity to cover the traditional mechanism and the newly- introduced mechanism adjustments for comparative analysis. The results have shown that increasing the stride length increases the demand on lower limbs muscles during the anti-phase mode while decreasing it on upper limb muscles. When comparing the two exercise modes, all muscle groups showed significantly higher activity in the in-phase mode except for thigh muscles (Hamstrings and Quadriceps). Hamstrings revealed significantly higher activity in the anti-phase mode, while Quadriceps showed no significantly different activity between the two modes. The introduced design modifications are shown to diversify the demand on major skeletal muscles hence improving its functionality at low added cost. Furthermore, these results can be exploited to implement gradual physiotherapeutic rehabilitation plans targeting various muscle groups with desired intensity levels.
... Stationary cycling exercise is another form of AE which is regarded as one of the most effective exercises to improve muscular coordination. 50,72 Three fair to good quality RCTs were included in this review that examined the effectiveness of stationary cycling exercise, and outcomes demonstrated that stationary cycling exercise was as effective as walking exercise, and stationary cycling exercise was not inferior to other interventions. 45,50,52 In addition, Chatzitheodorou et al. 56 showed that high-intensity AE, including running, was adequate to improve pain and disability in CLBP patients significantly. ...
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Background: Physical activity, including aerobic exercise, is highly recommended for chronic low back pain (CLBP) patients to improve pain intensity and functional disability. Objectives: To assess the effectiveness of different aerobic exercises to reduce pain intensity and functional disability in patients with CLBP. Methods: A computer-aided search was performed to find Randomised controlled Trials (RCTs) that evaluated the effectiveness of different aerobic exercises in CLBP. Articles published between January 2007 to December 2020 were included in the review. Quality assessment using the PEDro scale, extraction of relevant information, and evaluation of outcomes were done by two reviewers independently. Results: A total of 17 studies were included that involved 1146 participants. Outcomes suggested that aerobic exercise combined with other interventions was more effective than aerobic exercise alone. Aerobic exercise with higher frequency (≥ 5 days/week) and longer duration (≥ 12 weeks) were effective to gain clinically significant (≥ 30%) improvements. Environment and using pedometer did not seem to influence the outcomes. Conclusions: Pain intensity and functional disability in CLBP patients can be minimized by prescribing aerobic exercise. However, to get better improvements, aerobic exercise should be done in combination with other interventions and at optimum frequency and duration. Further studies should emphasize examining the optimal doses and period of different aerobic exercises.
... Advanced artificial intelligence techniques might also contribute to more practical closed-loop rehabilitation training designs and understanding of the impact of rehabilitation training on the neuromuscular system [68]. Furthermore, the application of NMES during gait training might further directly facilitate lower limb motor recovery although pedaling and walking share similar EMG activation patterns [69]. In addition, subject-specific rehabilitation paradigms and sub-group analyses for different protocols are necessary for subjects with different levels of motor dysfunctions. ...
Article
Neuromuscular electrical stimulation (NMES) has been widely utilized in post-stroke motor restoration. However, its impact on the closed-loop sensorimotor control process remains largely unclear. This is the first study to investigate the directional changes in cortico-muscular interactions after repetitive rehabilitation training by measuring the noninvasive electroencephalogram (EEG) and electromyography (EMG) signals. In this study, 10 subjects with chronic stroke received 20 sessions of NMES-pedaling interventions, and each training session included three 10-minutes NMES-driven pedaling trials. In addition, pre- and post-intervention assessments of lower limb isometric contraction were conducted before and after the whole NMES-pedaling interventions. The EEG (128 channels) and EMG (3 bilateral lower limb sensors) signals were collected during the isometric contraction tasks for the paretic and non-paretic lower limbs. Both the cortico-muscular coherence (CMC) and generalized partial directed coherence (GPDC) values were analyzed between eight selected EEG channels in the central primary motor cortex and EMG channels. The results revealed significant clinical improvements. Additionally, rehabilitation training facilitated cortico-muscular interaction of the ipsilesional brain and paretic lower limbs (p=0.004). Moreover, both the descending and ascending cortico-muscular pathways were altered after NMES-training (p=0.001, p < 0.001). Therefore, the results implied potential applications of EEG-EMG in understanding neuromuscular changes during the post-stroke motor rehabilitation process.
... Since most studies have documented CLS in healthy subjects only in particular conditions such as of neuromuscular fatigue [10,11] or in elderly subjects, it has been advanced the hypothesis that CLS may represent a loss of the physiological complexity of the system [12,14]. ...
Article
Different physiological signals could be coupled under specific conditions, in some cases related to pathologies or reductions in system complexity. Cardiac-locomotor synchronization (CLS) has been one of the most investigating coupling. The influence of a cognitive task on walking was investigated in dual-task experiments, but how different cognitive tasks may influence CLS has poorly been investigated. Twenty healthy subjects performed a dual-task walking (coupled with verbal fluency vs calculation) on a treadmill at three different speeds (comfortable speed CS; fast-speed: CS+2km/h; slow-speed: CS-2km/h) while cardiac and walking rhythms were recorded using surface electrodes and a triaxial accelerometer, respectively. According to previous studies, we found a cognitive-motor interference for which cognitive performance was affected by motor exercise, but not vice-versa. We found a CLS at the baseline condition, at fast speed in both cognitive tasks, while at comfortable speed only for the verbal fluency task. In conclusion, the cardiac and locomotor rhythms were not coupled at slow speed and at comfortable speed during subtraction task. Cognitive performances generally increased at faster speed, when cardiac locomotor coupling was stronger.
... The movement patterns and muscle demands of the elliptical training related with walking up and down stairs climbing. Previous study reported that walking on the stairs is a movement that requires greater lower-limb strength and balance than walking on the ground 20 . ...
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Objective: To determine the effects of I-Walk (Robotic-assisted gait device) training compared with over-ground walking training on motor impairments assessed by lower extremity scores, lower extremity angles during walking, and gait performances in patients with chronic stroke. Methods: A single blinded randomized controlled trial was conducted. Twenty four chronic stroke patients were randomly assigned into two groups; experimental group (n=12) and control group (n=12). For gait performances, patients in an experimental group received I-Walk training, while those in a control group received over-ground walking training. The duration of training was 60 min per day, 3 days per week for 8 weeks. The outcome measures included motor impairments assessed by the Fugl-Meyer Assessment of Lower Extremity (FMA-LE) scores, lower extremity angles during walking (hips, knees, ankles), and gait performances (step length, cadence, walking speed, stride length, and step length symmetry ratio). All variables were measured before and after the training period. Results: There was a statistically significant difference in motor impairments assessed by the FMA-LE scores, lower extremity angles during walking on hips and knees, as well as gait performances, including step length, cadence, and walking speed, between the experimental and the control groups (p<0.05). In particular, the statistically significant changes were demonstrated in motor impairments assessed by the FMA-LE scores, lower extremity angles during walking on hips, knees, and ankles, as well as gait performances, including step length, cadence, walking speed, stride length, and step length symmetry ratio, before and after the I-Walk training in the experimental group (p<0.05). Conclusions: The I-Walking training could yield a statistically significant improvement of motor impairments assessed by FMA-LE scores, lower extremity angles during walking, and gait performances in chronic stroke patients. Nonetheless, further studies are recommended to elucidate and ratify the effective outcomes in patients with other stages of stroke, different ranges of lower extremity, and various spatiotemporal parameters.
... During the intervention period, participants were instructed to perform a 20-minute exercise session on the leg training device on five days per week. Cycle training has the advantage that users remain seated, and improvements can be achieved almost entirely without the risk of injury [25,26]. At the beginning of the training, users were asked to cycle in a comfortable, even pace, which served to calculate the initial velocity. ...
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This mixed-methods study aimed to investigate to what extent two-week device-supported cycle training and app-based fall risk assessment are feasible measures for fall prevention in older people living at home (N = 10). A questionnaire assessed participants' motivation, and a fall risk score was calculated pre-and post-intervention. Semi-structured interviews with two experts were conducted retrospectively. The results revealed a high subjective motivation during the training and a slight reduction of the fall risk. Both the training and the assessment are feasible and well-received interventions with potential for technology-supported fall prevention.
... Several studies compared muscular effort during exercise on elliptical trainers and treadmill, although only during lowintensity exercise, i.e., walking (5,7,11,21). However, to our knowledge, no studies have investigated how muscular activation differs when exercising at moderate-to-high submaximal workloads. ...
Article
Eken, MM, Withers, A, Flanagan, K, Burger, J, Bosch, A, and Lamberts, RP. Muscular activation patterns during exercise on the treadmill, stepper, and elliptical trainer. J Strength Cond Res 36(7): 1847-1852, 2022-Because of the low-impact, the stepper and elliptical trainer are popular alternatives to running when runners sustain running-related injuries. Muscular effort is expected to be lower during exercise on the stepper and elliptical trainer compared with running. The aim of this study was to quantify this by comparing muscular effort when exercising at similar moderate-to-high exercise intensities on a treadmill, stepper, and elliptical trainer. Seventeen well-trained runners (V̇o2max: 53.3 ml·min-1·kg-1 [male: n = 9], 44.8 ml·min-1·kg-1 [female: n = 8]; average peak treadmill running speed: 18.7 km·h-1 [male], 16.3 km·h-1 [female]) performed exercise at submaximal levels (60%-70%-80% of peak workload) on the treadmill, stepper, and elliptical trainer. Peak workload was determined during peak exercise tests on separate days. Surface electromyography was recorded from lower extremity muscles. Root-mean-squared (RMS) values were calculated and compared between exercise modalities and submaximal levels. Significance was set at p < 0.05. Root-mean-squared levels of lower extremity muscles were significantly reduced during exercise on the stepper and elliptical trainer compared with treadmill running (p < 0.05, except for quadriceps (p > 0.05). Overall, similar RMS levels were found on stepper and elliptical trainer (p > 0.05), whereas in several cases higher RMS levels were found on the stepper compared with elliptical trainer (p < 0.05). These findings support clinical expectations that exercise on the stepper and elliptical trainer reduces muscular effort up to 60% compared with (treadmill) running, and therefore can be effective training modalities during rehabilitation from running-related injuries by restricting impact on lower extremities.
... The use of elliptical devices to strengthen lower extremity muscles and to improve cardiorespiratory fitness [5][6][7] has increased in popularity amongst the general population and rehabilitation professionals since ellipticals demonstrate an advantage over other modalities of cardiorespiratory training. Certain elliptical models can closely emulate the mechanics of gait without generating the repetitive high-impact plantar forces observed during overground or treadmill walking/running [3,[8][9][10][11][12]. ...
Article
Background Elliptical training may offer advantages over other cardiorespiratory exercises for those requiring podiatric care, since its constant double-limb support diminishes recurring high-impact plantar forces while allowing exercise in a functional, upright posture. Unknown is the impact of distinct elliptical models, that can alter user’s body mechanics, on potential variations in plantar pressure patterns. Purpose To compare plantar pressure variables while exercising on four ellipticals and walking. Methods For this cross-sectional pilot study, plantar pressure data were recorded from ten young adults while exercising on four ellipticals (True, Octane, Life Fitness, SportsArt) and walking overground. One-way repeated measures ANOVA identified differences in heel, arch, and forefoot maximum force (MF), peak pressure (PP), and pressure-time integral (PTI). Results MF was lower under the heel when exercising on all ellipticals compared with walking, with further differences detected between models. PP was lower on all three foot regions when exercising on all ellipticals compared with walking, except Octane under the arch, with differences detected between ellipticals under the heel. PTI was lower under the heel and arch when exercising on some of the ellipticals compared with walking, with differences again detected under the heel between models. Conclusion Plantar pressures were lower when exercising on the ellipticals compared with walking for most variables. Caution is recommended to which elliptical could be incorporated into therapeutic programs given that differences among models were detected under the heel.
... Several studies compared muscular effort during exercise on elliptical trainers and treadmill, although only during lowintensity exercise, i.e., walking (5,7,11,21). However, to our knowledge, no studies have investigated how muscular activation differs when exercising at moderate-to-high submaximal workloads. ...
... 31,32 This may be relevant as there exists an increased attentional demand with standing balance control as well as mobility in individuals with MS. [33][34][35] Additionally, there may have been some degree of transfer from the short bout of cycling to the subsequent task of walking in study participants. While kinematically the movements are quite different, 36 there is evidence of shared neural circuitry between cycling and walking. ...
Article
Background: Current mobility and functional assessments do not capture the subtle changes in balance and gait that may predispose people with multiple sclerosis (MS) to falling. The purpose of this study was to use clinical and instrumented measures to examine the effects of an acute bout of aerobic exercise on balance and gait in individuals with MS. Methods: Ten adults with MS performed 15 minutes of moderate-intensity recumbent cycling or 15 minutes of rest. Exercise and rest visit order was randomized and separated by 1 week. Balance and mobility were assessed before, immediately after, and 2 hours after each test condition. Results: There were no significant differences across measurement periods for Timed 25-Foot Walk test times or Brief Balance Evaluation Systems Test scores. Significant improvements in mean sway radius and sway velocity when standing on foam and in percentage of stance stride time variability were found immediately after exercise compared with immediately after rest. Conclusions: This study lends further evidence that individuals with MS can safely engage in single bouts of aerobic exercise without detrimental short-term effects on function and may actually receive some short-term benefit regarding standing postural sway and gait variability. Future research should examine the dose-dependent relationship of varying types, intensities, or timing of exercise necessary to elicit short-term functional benefit and long-term health outcomes.
... However, other devices may promote different aspects of the target task that may be even more important for transfer, particularly in var- ied rehabilitation applications. 2 In the present study, motorized treadmill shows more sig- nificant results as an adjunct to conventional exercises than stationary cycle in improving the functional status of knee OA patients (table of 3 and 4), but supporting the above study conclusion stationary cycle may give better results in improving the range of movement of the knee joint wherein the range is limited following specific disorders. ...
Research
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Comparative analysis of effects of a stationary cycle and motorized treadmill in improving the functional status of patients with knee osteoarthritis.
... In addition, this exercise showed a reduced rehabilitation protocol retirement rate 34 and can be used to improve muscular coordination more effectively than other exercises. 35 The purpose of this study was to evaluate the effect of adding a tailored aerobic exercise to a conventional 5-week back-school program in deconditioned older subjects with nonspecific LBP. We hypothesized that a tailored aerobic exercise performed on a stationary bike after a general back-school rehabilitation program will reduce pain and improve function in LBP subjects more than the general program alone. ...
Article
Purpose To demonstrate that a tailored, supervised aerobic exercise after a general back-school rehabilitation program will improve outcomes for older patients with low back pain more than the general back-school program alone. Method Twenty-two older patients with chronic nonspecific low back pain were recruited for this study, and they were randomly assigned to a control or an interventional group. Both groups received a standard back-school program, while subjects in the intervention group received an additional 15 minutes of the aerobic training program. The numerical pain rating scale (NPRS) and the Roland-Morris Questionnaire (RMQ) were used to assess pain intensity and disability before and after the 5-week treatment in both the participants' groups. Results Reduction percentage was found significantly increased in the interventional group when compared with the control group for both the NPRS and the RMQ index ( P < .05). Conclusion An adapted aerobic exercise, together with a standard back-school program, was effective in reducing pain symptoms and disability in low back pain subjects rather than the back-school program alone. This should be used as an advice to practitioners while managing low back pain.
... For OW the subjects walked in a straight line for 30 seconds at their self-selected walking speeds inside the laboratory. OW was performed first and gait speed measured during OW was applied to TW for assessment 19) . For TW the subjects walked on the treadmill for 30 seconds at the same speed as that in OW. ...
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[Purpose] Many studies have compared over-ground and treadmill walking, but the biomechanical relationship between the two gait modes is unclear. The aim of this study was to analyze differences in pelvic range of motion and lower limb muscles activity during over-ground and treadmill walking in healthy adults. Moreover, we aimed to analyze differences according to gender. [Subjects and Methods] Twenty-three healthy adults (9 men, 14 women) between 25 and 35 years of age walked at the identical speed for 30 seconds each in two difference gait modes. The pelvic range of motion were obtained by using three-axis accelerometer and lower limb muscle activation data were obtained by using wireless surface EMG. [Results] The results showed that pelvic obliquity showed a greater angular range of women than men, and the pelvic rotation decreased more in treadmill walking than over-ground walking. In the muscles activity, vastus lateralis and tibialis anterior increased, and gastrocnemius medialis decreased in treadmill walking than over-ground walking. [Conclusion] We conclude that treadmill walking reduces the range of motion of the pelvic and increases lower limb muscles activity therefore, when using treadmill for the purpose of rehabilitation at the clinic, consider this difference.
... Training devices are often used to facilitate or augment gait training because the reasons of feasibility, safety or intensity [6]. The therapeutic goals (e.g., strengthen muscles, improve reciprocal muscle activation, or simulate muscle activity patterns during walking) and the functional abilities of the patient influence the choice of a particular training device [8]. ...
... The treadmill walking test was performed the same way as the walking over-ground test. After 5 min of warm up walking on treadmill, the treadmill speed was set according to the speeds calculated during over-ground walking (Damiano et al., 2011;Riley et al., 2007;Stolze et al., 1997). Subjects were asked to walk for 3 min at each speed with 10 min rest between the tests. ...
... The treadmill walking test was performed the same way as the walking over-ground test. After 5 min of warm up walking on treadmill, the treadmill speed was set according to the speeds calculated during over-ground walking (Damiano et al., 2011;Riley et al., 2007;Stolze et al., 1997). Subjects were asked to walk for 3 min at each speed with 10 min rest between the tests. ...
... Smoothness and efficiency of human movements are achieved through the strength and appropriate combination of relevant muscles and delicate adjustments of aspects such as timing of the start and finish of muscle contractions [1][2][3] . This process is widely known by the term coordination 4,5) and represents an important analytical perspective from which physical therapists can assess patients' movements and motions. ...
Article
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[Purpose] The present study aimed to clarify the effects of balance control on the pronation and supination movements of the talocrural joint in community-dwelling elderly women by conducting a frequency analysis of the center of pressure during tandem stance. [Subjects and Methods] The study participants were 18 subjects who maintained tandem stance for 20 s and 11 who had difficulty maintaining tandem stance for 20 s. The frequency-power spectra were computed and classified into three frequency bands. Each power spectral value was divided by the sum of the power spectral values to obtain the %power. [Results] Significant differences in high-frequency band %power value for the center of pressure in both the mediolateral and anteroposterior components were evident between the groups. [Conclusion] A markedly significant difference was observed, particularly in high frequency band %power, depending on balance control. The present findings indicated that elderly participants with diminished balance control had difficulty with rapid adjustment centered on the ankles, suggesting that rapid joint movement involving interlimb coordination centered on the ankles is required to maintain tandem stance.
... The treadmill walking test was performed the same way as the walking over-ground test. After 5 min of warm up walking on treadmill, the treadmill speed was set according to the speeds calculated during over-ground walking (Damiano et al., 2011;Riley et al., 2007;Stolze et al., 1997). Subjects were asked to walk for 3 min at each speed with 10 min rest between the tests. ...
... Suspension systems, where the flexible pelvic support is suspended from overhead supports, allow for postural sway to allow the user to activate righting and balance systems in conjunction with standing and/or stepping. This may enhance motor function progress in children anticipated to progress to more independent walking (Damiano et al, 2011). Broadbent et al (2000 found that the children in their study ranged from requiring 37-81% body-weight support, and a change of 10% was found to have a profound effect. ...
Article
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Background/Aims: Children with cerebral palsy often use gait trainers to augment their mobility. These are supportive walking devices that take the weight of the body through a solid or fabric ‘seat’, stabilise the trunk, and support the pelvis. The purpose of this analysis article is to review the evidence and clinical considerations influencing the selection of gait trainer features for children with cerebral palsy and to describe gait trainer models. Methods: A scoping methodology was used to identify any relevant research and clinical literature supporting the selection of different gait trainer features. An internet search was undertaken to identify a wide range of gait trainers currently available. Factors influencing the selection of different gait trainer features including frame and wheel style and support options are discussed, combining information from manufacturers’ websites, expert opinion and evidence from the literature review. Results: Twenty-seven articles were included in this study. These included nine intervention studies, three articles describing gait trainer development, three expert opinion articles, a survey of therapist opinion and a study comparing physical properties of three different gait trainers. In addition information on device features relevant to gait trainers was drawn from 10 intervention studies of children using hand-held walkers. Twenty-four different gait trainers were identified as being commercially available in the UK, Canada and USA at time of searching. Conclusions: Evidence supporting selection of gait trainer styles and features for children with cerebral palsy is very limited. Further research is needed in all aspects of gait trainer assessment, selection and implementation. Clinical consensus may be helpful in providing guidance in decision-making around prescription and use of gait trainers and features for children with cerebral palsy who have differing clinical profiles and needs.
... We think that a possible explanation of such a lack of effectiveness lies first of all in the different degree of transferability to ambulation functions that can be achieved with different training equipment and methods. Damiano et al. [32] investigated the existence of possible kinematic similarities in four different locomotor tasks, namely overground walking, treadmill walking, elliptical training and stationary cycling. They found that since the treadmill is characterized by the best degree of similarity with level walking, this might be the most appropriate training technique for gait training purposes, while cycling appears to be the less similar, and thus probably less effective. ...
... Compared with the stair gait exercise, which repeatedly stimulates the TA, a person participating in the step climbing exercise does not need ankle dorsiflexion to climb to the next step, so the muscle strength of the TA increases relatively less. Damiano reported that in a cross-exercise of lower limbs, the short moment arm of the bent knee joint is increased with the extension of the knee to support one's weight, which exerts significant stress on the knee extensor to stabilize the knee joint 16) . Lu showed that an increased moment arm requires greater force, and thus, the muscle activity of the knee extensor is greater than in other walking conditions 17) . ...
Article
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[Purpose] The objective of this study was to examine the effect of step climbing exercise on the walking ability of stroke patients. [Subjects and Methods] Among hospitalized stroke patients, 24 were selected based on the study criteria and randomly divided into two groups: an experimental group (12 patients) and a control group (12 patients). The patients in both groups participated in 15-minute exercise sessions three times a week for eight weeks. To analyze the effect of the exercise, muscle strength, the Timed Up and Go test, and step length were measured before and after the exercise. [Results] step climbing exercise improved the muscle strength in the lower limbs of the stroke patients, as well as their Timed Up and Go results and step lengths. [Conclusion] The effects were similar to a stair gait exercise, and thus, step climbing may be more broadly applied to the treatment of stroke patients.
... Also loading is substantially decreased through lower limbs during cycling because of seated support. In cycling all the three joints of lower limb are highly coupled and constrained to move in unison [5]. ...
Article
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Background: The impairments in cerebral palsy can limit a child’s ability to play and exercise at intensities necessary to develop cardio respiratory fitness. Objective: To compare the effects of dynamic cycling, static cycling and conventional exercises in cardiovascular endurance, balance and walking ability in cerebral palsy children. Materials and Method: A total of 30 subjects were recruited in an experimental pre-post-test study design. Subjects were randomly assigned to 3 different treatment groups. The following outcome measures were measured: resting Heart Rate, 3 Minute Walk Test, GMFM-66, and Pediatric Balance Scale. All the three groups received conventional exercises. The experimental group 1 in addition received dynamic cycling protocol and experimental group 2 received static cycling protocol. The outcome was again evaluated at 6 weeks. Results: All the 3 groups showed significant pre to post improvement for the entire outcomes measured but GMFM-66. Results of the studied showed more significant improvement in both the cycling groups compared to the control group; Dynamic cycling group showing better response than static cycling group. Though all the groups showed improvement in GMFM-66, the dynamic cycling group showed better improvement followed by control group. Conclusion: Dynamic cycling incorporated with conventional exercises improves the cardiovascular endurance, balance and functional abilities than conventional exercises only. KEY WORDS: Cerebral Palsy, Dynamic Cycling, Static Cycling, Balance, Exercise, Walking, Endurance, Ability.
... These results may assist in selecting the most appropriate training device for specific patients. 25 Treadmill walking most closely resembled over-ground walking with near overlap, reinforcing its appropriateness for gait training. When comparing over-ground walking versus treadmill versus cycling versus elliptical exercise, cycling showed the largest gait deviation index difference from over-ground walking, with the elliptical closer but still a significant distance from all 3. Cycling showed greater hip reciprocation. ...
Article
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Background: Specific weightbearing instructions continue to be a part of routine orthopaedic clinical practice on an injured or postoperative extremity. Researchers and clinicians have struggled to define the best weightbearing strategies to maximize clinical outcomes. Purpose: To investigate the average percentage body weight (APBW) values, weightbearing distribution percentages (WBDP), and cadence values on the entire foot, hindfoot, and forefoot during changing resistance and incline on an elliptical trainer, as well as to suggest clinical implications. Study Design: Descriptive laboratory study. Methods: An original research study was performed consisting of 30 asymptomatic subjects (mean age, 29.54 ± 12.64 years; range, 21-69 years). The protocol included 3 consecutive tests of changing resistance and incline within a speed range of 70 to 95 steps/min. The SmartStep weightbearing gait analysis system was utilized to measure the values. Results: The APBW values for the entire foot ranged between 70% and 81%, the hindfoot values were between 27% and 57%, and the forefoot values between 42% and 70%. With regard to WBDP, the forefoot remained planted on the pedal (stance phase) 2 to 3 times more as compared with the hindfoot raise in the swing phase. Conclusion: The study findings highlight the fact that elliptical training significantly reduces weightbearing in the hindfoot, forefoot, and entire foot even at higher levels of resistance and incline. Clinical Relevance: Weightbearing on the hindfoot consistently displayed the lowest weightbearing values. Orthopaedic surgeons, now equipped with accurate weightbearing data, may recommend using the elliptical trainer as a weightbearing exercise early on following certain bony or soft tissue pathologies and lower limb surgical procedures.
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The objective of this article was to compare different cardiovascular training machines and their effects on the body, as well as to determine their suitability for people with low intensity or high intensity training needs. A total of 8 physically active and healthy male subjects (mean ± standard deviation; age: 28.45 ± 1.75 years; height: 1.84 ± 0.07 m; body weight 76.42 ± 8.62 kg; body mass index: 25.5 ± 2.6) were evaluated through of an incremental exercise test at different intensities on two different machines: Elliptical Domyos 680 (BED) and Deconstruct Elliptical 331-EF (DEC). To compare both machines against the two mentioned training needs, two different protocols were carried out: Low Intensity Protocol (LIP) and High Intensity Protocol (HIP). In addition, a thermographic analysis was carried out in order to determine the temperature differences reached in the musculature. No significant differences were found in HR and EE (p < .05) between the two machines. However, a greater and more progressive activation of the muscles of the upper extremities was observed in the DEC machine. In the HIP, HR and EE were measured, obtaining significant differences (p < .05) higher in the DEC machine. Therefore, in our comparison, the Deconstruct Elliptical machine produced more appropriate results for both low and high intensity training compared to the Elliptical machine. These results and the novel nature of the Deconstruct Elliptical raise the need for further studies to better understand this machine.
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Background and Aim: The purpose of this study was to evaluate the overall lower limb muscular activity pattern during treadmill walking compared to on the ground walking during stance phase. Materials and Methods: The study was conducted on 25 healthy female students (19 to 25 years). Surface electromyography was recorded from lateral gastrocnemis, lateral and medial hamstrings, medial and lateral vasti and Gluteus medius muscles. Subjects walked on the ground (along a 6-meter track) at 3 different speeds (slow, fast, and comfortable) and walked on treadmill with matched speeds. The overall pattern of muscle activity including muscle similarity index and magnitude were computed and compared between on the ground and treadmill walking from the heel strike of dominant foot until the heel strike of opposite foot. Results: The main effect of walking conditions (P<0.001) and speed(P<0.001) as well as the interaction effect of walking speed and conditions (P<0.001) on magnitude of muscle activity were significant. The main effect of walking conditions and speed as well as the interaction effect of condition and walking speed were not significant for similarity index. Conclusion: The pattern of muscular activity during walking on treadmil and on the ground was similar but walking on treadmill induced higher muscular activity in the lower limb musculature compared to on the ground walking. The results of this study are useful in assessment and planning of using treadmill in different groups of people considering the induced muscle fatigue and the risk of musculoskeletal injuries. J Rehab Med. 2015; 3(4): 73-80. over ground walking at different speeds Comparaison of lower limb muscular activity pattern during treadmill and over ground walking at different speeds.
Article
Background: There is no consensus about which training methods will give better early outcomes after total hip arthroplasty (THA). Objective: To investigate the short-term effects of cross trainer exercise on physical function and walking ability following THA. Methods: Fifty patients who underwent THA were randomly allocated into two groups. The intervention program was started 3 days after surgery. The main physical function results were pain, hip range of motion, knee extensor strength, single-leg stance time, and walking performance test. In addition, the number of days of requiring to walk and the length of hospital stay were recorded. Results: In the comparison between groups at discharge, the patients in the cross trainer group had significantly less hip pain while walking, improvement in knee extensor strength, increased single-leg stance time, as well as increased walking speed and stride length at discharge. The number of days required to walk and length of stay were also significantly lower in the intervention group. Conclusions: Conclusions: Cross trainer exercise commencing 3 days postoperatively improves physical function and walking ability after THA.
Article
The purpose of this research was to compare children’s lower extremity muscle activity and kinematics while walking at fast pace and training at fast speeds with and without motor-assistance on a pediatric-modified motor-assisted elliptical. Twenty-one children without disabilities were recruited and fifteen completed all three training conditions at self-selected fast pace. Repeated-measures ANOVAs identified muscle demand (peak, mean, duration) differences across device conditions and fast walking. Root mean square error compared overall kinematic profiles and statistical parametric mapping identified kinematic differences between conditions. Motor-assisted training reduced lower extremity muscle demands compared to training without the motor’s assistance (16 of 21 comparisons) and to fast walking (all but one comparison). Training without the motor’s assistance required less muscle effort than fast walking (16 of 21 comparisons). Kinematic differences between device conditions and fast walking were greater distally (thigh, knee, ankle) than proximally (trunk, pelvis, hip). In summary, transitioning from training with to without the motor’s assistance promoted progressively greater activity across the lower extremity muscles studied, with sagittal plane kinematic changes most apparent at the distal joints. Our findings highlight how motor-assistance can be manipulated to customize physiologic challenges to lower extremity muscles prior to fast overground walking.
Chapter
Gait analysis is used to monitor and diagnose changes in human locomotion parameters. It can be applied at various stages of training as well as in rehabilitation. In the light of current literature, it seems reasonable to apply gait analysis in patients with malalignment as a complementary method for overall assessment. Proper interpretation of the obtained results is aimed at early detection of existing biomechanical disorders, monitoring the treatment process and determining the safe moment of return to physical activity.
Article
Knee injuries at risk of post-traumatic knee osteoarthritis (PTOA) and knee osteoarthritis (OA) are closely associated with knee transverse plane and/or frontal plane instability and excessive loading. However, most existing training and rehabilitation devices involve mainly movements in the sagittal plane. An offaxis elliptical training system was developed to train and evaluate neuromuscular control about the off-axes (knee varus/valgus and tibial rotation) as well as the main flexion/extension axis (sagittal movements). Effects of the offaxis elliptical training systemin improving either transverse or frontal neuromuscular control depending on subjects’ need (Pivoting group, Sliding group) were demonstrated through 6 week subject-specific neuromuscular training on subjects with knee injuries at risk of PTOA or medial knee osteoarthritis. The combined pivoting and sliding group, named as offxis group demonstrated significant reduction in pivoting instability, minimum pivoting angle, and sliding instability. The pivoting group showed more reduction in pivoting instability, maximum and minimum pivoting angle than the sliding group. On the other hand, the sliding group showed more reduction in sliding instability, maximum and minimum sliding distance than the pivoting group. Based on these findings, the offaxis elliptical trainer system can potentially be used as a therapeutic and research tool to train human subjects for plane-dependent improvements for their neuromuscular control during functional weight-bearing stepping movements.
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The aim of this study was to analyse the effects of elliptical training on muscular endurance and speed among soccer players. Elliptical training was selected as independent variable and the following dependent variables were muscular endurance and speed. Twenty men soccer players were selected from Nellai youth and Nehru youth football clubs, Tirunelveli were randomly selected as subjects, they were divided into two groups, elliptical training group (n=10), and control group (n=10). The scientific method was used to assess the dependent variables were bent knee sit-ups and 30m sprint tests, and it were recorded as a pre and post-test. The training consists of eight weeks and three days in a week, the experimental group underwent their specific training and control group did not participated any special training on bar with experimental group. The collected data were analysed by using paired sample't' test and analysis of covariance to find the significant difference among the experimental and control groups. The results were tested at .05 level of confidence. It was concluded that there were significant improvement on muscular endurance and speed due to the effects of elliptical training when compared to the control group among the soccer players.
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We investigated differences in knee kinetic variables (external knee adduction, flexion, internal rotation moments, and impulses) between patients with knee osteoarthritis (KOA) and healthy controls during stepping on a custom elliptical trainer; and searched knee kinetic variable candidates for real-time biofeedback and for complementing diagnosis/evaluation on the elliptical trainer based on the knee kinetic variables associations with the knee injury and osteoarthritis outcome score (KOOS). Furthermore, we explored potential gait re-training strategies on the elliptical trainer by investigating the knee kinetic variables’ associations with 3-D ankle angles. The knee kinetic variables and ankle angles were determined in real-time in a patient group of 10 patients with KOA and an age-and sex-matched control group of 10 healthy subjects. The mean peak external knee adduction moment of the patient group was 47% higher than that of the control group. The KOOS-Sports and Recreational Activities and KOOS-Pain scores were found to be significantly associated with the knee kinetic variables. All the ankle angles were associated with the knee kinetic variables. The findings support the use of the knee kinetic variables on the elliptical trainer to complement KOA diagnosis quantitatively and provide potential real-time KOA gait re-training strategies/guides.
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BACKGROUND: The aim of this study is to evaluate heart rate and muscle activity and exercise intensity in trained and untrained individuals during exercise in four different positions on Cardio-wave tM , a device that works simultaneously on three axes with a “sliding” movement of the lower limbs. METHODS: Twelve subjects were enrolled: 6 trained and 6 untrained, all performed a 12 minute fixed intensity protocol on the Cardio-wave tM . Heart rate and surface electromyography activity of the rectus femoris, vastus medialis and the biceps femorishad been recorded in four different positions. RESULTS: Hearth rate ranged between 79 to 100% HR max , with no difference between groups. A main effect (P<0.05) was found between positions. For surface electromyography activity data, a significant difference (P<0.05) emerged among Groups, Muscles and the interaction Groups x Muscles. Post hoc analysis showed that untrained subjects had significantly higher values and standard deviations only for rectus femoris(221±365%) and vastus medialis (196 ±309%) activation when compared to trained (rectusfemoris: 0±166%; vastus medialis: 64 ±159%). CONCLUSIONS: These finding suggest that some positions on Cardio-wave tM are more stressed as muscle soreness perceived during the work than other and HR monitoring of exercises on the CW device might not be sufficient to evaluate training status and work load.
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The maximum oxygen uptake (VO2max), determined from graded maximal or submaximal exercise tests, is used to classify the cardiorespiratory fitness level of individuals. The purpose of this study was to examine the validity and reliability of the YMCA submaximal exercise test protocol performed on a newly-designed rectilinear stepping ergometer (RSE) that used up and down reciprocating vertical motion in place of conventional circular motion and giving precise measurement of workload, to determine VO2max in young healthy male adults. Thirty-two young healthy male adults (32 males; age range: 20 - 35 years; height: 1.75 ± 0.05 m; weight: 67.5 ± 8.6 kg) firstly participated in a maximal-effort graded exercise test using a cycle ergometer (CE) to directly obtain measured VO2max. Subjects then completed the progressive multistage test on the RSE beginning at 50W and including additional stages of 70, 90, 110, 130, and 150W, and the RSE YMCA submaximal test consisting of a workload increase every 3 minutes until the termination criterion was reached. A metabolic equation was derived from the RSE multistage exercise test to predict oxygen consumption (VO2) from power output (W) during the submaximal exercise test (VO2(mL ∙ min⁻¹) = 12.4 x W(watts) + 3.5 mL ∙ kg⁻¹ ∙ min⁻¹ × M + 160mL ∙ min⁻¹,R² = 0.91, standard error of the estimate (SEE) = 134.8mL ∙ min⁻¹). A high correlation was observed between the RSE YMCA estimated VO2max and the CE measured VO2max (r=0.87). The mean difference between estimated and measured VO2max was 2.5 mL ∙ kg⁻¹ ∙ min⁻¹, with an SEE of 3.55 mL ∙ kg⁻¹ ∙ min⁻¹. The data suggest that the RSE YMCA submaximal exercise test is valid for predicting VO2max in young healthy male adults. The findings show that the rectilinear stepping exercise is an effective submaximal exercise for predicting VO2max. The newly-designed RSE may be potentially further developed as an alternative ergometer for assessing cardiorespiratory fitness and the promotion of personalized health interventions for health care professionals.
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Background: Locomotor training using treadmills or robotic devices is commonly utilized to improve gait in cerebral palsy (CP); however, effects are inconsistent and fail to exceed those of equally intense alternatives. Possible limitations of existing devices include fixed nonvariable rhythm and too much limb or body weight assistance. Objective: To quantify and compare effectiveness of a motor-assisted cycle and a novel alternative, an elliptical, in CP to improve interlimb reciprocal coordination through intensive speed-focused leg training. Methods: A total of 27 children with bilateral CP, 5 to 17 years old, were randomized to 12 weeks of 20 minutes, 5 days per week home-based training (elliptical = 14; cycle = 13) at a minimum of 40 revolutions per minute, with resistance added when speed target was achieved. Primary outcomes were self-selected and fastest voluntary cadence on the devices and gait speed. Secondary outcomes included knee muscle strength, and selective control and functional mobility measures. Results: Cadence on trained but not nontrained devices increased, demonstrating task specificity of training and increased exercise capability. Mean gait speed did not increase in either group, nor did parent-reported functional mobility. Knee extensor strength increased in both. An interaction between group and time was seen in selective control with scores slightly increasing for the elliptical and decreasing for the cycle, possibly related to tighter limb coupling with cycling. Conclusions: Task-specific effects were similarly positive across groups, but no transfer was seen to gait or function. Training dose was low (≤20 hours) compared with intensive upper-limb training recommendations and may be insufficient to produce appreciable clinical change.
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Context: Motorized treadmills (MT) present an altered motor task compared to overground (OG) locomotion in that MT belt surfaces are motor-driven, whereas individuals walking/running OG must propel themselves. A possible solution may lie with novel non-motorized treadmill (NMT) devices as the belt surface is propelled by the user. Objective: The purpose of this study was to compare gait performance during both MT and NMT locomotion to OG. Design: Crossover study. Setting: A university research laboratory. Patients: Twenty healthy adults (10 women) participated in the study. Intervention: Each participant performed self-selected walking and running OG, and on both an MT and NMT. Main outcome measure: Shoulder, trunk and lower-extremity kinematics were analyzed for each treadmill condition and compared to OG. Results: The analyses demonstrated that there were no differences between MT and OG gait kinematics during either walking or running. However, NMT gait showed increased hip, knee and ankle flexion in late swing and early stance compared to OG during both walking and running. For example, during walking the NMT elicited hip, knee and ankle F/E angles of 34.7 deg, 8.0 deg and 3.6 deg at foot strike compared to 24.8 deg, -3.1 deg and -5.8 deg in the OG condition (P < 0.05). There was also a significant reduction in trunk F/E RoM during running compared to OG (7.7 deg in NMT vs. 9.8 deg in OG). Conclusions: These differences may have implications for both training and rehabilitation on an NMT. Future studies should consider the influence of NMT familiarization on gait performance, and should emphasize the assessment of neuromuscular performance.
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Purpose: The purpose of this study is to quantitatively assess the effect of 6 months of supervised adapted physical activity (APA i.e. physical activity designed for people with special needs) on spatio-temporal and kinematic parameters of gait in persons with Multiple Sclerosis (pwMS). Methods: Twenty-two pwMS with Expanded Disability Status Scale scores ranging from 1.5 to 5.5 were randomly assigned either to the intervention group (APA, n = 11) or the control group (CG, n = 11). The former underwent 6 months of APA consisting of 3 weekly 60-min sessions of aerobic and strength training, while CG participants were engaged in no structured PA program. Gait patterns were analyzed before and after the training using three-dimensional gait analysis by calculating spatio-temporal parameters and concise indexes of gait kinematics (Gait Profile Score – GPS and Gait Variable Score – GVS) as well as dynamic Range of Motion (ROM) of hip, knee, and ankle joints. Results: The training originated significant improvements in stride length, gait speed and cadence in the APA group, while GPS and GVS scores remained practically unchanged. A trend of improvement was also observed as regard the dynamic ROM of hip, knee, and ankle joints. No significant changes were observed in the CG for any of the parameters considered. Conclusions: The quantitative analysis of gait supplied mixed evidence about the actual impact of 6 months of APA on pwMS. Although some improvements have been observed, the substantial constancy of kinematic patterns of gait suggests that the full transferability of the administered training on the ambulation function may require more specific exercises.
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Damage to motor tracts in the periventricular white matter is a primary etiology in spastic diplegic cerebral palsy (CP). These tracts are responsible for the production of selective voluntary motor control (SVMC). Lower extremity motor control has been suggested as being an important predictor of improvement following interventions. While there are multiple impairments in spastic CP, the inability to perform purposeful voluntary movement is a critical factor in determining functional ability that merits investigation. The purpose of this study was to examine the relationship between SVMC ability and hip and knee coordination during the swing phase of gait in participants with spastic CP. Gait analysis and SVMC assessments were conducted for 15 participants with CP. Relative phase analysis was used to calculate the minimum relative phase (MRP) angle during swing; a measurement of interjoint coordination between the hip and the knee. SVMC ability was measured using the Selective Control Assessment of the Lower Extremity (SCALE) tool. Significant correlations were found between SCALE scores and both MRP values (p<0.0001) and duration of out-of-phase movement (p<0.005) during swing. These findings supported our hypothesis that SVMC ability is related to a patient's ability to move in an uncoupled pattern during the swing phase of gait (i.e., extending the knee while flexing the hip). An understanding of influence of SVMC on swing phase gait mechanics may help establish appropriate goals for interventions, in particular hamstring lengthenings.
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Empirical observations of subjects with an equinus gait have suggested that there is coupled motion between the ankle and knee such that, during single-limb stance, the ankle moves into equinus as the knee extends. Since the gastrocnemius-soleus muscle-tendon unit spans both joints, we hypothesized that this muscle-tendon unit may be responsible for the coupling and that lengthening of the gastrocnemius-soleus muscle alone would result in greater ankle dorsiflexion as well as greater knee extension in single-limb stance, effectively uncoupling these joints. The concept that gastrocnemius-soleus lengthening may promote knee extension is counter to the popular notion that crouch gait may result if the hamstrings are not lengthened concomitantly. A retrospective review identified thirty-four subjects with specific kinematic characteristics of equinus gait, and their gait was compared with that of normal children. Of the thirty-four subjects, eleven (twenty-two limbs) subsequently underwent isolated midcalf lengthening of the gastrocnemius and soleus muscles with use of a recession technique. Gait analysis including joint kinematics and joint kinetics, electromyography, and physical examination were performed to test the hypothesis. We found that, unlike the normal subjects, the patients with an equinus gait pattern had a positive correlation (r = 0.7) between ankle and knee motion during single-limb stance. As hypothesized, ankle plantar flexion occurred while the knee moved into extension during single-limb stance. Calculations of the lengths of the gastrocnemius-soleus muscle-tendon units showed them to be short throughout the gait cycle (p < 0.0001). After gastrocnemius-soleus recession, peak ankle dorsiflexion (p < 0.001) and peak ankle power (p < 0.001) shifted to occur later in stance than they did in the preoperative gait cycle. Furthermore, the magnitude of peak power increased (p < 0.001) in late stance despite the added length of the gastrocnemius-soleus muscle-tendon unit. The electromyographic amplitude of the gastrocnemius-soleus was reduced during loading (p < 0.02), and this finding, together with the kinetic changes, suggested that muscle tension was reduced. Changes at the knee were less pronounced but included greater knee extension at foot contact (p < 0.01). No increase in the knee flexion angle or extension moment occurred in midstance after the surgery. Patients with an equinus gait pattern function with a shortened gastrocnemius-soleus muscle-tendon unit, and this results in coupled motion between the ankle and knee during single-limb stance. Lengthening, with use of a recession technique, shifted ankle power generation and dorsiflexion to a later time in stance with no tendency to increase midstance knee flexion. Knee extension did increase at foot contact, but excessive midstance knee flexion persisted and was likely due to concomitant contracture of the hamstrings.
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The authors describe the rationale and methodology for the first prospective, multicenter, randomized clinical trial (RCT) of a task-oriented walking intervention for subjects during early rehabilitation for an acute traumatic spinal cord injury (SCI). The experimental strategy, body weight-supported treadmill training (BWSTT), allows physical therapists to systematically train patients to walk on a treadmill at increasing speeds typical of community ambulation with increasing weight hearing. The therapists provide verbal and tactile cues to facilitate the kinematic, kinetic, and temporal features of walking. Subjects were randomly assigned to a conventional therapy program for mobility versus the same intensity and duration of a combination of BWSTT and over-ground locomotor retraining. Subjects had an incomplete SCI (American Spinal Injury Association grades B, C, and D) from C-4 to T-10 (upper motoneuron group) or from T-11 to L-3 (lower motoneuron group). Within 8 weeks of a SCI, 146 subjects were entered for 12 weeks of intervention. The 2 single-blinded primary outcome measures are the level of independence for ambulation and, for those who are able to walk, the maximal speed for walking 50 feet, tested 6 and 12 months after randomization. The trial's methodology offers a model for the feasibility of translating neuroscientific experiments into a RCT to develop evidence-based rehabilitation practices.
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Gait evaluation protocols using instrumented treadmills will be increasingly used in the near future. For this reason, it must be shown that using instrumented treadmills will produce measures of the ground reaction force adequate for inverse dynamic analysis, and differences between treadmill and overground gait must be well characterized. Overground walking kinetics were estimated with the subjects walking at their self-selected comfortable walking speed. For the treadmill gait trials, the subjects walked on two treadmills, such that heel-strike occurred on the forward treadmill and toe-off occurred on the trailing treadmill. The treadmill was set to the average overground walking speed. Overground and treadmill data were evaluated using Vicon Plug-in Gait. The differences between the maxima and minima of kinematic and kinetic parameters for overground and treadmill gait were evaluated. The kinematics of treadmill and overground gait were very similar. Twelve of 22 kinematic parameter maxima were statistically significantly different (p<0.05), but the magnitude of the difference was generally less than 2 degrees . All GRF maxima were found to be statistically significantly smaller for treadmill versus overground gait (p<0.05) as were 15 of 18 moment, and 3 of 6 power maxima. However, the magnitude of the differences was comparable to the variability in normal gait parameters. The sagittal plane ankle moments were not statistically different for treadmill and overground gait. We have shown that treadmill gait is qualitatively and quantitatively similar to overground gait. Differences in kinematic and kinetic parameters can be detected in matched comparisons, particularly in the case of kinetic parameters. However, the magnitudes of these differences are all within the range of repeatability of measured kinematic parameters. Thus, the mechanics of treadmill and overground gait are very similar. Having demonstrated the essential equivalence of treadmill and overground gait, it is now possible for clinical movement analysis to take advantage of treadmill-based protocols.
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This paper emphasizes several characteristics of the neural control of locomotion that provide opportunities for developing strategies to maximize the recovery of postural and locomotor functions after a spinal cord injury (SCI). The major points of this paper are: (i) the circuitry that controls standing and stepping is extremely malleable and reflects a continuously varying combination of neurons that are activated when executing stereotypical movements; (ii) the connectivity between neurons is more accurately perceived as a functional rather than as an anatomical phenomenon; (iii) the functional connectivity that controls standing and stepping reflects the physiological state of a given assembly of synapses, where the probability of these synaptic events is not deterministic; (iv) rather, this probability can be modulated by other factors such as pharmacological agents, epidural stimulation and/or motor training; (v) the variability observed in the kinematics of consecutive steps reflects a fundamental feature of the neural control system and (vi) machine-learning theories elucidate the need to accommodate variability in developing strategies designed to enhance motor performance by motor training using robotic devices after an SCI.
Article
We studied the amount of time required for treadmill familiarisation in older people and also whether familiarised treadmill walking could be generalised to overground walking. Sixteen healthy volunteers over 65 years of age walked on a level overground walkway and on a treadmill at the same speed for up to 15 min. A motion measurement system was used to measure the sagittal-plane kinematics of the knee and cadence during overground walking and after 0, 2, 4, 6, 8, 10, 12 and 14 min of treadmill walking. Older adults had not familiarised to the treadmill within 15 min as many participants continued to hold the treadmill's handrails and as reliability and absolute difference scores were still changing. Participants were most familiarised after 14 min on the treadmill. Furthermore, treadmill walking after 14 min was not closely related to overground walking in older adults, with measures on the treadmill only being able to predict knee angles during overground to within 8.0 degrees , or cadence to within 16.6 steps/min with 95% confidence. Treadmill walking in older adults after a single 15-min training session could not be generalised to overground walking.
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People with physical disabilities often face barriers to regaining walking ability and fitness after discharge from rehabilitation. Physical therapists are uniquely positioned to teach clients the knowledge and skills needed to exercise on functionally relevant equipment available in the community, such as elliptical trainers. However, therapeutic use is hindered by a lack of empirical information. The purpose of this study was to examine joint kinematics and muscle activation recorded during walking and elliptical training to provide evidence-based data to guide clinical decision making. This was a prospective, controlled laboratory study using a repeated-measures design. Twenty adults free from impairments that might hinder gait participated. After familiarization procedures, subjects walked and trained on 4 elliptical devices while kinematic, electromyographic (EMG), and stride characteristic data were recorded. Movement similarities between elliptical training and walking were supported by the documentation of relatively high coefficients of multiple correlation for the hip (.85-.89), thigh (.92-.94), knee (.87-.89) and, to a lesser extent, the ankle (.57-.71). Significantly greater flexion was documented at the trunk, pelvis, hip, and knee during elliptical training than during walking. One of the elliptical trainers most closely simulated sagittal-plane walking kinematics, as determined from an assessment of key variables. During elliptical training, gluteus maximus and vastus lateralis muscle activation were increased; medial hamstring, gastrocnemius, soleus, and tibialis anterior muscle activation were decreased; and gluteus medius and lateral hamstring muscle activation were relatively unchanged compared with muscle activation of those muscles in walking. On the basis of EMG findings, no elliptical trainer clearly emerged as the best for simulating gait. To date, only 4 elliptical trainers have been studied, and the contributions of the upper extremities to movement have not been quantified. Although one of the elliptical trainers best simulated sagittal-plane walking kinematics, EMG analysis failed to identify one clearly superior device. This research provides evidence-based data to help guide clinical decision making related to the use of elliptical trainers across the health care continuum and into the community.
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Given the extensive literature on body weight-supported treadmill training (BWSTT) in adult rehabilitation, a systematic review was undertaken to explore the strength, quality, and conclusiveness of evidence supporting use of treadmill training and body weight support in those with pediatric motor disabilities. A secondary goal was to ascertain whether protocol guidelines for BWSTT are available to guide pediatric physical therapy practice. The database search included MEDLINE, EMBASE, CINAHL Plus, PEDro, Cochrane Library databases, and ERIC from January 1, 1980 to May 31, 2008 for articles that included treadmill training and body weight support for individuals under 21 years of age, with or at risk for a motor disability. We identified 277 unique articles from which 29 met all inclusion criteria. Efficacy of treadmill training in accelerating walking development in Down syndrome has been well demonstrated. Evidence supporting efficacy or effectiveness of BWSTT in pediatric practice for improving gait impairments and level of activity and participation in those with cerebral palsy, spinal cord injury, and other central nervous system disorders remains insufficient, although many studies noted positive effects. The original evidence demonstrates efficacy of BWSTT in children with Down syndrome, but large-scale controlled trials are needed to support the use of BWSTT in other pediatric subgroups. Increased use of randomized designs, studies with treadmill training-only groups, and dosage studies are needed before practice guidelines can be formulated. Neural changes in response to training warrant exploration, especially given the capacity for change in developing nervous systems.
Article
To identify the degree of difference between treadmill and floor walking, kinematic, electromyographic (EMG), and heart rate measurements were recorded in seven normal female subjects during walking at three speeds on the treadmill and on the floor. During treadmill walking, subjects tended to use a faster cadence and shorter stride length than during floor walking. In addition the displacements of the head, hip, and ankle in the sagittal plane showed statistically significant differences between floor and treadmill walking. Average EMG activity was usually greater on the treadmill than on the floor; however, this difference was only significant for the quadriceps. Heart rate was significantly higher during fast treadmill walking than floor walking. In general, treadmill walking was not found to differ markedly from floor walking in kinematic measurements or EMG patterns.
Article
Eighteen young adult male subjects, who were naive to treadmill walking, were walked for two l0 min periods per week on a motorized treadmill for 12 weeks. The subjects were split into three groups with the six subjects in each group walking at a prescribed speed. The relative speeds chosen were 0.55 (slow), 0.86 (normal) and 1.20 (fast) statures/s. The angular and temporal kinematics of gait were analysed in order to study the habituation process. The results show that there is an initial rapid accommodation each time the subjects mount the treadmill. On the first exposure this was followed by a longer and more gradual habituation, However after five 10 min practice sessions this habituation takes place much more rapidly. The results suggest that where measurements are to be made of gait patterns using motorized treadmills, subjects should be previously habituated in distributed practice sessions for about 1 hour, and then not measured within the first 2min of performance.
Article
We studied the familiarisation time required for reliable sagittal-plane knee kinematics and temporal-distance gait measurements to be obtained from treadmill walking. We also studied whether knee kinematics and temporal-distance gait measurements obtained from familiarised treadmill walking can be generalised to overground walking. Sixteen subjects without pathology walked on a level overground walkway and on a treadmill. A motion measurement system was used to measure sagittal plane knee movements and temporal-distance gait parameters during overground and treadmill walking. Highly reliable knee kinematics and temporal-distance gait measurements [intraclass correlation coefficient (ICC)(2,1)>/=0.93] were found after 6 min of treadmill walking. These measurements, obtained after 6 min of treadmill walking, were highly correlated with and not significantly different to those of overground walking. Reliable measurements that can be generalised to overground walking, can be obtained from the treadmill within a familiarisation time of 6 min.
Article
Objective. To compare overground and treadmill ambulation for possible differences in gait temporal variables and leg joint kinematics. Design. A human subject trial of walking in two conditions. Background. The treadmill is frequently used to simulate overground ambulation; however, the literature shows a wide difference of opinion as to whether the treadmill replicates the overground environment. Methods. A total of 17 uninjured subjects walked overground at their preferred velocity. The treadmill was then set at the average velocity obtained in overground walking. Gait temporal variables and leg joint kinematics were analysed using the three dimensional (3D) Kinemetrix Motion Analysis System. The data were analysed separately for the two gender groups and for the groups combined. Results. In the females, only the maximum hip flexion angle was significantly different in the two conditions with greater flexion occurring on the treadmill. For males, significant differences were noted between the two conditions for cadence and maximum knee flexion angle with greater values in the treadmill walking. When all subjects were compared, significant increases were seen during treadmill walking in hip range of motion, maximum hip flexion joint angle and cadence, while a significant decrease was observed in stance time. Conclusions. Statistically significant differences exist between overground and treadmill walking in healthy subjects for some joint kinematic and temporal variables.
Article
We investigated the correlation between movement patterns, measured by polyelectromyography (PEMG), and clinical motor manifestations in children with cerebral palsy. Subjects included 53 children with spastic cerebral palsy (diplegic [n = 43] and quadriplegic [n = 10] groups) and 18 normal children. All children underwent PEMG assessments, recorded from pairs of flexor/extensor muscles during voluntary movement. We correlated PEMG patterns with clinical motor assessments, including muscle tone, range of motion, and ambulatory and functional capacities in the children with cerebral palsy. Children with cerebral palsy exhibited four distinct PEMG patterns, ranging from partial reciprocal to complete synchrony. Lower PEMG pattern scores were significantly associated with better ambulatory (rho = 0.88, P < 0.01) and functional (rho = 0.78, P < 0.01) capacities. PEMG patterns also had weakly positive relationships with muscle tone (rho > 0.33, P < 0.01) and range of motion of both lower limbs (rho > 0.31, P < 0.01). Most children of spastic diplegia with PEMG patterns II and III had independent ambulatory capacities and mild limitation of functional capacity, whereas most children with pattern of IV and V had no ambulatory abilities and no independent functional capacities (P < 0.01). These findings suggest that PEMG patterns correlate with clinical motor deficits and may allow us to plan treatment strategies based on underlying motor control in cerebral palsy.
Article
Gait patterns vary among stroke patients. This study attempted to discover gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Data were gathered from 35 stroke patients and 15 healthy subjects. Gait performance and motor recovery were assessed 6 mos after stroke. Stroke patients further were divided into poor and good groups. The walking velocity was correlated with Brunnström's stages, and the temporal stride and motion variables of the two groups were compared. Walking velocity was positively correlated with the Brunnström's stages of the proximal lower limb. The poor group displayed slower walking velocity and shorter single-support time compared with the good group. Both groups displayed low maximum excursion of hip extension and ankle plantarflexion during the stance phase and low maximum excursion of hip and knee flexion and ankle dorsiflexion during the swing phase. Moreover, both groups displayed excessive pelvic tilts during the stance and swing phases. However, the poor group displayed different pelvic motion and timing sequences to each peak joint angle from normal subjects and the good group. Peak hip and knee angles of the affected limb during the stance phase occurred almost simultaneously in this group. Selective control of the proximal lower limb may be the main determinant of walking velocity. The compensatory adaptations were similar, except for pelvic motion, in stroke patients with different levels of motor recovery, whereas the poor group walked with synergistic mass patterns and reduced stability.
Article
Background: Treadmill training, with some body weight supported using a harness, is a method of treating walking after stroke. Systematic review is required to assess the cost, effectiveness and acceptance of this treatment. Objectives: To assess the effectiveness of treadmill training and/or body weight support in the treatment of walking after stroke. The primary outcomes investigated were walking speed and walking dependency. Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched 21 March 2003), the Cochrane Central Register of Controlled Trials (Cochrane Library, Issue 1 2003), MEDLINE (1966-March 2003), EMBASE (1980-March 2003), CINAHL (1982-February 2003) and PEDro (last searched 21 March 2003). In addition, we handsearched relevant conference proceedings, screened reference lists and contacted trialists to identify further published and unpublished trials. Selection criteria: Randomised, or quasi-randomised, controlled and cross-over trials of treadmill training and/or body weight support for the treatment of walking after stroke were eligible. Data collection and analysis: Two reviewers independently selected trials and extracted data. Trialists were contacted for additional information. A fixed effects model was used for analysis, but if heterogeneity existed (Chi squared statistic) a random effects model was used. Results were analysed as weighted mean differences (WMD) for continuous variables and relative risk (RR) for dichotomous variables. The main outcome variables were walking speed and dependency. Main results: Eleven trials (458 participants) were included. There were no statistically significant differences between treadmill training, with or without body weight support, and other interventions for walking speed or dependence. There was a small trend toward the effectiveness of treadmill training with body weight support for participants who could walk independently (WMD: 0.24 m/sec, 95% CI: -0.19 to 0.66 for speed; random effects). The one trial which compared treadmill training with and without body weight support showed benefit at the end of follow-up (mean difference: 0.22 m/sec, 95% CI: 0.05 to 0.39). Adverse events occurred slightly more frequently in participants receiving treadmill training, although statistically there were no differences. Reviewer's conclusions: Overall, no statistically significant effect of treadmill training and body weight support was detected. However, among people who could walk independently, treadmill training with body weight support appeared to be more effective than other interventions at improving walking speed, but this conclusion was not robust.
Article
To determine the joint loading during elliptical exercise (EE) by a detailed three-dimensional dynamic analysis, and to compare the results with those during level walking. Fifteen male adults performed level walking and EE while 3D kinematic data, right pedal reaction forces (PRF), and ground reaction forces (GRF) were measured. Pedal rate (cadence) and step length during EE without workload were set according to those measured during level walking for each subject. The motion of the body's center of mass, lower-limb-joint angles and moments were obtained. Pedal rates and step lengths were 52.20 rpm (SD=2.34) and 50.56 cm (SD=2.14), respectively. During early stance the vertical PRF was smaller than the GRF, and the medial and posterior shear components were greater. PRF also occurred during swing. Loading rates around heelstrike during EE were all smaller than those during walking. During EE, the peak flexion angles of the hip, knee and ankle were greater. Peak hip flexor and knee extensor moments were also greater, whereas peak ankle plantarflexor moments and all abductor moments were smaller. Different lower-limb kinematics and kinetics were found between EE and level walking. Smaller vertical PRF and loading rates during EE were achieved at the expense of greater hip flexor and knee extensor moments. Use of the elliptical trainer for athletic and rehabilitative training would have to consider users' joint function and muscle strength, especially at the knee, to avoid injuries.
Article
The goal of this study was to compare treadmill walking with overground walking in healthy subjects with no known gait disorders. Nineteen subjects were tested, where each subject walked on a split-belt instrumented treadmill as well as over a smooth, flat surface. Comparisons between walking conditions were made for temporal gait parameters such as step length and cadence, leg kinematics, joint moments and powers, and muscle activity. Overall, very few differences were found in temporal gait parameters or leg kinematics between treadmill and overground walking. Conversely, sagittal plane joint moments were found to be quite different, where during treadmill walking trials, subjects demonstrated less dorsiflexor moments, less knee extensor moments, and greater hip extensor moments. Joint powers in the sagittal plane were found to be similar at the ankle but quite different at the knee and hip joints. Differences in muscle activity were observed between the two walking modalities, particularly in the tibialis anterior throughout stance, and in the hamstrings, vastus medialis and adductor longus during swing. While differences were observed in muscle activation patterns, joint moments and joint powers between the two walking modalities, the overall patterns in these behaviors were quite similar. From a therapeutic perspective, this suggests that training individuals with neurological injuries on a treadmill appears to be justified.
Article
This article describes a new multivariate measure of overall gait pathology called the Gait Deviation Index (GDI). The first step in developing the GDI was to use kinematic data from a large number of walking strides to derive a set of mutually independent joint rotation patterns that efficiently describe gait. These patterns are called gait features. Linear combinations of the first 15 gait features produced a 98% faithful reconstruction of both the data from which they were derived and 1000 validation strides not used in the derivation. The GDI was then defined as a scaled distance between the 15 gait feature scores for a subject and the average of the same 15 gait feature scores for a control group of typically developing (TD) children. Concurrent and face validity data for the GDI are presented through comparisons with the Gillette Gait Index (GGI), Gillette Functional Assessment Questionnaire Walking Scale (FAQ), and topographic classifications within the diagnosis of Cerebral Palsy (CP). The GDI and GGI are strongly correlated (r(2)=0.56). The GDI scales with FAQ level, distinguishes levels from one another, and is normally distributed across FAQ levels six to ten and among TD children. The GDI also scales with respect to clinical involvement based on topographic CP classification in Hemiplegia Types I-IV, Diplegia, Triplegia and Quadriplegia. The GDI offers an alternative to the GGI as a comprehensive quantitative gait pathology index, and can be readily computed using the electronic addendum provided with this article.