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Parameters that remain consistent independent of pausing before gait-initiation during normal rise-to-walk behaviour delineated by sit-to-walk and sit-to-stand-and-walk.

ABSTRACT: BACKGROUND:Rising-to-walk is an everyday transitional movement task rarely employed in gait rehabilitation. Sit-to-walk (STW) and sit-to-stand-and-walk (STSW), where a pause separates sit-to-stand and gait-initiation (GI) represent extremes of rising-to-walk behaviour. Delayed GI can indicate pathological impairment but is also observed in healthy individuals. We hypothesise that healthy subjects express consistent biomechanical parameters, among others that differ, during successful rising-to-walk task performance regardless of behaviour. This study therefore sought to identify if any parameters are consistent between STW and STSW in health because they represent normal rise-to-walk performance independent of pause, and also because they represent candidate parameters sensitive enough to monitor change in pathology. METHODS:Ten healthy volunteers performed 5 trials of STW and STSW. Event timing, ground-reaction-forces (GRFs), whole-body-centre-of-mass (BCoM) displacement, and centre-of-pressure (CoP) to extrapolated BCoM (xCoM) distance (indicator of positional stability) up to the 3rd step were compared between-tasks with paired t-tests. For consistent parameters; agreement between-tasks was assessed using Bland-Altman analyses and minimal-detectable-change (MDC) calculations. RESULTS:Mean vertical GRFs, peak forward momentum and fluidity during rising; CoP-xCoM separation at seat-off, upright, GI-onset, and steps1-2; and forward BCoM velocity were all significantly greater in STW. In contrast, peak BCoM vertical momentum, flexion-momentum time, and 3rd step stability were consistent between tasks and yielded acceptable reliability. CONCLUSION:STW is a more challenging task due to the merging of rising with GI reflected by greater CoP-xCoM separation compared to STSW indicative of more positional instability. However, BCoM vertical momentum, flexion-momentum time, and step3 stability remained consistent in healthy individuals and are therefore candidates with which to monitor change in gait rehabilitation following pathology. Future studies should impose typical pause-durations observed in pathology upon healthy subjects to determine if the parameters we have identified remain consistent.

SUBMITTER: Jones GD

PROVIDER: S-EPMC6177161 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Parameters that remain consistent independent of pausing before gait-initiation during normal rise-to-walk behaviour delineated by sit-to-walk and sit-to-stand-and-walk.

Jones Gareth D GD James Darren C DC Thacker Michael M Green David A DA

PloS one 20181009 10

<h4>Background</h4>Rising-to-walk is an everyday transitional movement task rarely employed in gait rehabilitation. Sit-to-walk (STW) and sit-to-stand-and-walk (STSW), where a pause separates sit-to-stand and gait-initiation (GI) represent extremes of rising-to-walk behaviour. Delayed GI can indicate pathological impairment but is also observed in healthy individuals. We hypothesise that healthy subjects express consistent biomechanical parameters, among others that differ, during successful ris ...[more]

PMID: 30300414

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Project description:BACKGROUND:Gait-initiation onset (GI-onset) during sit-to-walk (STW) is commonly defined by mediolateral ground-reaction-force (xGRF) rising and crossing a threshold pre-determined from sit-to-stand peak xGRF. However, after stroke this method [xGRFthresh] lacks validity due to impaired STW performance. Instead, methodologies based upon instance of swing-limb maximum-vertical-GRF [vGRFmaxSWING], maximum-xGRF [xGRFmax], and swing-limb heel-off [firstHEELoff] can be applied, although their validity is unclear. Therefore, we determined these methodologies' validity by revealing the shortest transition-time (seat-off-GI-onset), their utility in routinely estimating GI-onset, and whether they exhibited satisfactory intra-subject reliability. METHODS:Twenty community-dwelling stroke (60 (SD 14) years), and twenty-one age-matched healthy volunteers (63 (13) years) performed 5 standardised STW trials with 2 force-plates and optical motion-tracking. Transition-time differences across-methods were assessed using Friedman tests with post-hoc pairwise-comparisons. Within-method single-measure intra-subject reliability was determined using ICC3,1 and standard errors of measurement (SEMs). RESULTS:In the healthy group, median xGRFthresh transition-time was significantly shorter than xGRFmax (0.183s). In both the healthy and stroke groups, xGRFthresh transition-times (0.027s, 0.695s respectively) and vGRFmaxSWING (0.080s, 0.522s) were significantly shorter than firstHEELoff (0.293s, 1.085s) (p<0.001 in all cases). GI-onset failed to be estimated in 48% of stroke trials using xGRFthresh. Intra-subject variability was relatively high but was comparable across all estimation methods. CONCLUSION:The firstHEELoff method yielded significantly longer transition-times. The xGRFthresh method failed to routinely produce an estimation of GI-onset estimation. Thus, with all methods exhibiting low, yet comparable intra-subject repeatability, averaged xGRFmax or vGRFmaxSWING repeated-measures are recommended to estimate GI-onset for both healthy and community-dwelling stroke individuals.

Dataset Information

Parameters that remain consistent independent of pausing before gait-initiation during normal rise-to-walk behaviour delineated by sit-to-walk and sit-to-stand-and-walk.

Publications

Parameters that remain consistent independent of pausing before gait-initiation during normal rise-to-walk behaviour delineated by sit-to-walk and sit-to-stand-and-walk.

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