Papers by Claudine Lamoth
Journal of Neuroengineering and Rehabilitation, 2011
Background Falls in frail elderly are a common problem with a rising incidence. Gait and postural... more Background Falls in frail elderly are a common problem with a rising incidence. Gait and postural instability are major risk factors for falling, particularly in geriatric patients. As walking requires attention, cognitive impairments are likely to contribute to an increased fall risk. An objective quantification of gait and balance ability is required to identify persons with a high tendency to fall. Recent studies have shown that stride variability is increased in elderly and under dual task condition and might be more sensitive to detect fall risk than walking speed. In the present study we complemented stride related measures with measures that quantify trunk movement patterns as indicators of dynamic balance ability during walking. The aim of the study was to quantify the effect of impaired cognition and dual tasking on gait variability and stability in geriatric patients. Methods Thirteen elderly with dementia (mean age: 82.6 ± 4.3 years) and thirteen without dementia (79.4 ± 5.55) recruited from a geriatric day clinic, walked at self-selected speed with and without performing a verbal dual task. The Mini Mental State Examination and the Seven Minute Screen were administered. Trunk accelerations were measured with an accelerometer. In addition to walking speed, mean, and variability of stride times, gait stability was quantified using stochastic dynamical measures, namely regularity (sample entropy, long range correlations) and local stability exponents of trunk accelerations. Results Dual tasking significantly (p < 0.05) decreased walking speed, while stride time variability increased, and stability and regularity of lateral trunk accelerations decreased. Cognitively impaired elderly showed significantly (p < 0.05) more changes in gait variability than cognitive intact elderly. Differences in dynamic parameters between groups were more discerned under dual task conditions. Conclusions The observed trunk adaptations were a consistent instability factor. These results support the concept that changes in cognitive functions contribute to changes in the variability and stability of the gait pattern. Walking under dual task conditions and quantifying gait using dynamical parameters can improve detecting walking disorders and might help to identify those elderly who are able to adapt walking ability and those who are not and thus are at greater risk for falling.
Medical Engineering & Physics, 2010
Variability and stability of walking of eight transfemoral amputees and eight healthy controls wa... more Variability and stability of walking of eight transfemoral amputees and eight healthy controls was studied under four conditions: walking inside on a smooth terrain, walking while performing a dual-task and walking outside on (ir)regular surfaces. Trunk accelerations were recorded with a tri-axial accelerometer. Walking speed, mean and coefficient of variation of stride times (ST) and the root mean squares (RMS) of trunk accelerations was calculated. Gait variability and stability were quantified using measures derived from the theory of stochastic dynamics. Regularity was indexed using the sample entropy (SEn) and the scaling exponent˛derived form Detrended Fluctuations Analysis. Local stability (LSE) quantified gait stability.
Clinical Biomechanics, 2002
Objective. To quantify gait impairments in women with pregnancy-related pain in the pelvis which ... more Objective. To quantify gait impairments in women with pregnancy-related pain in the pelvis which persisted post-partum. Design. Nine patients and nine healthy subjects were studied during treadmill walking at different velocities. Background. Walking problems in patients with pregnancy-related pain in the pelvis have been known to exist for a long time. To date, no quantitative gait studies have been conducted in this population.
Gait & Posture, 2002
The coordination between horizontal pelvic and thoracic rotations during treadmill walking was st... more The coordination between horizontal pelvic and thoracic rotations during treadmill walking was studied in ten subjects. Previous studies have considered the relative phase using the mean to characterize coordination mode, and the S.D. as an index of its stability. However, to use S.D. of relative phase as a measure for coordinative stability, the underlying oscillations have to be phase-locked at a certain value. Random fluctuations around this value can then be viewed as stochastic perturbations of a stable fixed point, resulting in a unimodal distribution of relative phase. Using methods of circular statistics this study shows that these conditions were not met in pelvis-thorax coordination. Spectral analyses revealed that, as walking velocity increased, a triphasic component emerged in the pelvic rotations, while the thoracic rotations remained harmonic across all walking velocities. These findings refute the use of standard relative phase measures to capture pelvis-thorax coordination. An alternative measure is introduced, namely the difference between the continuous Fourier phases of the component oscillations as determined for the main frequency of the thorax oscillation. With this measure, pelvis-thorax coordination was found to evolve from in-phase coordination towards antiphase coordination as walking velocity increased. This method may be used to assess reliably the properties of pelvis-thorax coordination in both healthy and pathological gait patterns in the future.
Human Movement Science, 2009
We studied multisegmental coordination and stride characteristics in nine participants while walk... more We studied multisegmental coordination and stride characteristics in nine participants while walking and running on a treadmill. The study's main aim was to evaluate the coordination patterns of walking and running and their variance as a function of locomotion speed, with a specific focus on gait transitions and accompanying features like hysteresis and critical fluctuations. Stride characteristics changed systematically with speed in a gait-dependent fashion, but exhibited no hysteresis. Multisegmental coordination of walking and running was captured by four principal components, the first two of which were present in both gaits. Locomotion speed had subtle yet systematic differential effects on the relative phasing between the identified components in both walking and running and its variance, in particular in the immediate vicinity of gait transitions. Unlike the stride characteristics, the identified coordination patterns revealed clear evidence of both hysteresis and critical fluctuations around transition points. Overall, the results suggest that walking and running entail similar, albeit speed-and gait-dependent, coordination structures, and that gait transitions bear signatures of nonequilibrium phase transitions. Application of multivariate analyses of whole-body recordings appears crucial to detect these features in a reliable fashion.
Neuroscience Letters, 2010
To examine whether the Haken-Kelso-Bunz model for rhythmic interlimb coordination applies to walk... more To examine whether the Haken-Kelso-Bunz model for rhythmic interlimb coordination applies to walking side-by-side on a treadmill, we invited six pairs of participants to coordinate their stepping movements at seven prescribed relative phases (between 0 • and 180 • ) to scan the attractor layout governing their coordination. Two auditory metronomes, one for each participant, specified the required relative phase. For each trial participants were instructed to synchronize their left heel strikes with the beeps of the metronome (2 min) and to continue walking after the metronome stopped (1 min). If the Haken-Kelso-Bunz model applies to interpersonal coordination during treadmill walking, then (1) the variability of in-and antiphase should be minimal, (2) intermediate relative phases should be attracted to either in-or antiphase, and (3) the absolute shift away from the required relative phase should be greatest for a required relative phase of 90 • . Only the third of these hypotheses was confirmed, indicating that the dynamical model for rhythmic interlimb coordination does not readily apply, at least not generically or robustly, to interpersonal coordination during walking side-by-side on a treadmill.
Clinical Biomechanics, 2004
Objective. To examine the effects of experimentally induced pain and fear of pain on trunk coordi... more Objective. To examine the effects of experimentally induced pain and fear of pain on trunk coordination and erector spinae EMG activity during gait.
European Spine Journal, 2006
Low back pain (LBP) is often accompanied by changes in gait, such as a decreased (preferred) walk... more Low back pain (LBP) is often accompanied by changes in gait, such as a decreased (preferred) walking velocity. Previous studies have shown that LBP diminishes the normal velocity-induced transverse counter-rotation between thorax and pelvis, and that it globally affects mean erector spinae (ES) activity. The exact nature and causation of these effects, however, are not well understood. The aim of the present study was to examine in detail the effect of walking velocity on global trunk coordination and ES activity as well as their variability to gain further insights into the effects of non-specific LBP on gait. The study included 19 individuals with non-specific LBP and 14 healthy controls. Gait kinematics and ES activity were recorded during treadmill walking at (1) a self-selected (comfortable) velocity, and (2) sequentially increased velocities from 1.4 up to maximally 7.0 km/h. Pain intensity, fear of movement and disability were measured before the experiment. The angular movements of thorax, lumbar and pelvis were recorded in three dimensions. ES activity was recorded with pairs of surface electrodes. Trunk–pelvis coordination and mean amplitude of ES activity were analyzed. In addition, invariant and variant properties of trunk kinematics and ES activity were studied using principal component analysis (PCA). Comfortable walking velocity was significantly lower in the LBP participants. In the transverse plane, the normal velocity-induced change in pelvis–thorax coordination from more in-phase to more antiphase was diminished in the LBP participants, while lumbar and pelvis rotations were more in-phase compared to the control group. In the frontal plane, intersegmental timing was more variable in the LBP than in the control participants, with additional irregular movements of the thorax. Rotational amplitudes were not significantly different between the LBP and control participants. In the LBP participants, the pattern of ES activity was affected in terms of increased (residual) variability, timing deficits, amplitude modifications and frequency changes. The gait of the LBP participants was characterized by a more rigid and less variable kinematic coordination in the transverse plane, and a less tight and more variable coordination in the frontal plane, accompanied by poorly coordinated activity of the lumbar ES. Pain intensity, fear of movement and disability were all unrelated to the observed changes in coordination, suggesting that the observed changes in trunk coordination and ES activity were a direct consequence of LBP per se. Clinically, the results imply that conservative therapy should consider gait training as well as exercises aimed at improving both intersegmental and muscle coordination.
Neuroscience Letters, 2008
We examined how people synchronize their leg movements while walking side-by-side on a treadmill.... more We examined how people synchronize their leg movements while walking side-by-side on a treadmill. Walker pairs were either instructed to synchronize their steps in in-phase or in antiphase or received no coordination instructions. Frequency and phase analysis revealed that instructed in-phase and antiphase coordination were equally stable and independent of walking speed and the difference in individually preferred stride frequencies. Without instruction we found episodes of frequency locking in three pairs and episodes of phase locking in four pairs, albeit not always at (or near) 0 • or 180 • . Again, we found no difference in the stability of in-phase and antiphase coordination and no systematic effects of walking speed and the difference in individually preferred stride frequencies. These results suggest that the Haken-Kelso-Bunz model for rhythmic interlimb coordination does not apply to interpersonal coordination during gait in a straightforward manner. When the typically involved parameter constraints are relaxed, however, this model may largely account for the observed dynamical characteristics.
Gait & Posture, 2006
regime against gravity only. A control group of 10 children with cerebral palsy/spastic diplegia ... more regime against gravity only. A control group of 10 children with cerebral palsy/spastic diplegia (GMFCS levels I-II, mean age 11 years) were also recruited for comparison.
Neurorehabilitation and Neural Repair, 2009
Background. In rehabilitation, acoustic rhythms are often used to improve gait after stroke. Acou... more Background. In rehabilitation, acoustic rhythms are often used to improve gait after stroke. Acoustic cueing may enhance gait coordination by creating a stable coupling between heel strikes and metronome beats and provide a means to train the adaptability of gait coordination to environmental changes, as required in everyday life ambulation. Objective. To examine the stability and adaptability of auditory-motor synchronization in acoustically paced treadmill walking in stroke patients. Methods. Eleven stroke patients and 10 healthy controls walked on a treadmill at preferred speed and cadence under no metronome, single-metronome (pacing only paretic or nonparetic steps), and double-metronome (pacing both footfalls) conditions. The stability of auditory-motor synchronization was quantified by the variability of the phase relation between footfalls and beats. In a separate session, the acoustic rhythms were perturbed and adaptations to restore auditory-motor synchronization were quantified. Results. For both groups, auditory-motor synchronization was more stable for double-metronome than single-metronome conditions, with stroke patients exhibiting an overall weaker coupling of footfalls to metronome beats than controls. The recovery characteristics following rhythm perturbations corroborated the stability findings and further revealed that stroke patients had difficulty in accelerating their steps and instead preferred a slower-step response to restore synchronization. Conclusions. In gait rehabilitation practice, the use of acoustic rhythms may be more effective when both footfalls are paced. In addition, rhythm perturbations during acoustically paced treadmill walking may not only be employed to evaluate the stability of auditory-motor synchronization but also have promising implications for evaluation and training of gait adaptations in neurorehabilitation practice.
Gait & Posture, 2006
In healthy walking, the timing between trunk and pelvic rotations, as well as erector spinae (ES)... more In healthy walking, the timing between trunk and pelvic rotations, as well as erector spinae (ES) activity varies systematically with walking velocity, whereas a comparable velocity-dependent adaptation of trunk-pelvis coordination is often reduced or absent in persons with low back pain (LBP). Based on the hypothesis that trunk-pelvis coordination is linked to overall gait stability, persons with LBP can be expected to have difficulties in dealing with perturbations. We examined the ability of 12 persons with LBP and 12 controls to adapt trunk and pelvis rotations and ES activity to sudden changes in velocity. 3D angular movements of thoracic, lumbar, and pelvic segments and surface EMG were recorded during treadmill walking at six different velocities, which increased or decreased unexpectedly. Relative phases of segmental rotations were determined and (in-)variant properties of kinematics and ES activity were studied using principal component analysis. Compared to healthy controls, persons with LBP exhibited a reduced ability to adapt trunk-pelvis coordination and ES muscle activity to changes in velocity. Altered coordination and muscular control may reflect an attempt to stabilise the spine and prevent the occurrence of unexpected perturbations. The assessment of gait patterns in terms of coordination may help clinicians to quantify movement impairments and may suggest interventions aimed at facilitating the emergence of desired coordination patterns. #
Gait & Posture, 2008
In walking faster than 3 km/h, transverse pelvic rotation lengthens the step (''pelvic step''). I... more In walking faster than 3 km/h, transverse pelvic rotation lengthens the step (''pelvic step''). It is often assumed that the thorax then starts to counter rotate to limit total body angular momentum around the vertical. But the relative timing of pelvis and thorax rotation during gait is insufficiently understood. The present study aimed at analysing how transverse pelvis and thorax rotations relate to the movements of the upper leg, and how these patterns contribute to total body angular momentum. Nine healthy male volunteers walked on a treadmill at nine different velocities, ranging from 2.0 km/h to 5.2 km/h. Full body kinematics were recorded. Femur-pelvis, pelvis-thorax, and femur-thorax relative phase were calculated, as well as transverse plane angular momentum of all body segments. The shift in pelvis-thorax coordination from in-phase to out of phase with increasing velocity was found to depend on the pelvis beginning to move in-phase with the femur, while the thorax continued to counter rotate with respect to the femur. Moreover, pelvic and thoracic contributions to total body angular momentum were low (less than 10%), while contributions of the legs and arms were much larger (approximately 90%), suggesting that pelvis-thorax coordination is relatively unimportant to the organisation of total body angular momentum. Taken together, these results may imply that our understanding of the pelvic step need to be changed. Moreover, the alterations in pelvis-thorax relative phase that were reported for different locomotor pathologies may depend on different mechanisms. #
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Papers by Claudine Lamoth