Physical Therapy

Recent studies on neurologically intact individuals and individuals with spinal cord injury indicate that rhythmic upper limb muscle activation has an excitatory effect on lower limb muscle activation during locomotor-like tasks. This finding suggests that gait rehabilitation therapy after neurological injury should incorporate simultaneous upper limb and lower limb rhythmic exercise to take advantage of neural coupling.

Effective locomotion training with robotic exoskeletons requires identification of optimal control algorithms to better facilitate motor learning. Two commonly employed training protocols emphasize use of training stimuli that either augment or reduce performance errors. The current study sought to identify which of these training strategies promote better short-term modification of a typical gait pattern in healthy individuals as a framework for future application to neurologically impaired individuals. Ten subjects were assigned to each of a performance-based error-augmentation or errorreduction training group. All subjects completed a 45-min session of treadmill walking at their preferred speed with a robotic exoskeleton. Target templates prescribed an ankle path for training that corresponded to an increased step height. When subjects' instantaneous ankle positions fell below the inferior virtual wall of the target ankle path, robotic forces were applied that either decreased (errorreduction) or increased (error-augmentation) the deviation from the target path. When the force field was turned on, both groups walked with ankle paths better approximating the target template compared to baseline. When the force field was removed unexpectedly during catch and post-training trials, only the error-augmentation group maintained an ankle path close to the target ankle path. Further investigation is required to determine if a similar training advantage is provided for neurologically impaired individuals. ß

Cognitive-motor interference, a negative influence on the performance of one or both tasks, is manifested when simultaneously performing a cognitive and a motor task. Motor fatigue reduces the ability of generating a required force level. However, little is known about the effects of motor fatigue on the cognitive-motor dual-tasking performance, an important capability during our daily lives. This study investigated how motor fatigue affects dual-task walking performance. Eighteen healthy younger adults walked on a treadmill under three different conditions: walking only, walking while receiving the Paced Auditory Serial Addition Test (PASAT) or a modified Stroop test before and after a lower-extremity fatiguing exercise. We computed dynamic margins of stability (MOS), step and joint kinematic variability, and short-term local divergence exponent (LDE) of the trunk motion. We found that subjects had similar values of short-term LDE during all conditions, indicating that local stability was not affected by the motor fatigue or dual-task conditions. Compared to the baseline, subjects had significantly greater mean MOS after the fatiguing exercise by walking with greater step length and width while having significantly greater gait variability. In contrast, subjects walked with similar mean MOS but significantly less gait variability during the dual-task conditions, indicating that subjects used different adaptive strategies when walking with motor fatigue and during dual-task conditions. There were no significant differences in the number of errors for the two cognitive tests before and after the fatiguing exercise. The current findings demonstrate that motor fatigue does not affect cognitive but motor performance in younger adults.

Cognitive-motor interference, a negative influence on the performance of one or both tasks, is manifested when simultaneously performing a cognitive and a motor task. Motor fatigue reduces the ability of generating a required force level. However, little is known about the effects of motor fatigue on the cognitive-motor dual-tasking performance, an important capability during our daily lives. This study investigated how motor fatigue affects dual-task walking performance. Eighteen healthy younger adults walked on a treadmill under three different conditions: walking only, walking while receiving the Paced Auditory Serial Addition Test (PASAT) or a modified Stroop test before and after a lower-extremity fatiguing exercise. We computed dynamic margins of stability (MOS), step and joint kinematic variability, and short-term local divergence exponent (LDE) of the trunk motion. We found that subjects had similar values of short-term LDE during all conditions, indicating that local stability was not affected by the motor fatigue or dual-task conditions. Compared to the baseline, subjects had significantly greater mean MOS after the fatiguing exercise by walking with greater step length and width while having significantly greater gait variability. In contrast, subjects walked with similar mean MOS but significantly less gait variability during the dual-task conditions, indicating that subjects used different adaptive strategies when walking with motor fatigue and during dual-task conditions. There were no significant differences in the number of errors for the two cognitive tests before and after the fatiguing exercise. The current findings demonstrate that motor fatigue does not affect cognitive but motor performance in younger adults.

Community dwelling stroke survivors most often fall while walking. Understanding how poststroke individuals control mediolateral footpath during walking may help elucidate the mechanisms that contribute to walking instability. By applying the Uncontrolled Manifold (UCM) approach, we investigated (1) how post-stroke individuals coordinate lower-extremity joint motions to stabilize mediolateral footpath of the swing leg, and (2) how the inter-joint coordination in footpath stabilization correlates to their walking stability. Nine stroke subjects and nine healthy controls walked on a treadmill at four different speeds. UCM analysis partitions the variance of kinematic configurations across gait cycles into "good variance" (i.e., the variance component leading to a consistent footpath) or "bad variance" (i.e., the variance component leading to an inconsistent footpath). We found that both groups had a significantly greater "good" than "bad" variance (p<0.05) for most of the swing phase, suggesting that mediolateral footpath is an important variable stabilized by the central nervous system during walking. Stroke subjects had significantly greater relative variance difference (ΔV) (i.e. normalized difference between "good" and "bad" variance) (p<0.05), indicating a stronger kinematic synergy in footpath stabilization, than the controls. In addition, the kinematic synergy in mediolateral footpath stabilization is strongest during mid-swing but weakest during late swing in healthy gait. However, this phase-dependent strategy is preserved for midswing but not for late swing in stroke gait. Moreover, stroke and healthy subjects demonstrated different relationships between UCM and walking stability measures. A stronger kinematic synergy in healthy gait is associated with better walking stability whereas having more "good variance" or stronger kinematic synergy in stroke gait is associated with less walking stability. The current findings suggest that walking with too much "good variance" in people following stroke, despite no effect on the footpath, may adversely affect their walking stability to some extent.

A robotic ankle-foot orthosis (AFO) that provides powered assistance could adjust to varying gait dynamics much better than a rigid AFO. To provide insight into how humans would adapt to a powered AFO, we studied the response of neurologically intact subjects walking with an active dorsiflexion assist orthosis proportionally controlled by tibialis anterior electromyography (EMG). We examined the two mechanical functions of ankle dorsiflexors in gait (power absorption at heel strike and power generation at toe-off) by recruiting two groups of healthy subjects: Group One, called Continuous Control, (n=5) had dorsiflexion assistance both at the initial heel contact and during swing; Group Two, called Swing Control, (n=5) had the assistance only during swing. We hypothesized both groups of subjects would reduce tibialis anterior EMG amplitude with practice walking with the powered dorsiflexion assist. Ten healthy subjects were fitted with custom-made orthoses that included an artificial...

The number of falls and/or accidental injuries associated with cellular phone use during walking is growing rapidly. Understanding the effects of concurrent cell phone use on human gait may help develop safety guidelines for pedestrians. It was shown previously that older adults had more pronounced dual-task interferences than younger adults when concurrent cognitive task required visual information processing. Thus, cell phone use might have greater impact on walking stability in older than in younger adults. This study examined gait stability and variability during a cell phone dialing task (phone) and two classic cognitive tasks, the Paced Auditory Serial Addition Test (PASAT) and Symbol Digit Modalities Test (SDMT). Nine older and seven younger healthy adults walked on a treadmill at four different conditions: walking only, PASAT, phone, and SDMT. We computed short-term local divergence exponent (LDE) of the trunk motion (local stability), dynamic margins of stability (MOS), step spatiotemporal measures, and kinematic variability. Older and younger adults had similar values of short-term LDE during all conditions, indicating that local stability was not affected by the dual-task. Compared to walking only, older and younger adults walked with significantly greater average mediolateral MOS during phone and SDMT conditions but significantly less ankle angle variability during all dual-tasks and less knee angle variability during PASAT. The current findings demonstrate that healthy adults may try to control foot placement and joint kinematics during cell phone use or another cognitive task with a visual component to ensure sufficient dynamic margins of stability and maintain local stability.