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1.  Comparison of two normative paediatric gait databases 
The availability of age-matched normative data is an essential component of clinical gait analyses. Comparison of normative gait databases is difficult due to the high-dimensionality and temporal nature of the various gait waveforms. The purpose of this study was to provide a method of comparing the sagittal joint angle data between two normative databases. We compared a modern gait database to the historical San Diego database using statistical classifiers developed by Tingley et al. (2002). Gait data were recorded from 60 children aged 1–13 years. A six-camera Vicon 512 motion analysis system and two force plates were utilized to obtain temporal-spatial, kinematic, and kinetic parameters during walking. Differences between the two normative data sets were explored using the classifier index scores, and the mean and covariance structure of the joint angle data from each lab. Significant differences in sagittal angle data between the two databases were identified and attributed to technological advances and data processing techniques (data smoothing, sampling, and joint angle approximations). This work provides a simple method of database comparison using trainable statistical classifiers.
doi:10.1186/1476-5918-6-8
PMCID: PMC1947956  PMID: 17640348
2.  Upper Extremity Dynamics During Lofstrand Crutch-Assisted Gait in Children With Myelomeningocele 
The Journal of Spinal Cord Medicine  2007;30(Suppl 1):S165-S171.
Background/Objective:
We present a 3-dimensional biomechanical model of the upper extremities to characterize joint dynamics during 2 patterns of Lofstrand crutch-assisted gait in children with myelomeningocele. The upper extremity model incorporates recommendations by the International Society of Biomechanics.
Methods:
A Vicon motion analysis system (14 cameras) captured the marker patterns. Instrumented crutches measured reaction forces. Five subjects with L3 or L4 level myelodysplasia (aged 9.8 ± 1.6 years) were analyzed during reciprocal and swing-through Lofstrand crutch-assisted gait.
Results:
The mean walking speed, cadence, and stride length were greatest during swing-through gait. Although the gait patterns had different morphologies, the thorax and elbows remained in flexion, the wrists remained in extension, and the shoulders demonstrated both flexion and extension throughout the gait cycles. Swing-through gait showed larger ranges of motion for all joints than reciprocal gait. Peak crutch forces were highest during swing-through gait. The model was effective in detecting significant differences in upper extremity joint dynamics between reciprocal and swing-through crutch-assisted gait in children with myelomeningocele.
Conclusions:
Results support continued testing. Future work should include clinical and functional assessment in a correlated study of dynamics and function. Knowledge from the study may be useful in treatment planning and intervention.
PMCID: PMC2031971  PMID: 17874703
Crutch-assisted gait; Myelomeningocele; Motion analysis; Upper extremity modeling; Biomechanics
3.  Gait impairment in cervical spondylotic myelopathy: comparison with age- and gender-matched healthy controls 
European Spine Journal  2012;21(12):2456-2466.
Introduction
Gait impairment is a primary symptom of cervical spondylotic myelopathy (CSM); however, little is known about specific kinetic and kinematic gait parameters. The objectives of the study were: (1) to compare gait patterns of people with untreated CSM to those of age- and gender-matched healthy controls; (2) to examine the effect of gait speed on kinematic and kinetic parameters.
Materials and methods
Sixteen patients with CSM were recruited consecutively from a neurosurgery clinic, and 16 healthy controls, matched to age (±5 years) and gender, were recruited for comparison. Patients and controls underwent three-dimensional gait analysis using a Vicon® motion analysis system, at self-selected speed over a 10-m track. Controls were also assessed at the speed of their CSM match.
Results
At self-selected speed, the CSM group walked significantly more slowly, with shorter stride lengths and longer double support duration. They showed significant decreases in several kinematic and kinetic parameters, including sagittal range of motion at the hip and knee, ankle plantarflexion, anteroposterior ground reaction force (GRF) at toe-off, power absorption at the knee in loading response and terminal stance, and power generation at the ankle. At matched speed, the CSM group showed significant decreases in knee flexion during swing, total sagittal knee range of motion, peak ankle plantarflexion and anteroposterior GRF.
Conclusion and implications
The findings suggested that people with CSM have significant gait abnormalities that have not been previously reported. In particular, there are key differences in the motor strategies used in the terminal stance phase of gait that cannot be explained by speed alone.
doi:10.1007/s00586-012-2433-6
PMCID: PMC3508234  PMID: 22825630
Cervical myelopathy; Gait; Gait analysis; Biomechanics
4.  Arm Swing Magnitude and Asymmetry During Gait in the Early Stages of Parkinson's Disease 
Gait & posture  2009;31(2):256.
The later stages of Parkinson's disease (PD) are characterized by altered gait patterns. Although decreased arm swing during gait is the most frequently reported motor dysfunction in individuals with PD, quantitative descriptions of gait in early PD have largely ignored upper extremity movements. This study was designed to perform a quantitative analysis of arm swing magnitude and asymmetry that might be useful in the assessment of early PD. Twelve individuals with early PD (in “off” state) and eight controls underwent gait analysis using an optically-based motion capture system. Participants were instructed to walk at normal and fast velocities, and then on heels (to minimize push-off). Arm swing was measured as the excursion of the wrist with respect to the pelvis. Arm swing magnitude for each arm, and inter-arm asymmetry, were compared between groups. Both groups had comparable gait velocities (p=0.61), and there was no significant difference between the groups in the magnitude of arm swing in all walking conditions for the arm that swung more (p=0.907) or less (p=0.080). Strikingly, the PD group showed significantly greater arm swing asymmetry (asymmetry angle: 13.9±7.9%) compared to the control group (asymmetry angle: 5.1±4.0%; p=0.003). Unlike arm swing magnitude, arm swing asymmetry unequivocally differs between people with early PD and controls. Such quantitative evaluation of arm swing, especially its asymmetry, may have utility for early and differential diagnosis, and for tracking disease progression in patients with later PD.
doi:10.1016/j.gaitpost.2009.10.013
PMCID: PMC2818433  PMID: 19945285
Parkinson's Disease; gait; biomechanics; arm swing; arm swing asymmetry
5.  Gait kinematic analysis in patients with a mild form of central cord syndrome 
Background
Central cord syndrome (CCS) is considered the most common incomplete spinal cord injury (SCI). Independent ambulation was achieved in 87-97% in young patients with CCS but no gait analysis studies have been reported before in such pathology. The aim of this study was to analyze the gait characteristics of subjects with CCS and to compare the findings with a healthy age, sex and anthropomorphically matched control group (CG), walking both at a self-selected speed and at the same speed.
Methods
Twelve CCS patients and a CG of twenty subjects were analyzed. Kinematic data were obtained using a three-dimensional motion analysis system with two scanner units. The CG were asked to walk at two different speeds, at a self-selected speed and at a slower one, similar to the mean gait speed previously registered in the CCS patient group. Temporal, spatial variables and kinematic variables (maximum and minimum lower limb joint angles throughout the gait cycle in each plane, along with the gait cycle instants of occurrence and the joint range of motion - ROM) were compared between the two groups walking at similar speeds.
Results
The kinematic parameters were compared when both groups walked at a similar speed, given that there was a significant difference in the self-selected speeds (p < 0.05). Hip abduction and knee flexion at initial contact, as well as minimal knee flexion at stance, were larger in the CCS group (p < 0.05). However, the range of knee and ankle motion in the sagittal plane was greater in the CG group (p < 0.05). The maximal ankle plantar-flexion values in stance phase and at toe off were larger in the CG (p < 0.05).
Conclusions
The gait pattern of CCS patients showed a decrease of knee and ankle sagittal ROM during level walking and an increase in hip abduction to increase base of support. The findings of this study help to improve the understanding how CCS affects gait changes in the lower limbs.
doi:10.1186/1743-0003-8-7
PMCID: PMC3040131  PMID: 21288347
6.  Gait characteristics of subjects with chronic fatigue syndrome and controls at self-selected and matched velocities 
Background
Gait abnormalities have been reported in individuals with Chronic Fatigue Syndrome (CFS) however no studies exist to date investigating the kinematics of individuals with CFS in over-ground gait. The aim of this study was to compare the over-ground gait pattern (sagittal kinematics and temporal and spatial) of individuals with CFS and control subjects at their self-selected and at matched velocities.
Methods
Twelve individuals with CFS and 12 matched controls participated in the study. Each subject walked along a 7.2 m walkway three times at each of three velocities: self-selected, relatively slow (0.45 ms-1) and a relatively fast (1.34 ms-1). A motion analysis system was used to investigate the sagittal plane joint kinematics and temporal spatial parameters of gait.
Results
At self-selected velocity there were significant differences between the two groups for all the temporal and spatial parameters measured, including gait velocity (P = 0.002). For the kinematic variables the significant differences were related to both ankles during swing and the right ankle during stance. At the relatively slower velocity the kinematic differences were replicated. However, the step distances decreased in the CFS population for the temporal and spatial parameters. When the gait pattern of the individuals with CFS at the relatively fast walking velocity (1.30 ± 0.24 ms-1) was compared to the control subjects at their self-selected velocity (1.32 ± 0.15 ms-1) the gait pattern of the two groups was very similar, with the exception of both ankles during swing.
Conclusion
The self-selected gait velocity and/or pattern of individuals with CFS may be used to monitor the disease process or evaluate therapeutic intervention. These differences may be a reflection of the relatively low self-selected gait velocity of individuals with CFS rather than a manifestation of the condition itself.
doi:10.1186/1743-0003-5-16
PMCID: PMC2424058  PMID: 18505580
7.  Temporal gait symmetry and velocity differ in their relationship to age 
Gait & posture  2012;35(4):590-594.
Measurement of gait is essential for identifying underlying deficits contributing to gait dysfunction, guiding clinical decisions and measuring rehabilitation outcomes. Velocity is commonly used to measure gait, however, its interpretation in patient populations is complicated by the confound of age. Gait symmetry may be an additional and valuable measure since it may not feature the same age-related changes as velocity. The purpose of this study was to determine if gait symmetry is related to age.
METHODS
Spatiotemporal gait parameters were recorded for 172 individuals with stroke and 81 healthy adults walking across a pressure sensitive mat at their preferred speed. Swing time, stance time and step length symmetry ratios were calculated. The relationship of age to velocity and symmetry was examined using Pearson correlations.
RESULTS
There was a significant negative association between velocity and age in the healthy group (r=−0.57, p<0.01). There were no significant relationships between age and any of the three symmetry ratios for either the stroke or healthy groups.
CONCLUSIONS
The main finding of the current study is that gait symmetry ratios are not significantly associated with age in either a healthy or a post-stroke group. Gait symmetry ratios may therefore, allow the clinician and the researcher to make judgments about the effects of disease (such as stroke) on the control of an individual’s gait without the confound of age.
doi:10.1016/j.gaitpost.2011.11.030
PMCID: PMC3914537  PMID: 22300728
8.  Real-Time Gait Cycle Parameter Recognition Using a Wearable Accelerometry System 
Sensors (Basel, Switzerland)  2011;11(8):7314-7326.
This paper presents the development of a wearable accelerometry system for real-time gait cycle parameter recognition. Using a tri-axial accelerometer, the wearable motion detector is a single waist-mounted device to measure trunk accelerations during walking. Several gait cycle parameters, including cadence, step regularity, stride regularity and step symmetry can be estimated in real-time by using autocorrelation procedure. For validation purposes, five Parkinson’s disease (PD) patients and five young healthy adults were recruited in an experiment. The gait cycle parameters among the two subject groups of different mobility can be quantified and distinguished by the system. Practical considerations and limitations for implementing the autocorrelation procedure in such a real-time system are also discussed. This study can be extended to the future attempts in real-time detection of disabling gaits, such as festinating or freezing of gait in PD patients. Ambulatory rehabilitation, gait assessment and personal telecare for people with gait disorders are also possible applications.
doi:10.3390/s110807314
PMCID: PMC3231731  PMID: 22164019
accelerometry; accelerometer; Parkinson’s disease; gait; mobility
9.  Hip joint load in relation to leg length discrepancy 
Objective:
Leg length discrepancy is common both in healthy subjects and after total hip arthroplasty (THA). Studies that evaluated leg length following THA have demonstrated a notable inconsistency in restoring leg length. The effects concerning joint load during gait is however not well known. The purpose of this study was to use three-dimensional (3D) gait analysis to evaluate joint load during gait with a simulated leg length discrepancy of 2 and 4 cm. Nine healthy subjects without any history of hip injury participated.
Method:
A 3D gait analysis (Vicon, Motion System, Oxford, England) was performed with 6 cameras and 2 force palates using a standard biomechanical gait model. Hip joint moments of force were calculated for all three degrees of motion freedom. ANOVA for repeated measurements was used for statistical calculations.
Results:
Abduction peak moment was significantly increased at the short side (P < 0.05) but unaffected on the long side. The adduction moment decreased on the long side between 0 and 4 cm (P < 0.01) but was unaffected on the short side. The internal hip rotation moments were unchanged for both the long and the short side. The external rotation moment was unchanged on the short side and decreased between bare foot and 4 cm on the long side (P < 0.05).
Conclusion:
A leg length discrepancy of 2 cm or more creates biomechanical changes concerning hip joint load both on the long and the short side and that the effects are larger on the short side. The increased stress may cause problems in the long run.
PMCID: PMC3417904  PMID: 22915902
gait analyses; leg length discrepancy; hip; biomechanics
10.  Gait Asymmetry of Transfemoral Amputees Using Mechanical and Microprocessor-Controlled Prosthetic Knees 
Background
Amputees walk with an asymmetrical gait, which may lead to future musculoskeletal degenerative changes. The purpose of this study was to compare the gait asymmetry of active transfemoral amputees while using a passive mechanical knee joint or a microprocessor-controlled knee joint.
Methods
Objective 3D gait measurements were obtained in 15 subjects (12 men and 3 women; age 42, range 26–57). Research participants were longtime users of a mechanical prosthesis (mean 20 years, range 3–36 years). Joint symmetry was calculated using a novel method that includes the entire waveform throughout the gait cycle.
Findings
There was no significant difference in hip, knee and ankle kinematics symmetry when using the different knee prostheses. In contrast, the results demonstrated a significant improvement in lower extremity joint kinetics symmetry when using the microprocessor-controlled knee.
Interpretation
Use of the microprocessor-controlled knee joint resulted in improved gait symmetry. These improvements may lead to a reduction in the degenerative musculoskeletal changes often experienced by amputees.
doi:10.1016/j.clinbiomech.2011.11.011
PMCID: PMC3335968  PMID: 22221344
amputee; artificial limbs; gait; knee; microprocessor
11.  Effects of unilateral robotic limb loading on gait characteristics in subjects with chronic stroke 
Background
Hemiparesis after stroke often leads to impaired ankle motor control that impacts gait function. In recent studies, robotic devices have been developed to address this impairment. While capable of imparting forces to assist during training and gait, these devices add mass to the paretic leg which might encumber patients' gait pattern. The purpose of this study was to assess the effects of the added mass of one of these robots, the MIT's Anklebot, while unpowered, on gait of chronic stroke survivors during overground and treadmill walking.
Methods
Nine chronic stroke survivors walked overground and on a treadmill with and without the anklebot mounted on the paretic leg. Gait parameters, interlimb symmetry, and joint kinematics were collected for the four conditions. Repeated-measures analysis of variance (ANOVA) tests were conducted to examine for possible differences across four conditions for the paretic and nonparetic leg.
Results
The added inertia and friction of the unpowered anklebot had no statistically significant effect on spatio-temporal parameters of gait, including paretic and nonparetic step time and stance percentage, in both overground and treadmill conditions. Noteworthy, interlimb symmetry as characterized by relative stance duration was greater on the treadmill than overground regardless of loading conditions. The presence of the unpowered robot loading reduced the nonparetic knee peak flexion on the treadmill and paretic peak dorsiflexion overground (p < 0.05).
Conclusions
Our results suggest that for these subjects the added inertia and friction of this backdriveable robot did not significantly alter their gait pattern.
doi:10.1186/1743-0003-7-23
PMCID: PMC2887457  PMID: 20492698
12.  Is Freezing of Gait in Parkinson's Disease a Result of Multiple Gait Impairments? Implications for Treatment 
Parkinson's Disease  2012;2012:459321.
Several gait impairments have been associated with freezing of gait (FOG) in patients with Parkinson's disease (PD). These include deteriorations in rhythm control, gait symmetry, bilateral coordination of gait, dynamic postural control and step scaling. We suggest that these seemingly independent gait features may have mutual interactions which, during certain circumstances, jointly drive the predisposed locomotion system into a FOG episode. This new theoretical framework is illustrated by the evaluation of the potential relationships between the so-called “sequence effect”, that is, impairments in step scaling, and gait asymmetry just prior to FOG. We further discuss what factors influence gait control to maintain functional gait. “Triggers”, for example, such as attention shifts or trajectory transitions, may precede FOG. We propose distinct categories of interventions and describe examples of existing work that support this idea: (a) interventions which aim to maintain a good level of locomotion control especially with respect to aspects related to FOG; (b) those that aim at avoiding FOG “triggers”; and (c) those that merely aim to escape from FOG once it occurs. The proposed theoretical framework sets the stage for testable hypotheses regarding the mechanisms that lead to FOG and may also lead to new treatment ideas.
doi:10.1155/2012/459321
PMCID: PMC3263650  PMID: 22288021
13.  An Evaluation of Symmetry in the Lower Limb Joints During the Able-Bodied Gait of Women and Men 
Journal of Human Kinetics  2012;35:47-57.
For many years, mainly to simplify data analysis, scientists assumed that during a gait, the lower limbs moved symmetrically. However, even a cursory survey of the more recent literature reveals that the human walk is symmetrical only in some aspects. That is why the presence of asymmetry should be considered in all studies of locomotion. The gait data were collected using the 3D motion analysis system Vicon. The inclusion criteria allowed the researchers to analyze a very homogenous group, which consisted of 54 subjects (27 women and 27 men). Every selected participant moved at a similar velocity: approximately 1,55 m/s. The analysis included kinematic parameters defining spatio-temporal structure of locomotion, as well as angular changes of the main joints of the lower extremities (ankle, knee and hip) in the sagittal plane. The values of those variables were calculated separately for the left and for the right leg in women and men. This approach allowed us to determine the size of the differences, and was the basis for assessing gait asymmetry using a relative asymmetry index, which was constructed by the authors. Analysis of the results demonstrates no differences in the temporal and phasic variables of movements of the right and left lower limb. However, different profiles of angular changes in the sagittal plane were observed, measured bilaterally for the ankle joint.
doi:10.2478/v10078-012-0078-5
PMCID: PMC3588688  PMID: 23486255
angular changes; relative asymmetry index; bilateral data; Vicon
14.  Gait asymmetries in patients with idiopathic scoliosis using vertical forces measurement only 
European Spine Journal  1998;7(2):95-98.
This study aimed at identifying measurable asymmetries during gait and relating them to the spinal deformity in subjects with idiopathic scoliosis. We investigated 21 patients aged between 10 and 26 years for gait asymmetries using force plates. All subjects completed five walking cycles over two force plates measuring vertical ground reaction forces. Among the parameters measured were contact time and magnitude of the two peaks of the vertical forces as well as the rate of application of those forces. Published gait data on normal subjects were used as a control group. In 20 subjects an asymmetry of at least one gait parameter was noted. Multiple regression analysis showed, however, that there was no relation between the noted gait asymmetry and the curve direction, curve magnitude or vertebral rotation. This suggests that although functional asymmetries of the central nervous system have been described in patients with idiopathic scoliosis, they do not appear to have a reproducible effect on gait.
doi:10.1007/s005860050037
PMCID: PMC3611223  PMID: 9629931
Key words Scoliosis; Gait; Nervous system
15.  Minimal detectable change for gait variables collected during treadmill walking in individuals post-stroke 
Gait & posture  2010;33(2):314-317.
Post-stroke gait impairments are common and result in slowed walking speeds and decreased community participation post-stroke. Treadmill training has recently emerged as an effective gait rehabilitation intervention. Furthermore, kinematic and kinetic data collected during treadmill walking are commonly used for assessing gait performance. The minimal detectable change (MDC) for gait variables provides a useful index to determine whether the magnitude of change in gait produced after an intervention is greater than the amount of change attributable to day-to-day variability in gait or test–retest measurement errors. The MDC values for kinematic, ground reaction force (GRF), spatial, and temporal variables collected during treadmill walking post-stroke have not been previously reported. The objective of this study was, therefore, to compute MDCs for post-stroke gait kinematics, GRF indices, temporal, and spatial measures during treadmill walking. Nineteen individuals with chronic post-stroke hemiparesis (12 males; age = 47–75 years; 72.6 ± 63.4 months since stroke) participated in 2 testing sessions separated by 20.7 ± 26.8 days. Our results showed that test–retest reliability was excellent for all gait variables tested (intraclass correlation coefficients = 0.799–0.986). MDCs were reported for hip, knee, and ankle joint angles (range 3.8° for trailing limb angles to 11.5° for hip extension), peak anterior GRF (2.85% body weight), mean vertical GRF (4.65% body weight), all temporal variables (range 3.2–4.2% gait cycle), and paretic step length (6.7 cm). These MDCs provide a useful reference to help interpret the magnitudes of changes in post-stroke gait variables.
doi:10.1016/j.gaitpost.2010.11.024
PMCID: PMC3042506  PMID: 21183350
Hemiparesis; Stroke; Treadmill; Gait; Reliability; Minimal detectable change
16.  Variation of hamstrings lengths and velocities with walking speed 
Journal of biomechanics  2010;43(8):1522-1526.
Crouch gait, one of the most prevalent movement abnormalities among children with cerebral palsy, is frequently treated with surgical lengthening of the hamstrings. To assist in surgical planning many clinical centers use musculoskeletal modeling to help determine if a patient's hamstrings are shorter or lengthen more slowly than during unimpaired gait. However, some subjects with crouch gait walk slowly, and gait speed may affect peak hamstring lengths and lengthening velocities. The purpose of this study was to evaluate the effects of walking speed on hamstrings lengths and velocities in a group of unimpaired subjects over a large range of speeds and to determine if evaluating subjects with crouch gait using speed matched controls alters subjects' characterization as having “short” or “slow” hamstrings. We examined 39 unimpaired subjects who walked at five different speeds. These subjects served as speed-matched controls for comparison to 74 subjects with cerebral palsy who walked in crouch gait. Our analysis revealed that peak hamstrings length and peak lengthening velocity in unimpaired subjects increased significantly with increasing walking speed. Fewer subjects with cerebral palsy were categorized as having hamstrings that were “short” (31/74) or “slow” (38/74) using a speed-matched control protocol compared to a non-speed-matched protocol (35/74 “short”, 47/74 “slow”). Evaluation of patients with cerebral palsy using speed-matched controls alters and may improve selection of patients for hamstrings lengthening procedures.
doi:10.1016/j.jbiomech.2010.01.008
PMCID: PMC2918640  PMID: 20381047
17.  Associative symmetry in a spatial sample-response paradigm 
Behavioural processes  2011;86(3):305-315.
Symmetry has been difficult to observe in nonhumans mainly because they seem to perceive stimuli as a conjunction of visual, spatial, and temporal characteristics. When such characteristics are controlled, symmetry does emerge in nonhumans (cf. Frank and Wasserman 2005; Urcuioli 2008). Recently, however, Garcia and Benjumea (2006) reported symmetry in pigeons without controlling for temporal order. The present experiments explored their paradigm and the ingredients for their success. Experiments 1 and 2 sought to replicate their findings and to examine different symmetry measures. We found evidence for symmetry using non-reinforced choice probe tests, a latency-based test, and a reinforced consistent versus inconsistent manipulation. Experiment 3 adapted their procedure to successive matching to evaluate their contention that a choice between at least two comparisons is necessary for symmetry to emerge. Contrary to their prediction, symmetry was observed following go/no-go training. Our results confirm Garcia and Benjumea’s findings, extend them to other test and training procedures, and once again demonstrate symmetry in the absence of language.
doi:10.1016/j.beproc.2011.01.002
PMCID: PMC3059401  PMID: 21238554
choice; matching-to-sample; associative symmetry; pigeons; latency
18.  Gait Variability and Multiple Sclerosis 
Gait variability, that is, fluctuations in movement during walking, is an indicator of walking function and has been associated with various adverse outcomes such as falls. In this paper, current research concerning gait variability in persons with multiple sclerosis (MS) is discussed. It is well established that persons with MS have greater gait variability compared to age and gender matched controls without MS. The reasons for the increase in gait variability are not completely understood. Evidence indicates that disability level, assistive device use, attentional requirement, and fatigue are related to gait variability in persons with MS. Future research should address the time-evolving structure (i.e., temporal characteristics) of gait variability, the clinical importance of gait variability, and underlying mechanisms that drive gait variability in individuals with MS.
doi:10.1155/2013/645197
PMCID: PMC3603667  PMID: 23533759
19.  Pain Reactivity and Plasma β-Endorphin in Children and Adolescents with Autistic Disorder 
PLoS ONE  2009;4(8):e5289.
Background
Reports of reduced pain sensitivity in autism have prompted opioid theories of autism and have practical care ramifications. Our objective was to examine behavioral and physiological pain responses, plasma β-endorphin levels and their relationship in a large group of individuals with autism.
Methodology/Principal Findings
The study was conducted on 73 children and adolescents with autism and 115 normal individuals matched for age, sex and pubertal stage. Behavioral pain reactivity of individuals with autism was assessed in three observational situations (parents at home, two caregivers at day-care, a nurse and child psychiatrist during blood drawing), and compared to controls during venepuncture. Plasma β-endorphin concentrations were measured by radioimmunoassay. A high proportion of individuals with autism displayed absent or reduced behavioral pain reactivity at home (68.6%), at day-care (34.2%) and during venepuncture (55.6%). Despite their high rate of absent behavioral pain reactivity during venepuncture (41.3 vs. 8.7% of controls, P<0.0001), individuals with autism displayed a significantly increased heart rate in response to venepuncture (P<0.05). Moreover, this response (Δ heart rate) was significantly greater than for controls (mean±SEM; 6.4±2.5 vs. 1.3±0.8 beats/min, P<0.05). Plasma β-endorphin levels were higher in the autistic group (P<0.001) and were positively associated with autism severity (P<0.001) and heart rate before or after venepuncture (P<0.05), but not with behavioral pain reactivity.
Conclusions/Significance
The greater heart rate response to venepuncture and the elevated plasma β-endorphin found in individuals with autism reflect enhanced physiological and biological stress responses that are dissociated from observable emotional and behavioral reactions. The results suggest strongly that prior reports of reduced pain sensitivity in autism are related to a different mode of pain expression rather than to an insensitivity or endogenous analgesia, and do not support opioid theories of autism. Clinical care practice and hypotheses regarding underlying mechanisms need to assume that children with autism are sensitive to pain.
doi:10.1371/journal.pone.0005289
PMCID: PMC2728512  PMID: 19707566
20.  The Profile of Memory Function in Children With Autism 
Neuropsychology  2006;20(1):21-29.
A clinical memory test was administered to 38 high-functioning children with autism and 38 individually matched normal controls, 8–16 years of age. The resulting profile of memory abilities in the children with autism was characterized by relatively poor memory for complex visual and verbal information and spatial working memory with relatively intact associative learning ability, verbal working memory, and recognition memory. A stepwise discriminant function analysis of the subtests found that the Finger Windows subtest, a measure of spatial working memory, discriminated most accurately between the autism and normal control groups. A principal components analysis indicated that the factor structure of the subtests differed substantially between the children with autism and controls, suggesting differing organizations of memory ability.
doi:10.1037/0894-4105.20.1.21
PMCID: PMC1847594  PMID: 16460219
autism; memory assessment; discriminant analysis; principal components analysis
21.  Changes in spatiotemporal gait variables over time during a test of functional capacity after stroke 
Background
Gait dysfunction and fatigue are common post-stroke, though it is unclear how extended walking activity, as would be performed during activities of daily living, may change over time. The purpose of this study was to examine if spatial and temporal gait variables deteriorate during an extended bout of walking in a test of functional capacity after stroke.
Methods
24 community dwelling, independently ambulating individuals greater than 3 months after stroke performed the Six-Minute Walk Test (6MWT). Participants walked over a pressure-sensitive mat on each pass of the 30 m course which recorded spatial and temporal parameters of gait. Mean gait speed and temporal symmetry ratio during each two-minute interval of the 6MWT were examined. Additional post hoc analyses examined the incidence of rests during the 6MWT and changes in gait speed and symmetry.
Results
On average, participants demonstrated a 3.4 ± 6.5 cm/s decrease in speed over time (p= 0.02). Participants who rested were also characterized by increased asymmetry in the final two minutes (p= 0.05). 30% of participants rested at some point during the test, and if a rest was taken, duration increased in the final two minutes (p= 0.001). Examination of factors which may have been associated with resting indicated that resters had poorer balance (p= 0.006) than non-resting participants.
Conclusion
This study supports previous findings establishing that walking performance after stroke declines over relatively short bouts of functionally-relevant ambulation. Such changes may be associated with both cardiorespiratory and muscular fatigue mechanisms that influence performance. The findings also indicate that rest duration should be routinely quantified during the 6MWT after stroke, and consequently, further research is necessary to determine how to interpret 6MWT scores when resting occurs.
doi:10.1186/1743-0003-6-27
PMCID: PMC2717983  PMID: 19594945
22.  Early Stage of Walking: Development of Control in Mediolateral and Anteroposterior Directions 
Journal of motor behavior  2006;38(3):229-237.
The authors examined the changes in bipedal gait of toddlers in the anteroposterior (AP) and mediolateral (ML) directions, as a set, at the onset of independent gait and 1 month after onset. Two groups with distinctly different dynamic resources were studied: 8 toddlers with typical development (TD) and 8 toddlers with Down syndrome (DS). Three-dimensional kinematic data were collected, and gait parameters, such as walking speed, stride length, and stride frequency, as well as the ratio of exchange between potential energy and kinetic energy of the center of mass (COM), were calculated. Displacement of the COM in the AP and ML directions were also analyzed. For some gait variables, toddlers with DS seemed to show more mature values at walking onset than their peers with TD. Those group differences reversed and increased by Visit 2. When the authors considered the motion of the COM of the system, it became clear that the qualitative differences between those groups were characterized primarily by constraints in the ML direction. The authors propose that establishment of coupling between AP and ML oscillations is a key component for the emergence of independent bipedal walking for both populations.
PMCID: PMC2041926  PMID: 16709562
dynamic strategies; mediolateral control; stability constraints; walking onset
23.  Visual orienting in the early broader autism phenotype: disengagement and facilitation 
Background
Recent studies of infant siblings of children diagnosed with autism have allowed for a prospective approach to examine the emergence of symptoms and revealed behavioral differences in the broader autism phenotype within the early years. In the current study we focused on a set of functions associated with visual attention, previously reported to be atypical in autism.
Method
We compared performance of a group of 9–10-month-old infant siblings of children with autism to a control group with no family history of autism on the ‘gap-overlap task’, which measures the cost of disengaging from a central stimulus in order to fixate a peripheral one. Two measures were derived on the basis of infants’ saccadic reaction times. The first is the Disengagement effect, which measures the efficiency of disengaging from a central stimulus to orient to a peripheral one. The second was a Facilitation effect, which arises when the infant is cued by a temporal gap preceding the onset of the peripheral stimulus, and would orient faster after its onset.
Results and conclusion
Infant siblings of children with autism showed longer Disengagement latencies as well as less Facilitation relative to the control group. The findings are discussed in relation to how differences in visual attention may relate to characteristics observed in autism and the broader phenotype.
doi:10.1111/j.1469-7610.2008.02051.x
PMCID: PMC3272379  PMID: 19298466
Infancy; autism; visual attention; gap-overlap task; disengagement
24.  Analysis of knee flexion characteristics and how they alter with the onset of knee osteoarthritis: a case control study 
Background
The purpose of this study was to examine the differences in gait profile between patients with knee osteoarthritis (OA) and healthy control and to create motion characteristics that will differentiate between them.
Methods
Twenty three patients diagnosed with knee OA and 21 healthy matched controls underwent a gait test using a sensor system (gaitWALK). Gait parameters evaluated were: stride duration, knee flexion range of motion (ROM) in swing and stance. T-Test was used to evaluate significant differences between groups (P < 0.05).
Results
Patients with knee OA had significant lower knee flexion ROM (10.3° ± 4.0°) during stance than matched controls (18.0° ± 4.0°) (p < 0.001). Patients with knee OA had significant lower knee flexion ROM (54.8° ± 5.5°) during swing than matched controls (61.2° ± 6.1) (p = 0.003). Patients with knee OA also had longer stride duration (1.12 s ± 0.09 s) than matched controls (1.06 s ± 0.11 s), but this was not statistically significant (p = 0.073). Motion characteristics differentiate between a patient with knee OA and a healthy one with a sensitivity of 0.952 and a specificity of 0.783.
Conclusions
Significant differences were found in the gait profile of patients with knee OA compared to matched control and motion characteristics were identified. This test might help clinicians identify and evaluate a knee problem in a simple gait test.
doi:10.1186/1471-2474-14-169
PMCID: PMC3663779  PMID: 23692671
Osteoarthritis; Gait; Electronic measurement systems
25.  Human odometer is gait-symmetry specific 
In 1709, Berkeley hypothesized of the human that distance is measurable by ‘the motion of his body, which is perceivable by touch’. To be sufficiently general and reliable, Berkeley's hypothesis must imply that distance measured by legged locomotion approximates actual distance, with the measure invariant to gait, speed and number of steps. We studied blindfolded human participants in a task in which they travelled by legged locomotion from a fixed starting point A to a variable terminus B, and then reproduced, by legged locomotion from B, the A–B distance. The outbound (‘measure’) and return (‘report’) gait could be the same or different, with similar or dissimilar step sizes and step frequencies. In five experiments we manipulated bipedal gait according to the primary versus secondary distinction revealed in symmetry group analyses of locomotion patterns. Berkeley's hypothesis held only when the measure and report gaits were of the same symmetry class, indicating that idiothetic distance measurement is gait-symmetry specific. Results suggest that human odometry (and perhaps animal odometry more generally) entails variables that encompass the limbs in coordination, such as global phase, and not variables at the level of the single limb, such as step length and step number, as traditionally assumed.
doi:10.1098/rspb.2009.1134
PMCID: PMC2817097  PMID: 19740881
Berkeley; idiothetic distance; legged locomotion; odometry; symmetry group

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