TY - JOUR A1 - Engel, Tilman A1 - Mueller, Juliane A1 - Kopinski, Stephan A1 - Reschke, Antje A1 - Mueller, Steffen A1 - Mayer, Frank T1 - Unexpected walking perturbations: Reliability and validity of a new treadmill protocol to provoke muscular reflex activities at lower extremities and the trunk JF - Journal of biomechanics N2 - Instrumented treadmills offer the potential to generate standardized walking perturbations, which are particularly rapid and powerful. However, technical requirements to release adequate perturbations regarding timing, duration and amplitude are demanding. This study investigated the test-retest reliability and validity of a new treadmill perturbation protocol releasing rapid and unexpected belt perturbations to provoke muscular reflex responses at lower extremities and the trunk. Fourteen healthy participants underwent two identical treadmill walking protocols, consisting of 10 superimposed one-sided belt perturbations (100 ms duration; 2 m/s amplitude), triggered by a plantar pressure insole 200 ms after heel contact. Delay, duration and amplitude of applied perturbations were recorded by 3D-motion capture. Muscular reflex responses (within 200 ms) were measured at lower extremities and the trunk (10-lead EMG). Data was analyzed descriptively (mean +/- SD). Reliability was analyzed using test-retest variability (TRV%) and limits of agreement (LoA, bias +/- 1.96*SD). Perturbation delay was 202 14 ms, duration was 102 +/- 4 ms and amplitude was 2.1 +/- 0.01 m/s. TRV for perturbation delay, duration and amplitude ranged from 5.0% to 5.7%. LoA reached 3 +/- 36 ms for delay, 2 +/- 13 ms for duration and 0.0 +/- 0.3 m/s for amplitude. EMG amplitudes following perturbations ranged between 106 +/- 97% and 909 +/- 979% of unperturbed gait and EMG latencies between 82 +/- 14 ms and 106 +/- 16 ms. Minor differences between preset and observed perturbation characteristics and results of test-retest analysis prove a high validity with excellent reliability of the setup. Therefore, the protocol tested can be recommended to provoke muscular reflex responses at lower extremities and the trunk in perturbed walking. (C) 2017 Elsevier Ltd. All rights reserved. KW - Perturbation KW - Stumbling KW - Gait KW - Treadmill KW - Reliability KW - MiSpEx Y1 - 2017 U6 - https://doi.org/10.1016/j.jbiomech.2017.02.026 SN - 0021-9290 SN - 1873-2380 VL - 55 SP - 152 EP - 155 PB - Elsevier CY - Oxford ER - TY - JOUR A1 - Brahms, Markus A1 - Heinzel, Stephan A1 - Rapp, Michael Armin A1 - Mückstein, Marie A1 - Hortobágyi, Tibor A1 - Stelzel, Christine A1 - Granacher, Urs T1 - The acute effects of mental fatigue on balance performance in healthy young and older adults – A systematic review and meta-analysis JF - Acta Psychologica N2 - Cognitive resources contribute to balance control. There is evidence that mental fatigue reduces cognitive resources and impairs balance performance, particularly in older adults and when balance tasks are complex, for example when trying to walk or stand while concurrently performing a secondary cognitive task. We conducted a systematic literature search in PubMed (MEDLINE), Web of Science and Google Scholar to identify eligible studies and performed a random effects meta-analysis to quantify the effects of experimentally induced mental fatigue on balance performance in healthy adults. Subgroup analyses were computed for age (healthy young vs. healthy older adults) and balance task complexity (balance tasks with high complexity vs. balance tasks with low complexity) to examine the moderating effects of these factors on fatigue-mediated balance performance. We identified 7 eligible studies with 9 study groups and 206 participants. Analysis revealed that performing a prolonged cognitive task had a small but significant effect (SMDwm = −0.38) on subsequent balance performance in healthy young and older adults. However, age- and task-related differences in balance responses to fatigue could not be confirmed statistically. Overall, aggregation of the available literature indicates that mental fatigue generally reduces balance in healthy adults. However, interactions between cognitive resource reduction, aging and balance task complexity remain elusive. KW - Cognitive fatigue KW - Exertion KW - Tiredness KW - Postural control KW - Gait KW - Sway Y1 - 2022 U6 - https://doi.org/10.1016/j.actpsy.2022.103540 SN - 1873-6297 VL - 225 SP - 1 EP - 13 PB - Elsevier CY - Amsterdam ER - TY - JOUR A1 - Verch, Ronald A1 - Hirschmüller, Anja A1 - Müller, Juliane A1 - Baur, Heiner A1 - Mayer, Frank A1 - Müller, Steffen T1 - Is in-toing gait physiological in children? BT - Results of a large cohort study in 5910 healthy (pre-) school children JF - Gait & posture N2 - Research question: This study aimed to establish reference values in 1-14 year old healthy children and to implement FPA-percentile curves for daily clinical use. Methods: 5910 healthy children performed at least 3 repetitions of barefoot walking over an instrumented walkway using a pressure measurement platform. The FPA [degrees] was extracted and analyzed by age and gender (mean +/- standard deviation; median with percentiles, MANOVA (age, gender) and Wilcoxon-Signed-Rank test for intra-individual side differences (alpha = 0.05). Results: FPA maximum was observed in 2-year-old children and diminished significant until the age of 4 to moderate out-toeing. For ages 5-14, no statistically significant differences in FPA values were present (p > 0.05). MANOVA confirmed age (p < 0.001) and gender (p < 0.001) as significant FPA influencing factors, without combined effect (p > 0.05). In every age group, right feet showed significantly greater out-toeing (p < 0.05). Significance: Percentile values indicate a wide FPA range in children. FPA development in young children shows a spontaneous shift towards moderate external rotation (age 2-4), whereby in-toeing <= 1-5 degrees can be present, but can return to normal. Bilateral in-toeing after the age of four and unilateral in-toeing after the age of seven should be monitored. KW - Foot progression angle KW - Children KW - In-toeing KW - Out-toeing KW - Gait Y1 - 2018 U6 - https://doi.org/10.1016/j.gaitpost.2018.08.019 SN - 0966-6362 SN - 1879-2219 VL - 66 SP - 70 EP - 75 PB - Elsevier CY - Clare ER - TY - JOUR A1 - Müller, Juliane A1 - Müller, Steffen A1 - Baur, Heiner A1 - Mayer, Frank T1 - Intra-individual gait speed variability in healthy children aged 1-15 years JF - Gait & posture N2 - Introduction: Gait speed is one of the most commonly and frequently used parameters to evaluate gait development. It is characterized by high variability when comparing different steps in children. The objective of this study was to determine intra-individual gait speed variability in children. Methods: Gait speed measurements (6-10 trials across a 3 m walkway) were performed and analyzed in 8263 children, aged 1-15 years. The coefficient of variation (CV) served as a measure for intra-individual gait speed variability measured in 6.6 +/- 1.0 trials per child. Multiple linear regression analysis was conducted to evaluate the influence of age and body height on changes in variability. Additionally, a subgroup analysis for height within the group of 6-year-old children was applied. Results: A successive reduction in gait speed variability (CV) was observed for age groups (age: 1-15 years) and body height groups (height: 0.70-1.90 m). The CV in the oldest subjects was only one third of the CV (CV 6.25 +/- 3.52%) in the youngest subjects (CV 16.58 +/- 10.01%). Up to the age of 8 years (or 1.40 m height) there was a significant reduction in CV over time, compared to a leveling off for the older (taller) children. Discussion: The straightforward approach measuring gait speed variability in repeated trials might serve as a fundamental indicator for gait development in children. Walking velocity seems to increase to age 8. Enhanced gait speed consistency of repeated trials develops up to age 15. KW - Development KW - Gait KW - Speed KW - Variability KW - Children Y1 - 2013 U6 - https://doi.org/10.1016/j.gaitpost.2013.02.011 SN - 0966-6362 SN - 1879-2219 VL - 38 IS - 4 SP - 631 EP - 636 PB - Elsevier CY - Clare ER - TY - JOUR A1 - Gschwind, Yves J. A1 - Bridenbaugh, Stephanie A. A1 - Reinhard, Sarah A1 - Granacher, Urs A1 - Monsch, Andreas U. A1 - Kressig, Reto W. T1 - Ginkgo biloba special extract LI 1370 improves dual-task walking in patients with MCI: a randomised, double-blind, placebo-controlled exploratory study JF - Aging clinical and experimental research N2 - Background In patients with mild cognitive impairment (MCI), gait instability, particularly in dual-task situations, has been associated with impaired executive function and an increased fall risk. Ginkgo biloba extract (GBE) could be an effective mean to improve gait stability. Aims This study investigated the effect of GBE on spatiotemporal gait parameters of MCI patients while walking under single and dual-task conditions. Methods Fifty patients aged 50-85 years with MCI and associated dual-task-related gait impairment participated in this randomised, double-blind, placebo-controlled, exploratory phase IV drug trial. Intervention group (IG) patients received GBE (Symfona (R) forte 120 mg) twice-daily for 6 months while control group (CG) patients received placebo capsules. A 6-month open-label phase with identical GBE dosage followed. Gait was quantified at months 0, 3, 6 and 12. Results After 6 months, dual-task-related cadence increased in the IG compared to the CG (p = 0.019, d = 0.71). No significant changes, but GBE-associated numerical non-significant trends were found after 6-month treatment for dual-task-related gait velocity and stride time variability. Discussion Findings suggest that 120 mg of GBE twice-daily for at least 6 months may improve dual-task-related gait performance in patients with MCI. Conclusions The observed gait improvements add to the understanding of the self-reported unspecified improvements among MCI patients when treated with standardised GBE. KW - Gait KW - Walking KW - Executive function KW - Mild cognitive impairment KW - Cognitive enhancer KW - Ginkgo biloba extract Y1 - 2017 U6 - https://doi.org/10.1007/s40520-016-0699-y SN - 1594-0667 SN - 1720-8319 VL - 29 SP - 609 EP - 619 PB - Springer CY - New York ER - TY - JOUR A1 - Granacher, Urs A1 - Lacroix, Andre A1 - Mühlbauer, Thomas A1 - Röttger, Katrin A1 - Gollhofer, Albert T1 - Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults JF - Gerontology N2 - Background: Age-related postural misalignment, balance deficits and strength/power losses are associated with impaired functional mobility and an increased risk of falling in seniors. Core instability strength training (CIT) involves exercises that are challenging for both trunk muscles and postural control and may thus have the potential to induce benefits in trunk muscle strength, spinal mobility and balance performance. Objective: The objective was to investigate the effects of CIT on measures of trunk muscle strength, spinal mobility, dynamic balance and functional mobility in seniors. Methods: Thirty-two older adults were randomly assigned to an intervention group (INT; n = 16, aged 70.8 +/- 4.1 years) that conducted a 9-week progressive CIT or to a control group (n = 16, aged 70.2 +/- 4.5 years). Maximal isometric strength of the trunk flexors/extensors/lateral flexors (right, left)/rotators (right, left) as well as of spinal mobility in the sagittal and the coronal plane was measured before and after the intervention program. Dynamic balance (i.e. walking 10 m on an optoelectric walkway, the Functional Reach test) and functional mobility (Timed Up and Go test) were additionally tested. Results: Program compliance was excellent with participants of the INT group completing 92% of the training sessions. Significant group x test interactions were found for the maximal isometric strength of the trunk flexors (34%, p < 0.001), extensors (21%, p < 0.001), lateral flexors (right: 48%, p < 0.001; left: 53%, p < 0.001) and left rotators (42%, p < 0.001) in favor of the INT group. Further, training-related improvements were found for spinal mobility in the sagittal (11%, p < 0.001) and coronal plane (11%, p = 0.06) directions, for stride velocity (9%, p < 0.05), the coefficient of variation in stride velocity (31%, p < 0.05), the Functional Reach test (20%, p < 0.05) and the Timed Up and Go test (4%, p < 0.05) in favor of the INT group. Conclusion: CIT proved to be a feasible exercise program for seniors with a high adherence rate. Age-related deficits in measures of trunk muscle strength, spinal mobility, dynamic balance and functional mobility can be mitigated by CIT. This training regimen could be used as an adjunct or even alternative to traditional balance and/or resistance training. KW - Elderly KW - Gait KW - Muscle strength KW - Physical performance KW - Postural balance Y1 - 2013 U6 - https://doi.org/10.1159/000343152 SN - 0304-324X VL - 59 IS - 2 SP - 105 EP - 113 PB - Karger CY - Basel ER - TY - JOUR A1 - Jafarnezhadgero, AmirAli A1 - Ghorbanloo, Farshad A1 - Fatollahi, Amir A1 - Dionisio, Valdeci Carlos A1 - Granacher, Urs T1 - Effects of an elastic resistance band exercise program on kinetics and muscle activities during walking in young adults with genu valgus BT - A double-blinded randomized controlled trial JF - Clinical biomechanics : a journal affiliated to the International Society of Biomechanics and the American Society of Biomechanics N2 - Background: This double-blinded randomized-controlled-trial aimed to identify the effects of an elastic band resistance training on walking kinetics and muscle activities in young adults with genu valgus. Methods: Forty-two male young adults aged 22.5(2.7) years with genu valgus were randomly allocated to two experimental groups. The intervention group (n = 21) conducted a 14-weeks elastic band resistance training. The control group was passive during the intervention period and received the same treatment after the post-tests. Pre and post training, ground reaction forces and lower limb muscle activities were recorded during walking. Findings: Results revealed significant group-by-time interactions for peak medial ground reaction force and timeto-peak for posterior ground reaction force in favor of the intervention group (p < 0.012; d = 0.83-3.76). Resistance training with elastic bands resulted in significantly larger peak medial ground reaction force (p < 0.001; d = 1.45) and longer time-to-peak for posterior ground reaction force (p < 0.001; d = 1.85). Finding showed significant group-by-time interactions for peak positive free moment amplitudes in favor of the intervention group (p < 0.001; d = 1.18-2.02). Resistance training resulted in a lower peak positive free moment amplitude (p = 0.001; d = 1.46). With regards to muscle activities, the analysis revealed significant group-by time interactions for rectus femoris and gluteus medius activities during the push-off phase in favor of the intervention group (p < 0.038; d = 0.68-0.89). Resistance training induced higher rectus femoris (p = 0.038; d = 0.84) and gluteus medius (p = 0.007; d = 0.54) activities. Interpretation: This study proved the effectiveness of resistance training using elastic bands on kinetics and muscle activities during walking in male adults with genu valgus disorder. Given that this training regime is low cost, effective, and easy-to-administer, we suggest that it should be implemented as a rehabilitative or preventive means for young adults with genu valgus. KW - Free moment KW - Gait KW - Knee valgus KW - Loading rate KW - Theraband training Y1 - 2021 U6 - https://doi.org/10.1016/j.clinbiomech.2020.105215 SN - 0268-0033 SN - 1879-1271 VL - 81 PB - Elsevier Science CY - Amsterdam [u.a.] ER - TY - JOUR A1 - Hirschmüller, Anja A1 - Konstantinidis, Lukas A1 - Baur, Heiner A1 - Müller, Steffen A1 - Mehlhorn, Alexander A1 - Kontermann, Julia A1 - Grosse, Ulrich A1 - Südkamp, Norbert P. A1 - Helwig, Peter T1 - Do changes in dynamic plantar pressure distribution, strength capacity and postural control after intra-articular calcaneal fracture correlate with clinical and radiological outcome? JF - Injury : international journal of the care of the injured N2 - Fractures of the calcaneus are often associated with serious permanent disability, a considerable reduction in quality of life, and high socio-economic cost. Although some studies have already reported changes in plantar pressure distribution after calcaneal fracture, no investigation has yet focused on the patient's strength and postural control. Method: 60 patients with unilateral, operatively treated, intra-articular calcaneal fractures were clinically and biomechanically evaluated >1 year postoperatively (physical examination, SF-36, AOFAS score, lower leg isokinetic strength, postural control and gait analysis including plantar pressure distribution). Results were correlated to clinical outcome and preoperative radiological findings (Bohler angle, Zwipp and Sanders Score). Results: Clinical examination revealed a statistically significant reduction in range of motion at the tibiotalar and the subtalar joint on the affected side. Additionally, there was a statistically significant reduction of plantar flexor peak torque of the injured compared to the uninjured limb (p < 0.001) as well as a reduction in postural control that was also more pronounced on the initially injured side (standing duration 4.2 +/- 2.9 s vs. 7.6 +/- 2.1 s, p < 0.05). Plantar pressure measurements revealed a statistically significant pressure reduction at the hindfoot (p = 0.0007) and a pressure increase at the midfoot (p = 0.0001) and beneath the lateral forefoot (p = 0.037) of the injured foot. There was only a weak correlation between radiological classifications and clinical outcome but a moderate correlation between strength differences and the clinical questionnaires (CC 0.27-0.4) as well as between standing duration and the clinical questionnaires. Although thigh circumference was also reduced on the injured side, there was no important relationship between changes in lower leg circumference and strength suggesting that measurement of leg circumference may not be a valid assessment of maximum strength deficits. Self-selected walking speed was the parameter that showed the best correlation with clinical outcome (AOFAS score). Conclusion: Calcaneal fractures are associated with a significant reduction in ankle joint ROM, plantar flexion strength and postural control. These impairments seem to be highly relevant to the patients. Restoration of muscular strength and proprioception should therefore be aggressively addressed in the rehabilitation process after these fractures. KW - Intra-articular calcaneal fracture KW - Calcaneus KW - Muscle strength KW - Peak torque KW - Plantar pressure distribution KW - Proprioception KW - Postural control KW - Balance KW - Gait KW - Rehabilitation Y1 - 2011 U6 - https://doi.org/10.1016/j.injury.2010.09.040 SN - 0020-1383 VL - 42 IS - 10 SP - 1135 EP - 1143 PB - Elsevier CY - Oxford ER - TY - JOUR A1 - Hortobagyi, Tibor A1 - Uematsu, Azusa A1 - Sanders, Lianne A1 - Kliegl, Reinhold A1 - Tollar, Jozsef A1 - Moraes, Renato A1 - Granacher, Urs T1 - Beam Walking to Assess Dynamic Balance in Health and Disease BT - a Protocol for the "BEAM" Multicenter Observational Study JF - Gerontology N2 - Background: Dynamic balance keeps the vertical projection of the center of mass within the base of support while walking. Dynamic balance tests are used to predict the risks of falls and eventual falls. The psychometric properties of most dynamic balance tests are unsatisfactory and do not comprise an actual loss of balance while walking. Objectives: Using beam walking distance as a measure of dynamic balance, the BEAM consortium will determine the psychometric properties, lifespan and patient reference values, the relationship with selected “dynamic balance tests,” and the accuracy of beam walking distance to predict falls. Methods: This cross-sectional observational study will examine healthy adults in 7 decades (n = 432) at 4 centers. Center 5 will examine patients (n = 100) diagnosed with Parkinson’s disease, multiple sclerosis, stroke, and balance disorders. In test 1, all participants will be measured for demographics, medical history, muscle strength, gait, static balance, dynamic balance using beam walking under single (beam walking only) and dual task conditions (beam walking while concurrently performing an arithmetic task), and several cognitive functions. Patients and healthy participants age 50 years or older will be additionally measured for fear of falling, history of falls, miniBESTest, functional reach on a force platform, timed up and go, and reactive balance. All participants age 50 years or older will be recalled to report fear of falling and fall history 6 and 12 months after test 1. In test 2, seven to ten days after test 1, healthy young adults and age 50 years or older (n = 40) will be retested for reliability of beam walking performance. Conclusion: We expect to find that beam walking performance vis-à-vis the traditionally used balance outcomes predicts more accurately fall risks and falls. Clinical Trial Registration Number: NCT03532984. KW - Aging KW - Gait KW - Balance KW - Dual tasks KW - Falls Y1 - 2018 U6 - https://doi.org/10.1159/000493360 SN - 0304-324X SN - 1423-0003 VL - 65 IS - 4 SP - 332 EP - 339 PB - Karger CY - Basel ER - TY - JOUR A1 - Beurskens, Rainer A1 - Mühlbauer, Thomas A1 - Granacher, Urs T1 - Association of dual-task walking performance and leg muscle quality in healthy children JF - BMC pediatrics N2 - Background Previous literature mainly introduced cognitive functions to explain performance decrements in dual-task walking, i.e., changes in dual-task locomotion are attributed to limited cognitive information processing capacities. In this study, we enlarge existing literature and investigate whether leg muscular capacity plays an additional role in children’s dual-task walking performance. Methods To this end, we had prepubescent children (mean age: 8.7 ± 0.5 years, age range: 7–9 years) walk in single task (ST) and while concurrently conducting an arithmetic subtraction task (DT). Additionally, leg lean tissue mass was assessed. Results Findings show that both, boys and girls, significantly decrease their gait velocity (f = 0.73), stride length (f = 0.62) and cadence (f = 0.68) and increase the variability thereof (f = 0.20-0.63) during DT compared to ST. Furthermore, stepwise regressions indicate that leg lean tissue mass is closely associated with step time and the variability thereof during DT (R2 = 0.44, p = 0.009). These associations between gait measures and leg lean tissue mass could not be observed for ST (R2 = 0.17, p = 0.19). Conclusion We were able to show a potential link between leg muscular capacities and DT walking performance in children. We interpret these findings as evidence that higher leg muscle mass in children may mitigate the impact of a cognitive interference task on DT walking performance by inducing enhanced gait stability. KW - Gait KW - Cognitive interference KW - Body composition KW - Muscle mass KW - Children Y1 - 2015 U6 - https://doi.org/10.1186/s12887-015-0317-8 SN - 1471-2431 VL - 15 IS - 2 PB - BioMed Central CY - London ER -