Dropped Head Syndrome (DHS) is caused by muscle weakness of the cervical extensor muscles (CEM), resulting in global imbalance. However, the relationship between CEM weakness and sagittal spinal alignment remains unclear. The purpose of this study was to investigate the correlation between CEM weakness and global spinal posture in patients with DHS.
Methods
The subjects were 159 patients diagnosed with DHS. CEM was evaluated by cervical extension performance in the prone position, and the subjects were classified into Mild DHS (MMT≥3; 33 subjects) and Severe DHS (MMT<3; 126 subjects). Sagittal spinal alignment was measured by standing whole-body radiography, and correlations between the parameters were analyzed individually.
Results
Both DHS groups had a positive correlation between CBVA (chin- brow vertical angle), C-SVA (cervical sagittal vertical axis) and TK (Thoracic kyphosis angle). In Mild DHS, T1S (T1 slope angle) showed a positive correlation with TK (thoracic kyphotic angle) but not with PT (pelvic tilt angle), while T1S of Severe DHS showed a positive correlation with TK as well as with PT.
Conclusions
CEM weakness affected the global sagittal spinal posture in patients with DHS. In CEM with MMT< 3, the compensation of head drop was lost to thoraco-lumbar segments, and the head imbalance was compensated for by the pelvic posterior tilt.
{"title":"Spinal compensation patterns in dropped head syndrome according to prone-position cervical extension performance","authors":"Hiroki Sano , Kenji Endo , Tsukasa Ooka , Ryutaro Deguchi , Tomoyasu Yamauchi , Masahiro Ishiyama , Takuya Osada , Ryuuichi Ueno , Kengo Yamamoto","doi":"10.1016/j.gaitpost.2025.110023","DOIUrl":"10.1016/j.gaitpost.2025.110023","url":null,"abstract":"<div><h3>Background</h3><div>Dropped Head Syndrome (DHS) is caused by muscle weakness of the cervical extensor muscles (CEM), resulting in global imbalance. However, the relationship between CEM weakness and sagittal spinal alignment remains unclear. The purpose of this study was to investigate the correlation between CEM weakness and global spinal posture in patients with DHS.</div></div><div><h3>Methods</h3><div>The subjects were 159 patients diagnosed with DHS. CEM was evaluated by cervical extension performance in the prone position, and the subjects were classified into Mild DHS (MMT≥3; 33 subjects) and Severe DHS (MMT<3; 126 subjects). Sagittal spinal alignment was measured by standing whole-body radiography, and correlations between the parameters were analyzed individually.</div></div><div><h3>Results</h3><div>Both DHS groups had a positive correlation between CBVA (chin- brow vertical angle), C-SVA (cervical sagittal vertical axis) and TK (Thoracic kyphosis angle). In Mild DHS, T1S (T1 slope angle) showed a positive correlation with TK (thoracic kyphotic angle) but not with PT (pelvic tilt angle), while T1S of Severe DHS showed a positive correlation with TK as well as with PT.</div></div><div><h3>Conclusions</h3><div>CEM weakness affected the global sagittal spinal posture in patients with DHS. In CEM with MMT< 3, the compensation of head drop was lost to thoraco-lumbar segments, and the head imbalance was compensated for by the pelvic posterior tilt.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"124 ","pages":"Article 110023"},"PeriodicalIF":2.4,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-24DOI: 10.1016/j.gaitpost.2025.110017
Daniela Benesova , Ladislav Cepicka , Lucie Kovarova , Chipo Malambo , Martin Musalek , Karel Svatora
Background
Postural stability is fundamental to motor control, daily activities, and motor learning. Emerging research suggests that emotional stimuli may modulate postural responses through neural pathways linking the limbic, vestibular, and motor systems. However, findings on this relationship remain inconsistent, particularly concerning the effects of emotional valence and arousal on static postural stability.
Research question
Does exposure to emotional stimuli influence postural stability, and how do factors such as stimulus valence, arousal, and individual differences contribute to these effects?
Methods
A systematic review was conducted following PRISMA guidelines. Literature searches were performed using predefined keywords on the Web of Science, Scopus, and PsycInfo. Studies published between 2004 and 2024 that investigated the influence of emotional stimuli on postural stability were included. A total of 19 studies met the eligibility criteria.
Results
Several studies suggested an effect of emotional stimuli on postural control; however, statistical support was inconsistently reported. Unpleasant stimuli often increased center of pressure (COP) displacements, particularly in the anterior-posterior direction, while pleasant stimuli had a less pronounced effect. Individual differences, including age, gender, and anxiety levels, modulated postural responses. Contradictory findings regarding the "freezing" response suggest that methodological and cultural factors may influence outcomes.
Significance
This review highlights the impact of emotional stimuli on postural stability but also underscores the variability in research methodologies. Standardized protocols, integration of dynamic balance assessments, and objective physiological measures, such as electrodermal activity and heart rate monitoring, are needed to refine our understanding of this relationship. These findings affect clinical assessments, sports performance, and rehabilitation strategies.
背景：体位稳定性是运动控制、日常活动和运动学习的基础。新兴研究表明，情绪刺激可能通过连接边缘、前庭和运动系统的神经通路调节姿势反应。然而，关于这种关系的研究结果仍然不一致，特别是关于情绪效价和唤醒对静态姿势稳定性的影响。研究问题：暴露于情绪刺激是否会影响姿势稳定性？刺激效价、唤醒和个体差异等因素如何影响这些影响？方法：按照PRISMA指南进行系统评价。在Web of Science、Scopus和PsycInfo上使用预定义的关键词进行文献搜索。2004年至2024年间发表的研究调查了情绪刺激对姿势稳定性的影响。共有19项研究符合入选标准。结果：多项研究表明情绪刺激对体位控制有影响；然而，统计支持的报告并不一致。不愉快的刺激通常会增加压力中心（COP）移位，特别是在前后方向，而愉快的刺激则没有那么明显的影响。个体差异，包括年龄、性别和焦虑水平，调节姿势反应。关于“冻结”反应的矛盾发现表明，方法和文化因素可能影响结果。意义：本综述强调了情绪刺激对体位稳定性的影响，但也强调了研究方法的可变性。标准化的方案，动态平衡评估的整合，以及客观的生理测量，如皮电活动和心率监测，需要完善我们对这种关系的理解。这些发现影响临床评估、运动表现和康复策略。
{"title":"The effect of emotional stimuli on static postural stability in adults: A systematic review","authors":"Daniela Benesova , Ladislav Cepicka , Lucie Kovarova , Chipo Malambo , Martin Musalek , Karel Svatora","doi":"10.1016/j.gaitpost.2025.110017","DOIUrl":"10.1016/j.gaitpost.2025.110017","url":null,"abstract":"<div><h3>Background</h3><div>Postural stability is fundamental to motor control, daily activities, and motor learning. Emerging research suggests that emotional stimuli may modulate postural responses through neural pathways linking the limbic, vestibular, and motor systems. However, findings on this relationship remain inconsistent, particularly concerning the effects of emotional valence and arousal on static postural stability.</div></div><div><h3>Research question</h3><div>Does exposure to emotional stimuli influence postural stability, and how do factors such as stimulus valence, arousal, and individual differences contribute to these effects?</div></div><div><h3>Methods</h3><div>A systematic review was conducted following PRISMA guidelines. Literature searches were performed using predefined keywords on the Web of Science, Scopus, and PsycInfo. Studies published between 2004 and 2024 that investigated the influence of emotional stimuli on postural stability were included. A total of 19 studies met the eligibility criteria.</div></div><div><h3>Results</h3><div>Several studies suggested an effect of emotional stimuli on postural control; however, statistical support was inconsistently reported. Unpleasant stimuli often increased center of pressure (COP) displacements, particularly in the anterior-posterior direction, while pleasant stimuli had a less pronounced effect. Individual differences, including age, gender, and anxiety levels, modulated postural responses. Contradictory findings regarding the \"freezing\" response suggest that methodological and cultural factors may influence outcomes.</div></div><div><h3>Significance</h3><div>This review highlights the impact of emotional stimuli on postural stability but also underscores the variability in research methodologies. Standardized protocols, integration of dynamic balance assessments, and objective physiological measures, such as electrodermal activity and heart rate monitoring, are needed to refine our understanding of this relationship. These findings affect clinical assessments, sports performance, and rehabilitation strategies.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"123 ","pages":"Article 110017"},"PeriodicalIF":2.4,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-24DOI: 10.1016/j.gaitpost.2025.110019
Mao-Lin Cui , Li-Ying Pan , Wei Lin , Zhuo-Ying Huang , Bei-Ning Ye , Chu-Yi Li , Ying-Xin Ye , Han Lin , Ming-Ting Lin , Ning Wang , Shi-Rui Gan , Yun-Ru Ma , on behalf of the OSCCAR Investigators
Background
Spinocerebellar Ataxia Type 3 (SCA3), the most common hereditary ataxia in China, is characterized by progressive gait dysfunction. While quantitative gait analysis provides critical insights into movement disorder management, conventional motion capture systems are often cost-prohibitive and impractical for clinical use.
Objectives
We propose using the markerless Azure Kinect, a cost-effective and portable tool for gait analysis, to detect SCA3-specific gait patterns and identify gait parameters associated with disease severity and duration.
Methods
We enrolled 38 patients with SCA3 patients and 42 healthy controls (HCs). Gait was recorded using an Azure Kinect. Multiple gait parameters were computed and compared with t-tests/Mann-Whitney U tests. The receiver operating characteristic (ROC) analysis identified discriminatory biomarkers, while Pearson’s test assessed gait-clinical characteristic associations.
Results
Patients with SCA3 exhibited increased mediolateral margins of stability (MOS, p < 0.01), wider step width (p < 0.001), shorter stride length (p = 0.003), slower gait speed (p = 0.007), and reduced hip/knee/ankle joint angles (p < 0.05) compared to HCs. Step width demonstrated the highest diagnostic accuracy (AUC = 0.878, cutoff = 0.197). Increased medial-lateral MOS was negatively correlated with step length (r = -0.52∼-0.45, P < 0.005). Minimal hip frontal angles negatively correlated with SARA scores (r = -0.46, p = 0.004) and disease duration (r = -0.35, p = 0.028), reflecting a progressive cerebellar degeneration.
Conclusion
In SCA3, gait abnormalities such as increased step width and shortened stride length indicate compensatory adaptations exist to enhance dynamic stability. Step width is identified as a sensitive biomarker for SCA3 screening.
{"title":"Multidimensional abnormal gait analysis and biomarker identification for patients with spinocerebellar ataxia type 3 using an Azure Kinect-based motion capture system","authors":"Mao-Lin Cui , Li-Ying Pan , Wei Lin , Zhuo-Ying Huang , Bei-Ning Ye , Chu-Yi Li , Ying-Xin Ye , Han Lin , Ming-Ting Lin , Ning Wang , Shi-Rui Gan , Yun-Ru Ma , on behalf of the OSCCAR Investigators","doi":"10.1016/j.gaitpost.2025.110019","DOIUrl":"10.1016/j.gaitpost.2025.110019","url":null,"abstract":"<div><h3>Background</h3><div>Spinocerebellar Ataxia Type 3 (SCA3), the most common hereditary ataxia in China, is characterized by progressive gait dysfunction. While quantitative gait analysis provides critical insights into movement disorder management, conventional motion capture systems are often cost-prohibitive and impractical for clinical use.</div></div><div><h3>Objectives</h3><div>We propose using the markerless Azure Kinect, a cost-effective and portable tool for gait analysis, to detect SCA3-specific gait patterns and identify gait parameters associated with disease severity and duration.</div></div><div><h3>Methods</h3><div>We enrolled 38 patients with SCA3 patients and 42 healthy controls (HCs). Gait was recorded using an Azure Kinect. Multiple gait parameters were computed and compared with t-tests/Mann-Whitney U tests. The receiver operating characteristic (ROC) analysis identified discriminatory biomarkers, while Pearson’s test assessed gait-clinical characteristic associations.</div></div><div><h3>Results</h3><div>Patients with SCA3 exhibited increased mediolateral margins of stability (MOS, p < 0.01), wider step width (p < 0.001), shorter stride length (p = 0.003), slower gait speed (p = 0.007), and reduced hip/knee/ankle joint angles (p < 0.05) compared to HCs. Step width demonstrated the highest diagnostic accuracy (AUC = 0.878, cutoff = 0.197). Increased medial-lateral MOS was negatively correlated with step length (r = -0.52∼-0.45, P < 0.005). Minimal hip frontal angles negatively correlated with SARA scores (r = -0.46, p = 0.004) and disease duration (r = -0.35, p = 0.028), reflecting a progressive cerebellar degeneration.</div></div><div><h3>Conclusion</h3><div>In SCA3, gait abnormalities such as increased step width and shortened stride length indicate compensatory adaptations exist to enhance dynamic stability. Step width is identified as a sensitive biomarker for SCA3 screening.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"123 ","pages":"Article 110019"},"PeriodicalIF":2.4,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145359800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The human subtalar joint is crucial for bipedal posture and locomotion, providing stability, adaptability, and force dissipation. While its kinematics have been studied, most research has been under non-weight-bearing conditions, leaving its function under physiological loading unclear.
Research question
What is the three-dimensional kinematics of the human subtalar joint during weight-bearing postures, as quantified by the helical axis?
Methods
This study analyzed three-dimensional in vivo subtalar joint kinematics during weight-bearing using upright CT. Fifteen healthy elderly adults (11 females, 4 males; mean age: 64.9 ± 5.0 years) underwent CT scans in neutral, inverted, and everted postures using 10° coronal wedges. Kinematics were quantified via helical axis representation relative to two talar coordinate systems: the foot longitudinal axis and the talus principal axis.
Results
The helical axis ran obliquely from anterior-medial-dorsal to posterior-lateral-plantar, with inclination and deviation angles of 22.4° ± 9.6° and 35.2° ± 5.6° in the former system, and 36.5° ± 10.7° and 12.0° ± 7.1° in the latter. Rotation along the axis was 9.9° ± 3.8°, with minimal translation (0.5 ± 0.5 mm).
Significance
These findings suggest subtalar joint movement is more constrained under weight-bearing conditions than in non-weight-bearing studies. This study underscores the importance of weight-bearing analyses for clinical applications and understanding human foot adaptations for bipedalism.
{"title":"Three-dimensional in vivo kinematics of the subtalar joint during weight-bearing standing on coronal-wedge surfaces using upright computed tomography","authors":"Naomichi Ogihara , Hiroyuki Seki , Asahi Sujino , Akimasa Ito , Yuka Matsumoto , Gen Suwa , Takeo Nagura , Yoichi Yokoyama , Minoru Yamada , Yoshitake Yamada , Masahiro Jinzaki","doi":"10.1016/j.gaitpost.2025.110021","DOIUrl":"10.1016/j.gaitpost.2025.110021","url":null,"abstract":"<div><h3>Background</h3><div>The human subtalar joint is crucial for bipedal posture and locomotion, providing stability, adaptability, and force dissipation. While its kinematics have been studied, most research has been under non-weight-bearing conditions, leaving its function under physiological loading unclear.</div></div><div><h3>Research question</h3><div>What is the three-dimensional kinematics of the human subtalar joint during weight-bearing postures, as quantified by the helical axis?</div></div><div><h3>Methods</h3><div>This study analyzed three-dimensional in vivo subtalar joint kinematics during weight-bearing using upright CT. Fifteen healthy elderly adults (11 females, 4 males; mean age: 64.9 ± 5.0 years) underwent CT scans in neutral, inverted, and everted postures using 10° coronal wedges. Kinematics were quantified via helical axis representation relative to two talar coordinate systems: the foot longitudinal axis and the talus principal axis.</div></div><div><h3>Results</h3><div>The helical axis ran obliquely from anterior-medial-dorsal to posterior-lateral-plantar, with inclination and deviation angles of 22.4° ± 9.6° and 35.2° ± 5.6° in the former system, and 36.5° ± 10.7° and 12.0° ± 7.1° in the latter. Rotation along the axis was 9.9° ± 3.8°, with minimal translation (0.5 ± 0.5 mm).</div></div><div><h3>Significance</h3><div>These findings suggest subtalar joint movement is more constrained under weight-bearing conditions than in non-weight-bearing studies. This study underscores the importance of weight-bearing analyses for clinical applications and understanding human foot adaptations for bipedalism.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"123 ","pages":"Article 110021"},"PeriodicalIF":2.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145359799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-22DOI: 10.1016/j.gaitpost.2025.110020
Andreia Carvalho , Jos Vanrenterghem , Todd C. Pataky , Mark A. Robinson , António P. Veloso , Vera Moniz-Pereira
Background/Aim
Markerless motion capture is an emerging tool for gait analysis. In some populations, e.g., older adults, traditional gait analysis poses practical challenges, such as reduced assessment tolerance, and the number of strides collected can be limited. This study aimed to investigate the influence of the number of strides on test-retest reliability and measurement error of markerless gait biomechanics in older adults.
Methods
Twenty strides were extracted from 29 healthy older adults for each of two sessions. Lower-limb kinematics and kinetics were computed. Subsequently, non-consecutive random subsets of k = 2–19 strides were averaged within-subjects and within-sessions, including scenarios with unequal k between sessions. Integrated Intraclass Correlation Coefficients (iICCA,k) and Standard Errors of Measurement (SEM) were calculated for trajectory data. ICCA,k [Confidence Intervals] were computed for the range of motion and peaks. Two arbitrary thresholds for the minimally acceptable number of strides were combined: (1) the smallest k that yielded an ICC within 10 % of the maximum ICC across all k, and (2) an absolute ICC threshold of 0.75. SEM≤ 2º was deemed suitable for kinematics, and SEM%≤ 5 % for kinetics.
Results
For joint angles and moments, iICC dropped less than 10 % from the highest iICC when using ≥ 7 strides with an equal number of strides across sessions, attaining iICCs≥ 0.75. Reducing the number of strides in one session had less impact than reducing both equally. Lower Confidence intervals were generally ≥ 0.75 for discrete parameters. Kinematic SEM rarely exceeds 2º. Globally, 4 strides are needed to have a kinetics SEM%≤ 5 %.
Conclusion
A minimum of 7 strides contributing to the average observation is generally sufficient to achieve reliable markerless kinematics and kinetics in older adults. These results have particular relevance to populations who may experience limited tolerance for lengthy assessments. Allowing flexibility in stride number collected across sessions, while maintaining reliability, contributes to optimizing data collection strategies.
{"title":"How many strides are needed for reliable markerless gait analysis?","authors":"Andreia Carvalho , Jos Vanrenterghem , Todd C. Pataky , Mark A. Robinson , António P. Veloso , Vera Moniz-Pereira","doi":"10.1016/j.gaitpost.2025.110020","DOIUrl":"10.1016/j.gaitpost.2025.110020","url":null,"abstract":"<div><h3>Background/Aim</h3><div>Markerless motion capture is an emerging tool for gait analysis. In some populations, e.g., older adults, traditional gait analysis poses practical challenges, such as reduced assessment tolerance, and the number of strides collected can be limited. This study aimed to investigate the influence of the number of strides on test-retest reliability and measurement error of markerless gait biomechanics in older adults.</div></div><div><h3>Methods</h3><div>Twenty strides were extracted from 29 healthy older adults for each of two sessions. Lower-limb kinematics and kinetics were computed. Subsequently, non-consecutive random subsets of k = 2–19 strides were averaged within-subjects and within-sessions, including scenarios with unequal k between sessions. Integrated Intraclass Correlation Coefficients (iICC<sub>A,k</sub>) and Standard Errors of Measurement (SEM) were calculated for trajectory data. ICC<sub>A,k</sub> [Confidence Intervals] were computed for the range of motion and peaks. Two arbitrary thresholds for the minimally acceptable number of strides were combined: (1) the smallest k that yielded an ICC within 10 % of the maximum ICC across all k, and (2) an absolute ICC threshold of 0.75. SEM≤ 2º was deemed suitable for kinematics, and SEM%≤ 5 % for kinetics.</div></div><div><h3>Results</h3><div>For joint angles and moments, iICC dropped less than 10 % from the highest iICC when using ≥ 7 strides with an equal number of strides across sessions, attaining iICCs≥ 0.75. Reducing the number of strides in one session had less impact than reducing both equally. Lower Confidence intervals were generally ≥ 0.75 for discrete parameters. Kinematic SEM rarely exceeds 2º. Globally, 4 strides are needed to have a kinetics SEM%≤ 5 %.</div></div><div><h3>Conclusion</h3><div>A minimum of 7 strides contributing to the average observation is generally sufficient to achieve reliable markerless kinematics and kinetics in older adults. These results have particular relevance to populations who may experience limited tolerance for lengthy assessments. Allowing flexibility in stride number collected across sessions, while maintaining reliability, contributes to optimizing data collection strategies.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"123 ","pages":"Article 110020"},"PeriodicalIF":2.4,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145359797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Falling is a major concern in the ageing population. Strengthening the plantar intrinsic foot muscles (PIFM) may improve gait and balance in older adults and, therefore, may have potential for fall prevention.
Research question
The aim of the present study is to examine the effect of a PIFM strengthening program on gait, balance and functional outcomes in older adults.
Methods
For this assessor-blinded RCT, older adults (> 65 years) with potentially increased fall risk were recruited at functional exercise classes and randomly assigned to an intervention (12-week supervised and progressive PIFM strengthening program) and a control group. The trial outcomes were between-group differences in mean change from baseline in maximum gait speed (primary outcome), balance during gait, foot and ankle biomechanics during gait and concerns about falling and within-group differences in capacity and strength of foot muscles.
Results
Thirty-three participants were included. No between group differences were found for change in maximum gait speed. However, the intervention group showed a larger reduction in concerns about falling. In addition, the intervention group showed increased capacity and strength of foot muscles, but this was not related to other findings.
Significance
This study did not show an effect of PIFM strengthening training on maximum gait speed in older adults who are involved in a functional exercise program. However, it seems to reduce concerns about falling. This advocates further research on the benefits of integrating PIFM strengthening exercises in functional exercise programs. In addition, future studies are needed to unravel the mechanism behind the reduction in concerns about falling.
{"title":"Effects of a 12-week intrinsic foot muscle strengthening program (STIFF) on gait, balance and concerns about falling in physically active older adults: An assessor-blinded randomized-controlled trial","authors":"Lydia Willemse , Eveline J.M. Wouters , Martijn F. Pisters , Benedicte Vanwanseele","doi":"10.1016/j.gaitpost.2025.110018","DOIUrl":"10.1016/j.gaitpost.2025.110018","url":null,"abstract":"<div><h3>Background</h3><div>Falling is a major concern in the ageing population. Strengthening the plantar intrinsic foot muscles (PIFM) may improve gait and balance in older adults and, therefore, may have potential for fall prevention.</div></div><div><h3>Research question</h3><div>The aim of the present study is to examine the effect of a PIFM strengthening program on gait, balance and functional outcomes in older adults.</div></div><div><h3>Methods</h3><div>For this assessor-blinded RCT, older adults (> 65 years) with potentially increased fall risk were recruited at functional exercise classes and randomly assigned to an intervention (12-week supervised and progressive PIFM strengthening program) and a control group. The trial outcomes were between-group differences in mean change from baseline in maximum gait speed (primary outcome), balance during gait, foot and ankle biomechanics during gait and concerns about falling and within-group differences in capacity and strength of foot muscles.</div></div><div><h3>Results</h3><div>Thirty-three participants were included. No between group differences were found for change in maximum gait speed. However, the intervention group showed a larger reduction in concerns about falling. In addition, the intervention group showed increased capacity and strength of foot muscles, but this was not related to other findings.</div></div><div><h3>Significance</h3><div>This study did not show an effect of PIFM strengthening training on maximum gait speed in older adults who are involved in a functional exercise program. However, it seems to reduce concerns about falling. This advocates further research on the benefits of integrating PIFM strengthening exercises in functional exercise programs. In addition, future studies are needed to unravel the mechanism behind the reduction in concerns about falling.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"123 ","pages":"Article 110018"},"PeriodicalIF":2.4,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-20DOI: 10.1016/j.gaitpost.2025.110015
Szu-Hua Chen , Li-Shan Chou
Background
Obstacle-crossing (OC) requires dynamic balance and cognitive attention, which may decline with age and fatigue. While age-related gait changes are known, the combined effects of fatigue and cognitive demand on OC remain unclear.
Research Question
How does performance fatigability affect balance and crossing performance during single- and dual-task OC in older versus younger adults?
Methods
Seventeen older and 17 young adults (9 females in each group) with post-fatigue Rating of Perceived Exertion (RPE) > 15/20 were included. In Visit 1, participants were familiarized with OC and a working memory task. In Visit 2, they performed single- and dual-task OC trials before and after a fatiguing sit-to-stand protocol. Motion capture and force plates recorded toe-obstacle clearance, foot placement, crossing velocity, and balance (measured as center of mass-center of pressure inclination angle, IA). Fatigue was assessed via RPE and knee extension torque. Cognitive performance was evaluated by accuracy and reaction time. Data were analyzed using repeated measures ANOVAs and mixed-effects models (α =.05).
Results
Both age groups experienced similar exertion and strength loss post-fatigue. Increased mediolateral IA indicated reduced balance control, though crossing velocity and foot placement remained stable. Post-fatigue, the typical increase in toe-obstacle clearance during dual-tasking was reduced. Surprisingly, cognitive performance improved post-fatigue, with higher accuracy and faster reaction times.
Significance
Fatigue impaired gait balance control in both age groups, shown by increased IA. The reduced toe-clearance during dual-tasking post-fatigue suggests decreased emphasis on safe obstacle navigation. Improved cognitive performance without slowing suggests a shift in attentional priorities.
{"title":"Balance control during obstacle-crossing in older adults after a fatiguing protocol","authors":"Szu-Hua Chen , Li-Shan Chou","doi":"10.1016/j.gaitpost.2025.110015","DOIUrl":"10.1016/j.gaitpost.2025.110015","url":null,"abstract":"<div><h3>Background</h3><div>Obstacle-crossing (OC) requires dynamic balance and cognitive attention, which may decline with age and fatigue. While age-related gait changes are known, the combined effects of fatigue and cognitive demand on OC remain unclear.</div></div><div><h3>Research Question</h3><div>How does performance fatigability affect balance and crossing performance during single- and dual-task OC in older versus younger adults?</div></div><div><h3>Methods</h3><div>Seventeen older and 17 young adults (9 females in each group) with post-fatigue Rating of Perceived Exertion (RPE) > 15/20 were included. In Visit 1, participants were familiarized with OC and a working memory task. In Visit 2, they performed single- and dual-task OC trials before and after a fatiguing sit-to-stand protocol. Motion capture and force plates recorded toe-obstacle clearance, foot placement, crossing velocity, and balance (measured as center of mass-center of pressure inclination angle, IA). Fatigue was assessed via RPE and knee extension torque. Cognitive performance was evaluated by accuracy and reaction time. Data were analyzed using repeated measures ANOVAs and mixed-effects models (α =.05).</div></div><div><h3>Results</h3><div>Both age groups experienced similar exertion and strength loss post-fatigue. Increased mediolateral IA indicated reduced balance control, though crossing velocity and foot placement remained stable. Post-fatigue, the typical increase in toe-obstacle clearance during dual-tasking was reduced. Surprisingly, cognitive performance improved post-fatigue, with higher accuracy and faster reaction times.</div></div><div><h3>Significance</h3><div>Fatigue impaired gait balance control in both age groups, shown by increased IA. The reduced toe-clearance during dual-tasking post-fatigue suggests decreased emphasis on safe obstacle navigation. Improved cognitive performance without slowing suggests a shift in attentional priorities.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"123 ","pages":"Article 110015"},"PeriodicalIF":2.4,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-17DOI: 10.1016/j.gaitpost.2025.110016
Meichan Zhu , Paul Willems , Rik Marcellis , Rachel Senden , Lisa van Stiphout , Mustafa Karabulut , Wouter Bijnens , Nefeli Koutsoureli , Miranda Janssen , Angélica Pérez Fornos , Nils Guinand , Raymond van de Berg , Kenneth Meijer , Christopher McCrum
Background
Gait and balance impairments, including increased gait variability, are prevalent in people with bilateral vestibulopathy (BVP). Wearable accelerometers may provide a clinically feasible method to objectively assess gait variability but have not yet been explored in BVP.
Research question
Is accelerometer-based assessment of step time variability during treadmill walking valid in people with BVP?
Methods
Adults with BVP and age-sex-matched healthy controls walked at 0.6 m/s, 0.8 m/s, and 1.0 m/s on the treadmill of the Computer Assisted Rehabilitation Environment. We examined differences in step time means and coefficients of variation (CoV) between accelerometery (single lower back sensor; MOX1) and 3D motion capture and force plates (Vicon). Validity was assessed using intraclass correlation coefficients (ICC3,1), Pearson and Spearman correlation coefficients, and Bland-Altman analyses to determine agreement, association and consistency between the methods. Validity was additionally assessed by comparing statistical significant differences and the effect sizes between the groups using each method.
Results
Mean step time showed moderate to excellent agreement between methods, while step time CoV showed poor agreement and proportional bias. Accelerometery showed consistent between-group significance and effect size values, particularly at 0.6 m/s, although effect sizes were larger in motion capture data than in accelerometer data.
Significance
An accelerometer-based assessment is valid for assessing mean step time in people with BVP. For assessing step time variability, it can distinguish between known groups (particularly at slower speeds) but does not demonstrate criterion validity. Before clinical application, test-retest reliability and sensitivity to change should be assessed in BVP.
{"title":"Validity of accelerometer-based analysis of step time and step time variability during treadmill walking in people with bilateral vestibulopathy","authors":"Meichan Zhu , Paul Willems , Rik Marcellis , Rachel Senden , Lisa van Stiphout , Mustafa Karabulut , Wouter Bijnens , Nefeli Koutsoureli , Miranda Janssen , Angélica Pérez Fornos , Nils Guinand , Raymond van de Berg , Kenneth Meijer , Christopher McCrum","doi":"10.1016/j.gaitpost.2025.110016","DOIUrl":"10.1016/j.gaitpost.2025.110016","url":null,"abstract":"<div><h3>Background</h3><div>Gait and balance impairments, including increased gait variability, are prevalent in people with bilateral vestibulopathy (BVP). Wearable accelerometers may provide a clinically feasible method to objectively assess gait variability but have not yet been explored in BVP.</div></div><div><h3>Research question</h3><div>Is accelerometer-based assessment of step time variability during treadmill walking valid in people with BVP?</div></div><div><h3>Methods</h3><div>Adults with BVP and age-sex-matched healthy controls walked at 0.6 m/s, 0.8 m/s, and 1.0 m/s on the treadmill of the Computer Assisted Rehabilitation Environment. We examined differences in step time means and coefficients of variation (CoV) between accelerometery (single lower back sensor; MOX1) and 3D motion capture and force plates (Vicon). Validity was assessed using intraclass correlation coefficients (ICC<sub>3,1</sub>), Pearson and Spearman correlation coefficients, and Bland-Altman analyses to determine agreement, association and consistency between the methods. Validity was additionally assessed by comparing statistical significant differences and the effect sizes between the groups using each method.</div></div><div><h3>Results</h3><div>Mean step time showed moderate to excellent agreement between methods, while step time CoV showed poor agreement and proportional bias. Accelerometery showed consistent between-group significance and effect size values, particularly at 0.6 m/s, although effect sizes were larger in motion capture data than in accelerometer data.</div></div><div><h3>Significance</h3><div>An accelerometer-based assessment is valid for assessing mean step time in people with BVP. For assessing step time variability, it can distinguish between known groups (particularly at slower speeds) but does not demonstrate criterion validity. Before clinical application, test-retest reliability and sensitivity to change should be assessed in BVP.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"123 ","pages":"Article 110016"},"PeriodicalIF":2.4,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prevention of spine disorders and their management require better understanding of related biomechanical issues. While tremendous progress has been performed for musculoskeletal modelling of the spine, subject specific modelling of the gravitational loads and their effects on the spine is still an issue.
Recently, 3D reconstruction of the skeleton from biplanar head to feet X-rays in erect position has been completed by the external body envelope. An approach named “barycentremetry” has been proposed, based on density models to estimate the mass and centre of mass of each body segment, yielding a force plate less estimation of the gravity line, together with the estimation of the gravitational loads and the associated lever arm at each vertebral level.
Principal results
Due to vertebral pose, gravitational loads effect on intervertebral disc shows wide variation. Studies exploring barycentremetry clinical relevance were analysed, particularly for adolescent idiopathic scoliosis, adult spinal deformities and osteoporosis. They progressively yield a better comprehension of the potential vicious circles linking postural disorder to increase of spine loads to increase of postural disorder.
Barycentremetry was also explored within gait and motion analysis research, allowing to estimate subject specific body segments inertial parameters for patient specific dynamic analysis. Indeed, 3D musculoskeletal modelling of posture and motion could benefit from subject specific dynamic analysis based on barycentremetry.
Major conclusions
Such approaches progressively provide a better understanding of the stability of this complex system and compensation strategies that could be useful for early detection of disorders that are responsible of a biomechanical cascade.
{"title":"Barycentremetry, spine disorders, posture and motion analysis","authors":"Wafa Skalli , Tristan Langlais , Marc Khalifé , Emmanuelle Ferrero , Claudio Vergari , Ismat Ghanem , Ayman Assi","doi":"10.1016/j.gaitpost.2025.110014","DOIUrl":"10.1016/j.gaitpost.2025.110014","url":null,"abstract":"<div><h3>Purpose of the research</h3><div>Prevention of spine disorders and their management require better understanding of related biomechanical issues. While tremendous progress has been performed for musculoskeletal modelling of the spine, subject specific modelling of the gravitational loads and their effects on the spine is still an issue.</div><div>Recently, 3D reconstruction of the skeleton from biplanar head to feet X-rays in erect position has been completed by the external body envelope. An approach named “barycentremetry” has been proposed, based on density models to estimate the mass and centre of mass of each body segment, yielding a force plate less estimation of the gravity line, together with the estimation of the gravitational loads and the associated lever arm at each vertebral level.</div></div><div><h3>Principal results</h3><div>Due to vertebral pose, gravitational loads effect on intervertebral disc shows wide variation. Studies exploring barycentremetry clinical relevance were analysed, particularly for adolescent idiopathic scoliosis, adult spinal deformities and osteoporosis. They progressively yield a better comprehension of the potential vicious circles linking postural disorder to increase of spine loads to increase of postural disorder.</div><div>Barycentremetry was also explored within gait and motion analysis research, allowing to estimate subject specific body segments inertial parameters for patient specific dynamic analysis. Indeed, 3D musculoskeletal modelling of posture and motion could benefit from subject specific dynamic analysis based on barycentremetry.</div></div><div><h3>Major conclusions</h3><div>Such approaches progressively provide a better understanding of the stability of this complex system and compensation strategies that could be useful for early detection of disorders that are responsible of a biomechanical cascade.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"123 ","pages":"Article 110014"},"PeriodicalIF":2.4,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-16DOI: 10.1016/j.gaitpost.2025.110013
Marc Khalifé , Renaud Lafage , Bassel Diebo , Alan Daniels , Munish Gupta , Christopher Ames , Shay Bess , Douglas Burton , Khaled Kebaish , Michael Kelly , Han Jo Kim , Eric Klineberg , Lawrence Lenke , Stephen Lewis , Peter Passias , Christopher Shaffrey , Justin S. Smith , Frank Schwab , Virginie Lafage , ISSG
Background
Pelvic tilt (PT) has been a parameter of interest in biomechanics of spinal deformity for decades. It remains unclear how patients achieve different values of PT pre- and postoperatively.
Research question
This study aimed at assessing the relative contribution of hip extension, knee flexion and ankle extension to PT, factoring malalignment and hip osteoarthritis (OA).
Methods
This retrospective study included Adult Spinal Deformity (ASD) patients with preoperative full-body radiographs from a multicenter database, with a sub-analysis of patients with complete 1-year follow-up (1yFU). Age and PI-adjusted normative PT (NormPT) and offset from norm (OffPT) were calculated, as for sacro-femoral angle (SFA), knee flexion angle (KA) and ankle angle (AA). Multivariate linear regression models controlling for age, frailty, severe hip OA, pelvic incidence (PI), SFA, and KA were used to predict PT at baseline, and offset from NormPT. Another model was generated to predict PT change.
Results
600 patients at baseline and 336 with 1yFU were included. Mean age was 61 ± 15, 70.2 % were females and 40 % were revision cases. At baseline, regression analysis revealed that 0.9° increase in hip extension (SFA) and a 0.6° increase in knee flexion (KA) amounted to 1° increase in PT.
Knee and ankle contribution to PT significantly increased for while hip extension decreased as TPA augmented (p < 0.001). Patients with low deformity compensated with hip extension, while knee flexion was the largest contributor of PT in high deformity patients: 70.7 % (44.7 – 111.9). Median contribution of knee flexion to PT was larger for patients who presented hip OA.
Significance
This study demonstrated that PT is a phenomenon driven by extension of the hips and flexion of the knees and proposed values to predict PT from those two compensatory mechanisms. Magnitude of spinal deformity and hip OA alters the magnitude of SFA/KA contribution to PT.
{"title":"The contribution of lower limbs to Pelvic Tilt: A baseline and postoperative full-body analysis","authors":"Marc Khalifé , Renaud Lafage , Bassel Diebo , Alan Daniels , Munish Gupta , Christopher Ames , Shay Bess , Douglas Burton , Khaled Kebaish , Michael Kelly , Han Jo Kim , Eric Klineberg , Lawrence Lenke , Stephen Lewis , Peter Passias , Christopher Shaffrey , Justin S. Smith , Frank Schwab , Virginie Lafage , ISSG","doi":"10.1016/j.gaitpost.2025.110013","DOIUrl":"10.1016/j.gaitpost.2025.110013","url":null,"abstract":"<div><h3>Background</h3><div>Pelvic tilt (PT) has been a parameter of interest in biomechanics of spinal deformity for decades. It remains unclear how patients achieve different values of PT pre- and postoperatively.</div></div><div><h3>Research question</h3><div>This study aimed at assessing the relative contribution of hip extension, knee flexion and ankle extension to PT, factoring malalignment and hip osteoarthritis (OA).</div></div><div><h3>Methods</h3><div>This retrospective study included Adult Spinal Deformity (ASD) patients with preoperative full-body radiographs from a multicenter database, with a sub-analysis of patients with complete 1-year follow-up (1yFU). Age and PI-adjusted normative PT (NormPT) and offset from norm (OffPT) were calculated, as for sacro-femoral angle (SFA), knee flexion angle (KA) and ankle angle (AA). Multivariate linear regression models controlling for age, frailty, severe hip OA, pelvic incidence (PI), SFA, and KA were used to predict PT at baseline, and offset from NormPT. Another model was generated to predict PT change.</div></div><div><h3>Results</h3><div>600 patients at baseline and 336 with 1yFU were included. Mean age was 61 ± 15, 70.2 % were females and 40 % were revision cases. At baseline, regression analysis revealed that 0.9° increase in hip extension (SFA) and a 0.6° increase in knee flexion (KA) amounted to 1° increase in PT.</div><div>Knee and ankle contribution to PT significantly increased for while hip extension decreased as TPA augmented (<em>p < 0.001</em>). Patients with low deformity compensated with hip extension, while knee flexion was the largest contributor of PT in high deformity patients: 70.7 % (44.7 – 111.9). Median contribution of knee flexion to PT was larger for patients who presented hip OA.</div></div><div><h3>Significance</h3><div>This study demonstrated that PT is a phenomenon driven by extension of the hips and flexion of the knees and proposed values to predict PT from those two compensatory mechanisms. Magnitude of spinal deformity and hip OA alters the magnitude of SFA/KA contribution to PT.</div></div>","PeriodicalId":12496,"journal":{"name":"Gait & posture","volume":"123 ","pages":"Article 110013"},"PeriodicalIF":2.4,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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