Asymmetry in weight-bearing is a common feature in poststroke hemiparesis and is related to temporal asymmetry during walking. The aim of this study was to investigate the effect of an auditory cue for stepping in place on measures of temporal and weight-bearing asymmetry. A total of 10 community-dwelling adults (6 males and 4 females) with chronic poststroke hemiparesis performed 5 un-cued stepping trials and 5 stepping trials cued by an auditory metronome cue. A Vicon system was used to collect full body kinematic trajectories. Two force platforms were used to measure ground reaction forces. Step, swing, and stance times were used to calculate temporal symmetry ratios. Weight-bearing was assessed using the vertical component of the ground reaction force and center of mass-center of pressure separation at mid-stance. Weight-bearing asymmetry was significantly reduced during stepping with an auditory cue. Asymmetry values for step, swing, and stance times were also significantly reduced with auditory cueing. These findings show that auditory cueing when stepping in place produces immediate reductions in measures of temporal asymmetry and dynamic weight-bearing asymmetry.

Lightly touching an external reference, whether a fixed point or another person, reliably improves postural stability.In hemiparetic stroke patients, however, the effect of fixed point light touch (LT) on balance is uncertain.Moreover, it is not clear whether stroke patients respond in the same manner as healthy controls to light interpersonal touch (IPT).In the present study, therefore, the effects of LT and IPT on balance were contrasted in older adults with and without chronic hemiparetic stroke.Participants stood with open eyes in comfortable, normal bipedal quiet stance and performed 4 contact conditions in random order: no contact, fingertip LT, active fingertip IPT and passive elbow IPT.Body sway varied in response to the contact condition in both groups.The hemiparetic patients, whose impairment was relatively mild, showed responsiveness to LT and IPT similar to the non-hemiparetic group in terms of proportional sway reduction in the anteroposterior but not in the mediolateral sway direction.This indicates that light touch effects are robust but cannot be generalized from healthy older adults to hemiparetic stroke patients without consideration of moderating functional constraints of the individual and the specific postural context.Future research should include hemiparetic individuals with moderate to severe postural deficits to determine possible limitations of light touch balance support in stroke.

BACKGROUND:Hemiparesis after stroke typically results in a reduced walking speed, an asymmetrical gait pattern and a reduced ability to make gait adjustments. The purpose of this pilot study was to investigate the feasibility and preliminary efficacy of home-based training involving auditory cueing of stepping in place. METHODS:Twelve community-dwelling participants with chronic hemiparesis completed two 3-week blocks of home-based stepping to music overlaid with an auditory metronome. Tempo of the metronome was increased 5% each week. One 3-week block used a regular metronome, whereas the other 3-week block had phase shift perturbations randomly inserted to cue stepping adjustments. RESULTS:All participants reported that they enjoyed training, with 75% completing all training blocks. No adverse events were reported. Walking speed, Timed Up and Go (TUG) time and Dynamic Gait Index (DGI) scores (median [inter-quartile range]) significantly improved between baseline (speed = 0.61 [0.32, 0.85] m⋅s-1; TUG = 20.0 [16.0, 39.9] s; DGI = 14.5 [11.3, 15.8]) and post stepping training (speed = 0.76 [0.39, 1.03] m⋅s-1; TUG = 16.3 [13.3, 35.1] s; DGI = 16.0 [14.0, 19.0]) and was maintained at follow-up (speed = 0.75 [0.41, 1.03] m⋅s-1; TUG = 16.5 [12.9, 34.1] s; DGI = 16.5 [13.5, 19.8]). CONCLUSION:This pilot study suggests that auditory-cued stepping conducted at home was feasible and well-tolerated by participants post-stroke, with improvements in walking and functional mobility. No differences were detected between regular and phase-shift training with the metronome at each assessment point.

Exercise-induced increases in brain blood flow are a key mechanistic pathway for improved brain function through regular exercise. Water-based exercise augments this response and therefore may represent an optimal exercise strategy to target this mediator of improved brain health, particularly for those with impaired cerebrovascular vascular function such as stroke survivors. While aquatic treadmill exercise has been reported to improve gait re-education in stroke rehabilitation, no research has assessed whether cerebrovascular function in stroke survivors is improved following water-based training. PURPOSE: To examine the effect of a 4-wk aquatic treadmill (ATM) training intervention on cerebrovascular responsiveness in community-dwelling stroke survivors. METHODS: Six community-dwelling stroke survivors (58 ± 11 yrs), with chronic stroke (>6 months), completed a 4-wk ATM training intervention of 30 min water-based walking, 3 times/wk. Before and following the intervention, resting cerebral blood flow velocity (Transcranial Doppler) of the stroke affected and unaffected cerebral hemispheres was assessed along with cerebrovascular responsiveness, as indexed from the percent change in middle cerebral artery blood velocity (MCAv) to a 4-min hypercapnic stimulus (5% CO2 in air). ANOVA was used to compare pre and post intervention measures. RESULTS: Pre-training resting MCAv was similar between the affected and unaffected side (mean ± SD: 46 ± 12 vs 46 ± 19 cm/s, respectively; p=0.96), and the 4-wk intervention did not change this relation (p=0.42) nor significantly change the resting MCAv value (post training: 47 ± 11 vs 52 ± 15 cm/s; p=0.29). MCAv-CO2 responsiveness increased by 40% in the affected hemisphere (2.8 ± 1.9 to 4.2 ± 1.8 %MCAv / mm Hg PETCO2) and 65% in the unaffected hemisphere (3.0 ± 1.1 to 4.9 ± 0.9 %MCAv / mm Hg PETCO2) following the 4-wk intervention, although this main effect did not reach statistical significance (p=0.08) nor was there statistical support for a differential increase between hemispheres (interaction effect: p=0.41). CONCLUSIONS: This pilot study supports ATM training as a feasible option in stroke rehabilitation, and shows promising potential of enhanced cerebrovascular function for stroke survivors in this chronic phase of the rehabilitation pathway.

Cerebellar stroke typically results in increased variability during walking. Previous research has suggested that auditory cueing reduces excessive variability in conditions such as Parkinson’s disease and post-stroke hemiparesis. The aim of this case report was to investigate whether the use of a metronome cue during walking could reduce excessive variability in gait parameters after a cerebellar stroke. An elderly female with a history of cerebellar stroke and recurrent falling undertook three standard gait trials and three gait trials with an auditory metronome. A Vicon system was used to collect 3-D marker trajectory data. The coefficient of variation was calculated for temporal and spatial gait parameters. SDs of the joint angles were calculated and used to give a measure of joint kinematic variability. Step time, stance time, and double support time variability were reduced with metronome cueing. Variability in the sagittal hip, knee, and ankle angles were reduced to normal values when walking to the metronome. In summary, metronome cueing resulted in a decrease in variability for step, stance, and double support times and joint kinematics. Further research is needed to establish whether a metronome may be useful in gait rehabilitation after cerebellar stroke and whether this leads to a decreased risk of falling.

In para-cycling, competitors are classed based on functional impairment resulting in cyclists with neurological and locomotor impairments competing against each other. In Paralympic competition, classes are combined by using a factoring adjustment to race times to produce the overall medallists. Pacing in short-duration track cycling events is proposed to utilize an “all-out” strategy in able-bodied competition. However, pacing in para-cycling may vary depending on the level of impairment. Analysis of the pacing strategies employed by different classification groups may offer scope for optimal performance; therefore, this study investigated the pacing strategy adopted during the 1-km time trial (TT) and 500-m TT in elite C1 to C3 para-cyclists and able-bodied cyclists. Total times and intermediate split times (125-m intervals; measured to 0.001 s) were obtained from the C1-C3 men's 1-km TT (n = 28) and women's 500-m TT (n = 9) from the 2012 Paralympic Games and the men's 1-km TT (n = 19) and women's 500-m TT (n = 12) from the 2013 UCI World Track Championships from publically available video. Split times were expressed as actual time, factored time (for the para-cyclists) and as a percentage of total time. A two-way analysis of variance was used to investigate differences in split times between the different classifications and the able-bodied cyclists in the men's 1-km TT and between the para-cyclists and able-bodied cyclists in the women's 500-m TT. The importance of position at the first split was investigated with Kendall's Tau-b correlation. The first 125-m split time was the slowest for all cyclists, representing the acceleration phase from a standing start. C2 cyclists were slowest at this 125-m split, probably due to a combination of remaining seated in this acceleration phase and a high proportion of cyclists in this group being trans-femoral amputees. Not all cyclists used aero-bars, preferring to use drop, flat or bullhorn handlebars. Split times increased in the later stages of the race, demonstrating a positive pacing strategy. In the shorter women's 500-m TT, rank at the first split was more strongly correlated with final position than in the longer men's 1-km TT. In conclusion, a positive pacing strategy was adopted by the different para-cycling classes.

Recovery of walking function is a vital goal of post-stroke rehabilitation. Cueing using audio metronomes has been shown to improve gait, but can be impractical when interacting with others, particularly outdoors where awareness of vehicles and bicycles is essential. Audio is also unsuitable in environments with high background noise, or for those with a hearing impairment. If successful, lightweight portable tactile cueing has the potential to take the benefits of cueing out of the laboratory and into everyday life. The Haptic Bracelets are lightweight wireless devices containing a computer, accelerometers and low-latency vibrotactiles with a wide dynamic range. In this paper we review gait rehabilitation problems and existing solutions, and present an early pilot in which the Haptic Bracelets were applied to post-stroke gait rehabilitation. Tactile cueing during walking was well received in the pilot, and analysis of motion capture data showed immediate improvements in gait.

Hemiparetic gait due to stroke is characterized by temporal asymmetry and variability. Research shows this can be improved by auditory cueing, whereby participants train to step in time and space with a visual or auditory cue. This particular method is effective in training a symmetrical gait and helps to improve coordination and speed. We describe a pilot study that investigates the possibility of training with an auditory rhythmical metronome embedded in music, during stepping in place within a home- based setting. Stepping in place incorporates aspects of movements that are also important for a successful gait, such as reciprocal flexion and extension of the legs in timely coordination and synchronization, creating a step frequency, a swing phase and single limb support. Stepping in place may also provide a valuable method for home-based training, as little space in the home is required and, therefore, participants are less likely to fall. This case study seeks to obtain proof of the concept that stepping in place within a home setting may be a useful tool for locomotor training after stroke.

Humans can synchronize movements with auditory beats or rhythms without apparent effort. This ability to entrain to the beat is considered automatic, such that any perturbations are corrected for, even if the perturbation was not consciously noted. Temporal correction of upper limb (e.g., finger tapping) and lower limb (e.g., stepping) movements to a phase perturbed auditory beat usually results in individuals being back in phase after just a few beats. When a metronome is presented in more than one sensory modality, a multisensory advantage is observed, with reduced temporal variability in finger tapping movements compared to unimodal conditions. Here, we investigate synchronization of lower limb movements (stepping in place) to auditory, visual and combined auditory-visual (AV) metronome cues. In addition, we compare movement corrections to phase advance and phase delay perturbations in the metronome for the three sensory modality conditions. We hypothesized that, as with upper limb movements, there would be a multisensory advantage, with stepping variability being lowest in the bimodal condition. As such, we further expected correction to the phase perturbation to be quickest in the bimodal condition. Our results revealed lower variability in the asynchronies between foot strikes and the metronome beats in the bimodal condition, compared to unimodal conditions. However, while participants corrected substantially quicker to perturbations in auditory compared to visual metronomes, there was no multisensory advantage in the phase correction task-correction under the bimodal condition was almost identical to the auditory-only (AO) condition. On the whole, we noted that corrections in the stepping task were smaller than those previously reported for finger tapping studies. We conclude that temporal corrections are not only affected by the reliability of the sensory information, but also the complexity of the movement itself.

Studying the relationships between centre of mass (COM) and centre of pressure (COP) during walking has been shown to be useful in determining movement stability. The aim of the current study was to compare COM-COP separation measures during walking between groups of older adults with no history of falling, and a history of falling due to tripping or slipping. Any differences between individuals who have fallen due to a slip and those who have fallen due to a trip in measures of dynamic balance could potentially indicate differences in the mechanisms responsible for falls. Forty older adults were allocated into groups based on their self-reported fall history during walking. The non-faller group had not experienced a fall in at least the previous year. Participants who had experienced a fall were split into two groups based on whether a trip or slip resulted in the fall(s). A Vicon system was used to collect full body kinematic trajectories. Two force platforms were used to measure ground reaction forces. The COM was significantly further ahead of the COP at heel strike for the trip (14.3 ± 2.7 cm) and slip (15.3 ± 1.1 cm) groups compared to the non-fallers (12.0 ± 2.7 cm). COM was significantly further behind the COP at foot flat for the slip group (-14.9 ± 3.6 cm) compared to the non-fallers (-10.3 ± 3.9 cm). At mid-swing, the COM of the trip group was ahead of the COP (0.9 ± 1.6 cm), whereas for the slip group the COM was behind the COP (-1.2 ± 2.2 cm). These results show identifiable differences in dynamic balance control of walking between older adults with a history of tripping or slipping and non-fallers.

Recovery of walking function is a major goal of post-stroke rehabilitation. Audio metronomic cueing has been shown to improve gait, but can be impractical and inconvenient to use in a community setting, for example outdoors where awareness of traffic is needed, as well as being unsuitable in environments with high background noise, or for those with a hearing impairment. Silent lightweight portable tactile cueing, if similarly successful, has the potential to take the benefits out of the lab and into everyday life. The Haptic Bracelets, designed and built at the Open University originally for musical purposes, are selfcontained lightweight wireless devices containing a computer, Wi-Fi chip, accelerometers and low-latency vibrotactiles with a wide dynamic range. In this paper we outline gait rehabilitation problems and existing solutions, and present an early pilot in which the Haptic Bracelets were applied to post-stroke gait rehabilitation.

Hemiparetic gait is characterised by temporal asymmetry and variability, and these variables are improved by auditory cueing. Stepping in place incorporates aspects of gait and may be a useful tool for locomotor training. The aim of this pilot study was to investigate the use of a single-tone and dual-tone metronome to cue stepping in place after hemiparetic stroke. Eight participants completed an uncued baseline stepping condition and two cued stepping conditions utilising a single-tone and a dual-tone metronome. Step times were determined from force plate data, and asymmetry and variability were calculated for the three conditions. Step time asymmetry was significantly reduced in the single-tone condition compared to baseline, and paretic step time variability was significantly reduced in both cued conditions. The single-tone metronome appeared to be preferred to the dual-tone metronome based on participant feedback. The results of this pilot study suggest that metronome cueing produces similar benefits on stepping in place to previously reported findings in walking. Further research on whether stepping in place to a metronome can be used for locomotor training is needed.

Background: The assessment of standing turning performance is proposed to predict fall risk in older adults. This study investigated differences in segmental coordination during a 360 degrees standing turn task between older community-dwelling fallers and non-fallers.Methods: Thirty-five older adults age mean (SD) of 71 (5.4) years performed 360 degrees standing turns. Head, trunk and pelvis position relative to the laboratory and each other were recorded using a Vicon motion analysis system. Fall incidence was monitored by monthly questionnaire over the following 12 months and used to identify non-faller, single faller and multiple faller groups.Results: Multiple fallers were found to have significantly different values, when compared to non-fallers, for pelvis onset (p = 0.002); mean angular separation in the transverse plane between the head and trunk (p = 0.018); peak angular separation in the transverse plane between the trunk and pelvis (p = 0.013); and mean angular separation between the trunk and pelvis (p < 0.001).Conclusions: Older adults who subsequently experience multiple falls show a simplified turning pattern to assist in balance control. This may be a predictor for those at increased risk of falling. (C) 2012 Elsevier B.V. All rights reserved.

PURPOSE Given the paucity of research on pacing strategies during competitive events, this study examined changes in dynamic high-resolution performance parameters to analyze pacing profiles during a multiple-lap mountain-bike race over variable terrain. METHODS A global-positioning-system (GPS) unit (Garmin, Edge 305, USA) recorded velocity (m/s), distance (m), elevation (m), and heart rate at 1 Hz from 6 mountain-bike riders (mean±SD age=27.2±5.0 y, stature=176.8±8.1 cm, mass=76.3±11.7 kg, VO2max=55.1±6.0 mL·kg(-1)·min1) competing in a multilap race. Lap-by-lap (interlap) pacing was analyzed using a 1-way ANOVA for mean time and mean velocity. Velocity data were averaged every 100 m and plotted against race distance and elevation to observe the presence of intralap variation. RESULTS There was no significant difference in lap times (P=.99) or lap velocity (P=.65) across the 5 laps. Within each lap, a high degree of oscillation in velocity was observed, which broadly reflected changes in terrain, but high-resolution data demonstrated additional nonmonotonic variation not related to terrain. CONCLUSION Participants adopted an even pace strategy across the 5 laps despite rapid adjustments in velocity during each lap. While topographical and technical variations of the course accounted for some of the variability in velocity, the additional rapid adjustments in velocity may be associated with dynamic regulation of self-paced exercise.

When information is available in more than one sensory modality, the central nervous system will integrate the cues to obtain a statistically optimal estimate of the event or object perceived (Alais and Burr, 2004; Ernst and Banks, 2002). For synchronising movements to a stream of events, this multisensory advantage is observed with reduced temporal variability of the movements compared to unimodal conditions (Elliott et al., 2010, 2011; Wing et al., 2010). Currently, this has been demonstrated for upper limb movements (finger tapping). Here, we investigate synchronisation of lower limb movements (stepping on the spot) to auditory, visual and combined auditory-visual metronome cues. In addition, we compare movement corrections to a phase perturbation in the metronome for the three sensory modality conditions. We hypothesised that, as with upper limb movements, there would be a multisensory advantage, with stepping variability being lowest in the bimodal condition. As such, we further expected correction to the phase perturbation to be quickest in the bimodal condition. Our results show that while we see evidence of multisensory integration taking place, there was no multisensory advantage in the phase correction task — correction under the bimodal condition was almost identical to the auditory-only condition. Both bimodal and auditory-only conditions showed larger corrections for each step after the perturbation, compared to the visual-only condition. We conclude that rapid lower limb corrections are possible when synchronising with salient, regular auditory cues, such that integration of information from other modalities does not improve correction efficiency. However, if the auditory modality is less reliable it is likely that multisensory cues would become advantageous in such a task.

Falling is a major health concern for community-dwelling older adults. Regular physical activity has been proposed to prevent falls. The aim of this study was to assess whether the achievement of the 2004 UK Department of Health physical activity recommendations over a lifetime had a protective effect against falling in older people. 313 community-dwelling older adults completed a questionnaire about lifetime physical activity and fall occurrence. There were significantly fewer falls in those who had led an active lifestyle compared to those who had not (χ2Yates = 4.568, p = 0.033), with a lower relative risk of fall occurrence for the active respondents (RR = 0.671) compared to the inactive (RR = 1.210). Of those who were sufficiently active in their early adulthood, the decade where there was the biggest decrease in remaining active enough was in the 60s. It is concluded that an active lifestyle may have decreased the likelihood of having a fall in older age.

When manipulating an object we use weight information in order to apply an effective grip to prevent it from slipping as well effective arm muscular force to maintain a desirable distance from the ground. In such task, the main sources of weight information that we use may come from cutaneous and proprioception feedback. Even though the contribution of these two cues has been partially demonstrated, there is no evidence about their relative importance in weight perception. Here, we conducted a weight discrimination experiment using a 2IFC constant stimuli procedure to investigate the role of cutaneous and proprioceptive feedback in weight perception. The participants judged weights using both proprioception and cutaneous cues, proprioception-only cues and cutaneous-only cues. Preliminary results showed that performance deteriorates when either of these cues is missing. There is also an early indication that the two cues may be integrated on the basis of maximum likelihood estimation (MLE).