Background and Aim: Type 2 Diabetes (T2DM) in midlife represents a potent risk factor for the development of dementia in later life. Early indicators to highlight particular individuals with T2DM who are at risk of cognitive decline are lacking. Subtle abnormalities in gait (and particularly dual-task gait with a cognitive task) have emerged as a potential predictor of cognitive decline in older adults, but have not been investigated in patients with T2DM. The ENBIND Study (Exploring Novel Biomarkers of Brain health IN Diabetes) aims to assess patients with T2DM in midlife without cognitive impairment and follow participants over the course of several years to establish early predictors of cognitive decline in this poorly characterised yet high-risk group. Methods: Patients with midlife T2DM (40-65 yrs) were recruited at the time of their diabetic clinic appointment. Patients were excluded if they had a diagnosis of peripheral neuropathy, peripheral vascular disease, musculoskeletal disease, previous stroke, any form of diagnosed cognitive impairment or diabetic retinopathy/nephropathy. Patients underwent medical/diabetes assessment and examination by a physician. Cognition was screened using the Montreal Cognitive Assessment (MoCA) and assessed using a computerised cognitive battery designed for prodromal Alzheimer's Disease (CANTAB®). Gait was then assessed using both a raw clinical measure (stopwatch) and Shimmer® Inertial Measurement Units (IMUs) across four tasks: (i) 30 metre walk at a normal pace (turn at 15m), (ii) 30 metre fast walk (turn at 15m) (iii) dual cognitive-gait task (reciting alternate letters of the alphabet) and (iv) a long walk at a self-selected pace. Between group differences were assessed using t-tests and appropriate non-parametric equivalents Results: 20 participants with T2DM (52.05 yrs ± 2.13) and 10 matched healthy volunteers (mean age 52.2 yrs ± 2.74) were recruited. T2DM was associated with a significantly lower score on the MoCA (29.2 vs 27.6; p=0.0452). Participants with T2DM had slower but non-significant self-selected (0.87 ms-1 vs 0.8ms-1) and fast gait speed (0.66 ms-1 vs 0.59 ms-1). On the dual-cognitive task, participants with T2DM made more errors (1.1 vs 0.6), and had higher dual-task cost (9.17% vs 2.7%, p=0.014). Dual-task cost (the percentage decrement in walking speed due to introduction of the cognitive task) was significantly correlated with total MoCA score (R2 = 0.17, p =0.031). Discussion: Otherwise healthy participants with midlife T2DM display significantly poorer scores on MoCA. Performance on the dual-cognitive gait task was significantly correlated with MoCA score. Our study adds evidence to the presence of cognitive decrements in midlife T2DM, in-keeping with its role as a potent risk factor for the later development of dementia. We provide early data to support the utility of simple clinical gait analysis, particularly where a dual-cognitive paradigm is employed. Expansion of the sample size of patients in this study as well as longitudinal follow up should afford more detailed insight into using gait as a potential marker for cognition in this high risk cohort
Listed In: Biomechanical Engineering, Biomechanics, Gait, Neuroscience

Patients with chronic obstructive pulmonary disease (COPD) have an increased fall risk [1] and demonstrate gait deficits [2,3]. Gait variability has been associated with increased fall risk in the aging population [4]. However, studies reporting gait variability in COPD are scarce. Therefore, we aim to assess gait variability in patients with COPD during the 6-minute walk test (6MWT). Eighty patients with COPD (62±7yrs; FEV1:56±19%pred.) and 39 healthy subjects (62±6yrs; FEV1:119±17%pred.) performed two self-paced 6MWTs while kinematic parameters were recorded (100Hz, Vicon). The amount (coefficient of variation; CoV) and structure (sample entropy; SE) of variability of stride time, stride length and step width, and local divergence exponent (LDE) of the centre of mass velocity (CoMv) in three directions were computed. The sub-analysis accounted for gait speed influences on gait variability between groups. Stride time was longer (MD:0.13s, p<0.001) and stride length was smaller (MD:-0.30 m, p<0.001) in COPD. CoV for stride length was increased (MD:1.8%, p<0.001) and stride length SE was lower in COPD (MD:0.21, p<0.001). LDE for CoMv differed in vertical (MD: -0.12, p=0.001) and anteroposterior direction (MD: 0.10, p=0.017). The CoV for stride length remained higher in COPD (MD:1.0%, p=0.003) and stride length SE remained lower in COPD (MD:-0.12, p=0.011), after the sub-analysis of 14 patients with COPD and 14 healthy subjects with comparable walking speeds (MD:-0.02m/s, p=0.588). Patients with COPD demonstrate alterations in the amount and structure of variability in stride length, indicating alterations in the control of stride length variability patterns.
Listed In: Biomechanics, Gait

Background: Approximately 33% of the adult population in the United States is considered obese (28), which increases the risk of comorbidities such as osteoarthritis (OA) (34). The most notable feature of OA is the loss of articular cartilage within a joint, resulting in pain and physical disability (3). The association between obesity and OA is due to a combination of mechanical and metabolic factors (3). Greater weight from obesity adds stress to articular cartilage in weight-bearing joints, and contributes to cartilage breakdown (21). Previous studies have demonstrated an association between gait biomechanics and OA in older populations (15, 25), but data are lacking in young obese individuals without OA. Young obese compared to normal weight adults have lesser knee flexion excursion (KFE) (31), and greater vertical loading rates (vLR) during gait (30, 31). However, the source of aberrant gait mechanics in obese adults is unclear, and could be related to impaired shock attenuation from weakened musculature in the lower extremity. Obese young adults have deficits in quadriceps function after normalizing to fat-free mass, and walk slower compared to normal weight young adults. RTD was moderately associated with KEM at habitual gait speed, and KEM was also lesser in obese compared to normal weight adults. The lesser KEM in the obese group suggests that obese young adults walk with a quadriceps avoidance gait, which may contribute to knee OA development. Exercise interventions targeting RTD may be useful for improving walking mechanics in obese adults.
Listed In: Biomechanics, Gait, Orthopedic Research

Purpose: Knee pain is a chief symptom of knee pathology. Both acute and chronic knee pain result in altered joint loads during walking, which potentially result in mechanical and biological changes in knee articular cartilage. Due to confounding factors in clinical knee pain (effusion, muscle weakness, inflammation, structural changes), it is difficult to examine the independent effect of knee pain on walking mechanics. The purpose of this study is to examine whether unilateral experimentally induced knee pain influences bilateral loading patterns during walking in healthy individuals. Methods: This study was a controlled laboratory, cross-over trial. Each of 30 able-bodied subjects (M = 20, F = 10; 23 ± 2.4 yrs, 71 ± 12.7 kg, 178 ± 8.2 cm) completed three experimental sessions: pain (5.0% NaCl infusion), sham (0.9% NaCl infusion), and control (no infusion) in a counterbalanced order, 2 days apart (a washout period). For the experimental sessions, hypertonic (5% NaCl) or isotonic (0.9% NaCl) saline was continuously infused into the right (involved limb) infrapatellar fat pad using a portable infusion pump, which produced a continuous saline flow of 0.154mL/min (total 2.16 mL) for 14 min for the pain or sham session, respectively. No infusion was administered to the control session. Subjects and investigators were blinded regarding the saline solution which was being infused. During each of three experimental sessions, subjects performed 30-sec gait trials at a self-selected speed at two time points (pre- and post-infusion). Ground reaction force (GRF) data were collected using an AMTI instrumented force-sensing tandem treadmill (1200 Hz). The first 4 successful gait cycles in each limb were used for data analysis. A functional data analysis approach (α = .05) was used to detect time (pre- and post-infusion) x limb (involved vs. uninvolved) interactions for the vertical, anterior-posterior, and medial-lateral GRF. Results: Significant time x limb interactions were observed during the pain session (hypertonic saline; 5.0% NaCl; p < .05). Experimental knee pain resulted in up to (i) 0.05 N/kg less vertical GRF and 0.02 N/kg more vertical GRF during various stance phases, (ii) 0.01 N/kg less breaking GRF during loading response, and (iii) 0.007 N/kg less lateral GRF and 0.007 N/kg more lateral GRF during various stance phases in the involved limb. Conclusions: Relative to the pre-infusion condition, subjects during the knee pain condition tended to walk with less vertical, posterior and lateral GRF in the involved limb (painful limb) across various portions of stance, which simultaneously increased loads in the uninvolved limb (non-painful limb). Our data suggest that compensatory loading patterns occur simultaneously for the involved and uninvolved limbs. This unloading pattern in the involved limb may be due to perception of knee pain, which can make subjects feel fear for damaging or provoking pain more during walking. Moreover, voluntary and/or involuntary quadriceps inhibition (e.g., neuromuscular activation and strength) due to experimentally induced knee pain may play a role in reducing the loads in the involved limb because the quadriceps support the center of body mass eccentrically from initial loading response to midstance to prevent collapse of the lower limbs. These asymmetrical loading patterns due to knee pain and associated with neural inhibition may be a risk factor for knee joint disease progression via changes in mechanical components.
Listed In: Biomechanics, Gait

Calculating and interpreting joint moments using marker position and ground reaction force (GRF) data is a fundamental part of gait biomechanics research. Due to noise in marker positions, these data are low-pass filtered prior to performing inverse dynamics. Traditionally, kinematic data are filtered at low cutoff frequencies (~6 Hz) and kinetic data are filtered at high frequencies (~30-100 Hz). This technique can result in joint moment impact peaks, particularly during high-impact movements. Filtering marker and GRF data at the same cutoff frequency has been suggested to attenuate these impact artefacts. The effect of various filtering approaches on joint moments in walking is unknown. The purpose of this study was to compare the effect of low-pass filtering cutoff frequencies on joint moments during walking. We hypothesized that filtering would not affect peak joint moments during walking due to smaller violations of the rigid body assumption compared to high-impact movements. Kinetic and kinematic data were collected for twenty-four health adults walking at self-selected speed. Marker position and GRF were smoothed using a 4th-order dual-pass Butterworth filter with cutoff frequencies of 6/45 Hz, 6/6 Hz, 10/10 Hz, for markers and GRF, respectively. A one-way repeated measures ANOVA tested for the effect of filter frequency on peak hip and knee joint moments. Peak hip and knee moments were greater when filtered at 10/10 Hz compared to 6/45 Hz. Although there were differences between cutoff frequency conditions, the effect sizes were small, suggesting that the differences are not large enough to have a meaningful effect.
Listed In: Biomechanics