Spatiotemporal gait characteristics and ankle kinematics of backward walking in people with chronic ankle instability

Abstract

Backward walking offers a unique challenge to balance and ambulation. This study investigated the characteristics of spatiotemporal gait factors and ankle kinematics during backward walking in people with chronic ankle instability. Sixteen subjects with chronic ankle instability and 16 able-bodied controls walked on a treadmill at their self-selected speed under backward and forward walking conditions. Gait speed, cadence, double limb support percentage, stride time variability, and threedimensional ankle kinematics were compared between groups and conditions. During backward walking, both groups had significantly slower gait speed, lower cadence, and greater stride time variability. In addition, under backward walking condition, subjects in both groups demonstrated significant sagittal and frontal kinematic alternations, such as greater dorsiflexion and inversion following initial contact (0-27.7%, 0-25.0% of gait cycle respectively, p < 0.001). However, there were no significant differences between groups in any of the measured outcomes. This indicates that subjects with chronic ankle instability adapt to self-selected speed backward walking similarly to healthy controls. Assessments with more challenging tasks, such as backward walking with dual task and backward walking at fast speed, may be more appropriate for testing gait impairments related to chronic ankle instability. Chronic ankle instability (CAI) may be present in up to 40% of individuals who have previously experienced lateral ankle sprain 1. CAI is characterized by repetitive episodes and subjective feeling of ankle 'giving way' , and symptoms such as pain, swelling and limited motion 2-4. Compared to healthy controls, individuals with CAI report quality-of-life deficits and functional limitations in addition to the physical impairments 2,5,6. While mechanical factors, such as ankle ligaments hyperlaxity, may be responsible for CAI in some patients 2 , it can occur even when the mechanical constraints at the ankle are intact 7. Recent evidence suggest that CAI can be explained by sensorimotor deficits 3,7,8. Arthrogenic neuromuscular inhibition 9,10 , ankle muscle weakness 4,11 , reduced ankle range of motion 3,9 , impaired sense of joint position 12 , and postural control are found in CAI. Altered movement patterns during functional tasks, including walking, are often described in individuals with CAI 13. During walking, subjects with CAI may exhibit typical kinematic patterns of increased ankle inversion and a laterally deviated center of pressure throughout the stance phase of gait 6. Conversely, Chinn et al. 5 reported that CAI subjects demonstrated more inversion while jogging but not while walking. Linear variability measures that investigated the amplitude of variability, such as coefficient of variation, and non-linear variability approaches that evaluated the dynamic aspects of variability using mathematical tools related to chaos theory, have both reported differences in gait variability between individuals with and without CAI. For examp...

Effectiveness of Hospital-Based Systemic Rehabilitation in Improving Ankle Function after Surgery in Chronic Ankle Instability Patients

“…Previous studies have suggested several methods to evaluate the gait function of CAI patients more accurately. For example, the modified backward walking test or faster treadmill speed test could more clearly reflect walking ability in the CAI patients than conventional gait analysis [ 30 , 31 ]. The use of these methods should be considered for future trials for CAI patients.…”

The Immediate Carryover Effects of Peroneal Functional Electrical Stimulation Differ between People with and without Chronic Ankle Instability

“…To compare between-group baseline characteristics, nonparametric Mann-Whitney U tests and X 2 tests were used for continuous and categorical variables, respectively. Time series data (frontal plane mean angles and normalized peroneal EMG) were plotted throughout the stance phase with their corresponding 95% confidence intervals (CI) [62]. A significant, meaningful difference was defined in case a nonoverlapping CI was demon-strated for consecutive 3% of the stance [62,63].…”

“…Time series data (frontal plane mean angles and normalized peroneal EMG) were plotted throughout the stance phase with their corresponding 95% confidence intervals (CI) [62]. A significant, meaningful difference was defined in case a nonoverlapping CI was demon-strated for consecutive 3% of the stance [62,63]. Additionally, a 2 × 2 mixed analysis of variance (ANOVA) was conducted using Statistical Parametric Mapping (SPM), to compare the between-group (group), within-group (time), and interaction (group × time) effects on the ankle's frontal plane angle and muscle activation normalized amplitude.…”

Ankle-Injury Patients Perform More Microadjustments during Walking: Evidence from Velocity Profiles in Gait Analysis

“…These detailed descriptions can also assist physiotherapists to improve their rehabilitation treatment and help designers develop rehabilitation-assistive products [ 7 – 9 ]. Gait analysis using motion tracking data allows scientists to understand posture control and force application of the foot during walking [ 10 , 11 ]. For example, Chinn et al found that subjects with ankle instability experienced more inversions during jogging than walking [ 12 ].…”