When the nervous system breaks down, gait becomes more primitive.

Whether we are looking at an injury or a neurological disorder, when something goes awry, we can almost always predict that the gait pattern will start to decompose. We can learn a lot about gait from watching this kiddo walk. An immature nervous system is very similar to one which is compensating meaning there will often "cheat" around a more proper and desirable movement pattern; we often resort to a more primitive state when challenges beyond our ability are presented. This is very common when we lose some aspect of proprioception, particularly from some peripheral joint or muscle, which in turn, leads to a loss of cerebellar input (and thus cerebellar function). Remember, the cerebellum along with the upper brainstem is a temporal pattern generating center so a loss of cerebellar sensory input leads to poor pattern generation output.

Watch this clip several times and then try and note each of the following:

• Wide based gait; this is because proprioception is still developing (joint and muscle mechanoreceptors and of course, the spino cerebellar pathways and motor cortex)

• increased progression angle of the feet: this again is to try and retain stability. External rotation allows them to access a greater portion of the glute max and the frontal plane (engaging an additional plane is always more stable).

• Shortened step length: this keeps the center of gravity close to the body and makes corrections for errors that much easier This immature DEVELOPING system is very much like a mature system that is REGRESSING. This is a paramount learning point !)

• Decreased speed of movement; this allows more time to process proprioceptive clues, creating accuracy of motion

• Sometimes we see increased arm and accessory movements, again to try and increase proprioceptive input and provide additional stability.

Proprioceptive clues are an important aspect of gait analysis, in both the young and old, especially since we tend to revert back to an earlier phase of development when we have an injury or dysfunction.

We will be talking about these principals along with 2 cases of neurological disorders and more this Wednesday evening for our "3rd Wednesdays" talk on online.com: Biomechanics 321. 5 PST, 6MST, 7CST, 8EST

Dr Ivo Waerlop, one of The Gait Guys

#gaitanalysis #decompositionofgait #proprioception #neurologicaldisorder #thegaitguys

Whole-body coordination patterns may become partitioned in particular ways as a function of task requirements

Just some more thoughts for those who insist on coaching arm swing changes.

"Whole-body coordination patterns may become partitioned in particular ways as a function of task requirements.”

Toddlers actively reorganize their whole body coordination to maintain walking stability while carrying an object. Hsu WH1, Miranda DL2, Chistolini TL3, Goldfield EC4. Gait Posture. 2016 Oct;50:75-81

Today we seem to be going back to dual-tasking again, in this case utilizing the arms as balance assistance devices, amongst their other functions. However, we all know that walking with a hand in a pocket, or carrying something alters our ability to maximize their ballast-like function. Balanced walking involves freely swinging the limbs in pendullar motion. Changes in arm swing will change gait economy and efficiency. We have all run with a water bottle or bag/briefcase and know how that changes the symmetry and fluidity of our gait.

Today's research piece discusses toddlers and their function as they carry objects. "children immediately begin to carry objects as soon as they can walk. One possibility for this early skill development is that whole body coordination during walking may be re-organized into loosely coupled collections of body parts, allowing children to use their arms to perform one function, while the legs perform another. Therefore, this study examines: 1) how carrying an object affects the coordination of the arms and legs during walking, and 2) if carrying an object influences stride length and width." -Hsu et al.In this study of 10 toddlers with 3-12 months of walking experience were recruited to walk barefoot while carrying or not carrying a small toy. "Stride length, width, speed, and continuous relative phase (CRP) of the hips and of the shoulders were compared between carrying conditions. While both arms and legs demonstrated destabilization and stabilization throughout the gait cycle, the arms showed a reduction in intra-subject coordination variability in response to carrying an object. Carrying an object may modify the function of the arms from swinging for balance to maintaining hold of an object. The observed period-dependent changes of the inter-limb coordination of the hips and of the shoulders also support this interpretation. Overall, these findings support the view that whole-body coordination patterns may become partitioned in particular ways as a function of task requirements." -Hsu et al.

So once again we will say it, if you are coaching the arm swing YOU want, because you do not like what you see in your client, or if you think you are helping your client get more out of their body in terms of speed, power, efficiency or anything of the sort, know that there is a higher, smarter program running the show. And that program in the client’s CNS is smarter than you when it comes to what they need for whole-body coordination pattern generation.

Something you can do NOW to help Parkinsons folks

Anything that can help get more balance and coordination info to the higher centers is a plus for Parkinsons folks, and the texture of the surface they are walking on or the texture of the insole is no different. The more afferent info we can get in through the tactile receptors, joint mechanoreceptors and muscle receptors like the spindles and golgi tendon organs, the better. These all feed (eventually or sometimes directly) to the cerebellum, the king of balance.

In this study they placed little half spheres at the distal phalanx of the hallux, heads of metatarsophalangeal joints and heel. Theses are all areas of increased cortical representation when you look at the sensory homunculus.  They wore them for a week and plantar sensation and stride length both improved, but only the increased plantar sensation remained. Neuroplasticity takes time and we are willing to bet that if they wore them longer, the results would have been more profound.

Sometimes the simplest interventions can go a long way.

Lirani-Silva E, Vitorio R, Barbieri FA, et al. Continuous use of textured insole improve plantar sensation and stride length of people with Parkinson disease: A pilot study. Gait Posture 2017;58:495-497. [

Cerebellar impairment = Gait Changes = Happy Patient

This is a fairly info dense post with many links. please take the time to explore each one to get the most out of it. 

If you have been with us here on TGG long enough, you know the importance of the cerebellum and gait. Mechanoreceptor information travels north to the cortex via the dorsal (and ventral) spinocerebellar pathways to be interpreted (and interpolated, in the case of the ventral pathway), with the information relaying back to the motor cortex and vestibular nucleii and eventually back down to the alpha (and gamma) motor neurons that proved the thing you call movement and thus gait. (Cool video on spinocerebellar pathways here and here).

This FREE FULL TEXT paper has some cool charts, like this one, that show the parameters of gait that change with cerebellar dysfunction (in this case, disease, although idiopathic means they really don't know. Anatomical or physiological lesions will behave the same, no? Doesn't the end result of a functional short leg look the same as an anatomical one?)

Looking tat this chart, what do we really see? People with cerebellar dysfunction:

• a shorter step length
• a wider base of gait
• decreased velocity
• increased lateral sway
• slower overall gait cycle

Hmmmm...Beginning to sound like a move toward more primitive gait. Just like we talked about in this post on the 5 factors and proprioception here several years ago. We like to call this decomposition of gait. 

They go on to talk about specific anatomic regions of the cerebellum and potential correlation to specific gait abnormalities, like the intermediate zone and interposed nucleii controlling limb dynamics and rhythmic coordination like hypermetria (overshooting a target), especially when walking in uneven surfaces or when gait is perturbed, like walking into something or changes in surface topography, or the lateral zone of the cerebellum, for voluntary limb control, such as where you place your foot. Definitely gait nerd material.

There aren't any direct tips on rehab, but it would stand to reason that activities that activate the cerebellum and collateral pathways would give you the most clinical gains. Lots of propriosensory exercises like here, here, here and here for a start.

Happy cerebellum = Happy patient

The Gait Guys

Winfried Ilg, Heidrun Golla, Peter Thier, Martin A. Giese; Specific influences of cerebellar dysfunctions on gait. Brain 2007; 130 (3): 786-798. doi: 10.1093/brain/awl376  FREE FULL TEXT

Podcast 116: Running Cadence & Tricks

Key tag words:
running, cadence, form, running form, running tricks, gait, gait analysis, the gait guys, CRISPR, brain implants, spinal regeneration, coordination

Direct download URL:
http://traffic.libsyn.com/thegaitguys/pod_116_final_2.mp3

Permalink URL:
http://thegaitguys.libsyn.com/episode-116

Libsyn directory URL:  http://directory.libsyn.com/episode/index/id/4901265

Key tag words:
running, cadence, form, running form, running tricks, gait, gait analysis, the gait guys, CRISPR, brain implants, spinal regeneration, coordination
 
Show sponsors:
 
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Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Human patient treated with CRISPR gene editing for the first time.
http://www.popsci.com/crispr-tested-in-human-patient-for-first-time

For the First Time, a Wireless Brain Implant Has Enabled Paralysed Primates to Walk Again
http://www.sciencealert.com/for-the-first-time-a-wireless-brain-implant-has-enabled-paralysed-primates-to-walk-again

Scientists May Have Found Protein That Could Help Unlock Spinal Regeneration in Humans
http://futurism.com/scientists-may-have-found-protein-that-could-help-unlock-spinal-regeneration-in-humans/

Cadence:
"Coordination variability decreased with an increase in cadence across all couples and phases of gait. These results suggest examination of coordination and its variability could give insight into the risk of intervention-induced injury."

Hafer JF, Freedman Silvernail J, Hillstrom HJ, Boyer KA. Changes in coordination and its variability with an increase in running cadence. J Sports Sci. 2016 Aug;34(15):1388-95. doi: 10.1080/02640414.2015.1112021. Epub 2015 Nov 20.

http://www.thegaitguys.com/thedailyblog/2016/10/16/music-to-my-earsand-steps-to-my-cadence

http://www.thegaitguys.com/thedailyblog/2016/10/16/step-rate-to-change-foot-strike

http://www.thegaitguys.com/thedailyblog/2016/10/16/cadence
-cadence and running. Increasing it as little as 5% seems to decrease vertical loading rates in the achilles tendon.