[ARTICLE] Effects of dual-task and walking speed on gait variability in people with chronic ankle instability: a cross-sectional study – Full Text

Abstract

Background

Recent evidence suggests that impaired central sensorimotor integration may contribute to deficits in movement control experienced by people with chronic ankle instability (CAI). This study compared the effects of dual-task and walking speed on gait variability in individuals with and without CAI.

Methods

Sixteen subjects with CAI and 16 age- and gender-matched, able-bodied controls participated in this study. Stride time variability and stride length variability were measured on a treadmill under four different conditions: self-paced walking, self-paced walking with dual-task, fast walking, and fast walking with dual-task.

Results

Under self-paced walking (without dual-task) there was no difference in stride time variability between CAI and control groups (P = 0.346). In the control group, compared to self-paced walking, stride time variability decreased in all conditions: self-paced walking with dual-task, fast speed, and fast speed with dual-task (P = 0.011, P = 0.016, P = 0.001, respectively). However, in the CAI group, compared to self-paced walking, decreased stride time variability was demonstrated only in the fast speed with dual-task condition (P = 1.000, P = 0.471, P = 0.008; respectively). Stride length variability did not change under any condition in either group.

Conclusions

Subjects with CAI and healthy controls reduced their stride time variability in response to challenging walking conditions; however, the pattern of change was different. A higher level of gait disturbance was required to cause a change in walking in the CAI group compared to healthy individuals, which may indicate lower adaptability of the sensorimotor system. Clinicians may use this information and employ activities to enhance sensorimotor control during gait, when designing intervention programs for people with CAI.

The study was registered with the Clinical Trials network (registration NCT02745834, registration date 15/3/2016).

Background

Recurrent ankle sprains occur in up to 40% of individuals who have previously experienced a lateral ankle sprain [1, 2]. Individuals who report residual symptoms, which include repetitive episodes of ‘giving way’ and subjective feeling of ankle joint instability are termed as having chronic ankle instability (CAI) [3]. The cause of these symptoms and the high frequency of recurrent ankle sprain is not fully understood [4]. It has been suggested that the residual joint instability and the high reoccurrence rates can be attributed to loss of sensory input from articular mechano-receptors, decreased muscle strength, mechanical instability of the ankle joint, and reduced ankle range of motion [5, 6].

Recent evidence suggests that deficits in central neural sensorimotor integration can contribute to impaired movement control in people with CAI [7, 8, 9, 10, 11, 12, 13, 14]. For example, Springer et al. [8] assessed the correlation between single-limb stance postural control (Overall Stability Index) and shoulder position sense (Absolute Error Score) among people with CAI and healthy controls. Correlations between the lower and upper limbs were observed only in the healthy controls, indicating altered sensorimotor integration in the CAI group. Several studies have observed altered gait mechanism in people with CAI, which was explained by compromised central nervous system (CNS) control [9, 14, 15, 16]. It was shown that people with CAI have a typical gait pattern of increased inversion kinematics and kinetics, lateral shift of body weight, increased hip flexion during terminal swing to mid stance, reduced hip extension and increased knee flexion during terminal stance to initial swing, and slow weight transfer at the beginning and end of the stance [15, 16, 17]. Altered biomechanical strategies during gait initiation and termination tasks (e.g., reduced center of pressure displacement), have also been demonstrated in this population [9, 14]. Studies that assessed movement variability, such as knee and hip joint motions during single leg jump landing, identified differences between individuals with and without CAI, which may also indicate central motor programming deficits [10, 11, 12, 13]. Hence, further investigation of motor control adaptations may contribute to understanding the underlying neurophysiologic mechanisms of CAI.

Gait speed and other spatio-temporal parameters during daily activities should reflect behavioral goals and environmental conditions [18]. Studies revealed that walking speed has a significant effect on joint coordination pattern and gait variability [18, 19, 20]. Therefore, assessing gait variability under challenging situations such as walking at different speeds might test CNS flexibility in controlling gait [19, 20]. Moreover, based on the understanding that for many daily activities even a fully intact motor control system requires attention and cognitive resources [21], the dual-task paradigm has been used to provide insight into the demands of postural control and gait on attention. Performance of a cognitive task has been shown to decrease postural control in participants with CAI as compared to healthy controls [7, 22]. However, no previous study examined the impact of cognitive task and walking speed on gait performance in subjects with CAI.

Balance during walking is reflected by precise spatial and temporal control of foot placement. Stride to stride fluctuations in time and length are related to control of the rhythmic walking mechanism. Thus, previous research has suggested that studying gait variability is a reliable way to quantify locomotion [23]. The mechanism of adjusting movement variability is considered beneficial for coping with changes, maintaining stability, preventing injury, and attaining higher motor skills [24]. Performing a cognitive task while walking or while altering self-paced walking speed has been related to changes in gait variability in populations with neurological and musculoskeletal pathologies, as well in healthy young individuals [25, 26, 27, 28]. Yet, there is no consensus in the literature as to how to interpret these changes. Decreased variability while performing demanding gait tasks may reflect voluntary gait adaptation toward a more conservative gait pattern [26]. Alternatively, it has been suggested that increased variability may indicate CNS flexibility and adaptability to changes in task demands [29]. A possible central sensorimotor control deficit in people with CAI may constrain the ability of the CNS to adjust to different task demands; thus, affecting central control over gait variability and reducing the ability to cope with varied tasks. Consequently, testing the mechanism of adjusting gait variability as a response to complex walking conditions in people with CAI compared to healthy controls may provide more information on sensorimotor control in this population.

The present study was designed to compare the effects of dual-task and walking speed on gait variability in individuals with and without CAI. Previous reports, including a meta-analysis, indicated that simple postural tasks do not always discriminate between participants with CAI and those without [6, 8, 30]. Consequently, we hypothesized that gait variability among individuals with and without CAI will be similar during “normal” self-paced walking, whereas gait will vary under complex walking conditions.[…]

Continue —> Effects of dual-task and walking speed on gait variability in people with chronic ankle instability: a cross-sectional study | BMC Musculoskeletal Disorders | Full Text

Fig. 1 Stride time variability results of the two groups under all gait conditions. CAI- chronic ankle instability, SP- self-paced, DT- dual task

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