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Gait Variability Patterns Are Altered in Healthy Young Individuals During the Acute Reperfusion Phase of Ischemia-Reperfusion Sara A

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Gait Variability Patterns Are Altered in Healthy Young Individuals During the Acute Reperfusion Phase of Ischemia-Reperfusion Sara A University of Nebraska at Omaha DigitalCommons@UNO Journal Articles Department of Biomechanics 11-2010 Gait Variability Patterns are Altered in Healthy Young Individuals During the Acute Reperfusion Phase of Ischemia-Reperfusion Sara A. Myers University of Nebraska at Omaha, [email protected] Nicholas Stergiou University of Nebraska at Omaha, [email protected] Iraklis Pipinos University of Nebraska Medical Center Jason Johanning University of Nebraska Medical Center Follow this and additional works at: https://digitalcommons.unomaha.edu/biomechanicsarticles Part of the Biomechanics Commons Recommended Citation Myers, Sara A.; Stergiou, Nicholas; Pipinos, Iraklis; and Johanning, Jason, "Gait Variability Patterns are Altered in Healthy Young Individuals During the Acute Reperfusion Phase of Ischemia-Reperfusion" (2010). Journal Articles. 56. https://digitalcommons.unomaha.edu/biomechanicsarticles/56 This Article is brought to you for free and open access by the Department of Biomechanics at DigitalCommons@UNO. It has been accepted for inclusion in Journal Articles by an authorized administrator of DigitalCommons@UNO. For more information, please contact [email protected]. 1 1 Gait variability pattern are altered in healthy young individuals during the acute 2 reperfusion phase of ischemia-reperfusion. 3 Sara A. Myers MS1, Nick Stergiou PhD1,4, Iraklis I. Pipinos MD2,3, Jason M. Johanning MD2,3 4 1 Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE 5 2Dept of Surgery, University of Nebraska Medical Center, Omaha, NE 6 3Dept of Surgery, Veterans Affairs Medical Center of Nebraska and Western Iowa, Omaha, NE 7 4College of Public Health, University of Nebraska Medical Center, Omaha, NE 8 9 Corresponding Author: Jason M. Johanning, MD 10 Address 983280 Nebraska Medical Center 11 Email: [email protected] 12 Phone: (402) 559-4395 13 Fax: (402) 559-6479 14 15 Running Head: Gait variability changes with occlusion 16 Subject Category: Vascular 2 17 Abstract 18 Background: The role of ischemia reperfusion contributing to functional impairment in lower 19 extremity peripheral arterial disease (PAD) patients has not previously been elucidated. The 20 evaluation of gait variability patterns has proven useful in many pathological populations. 21 Therefore, the purpose of this study is to isolate and determine the specific effect of the acute 22 reperfusion phase of ischemia-reperfusion on gait variability in young individuals with no 23 vascular disease. 24 Materials and Methods: Thirty healthy young individuals walked on a treadmill during baseline 25 and acute reperfusion phase of ischemia-reperfusion conditions while lower extremity joint 26 kinematics were captured. Stride to stride variability was assessed using the largest Lyapunov 27 exponent, approximate entropy, standard deviation, and coefficient of variation. Differences in 28 gait variability between conditions were assessed using dependent t-tests. 29 Results: The largest Lyapunov exponent values and approximate entropy values were 30 significantly higher in the acute reperfusion phase of ischemia-reperfusion condition for the 31 ankle, knee, and the hip. Coefficient of variation was significantly higher at the hip and standard 32 deviation was higher at the knee and the hip during the acute reperfusion phase of ischemia- 33 reperfusion condition. 34 Conclusions: The acute reperfusion phase of the ischemia-reperfusion cycle alters gait variability 35 patterns at the ankle, knee and the hip in healthy young individuals. Our findings indicate 36 increased noise and irregularity of gait variability patterns post ischemia. In young healthy 37 individuals that do not have neuromuscular impairments, significant gait alterations are present 38 during walking after a period of interruption of blood flow. 39 Keywords: Peripheral arterial disease, atherosclerosis, peripheral vascular disease 40 3 41 Introduction 42 The differences in gait parameters that occur across multiple steps are referred to as gait 43 variability. The presence of a certain amount and an ordered structure of variability during 44 movement are thought to be “healthy”, and these fluctuations allow individuals to adjust to 45 changing stresses encountered during daily activities, including walking. Changes to this 46 “optimal” amount or structure of variability are generally associated with disease and could be 47 related with several physiological factors such as neural control, muscle function and posture(1). 48 Increased gait variability has been associated with unsteadiness during walking(2) and increased 49 variability in elderly individuals has been linked to increased risk of falling(3-7). Previous work in 50 our laboratory determined that symptomatic peripheral arterial disease (PAD) patients have 51 increased lower extremity gait variability as compared to healthy matched controls(8). This is 52 consistent with significant deterioration in the locomotor system of PAD patients. However, the 53 specific mechanisms resulting in this deterioration and leading to mobility problems in patients 54 with PAD remain unclear. Possible mechanisms resulting in functional impairment of PAD 55 patients include insufficient blood flow, underlying neural and muscular abnormalities of the 56 lower extremity, and systemic co-morbidities(9). To attempt to isolate and determine the impact 57 of reduced flow on gait parameters by evaluating joint kinematic variability during baseline and 58 the acute reperfusion phase of ischemia reperfusion in healthy young individuals. We 59 hypothesized that evaluation of the acute reperfusion phase of ischemia-reperfusion in the 60 absence of underlying neuromuscular or systemic dysfunction would result in significant gait 61 variability alteration in comparison to baseline gait. 62 4 63 Methods 64 Participants 65 Thirty healthy young participants (Age: 22.8 ± 4.16 years, Mass: 75.8 ± 13.4 kg, Height: 66 175.3 ± 8.7 cm, Gender: 26 males, 4 females) were recruited to participate in the study from the 67 campus of the University of Nebraska at Omaha. The gender composition was recruited to reflect 68 the composition of the PAD patients based on our previous studies (8, 10-12). Informed consent was 69 obtained from all participants before data collection according to the guidelines of the 70 Institutional Review Board. Subjects were free from any significant health co-morbidities, 71 including arthritis, history of lower extremity joint surgery, history of back or lower extremity 72 injury or surgery that affects the subject’s mobility or any other process limiting the ability to 73 walk, including neurological disease or impairment (stroke, Parkinson’s disease, multiple 74 sclerosis). Additionally, all subjects had normal ankle brachial index values (ABI; >1.0), and no 75 subjective or objective ambulatory dysfunction. All subjects reported to our biomechanics 76 facility for gait testing. 77 78 Experimental procedure and data collection 79 Upon arrival to the laboratory, lower extremity blood flow was measured by taking the 80 systolic pressures at the brachial artery in the arm and the dorsal pedis and posterior tibial 81 arteries at the ankle to confirm acceptable ABI values. Next, subjects’ height, weight and 82 anthropometric measures were taken. Before data collection reflective markers were placed as 83 previously described (8). After the markers were placed, participants were given ample time to get 84 accustomed to walking on the treadmill (BodyGuard Fitness, St-Georges, QC (Canada)), during 5 85 which time they were asked to select a comfortable walking speed. This speed was identified as 86 the self-selected walking speed. 87 88 Three-dimensional kinematics were acquired at 60 Hz using EVART software (Motion 89 Analysis Corp, Santa Rosa, Calif) while participants walked on the treadmill. First the 90 participants walked at their self-selected speed for three minutes. This was the baseline 91 condition. Next, vascular occlusion was induced by placing thigh cuffs (Omron® Exactus 92 Aneroid Sphygmomanometer Model 108MLNL) bilaterally on the upper thighs and occlusion 93 tourniquets (CyberTech™ Mechanical Advantage Tourniquet MAT01) just above the knee while 94 subjects stood on the treadmill. The cuffs were inflated to 200 mmHg and maintained for three 95 minutes. The chosen level of pressure and time of occlusion are standard ranges used in the 96 literature to induce ischemia in the legs (13-18). After three minutes of occlusion, the thigh cuffs 97 were removed and the subjects immediately began walking on the treadmill. Three minutes of 98 treadmill walking was recorded during the acute reperfusion phase of ischemia reperfusion. 99 100 Data analysis 101 Coordinate trajectories of each marker were exported and processed in custom software using 102 MATLAB software (MathWorks Inc, Natick, Mass). This software was used to calculate relative 103 joint angle time series from the kinematic data for the ankle, knee and hip for all trials. Joint 104 kinematic variability was examined, because it has been shown that variability of stride 105 characteristics (i.e. stride time, step time) offers a less sensitive measure of differences between 106 groups than does variability of the joint kinematics (19). All trials were cropped to 3300 data 107 points, which corresponds to precisely 55 seconds and is long enough to allow 30 continuous 6 108 footfalls and is considered adequate for nonlinear analysis (20, 21). The data were analyzed 109 unfiltered
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