title: Kinematic adaptations to ischemic pain in claudicants during continuous walking.
abstract: Intermittent claudication has been associated with impaired gait and balance. The study aim was to compare gait adaptations over time between claudicants classified with good versus poor balance. Kinematic data were collected from 24 claudicants during continuous walking. Balance was assessed using; Timed Up and Go test (TUG), and Sensory Organisation (SOT) and Motor Control (MCT) Tests using NeuroCom Equitest®. 'Good balance' (GB) was operationally defined as those claudicants achieving normal scores on at least 2 of 3 tests whereas 'poor balance' (PB) claudicants achieved normal scores on 0 or 1 test. Temporal-spatial and sagittal plane joint kinematics were analysed at three time intervals; 'no pain' (prior to onset), 'initial pain' and 'maximal pain' (unable to continue walking). A two-way mixed design ANOVA was performed. Claudicants demonstrated a significant decrease in walking speed, step frequency and increased time in double support (p<0.05). Inter-group analysis showed no differences between GB and PB on any temporal-spatial or kinematic parameters (p>0.05). There was no significant time and group interaction for any temporal-spatial or kinematic variable except hip flexion. GB claudicants demonstrated increased hip flexion as pain progressed but this adaptive strategy was not seen in PB claudicants. Claudicants make adaptations to walking by slowing (down) when in pain. Differences between GB and PB were not seen in temporal-spatial or ankle, knee and pelvic kinematic gait parameters. However adaptation to pain in GB claudicants involved a hip strategy, not seen in PB claudicants.
authors.affiliation: Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull & East Yorkshire NHS Trust, UK.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Mockford
authors.forename: Natalie
authors.initials: N
authors.lastname: Vanicek
authors.forename: Alastair
authors.initials: A
authors.lastname: Jordan
authors.forename: Ian C
authors.initials: IC
authors.lastname: Chetter
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coughlin
mesh_terms: D000054:Acceleration; D000222:Adaptation, Physiological / Q000502:physiology*; D000367:Age Factors; D000368:Aged; D000886:Anthropometry; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement; D004856:Postural Balance / Q000502:physiology*; D018570:Risk Assessment; D012737:Sex Factors; D013997:Time Factors; D016138:Walking / Q000502:physiology*