title: Comparison of walking overground and in a Computer Assisted Rehabilitation Environment (CAREN) in individuals with and without transtibial amputation.
abstract: BACKGROUND
  Due to increased interest in treadmill gait training, recent research has focused on the similarities and differences between treadmill and overground walking. Most of these studies have tested healthy, young subjects rather than impaired populations that might benefit from such training. These studies also do not include optic flow, which may change how the individuals integrate sensory information when walking on a treadmill. This study compared overground walking to treadmill walking in a computer assisted virtual reality environment (CAREN) in individuals with and without transtibial amputations (TTA).
  
  
  METHODS
  Seven individuals with traumatic TTA and 27 unimpaired controls participated. Subjects walked overground and on a treadmill in a CAREN at a normalized speed. The CAREN applied optic flow at the same speed that the subject walked. Temporal-spatial parameters, full body kinematics, and kinematic variability were collected during all trials.
  
  
  RESULTS
  Both subject groups decreased step time and control subjects decreased step length when walking in the CAREN. Differences in lower extremity kinematics were small (< 2.5(○)) and did not exceed the minimal detectable change values for these measures. Control subjects exhibited decreased transverse and frontal plane range of motion of the pelvis and trunk when walking in the CAREN, while patients with TTA did not. Both groups exhibited increased step width variability during treadmill walking in the CAREN, but only minor changes in kinematic variability.
  
  
  CONCLUSIONS
  The results of this study suggest that treadmill training in a virtual environment should be similar enough to overground that changes should carry over. Caution should be made when comparing step width variability and step time results from studies utilizing a treadmill to those overground.
authors.affiliation: Department of Orthopaedics & Rehabilitation, Center for the Intrepid, Brooke Army Medical Center, Ft. Sam Houston, TX 78234, USA.
authors.forename: Deanna H
authors.initials: DH
authors.lastname: Gates
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Darter
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Dingwell
authors.forename: Jason M
authors.initials: JM
authors.lastname: Wilken
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000534:rehabilitation*; D001696:Biomechanical Phenomena; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007596:Joints / Q000502:physiology; D035002:Lower Extremity / Q000502:physiology; D008297:Male; D009038:Motion; D010388:Pelvis / Q000502:physiology; D010806:Physical Education and Training; D016059:Range of Motion, Articular; D013909:Thorax / Q000502:physiology; D013977:Tibia; D014584:User-Computer Interface; D016138:Walking / Q000502:physiology*; D055815:Young Adult