The fist edition of this book represented the standard text for understanding human locomotion. The second edition provides an update on several areas. It is not a primer on human walking for someone with a passing interest. The level of detail and the different views of the process of walking will present a challenge for the enthusiast. For example the gait cycle is considered according to its phases, the basic functions and then from an anatomical perspective, joint by joint. Kinematic and kinetic tracings are presented at the point where the function of each joint is considered, but it is not until chapter 20 that motion analysis is discussed; and kinetics (which underpins the motions seen) is considered two chapters further on. There are one or two curious assertions, for example that the knee is straight at initial contact; and on occasions the text is not entirely clear as to what the authors intend. Again, the handling of pathological gait problems is tackled from the perspective of gait deviations and then, a second time around, by clinical examples.
The mechanics of instrumented gait analysis, from how to set up video cameras to marker and electrode placement, are not covered. Although different proprietary systems have differing fine details, the general principles and the consequences of poor technique are not critically addressed. The last chapter on energy expenditure measurement is good but there is no mention of less demanding surrogates such as the physiological cost index.
I will continue to use this book on a regular basis during clinical gait analysis. As a source of answers when puzzling findings arise, it remains a valuable addition to any gait laboratory bookshelf.
Numerous people never receive a formal dementia diagnosis. This issue can be addressed by early detection systems that utilize alternative forms of classification, such as gait, balance, and sensory function parameters. In the present study, said functions were compared between older adults with healthy cognition, older adults with low executive function, and older adults with cognitive impairment, to determine which parameters can be used to distinguish these groups.
Older adults with low executive function showcased a lower walking pace, but their postural stability and sensory functions did not differ from those of the older adults with healthy cognition. The variables concluded as good cognitive status markers were (1) gait cadence for dividing cognitively healthy from the rest and (2) single limb support portion, mediolateral stability index, and the number of mistakes on the sentence recognition test for discerning between the low executive function and cognitive impairment groups.
According to the gait function analysis results, participants in the IC group exhibit poorer balance than those in the HC and LEF groups. Postural stability testing confirmed this indication. There were significant differences between HC and IC for all postural stability indexes and there were significant differences between LEF and IC in the case of mediolateral and overall postural stability index. As suggested by earlier studies, this finding brings further confirmation that low postural stability is a sign of cognitive deterioration .
Sensory, postural stability and gait functions of the three groups have shown that some variables have a high discriminative ability. The variables that were found to be good at discerning between groups and could therefore be used in detection systems were (1) cadence during level walking for dividing cognitively healthy older individuals from the rest and (2) single limb support portion, mediolateral stability index, and the number of mistakes on the sentence recognition test for discerning between older adults at risk of cognitive impairment from the ones with cognitive impairment.
The present study assessed the differences in gait, balance, and sensory functions of cognitively healthy older individuals, those who scored above the cutoff points on the cognitive test but have lower executive function, and older adults with cognitive impairment. Participants were divided into 3 groups based on their K-MoCA score and executive function score. The statistical analysis showed that lower executive function coincides with slower walking pace, similar to that of the cognitively impaired. However, despite the slowing of the gait, the group with lower executive function showed greater balance, similar to that of the cognitively healthy. Additionally, this group showed the best average auditory and visual capacity among the 3 groups, with significantly higher auditory retention than the cognitively impaired. It was determined that cognitively healthy older individuals could be discerned from the rest by using the gait cadence variable, due to its high AUC. For discerning older adults with lower executive function from the ones with cognitive impairment, single limb support portion, mediolateral stability index and the number of mistakes on the sentence recognition test can be used as markers.
Cognitive performance of the participants was assessed using the Korean version of the Montreal cognitive assessment (K-MoCA). Participants whose scores were compatible with the presence of cognitive impairment were placed in the impaired cognition (IC) group, using the cutoff points from a normative study . The given cutoff points differ based on age and education and range from 6 to 26 points. The K-MoCA test examines seven cognitive abilities: visuospatial executive function; naming; attention; language; abstraction; delayed recall; and orientation. The first question of the visuospatial executive function section, a modified trail making test with Korean letters (TMT-KL), was used to divide the participants who scored above their respective cutoff points into participants with lower executive function (LEF) and ones with healthy cognition (HC). This test is equivalent to the trail-making test B (TMT-B), except it consists of only 5 numbers and 5 letters, and instead of the letters of the English alphabet, Korean letters are used. In the K-MoCA test, the TMT-KL score is a categorical variable describing whether the participant completed the test without mistakes. The trail making test is useful in evaluating mental flexibility because of the required shifting between numbers and letters  and is a measure of executive function, specifically problem solving , which has been shown to be impaired in all types of mild cognitive impairment (MCI) . Additionally, a cutoff of one mistake on the TMT-B was found to be a fairly good discriminator between cognitively healthy and cognitively impaired . Participants in said study who had no mistakes on the TMT-B also had significantly higher MMSE scores, indicating a higher cognitive ability. For this reason, the participants whose scores indicate normal cognition but have not completed the TMT-KL can be considered as being at risk of progressing to mild cognitive impairment.
Tibialis posterior has a vital role during gait as the primary dynamic stabiliser of the medial longitudinal arch; however, the muscle and tendon are prone to dysfunction with several conditions. We present an overview of tibialis posterior muscle and tendon anatomy with images from cadaveric work on fresh frozen limbs and a review of current evidence that define normal and abnormal tibialis posterior muscle activation during gait. A video is available that demonstrates ultrasound guided intra-muscular insertion techniques for tibialis posterior electromyography.
Current electromyography literature indicates tibialis posterior intensity and timing during walking is variable in healthy adults and has a disease-specific activation profile among different pathologies. Flat-arched foot posture and tibialis posterior tendon dysfunction are associated with greater tibialis posterior muscle activity during stance phase, compared to normal or healthy participants, respectively. Cerebral palsy is associated with four potentially abnormal profiles during the entire gait cycle; however it is unclear how these profiles are defined as these studies lack control groups that characterise electromyographic activity from developmentally normal children. Intervention studies show antipronation taping to significantly decrease tibialis posterior muscle activation during walking compared to barefoot, although this research is based on only four participants. However, other interventions such as foot orthoses and footwear do not appear to systematically effect muscle activation during walking or running, respectively. This review highlights deficits in current evidence and provides suggestions for the future research agenda.
Current literature has characterised TP EMG during gait among normal and pathological populations and with various interventions including antipronation taping, foot orthoses and athletic footwear. Figure 4 summarises TP EMG profiles during walking among these populations.
Overall, the availability of normative EMG for TP during walking is based on relatively small sample sizes and is limited to only adult and older adult participants. Despite the absence of normative data, other studies have investigated TP EMG activation with pathological conditions including rheumatological and neurogenic diseases. With the high variability seen in healthy people, it is difficult to conclude whether the findings from studies investigating abnormal muscle activity are meaningful.
A further study by Michlitsch and colleagues  involved a retrospective study from pre-operative data recorded from seventy-eight patients assessed over an 11-year period. They reported approximately 1/3 of varus deformities linked with cerebral palsy are associated with TP alone and a further 1/3 are associated with abnormal activity from a combination of abnormal TP and tibialis anterior muscle dysfunction. One subtype of TP