This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Recently though various hip seats for carrying infant of women was designed and developed, then, wearing slipper may restrain the movement of bare foot. The study was undertaken to investigate the dynamic stability and kinetic variables according to between position of carrying infant and wearing slipper. Adult female (n=10) and under one year age of infant (n=10) participated in the study. Extrapolated center of mass, center of pressure, ground reaction force (GRF), and leg stiffness of gait characteristics using 3-dimensional cinematography and GRF were analyzed. Dynamic stability according to position of carrying infant and wearing slipper was not significant. While when carried an infant against normal gait showed significant difference in breaking force, leg stiffness and loading rate (P<0.001). Of which breaking force and vertical impulse were more increased when the back-carried against fore-carried of trunk. Thus it resulted in transformation on types of impulse transfer to leg and COG of women’s carrying infant, which may be strategy for securing a dynamic stability. Therefore experts related with exercise rehabilitation should understand sufficiently on gait characteristics of women with diseases on muscular-skeletal system and perform effective rehabilitation and treatment.
Skinship between women and infant commonly occurs during standing, sitting and gait, and then, cause of falling injury composes of the two-thirds in a situation of slipping floor and a motion carrying a parcel hastily (Dunning et al., 2003). In spite of complicated nerve-control system during gait, human manages to continue the rhythmic, regular and repetitive movement of gait (Vaughan, 2003). But movement bracing and backing of infant means overloaded body weight as that of infant, and thus elevate whole body weight and height of center of gravity (COG) by added mass.
When these problems interacts during gait, pelvic movement and gait posture with a reciprocity action against gravity may be altered, and also torque and linear force on body structure due to excessive movement of vertebrae increased (Cook and Neumann, 1987; Filaire et al., 2001; Pascoe et al., 1997).
Inadequate wearing shoe during gait may deteriorate of muscular function contributing to static and dynamic stability (Jackman and Kandarian, 2004), thus which may cause pain and abnormality of foot (Yick et al., 2016). Women usually wears slipper for noise prevention of interfloor and comfort of foot in a condition of backing infant (Zhang et al., 2013), but may injure foot-health and alter the gait movement potentially (Price et al., 2014). Doctors in charge of women of predelivering of baby accentuates exercise and posture control for early prevention on problems of muscular-skeletal system and rehabilitation management (Foti et al., 2000). Particularly even postdelivering, women undergo swell of ankle and leg, incomplete gait, increase of gait width and pain of hip (Ponnapula and Boberg, 2010). In the course, women usually may undergo abnormality of body shape and deficit of body function by interaction in due to shoe’s type and positions of carrying infant.
Therefore the purpose of the study was to investigate the change of dynamic and kinetic variables according to between position of carrying infant and wearing slipper.
MATERIALS AND METHODS
Subject
The adult female (n=10; mean age, 28.00±6.73 years; mean height, 163.25±4.90 cm; mean weight, 54.81±5.54 kg) and infant (n=10; mean weight, 11.27±1.51 kg) were selected as subjects. The experimental approval for safety, prevention and ethics of all was obtained from Institutional Review Board of Jeju National University (JJNU-IRB-2017-020-001).
Experimental procedure
GRF (AMTI-OR9-7, AMTI, Watertown, MA, USA) in line with the center of gait path and camera (4 ea.) (HDR/HDV 1980i, Sony Corp., Tokyo, Japan) were set up at 60 frame/sec of speed and 1/500 sec of exposure time. All participants performed each 3 times of gait trial in order of fore-carrying and back-carrying of infant in a condition of bare and slipper gait after rehearsing of enough gait exercise on condition of touch of right foot on the ground reaction force (GRF) with carrying infant. The order of experiment was performed randomly, and only 1 trial selected verified from Kwon 3D XP ver4.0 (Visol, Gwangmyeong, Korea) sampled at 600 Hz was analyzed for the study.
Definition of analysis phase
Gait characteristics were evaluated with trunk declined angle of medial-lateral, COP variables (medial-lateral COP, anterior-posterior COP excursions), GRF variables (peak vertical force, loading rate, decay rate) and leg stiffness.
Appropriate stable area was evaluates with position of medial-lateral COM projected in dynamic situation and COM position and velocity (dx/dt) supporting phase using XCOM (extrapolated center of mass position) (Hof et al., 2007).
h = effective height of the body COM above the floor=1.34ℓ
x (i) = lateral position of COM
X (i), Z (i) = vertical and lateral position of COM
x (i), z (i) = vertical and lateral position of COP
Index in medial-lateral and anterior-posterior direction, which mean index of stability resulted from value of COP (Michell et al., 2006). The formulae means the increase of COP, the less of stability.
Leg stiffness was normalized 100% (lo) to the initial touch-down of right foot in 3 dimensional spatial coordinates, and quantified dimensionally by division peak vertical force (N/BW) with change rate (lo − lmin)/lo) of leg length (lmin) (Silder et al., 2015).
Analysis and process of data
Primary variables calculated using IBM SPSS Statistics ver. 21.0 (IBM Co., Armonk, NY, USA) was mean±standard deviation and performed repeated two-way analysis of variance according to conditions of position (fore and rear of truck) and gait condition (barefoot and slipper) at P<0.05 level.
RESULTS
Velocity and dynamic stability according to position of carrying infant and wearing slipper was as (Table 1). Difference among gait velocity, XCOM, M-LCOPE, and A-PCOPE according to position of carrying infant and wearing slipper was not significant (P>0.05).
Kinetic variables during gait was as (Table 2). Difference between position of carrying infant and wearing slipper in GRF in medial-lateral direction and loading rate was not significant (P>0.05).
Difference between position of carrying infant and wearing slipper in GRF in anterior-posterior direction, loading rate and leg stiffness was significant (P>0.01), while the variables in case of wearing slipper did not show significant difference and interaction effect.
DISCUSSION
Usually female go through abnormal muscular-skeletal during women’s delivery, which is a cause of factors of functional deterioration and occurrence of body handicap (Segal et al., 2013). The high rate of new handicap occurrence of muscular-skeletal system on lower limbs during pregnancy (Foley et al., 2007) and furthermore abnormal exercise of joint due to frequent skinship with infant after delivering may result in acute or chronic deficit of body (Segal et al., 2013). Women delivered an infant generally participate in various treatment and exercise rehabilitation to resolve physical deficient occurring functionally, but profitable information helpful for prevention and improvement of motor ability is deficient.
In the analysis, difference between wearing slipper and bare gait in variables of dynamic stability and impulse type is not significant. unwell and inconvenience shoe for individual during gait induces insole pressure of foot, which result in pain of foot, injuries of tissue and ulcer, and finally handicap of balancing ability (Burns et al., 2005; Hodge et al., 1999; Jannink et al., 2006). But this study did not give an influence to dynamic stability by wearing slipper.
This result was not certain whether influence of shape, material or size of slipper, or wearing of loosen fixing slipper for long time had relation with pain of heel and excessive injury around of foot finger (Chard et al., 2013; Zhang et al., 2013). In further study, a study of dynamic stability during carrying infant and wearing time is necessary.
Carrying infant showed more increased in variables of anterior-posterior GRF, Max. vertical GRF, leg stiffness, and loading rate, which was inferred to proportionally increasing relation of impulse type due to infant weight, and particularly showed more increased breaking force and impulse force when positioned fore than post of trunk during carrying infant.
Generally when infant was positioned fore of trunk, visual information to move the other foot forward proper position may be interfered, but sensual strategy to secure the dynamic stability may be selected when given a condition at easy (Reynard and Terrier, 2015). But Stable gait based on reverse pendulum model should place COG of whole body to a position on new supporting ground (Hsiang and Chang, 2002), and then added infant weight in the course be due to momentum of forward movement of COG of whole body after touch-down of heel.
As these, regardless of fore or post carrying infant, women can secure a dynamic stability by altering mechanical function (impulse type) during women gait. That is, it suggests that carrying infant during gait has more close relation with increase of impulse type of muscular-skeletal system than decrease of stability. This result may be expected for expert of clinics or exercise rehabilitation to treat an exercise prescription through understanding of gait characteristics in various aspects in women of post delivering. In addition it is necessary to investigate gait stability considering effect slipping friction coefficient and others.
Notes
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
ACKNOWLEDGMENTS
This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2017S1A5A2A01023265).
REFERENCES
Bloom D, Woodhull-McNeal AP. Postural adjustments while standing with two types of loaded backpack. Ergonomics. 1987;30:1425–1430.
Burns J, Crosbie J, Hunt A, Ouvrier R. The effect of pes cavus on foot pain and plantar pressure. Clin Biomech (Bristol, Avon). 2005;20:877–882.
Chard A, Greene A, Hunt A, Vanwanseele B, Smith R. Effect of thong style flip-flops on children’s barefoot walking and jogging kinematics. J Foot Ankle Res. 2013;6:8
Cook TM, Neumann DA. The effects of load placement on the EMG activity of the low back muscles during load carrying by men and women. Ergonomics. 1987;30:1413–1423.
Dunning K, LeMasters G, Levin L, Bhattacharya A, Alterman T, Lordo K. Falls in workers during pregnancy: risk factors, job hazards, and high risk occupations. Am J Ind Med. 2003;44:664–672.
Filaire M, Vacheron JJ, Vanneuville G, Poumarat G, Garcier JM, Harouna Y, Guillot M, Terver S, Toumi H, Thierry C. Influence of the mode of load carriage on the static posture of the pelvic girdle and the thoracic and lumbar spine in vivo. Surg Radiol Anat. 2001;23:27–31.
Foley S, Ding C, Cicuttini F, Jones G. Physical activity and knee structural change: a longitudinal study using MRI. Med Sci Sports Exerc. 2007;39:426–434.
Foti T, Davids JR, Bagley A. A biomechanical analysis of gait during pregnancy. J Bone Joint Surg Am. 2000;82:625–632.
Hodge MC, Bach TM, Carter GM. Novel Award First Prize Paper. Orthotic management of plantar pressure and pain in rheumatoid arthritis. Clin Biomech (Bristol, Avon). 1999;14:567–575.
Hof AL, van Bockel RM, Schoppen T, Postema K. Control of lateral balance in walking. Experimental findings in normal subjects and above-knee amputees. Gait Posture. 2007;25:250–258.
Hong Y, Li JX, Fong DT. Effect of prolonged walking with backpack loads on trunk muscle activity and fatigue in children. J Electromyogr Kinesiol. 2008;18:990–996.
Hsiang SM, Chang CC. The effect of gait speed and load carrying on the reliability of ground reaction forces. Saf Sci. 2002;40:639–657.
Jackman RW, Kandarian SC. The molecular basis of skeletal muscle atrophy. Am J Physiol Cell Physiol. 2004;287:C834–843.
Jannink M, van Dijk H, Ijzerman M, Groothuis-Oudshoorn K, Groothoff J, Lankhurst G. Effectiveness of custom-made orthopaedic shoes in the reduction of foot pain and pressure in patients with degenerative disorders of the foot. Foot Ankle Int. 2006;27:974–979.
Martin PE, Nelson RC. The effect of carried loads on the walking patterns of men and women. Ergonomics. 1986;29:1191–1202.
Michell TB, Ross SE, Blackburn JT, Hirth CJ, Guskiewicz KM. Functional balance training, with or without exercise sandals, for subjects with stable or unstable ankles. J Athl Train. 2006;41:393–398.
Pascoe DD, Pascoe DE, Wang YT, Shim DM, Kim CK. Influence of carrying book bags on gait cycle and posture of youths. Ergonomics. 1997;40:631–641.
Price C, Andrejevas V, Findlow AH, Graham-Smith P, Jones R. Does flip-flop style footwear modify ankle biomechanics and foot loading patterns? J Foot Ankle Res. 2014;7:40
Reynard F, Terrier P. Role of visual input in the control of dynamic balance: variability and instability of gait in treadmill walking while blindfolded. Exp Brain Res. 2015;233:1031–1040.
Segal NA, Boyer ER, Teran-Yengle P, Glass NA, Hillstrom HJ, Yack HJ. Pregnancy leads to lasting changes in foot structure. Am J Phys Med Rehabil. 2013;92:232–240.
Silder A, Besier T, Delp SL. Running with a load increases leg stiffness. J Biomech. 2015;48:1003–1008.
Smith B, Ashton KM, Bohl D, Clark RC, Metheny JB, Klassen S. Influence of carrying a backpack on pelvic tilt, rotation, and obliquity in female college students. Gait Posture. 2006;23:263–267.
Vaughan CL. Theories of bipedal walking: an odyssey. J Biomech. 2003;36:513–523.
Yick KL, Tse LT, Lo WT, Ng SP, Yip J. Effects of indoor slippers on plantar pressure and lower limb EMG activity in older women. Appl Ergon. 2016;56:153–159.
Zhang X, Paquette MR, Zhang S. A comparison of gait biomechanics of flip-flops, sandals, barefoot and shoes. J Foot Ankle Res. 2013;6:45
Table 1
Change of mean velocity, extrapolated centre of mass position, and center of pressure variables during level walking
Section
Walking conditions (W)
Carrying positions (C)
Total average
Source
F
P-value
Post hoc
Normal walking
Front of trunk
Rear of trunk
Mean velocity (m/sec)
Barefoot
1.25±0.15
1.20±0.13
1.24±0.17
1.23±0.15
W
0.432
0.519
NS
Slipper
1.18±0.06
1.18±0.08
1.24±0.18
1.20±0.12
C
1.004
0.359
NS
Total average
1.22±0.12
1.19±0.11
1.24±0.17
1.22±0.14
W×C
0.466
0.578
NS
XCOMθ (°)
Barefoot
4.84±4.85
6.38±3.37
6.42±4.48
5.88±1.19
W
0.186
0.671
NS
Slipper
4.97±2.19
6.91±4.59
7.56±4.42
6.47±3.91
C
2.310
0.114
NS
Total average
4.90±3.66
6.65±3.93
6.99±4.37
6.18±1.03
W×C
0.119
0.888
NS
M-LCOPE
Barefoot
2.97±1.35
2.92±1.44
2.80±1.11
2.89±1.26
W
0.102
0.754
NS
Slipper
3.27±1.13
2.48±0.91
2.52±1.11
2.75±1.07
C
2.168
0.128
NS
Total average
3.12±1.22
2.7±1.19
2.66±1.09
2.82±1.16
W×C
1.244
0.300
NS
A-PCOPE
Barefoot
19.92±1.19
21.15±4.54
21.46±3.04
20.84±3.18
W
0.019
0.891
NS
Slipper
19.27±3.35
20.58±1.51
23.00±4.44
20.95±3.57
C
2.998
0.062
NS
Total average
19.59±2.47
20.87±3.30
22.23±3.78
20.89±3.35
W×C
0.669
0.519
NS
Values are presented as mean±standard deviation.
NS, not significant; M-LCPOE, medial-lateral center of mass excursions; A-PCOPE, anterior-posterior center of mass excursions; W, main effect of the walking conditions; C, main effect of the carrying positions; W×C, interaction.
Table 2
Change of ground reaction force variables and leg stiffness during level walking