The influence of the aquatic environment on the center of pressure, impulses and upper and lower trunk accelerations during gait initiation

Gait initiation is defined as the transition from stationary standing to steady-state walking. Despite the frequent use of therapy pools for training walking in early stages of rehabilitation, none have been reported on the effects of immersion on gait initiation. We aimed to analyze the center of pressure (COP) trajectories, the vertical and anteroposterior impulses and upper and lower trunk accelerations during anticipatory (APA) and execution phases of gait initiation. In the COP trajectory, the execution (EXE) phase was further subdivided in two phases: predominantly mediolateral (EXE1), and predominantly anteroposterior (EXE2). Able-bodied participants initiated gait while standing on a force plate and walked approximately 4 steps following a visual cue. The participants were wearing three inertial sensors placed on the lower and upper trunk, and on the stance shank. Individuals performed 10 trials each on land and in water, in two consecutive days. The lengths and velocities of COP trajectories increased in water compared to land during APA, while the COP length increased and the COP velocity reduced in water during EXE2. The anteroposterior impulses increased in water during EXE. Lower trunk acceleration was smaller in water while the upper trunk acceleration did not differ, resulting in the larger ratio of upper to lower trunk acceleration in water during EXE. Overall, immersion in water increases COP length during gait initiation, and reduces COP velocity during EXE2, indicating a new postural strategy in water. The aquatic medium may be favorable for individuals who need weight support, gradual resistance and a longer time to execute gait initiation.