Gait & posture最新文献

{"title":"Kinematic limitations during obstacle-crossing in adolescent idiopathic scoliosis","authors":"Maria Rassam, Karim Hoyek, Rony El Hayeck, Georges Haddad, Emmanuelle Wakim, Elio Mekhael, Nabil Nassim, Ismat Ghanem, Rami El Rachkidi, Ayman Assi","doi":"10.1016/j.gaitpost.2023.07.203","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.203","url":null,"abstract":"Scoliosis is a 3D spinal deformity that is known to affect patient’s alignment on static radiographs [1] and their movement during walking or other daily life activities [2]. Crossing obstacles is a common activity that can challenge patients’ stability. However, kinematics of the obstacle-crossing movement is still unknown in adolescent idiopathic scoliosis (AIS). Are kinematics affected in patients with AIS during obstacle-crossing? 18 AIS patients with major right convexity thoracic scoliosis (Cobb: 38° [25-55°]) and 15 controls (age and sex matched: 16 years, 85% F) underwent biplanar X-rays in standing position with the calculation of 3D radiographic spinopelvic parameters. 3D movement analysis was performed during obstacle-crossing, obstacle being fixed at 30% of lower limb length, and executed once with each leg leading the movement. Kinematic parameters of the head, trunk, pelvis, lower limbs and spinal segments were calculated [3,4]. Parameters were compared between the 2 groups and the relationship between kinematic and radiographic variables was investigated. During obstacle-crossing, AIS patients showed an increased thorax extension compared to controls (-19 vs 6°, p<0.05), especially in the main thoracic segment (T3T6-T6T9= 9 vs 14°, p<0.05). Conversely, AIS patients showed a decreased lumbar lordosis when compared to controls (T12L3-L3L5=-14 vs -20°, p<0.05). Moreover, AIS patients showed an anterior rotation (-2 vs 2°) and elevation (6 vs 0°, both p<0.05) of the right shoulder. Patients also showed a decreased hip abduction of the leading leg when compared to controls (-5 vs -9°, p<0.05). The main thoracic extension was correlated to the Cobb angle (r=-0.50) and the shoulder axial rotation to the apical vertebral rotation (r=0.75, both p<0.05; Fig. 1). AIS patients are known to have back flattening with a loss of lumbar lordosis due to their spinal deformity. This spinal malalignment was shown to persist dynamically during obstacle-crossing, associated with a forward shift and elevation of the convexity-side shoulder. The backward movement of the trunk and the shoulder rotation attitude, along with the decreased hip abduction, might hinder stability during obstacle-crossing. These kinematic alterations were shown to increase with the spinal deformity (increased Cobb and apical vertebral rotation). Future studies will investigate kinematic changes in AIS patients following spinal fusion. Fig. 1 Correlations between kinematic limitations and scoliosis severity in adolescent idiopathic scoliosis during obstacle-crossing movement.Download : Download high-res image (100KB)Download : Download full-size image","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of varus foot deformities on muscle moment arms in children with cerebral palsy","authors":"Gaia Van Den Heuvel, Wouter Schallig, Marjolein van der Krogt, Ruud Wellenberg, Mario Maas, Annemieke Buizer, Ajay Seth","doi":"10.1016/j.gaitpost.2023.07.256","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.256","url":null,"abstract":"Children with cerebral palsy (CP) commonly develop deformities of the foot [1], which lead to pain and gait problems. One of the causes of such deformities is likely an imbalance in muscle forces around the foot [2]. In turn, these deformities can also alter muscle function due to altered muscle moment arms. Moment arms can be estimated using musculoskeletal models, but models based on generic bone geometry are unlikely to represent the deformity accurately. Weight-bearing computed tomography (WBCT) enables assessment of abnormal bone alignment under loaded conditions [3]. What are the changes in moment arm lengths of the main invertors and evertors (i.e. the tibialis and peroneal muscles) around the subtalar joint in children with cavovarus and equinovarus foot deformity due to CP? Six children with a severe hindfoot varus deformity due to CP (one female, aged 13.8 ± 2.3 years) and four typically developed (TD) adults (one female, aged 35.8 ± 4.8 years) were included. Personalized musculoskeletal foot models were created in OpenSim Creator [4] using WBCT scans. This foot was attached to the full-body OpenSim gait2392 model, which was scaled using gait analysis data. Muscle moment arms were calculated using OpenSim [5,6] and normalized to tibia length. A non-parametric Mann-Whitney U test was used to compare between groups. Normalized inversion-eversion moment arm lengths are shown in Fig. 1. The tibialis anterior had an inversion moment arm in the deformed CP feet, in contrast to an eversion moment arm in the TD group. No differences were found for the tibialis posterior. Although there was no overall group effect, the eversion moment arm of the peroneal muscles was smaller in most CP children compared to the TD group. Fig. 1 - Moment arms around the subtalar joint, normalized to tibia length. Note the different scales on the vertical axes. * p <.01.Download : Download high-res image (93KB)Download : Download full-size image We present the first study to evaluate altered moment arms in feet of children with CP using personalized musculoskeletal foot models based on WBCT scans. Our results indicate that the tibialis anterior becomes a more effective invertor with a varus deformity of the foot. Despite the fact that the tibialis posterior is often seen as an important cause of the varus deformity, its function as expressed by the moment arm does not change. On the other hand, the eversion moment arms of the peroneal muscles tend to become smaller, meaning they would be less effective in counterbalancing the deformity. Together, these altered moment arms would lead to an even larger varus moment in the subtalar joint with similar muscle forces, thereby pulling the foot even more towards varus. Our results could explain the progression of the deformity once the deformity is present.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135299039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between trunk muscle forces, static and dynamic postural malalignment in patients with adult spinal deformity","authors":"Maria Saade, Ali Rteil, Rami El Rachkidi, Celine Chaaya, Elma Ayoub, Elena Jaber, Elio Mekhael, Nabil Nassim, Abir Massaad, Ayman Assi","doi":"10.1016/j.gaitpost.2023.07.214","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.214","url":null,"abstract":"Patients with Adult spinal Deformity (ASD) are known to have a deteriorated quality of life (QOL). Severe spinal deformity can develop into postural malalignment caused by a forward shift of the trunk and head. Recent studies have shown that sagittal malalignment in patients with ASD can affect joints and segments’ kinematics during daily life activities [1,2]. On the other hand, ASD patients are known to present with muscular degeneration [3]. However, it is still unknown how trunk muscle’s weakness can affect ASD postural alignment in static position and during daily life activities. To investigate the relationship between muscle forces, radiographic parameters, joint kinematics during daily activities, and QOL scores in ASD. 25 ASD & 19 controls underwent biplanar radiographs in both standing and sitting positions with the calculation of 3D classic spinopelvic and postural alignment parameters (i.e: SVA plumbline between C7 and posterior corner of the sacrum; ODHA angle between line joining odontoid process and middle of hip axis with the vertical). Movement analysis was performed during walking, sit-to-stand, and stair ascent-descent with the calculation of 3D joint and segment kinematics. Participants filled out QOL questionnaires (SF-36 with both physical and mental components, Oswestry Disability Index ODI). The strength of the following muscle groups was measured using a hand-held dynamometer: trunk extensors, flexors, and right & left lateral flexors. ASD were divided into 2 groups based on the age-normalized strength of trunk extensors compared to controls: ASD-normal extensors and ASD-weak extensors (having strength<mean-1SD in controls). Radiographic parameters, kinematic variables, and QOL scores were compared between groups. 6 ASD had weak extensors (F=20 vs. 26 N in controls). The ASD-weak extensors patients showed a forward sagittal alignment compared to ASD-normal extensors in the standing position (ODHA=5 vs 3°, SVA =73 vs 24 mm). They had to increase their pelvic retroversion while sitting in order to maintain a horizontal gaze (sitting-pelvic tilt=41 vs 35° in ASD-normal extensors). The sagittal malalignment persisted during the different performed movements (dynamic-ODHA=16° vs 9° in ASD-normal extensors). However, ASD with normal extensors had less alterations in their radiographic and kinematic parameters. Muscle weakness was correlated to the deterioration of QOL (physical component-SF36: r=0.55; p<0.001) and decreased walking speed (r=0.44; p<0.001, Fig. 1). This pilot study showed that weak trunk extensors are associated with sagittal malalignment in standing and sitting positions, as well as during daily life activities. Weak extensors also correlate to deteriorated quality of life in ASD. Normal strength of trunk extensors seems to help ASD patients in compensating for their spinal deformity both in static and during movement. Future studies will investigate the effect of muscle strengthening on both static and dynamic","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135299054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relation between bimanual coordination, lesion timing, and corticospinal tract wiring pattern in children with unilateral cerebral palsy","authors":"Charlotte Lambrechts, Alexandra Kalkantzi, Lisa Decraene, Lize Kleeren, Monica Crotti, Katrijn Klingels, Els Ortibus, Hilde Feys, Lisa Mailleux","doi":"10.1016/j.gaitpost.2023.07.138","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.138","url":null,"abstract":"In children with unilateral cerebral palsy (uCP), it is well-described that the corticospinal tract (CST) wiring pattern and lesion timing are strongly related to unimanual upper limb function.1 Remarkably, the relation between those neurological factors and bimanual coordination is not yet thoroughly examined, while most daily life activities require the integrated use of both hands. Does bimanual coordination differ depending on the CST-wiring pattern and lesion timing in children with uCP? Bimanual coordination was assessed in 29 children with uCP (12.1 y±2.7 y) using the ball-on-bar task on the Kinarm robotic exoskeleton.2 This task consists of two levels of increasing difficulty, during which participants move a ball to a target while balancing it on a bar through two-dimensional virtual reality visual guidance. Eight parameters of each level were included. Using transcranial magnetic stimulation, the participants were classified into two groups according to their CST-wring pattern: the contralateral (N=10) versus the reorganized ipsilateral or bilateral (N=3/7) CST-wiring. In 9 children, this assessment was not feasible. Based on magnetic resonance imaging, the participants were classified according to their lesion timing in predominant white matter (PWM) lesions (N=16) versus predominant grey matter (PGM) lesions (N=5). In 8 children, brain imaging was missing. Between-group comparisons were calculated with ANCOVA or the non-parametric Quade’s Rank (p<0.05), with age as covariate. Effect sizes were calculated using partial eta squared (np2) and interpreted as: ηp2=0.01 small effect, ηp2=0.06 medium effect, ηp2=0.14 large effect Between the CST-wiring groups, a significant difference was found for hand speed difference in level 2 (F=4.876, p=0.04, ηp2=0.22), indicating a better hand synchrony in children with a contralateral CST-wiring compared to children with a reorganized CST-wiring. Between the lesion timing groups, a significant difference was found for bar tilt standard deviation (SD) in level 1 (F=7.679, p=0.01, ηp2=0.29), reflecting a more stable maintenance of the bar by the PGM-group compared to the PWM-group. Interestingly, a significant group*age interaction was found for level 2 of this parameter (p=0.03), revealing more variability of the bar tilt in the PGM-group with increasing age, in contrast to the PWM-group, which had less variability (Fig. 1).Download : Download high-res image (49KB)Download : Download full-size image Our findings are partially in line with current literature suggesting that children with a contralateral wiring have a better motor function. However, in contrast to previous studies, our results suggest worse bimanual coordination in children with PWM-lesions, which could be explained by the higher incidence of bilateral lesions in PWM-lesions compared to PGM-lesions.3 Nevertheless, future research with larger samples accounting for age interactions is warranted.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"104-B 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee flexion while walking versus knee contractures in children with bilateral spastic cerebral palsy","authors":"Cecilia Lidbeck, Bartonek Åsa","doi":"10.1016/j.gaitpost.2023.07.141","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.141","url":null,"abstract":"Flexed knee is a multidimensional kinematic walking pattern in children with bilateral spastic CP that has been described to develop as gait matures, particularly at higher GMFCS levels (1). One cause might be limited knee extension that have been described to lead to significant disability with a flexed knee gait posture during walking (2). The aim of this study was to compare knee position during walking with passive knee extension in an unloaded body position, and with respect to functional mobility during walking. Gait in 30 children with bilateral spastic CP (13 females) median [min, max] age 11.3 [7.6, 17.1] years and 22 typical developing (TD) children (11 females) median [min-max] age 8.9 [6.5-16.9], was assessed with 3D-motion analysis (Vicon MX40®). Joint contractures in ankle, knee and hip, defined from a neutral joint position, were assessed through goniometric measurement of passive hip extension, knee extension, and ankle dorsiflexion with extended knee in supine position. Orthopaedic lower limb surgeries were documented. Functional mobility was measured with the time up and go test (TUG). Non-parametric statistics were used (p<0.05). Knee contractures were greater at GMFCS III than at GMFCS I and in the TD group (p=0.046 and p= 0.002). During walking, knee angle at initial contact (KneeAngleIC) was greater than peak knee extension in stance (MinKneeFlexSt) in the TD group and at GMFCS I, II, and III (p=0.008, p=0.043, 0.005, and p=0.002) respectively. MinKneeFlexSt exceeded maximum passive knee extension at GMFCS levels II (p=0.004), and III (p=0.002). Both KneeAngleIC and MinKneeFlexSt were greater at GMFCS II and III, than at GMFCS I and the TD group (Fig. 1). TUG took longer for GMFCS II and GMFCS III compared to TD (p<.001 and p<.001) and GMFCS I (p= 0.001 and p<0.001), and longer for GMFCS III compared to GMFCS II (p<0.001). Fig. 1 Light bars represent KneeAngleIC and dark bars MinKneeFlexSt. (+) indicates knee flexion, brackets above the boxes: differences at KneeAngleIC, and below: differences at MinKneeFlexSt.Download : Download high-res image (58KB)Download : Download full-size image This study found that knee flexion in stance was significantly greater than knee contractures at GMFCS levels II and III with no difference in occurrence of orthopaedic surgery. Furthermore, walking ability took longer at GMFCS level III compared to at level II at similar knee flexion contracture. The discrepancy in knee position in weight-bearing versus passive knee extension in the unloaded position at GMFCS II and III, and the large difference in TUG between children at GMFCS level III and those in the other groups, are likely explained by the effort to overcome motor disorders such as spasticity, however, may also be explained by the commonly occurring sensorimotor disorders (4).","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of spine structure, mobility, and competency in dentists with and without low back pain","authors":"Merve Keskin, Mehmet Irfan Karadede, Derya Ozer Kaya","doi":"10.1016/j.gaitpost.2023.07.120","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.120","url":null,"abstract":"Dental practices can cause musculoskeletal pain and dysfunction due to cumulative microtrauma and inappropriate working positions (1). The prevalence of musculoskeletal pain in dentists was declared between 64% and 93% (2). The prevalence of low back pain in dentists was reported as 47.6% as the most common musculoskeletal dysfunction (3,4). Is there a difference in spine structure, mobility, and competency of dentists with low back pain compared to those without low back pain? In the study, 65 dentists with low back pain (40 females, 25 males, age: 25.57±2.83 years, weight: 67.64±13.20 kg, height: 171.72±8.46 cm, BMI, 22.75±3.25 kg/m2) and 57 pain-free matched control group (30 females, 27 males, age: 26.36±3.94 years, weight: 69.05±13.00 kg, height: 170.53±7.78 cm, BMI, 23.64±3.52 kg/m2) were included. Spine structure, mobility, and competency in the sagittal and frontal planes were evaluated with the Valedo®Shape device (Idiag, Fehraltorf, Switzerland). Parameters were obtained in degrees: thoracic, lumbar, sacral/hip angle, and trunk inclination angle (angle between straight line from T1 to S1 and vertical line). After the spinous processes of the spine were marked as reference points, the Valedo®Shape device was moved down by the evaluator over all the spinous processes starting from the C7 spinous process to approximately the S3 spinous process. The response of the spine to loading was evaluated using weight for competency measurement. After measuring before the weight, the participant was asked to wait for 30 seconds with the weights in hand, and the measurement was repeated (6). The normality distributions of the data were determined by the Shapiro-Wilk test. In the comparison of the data, the independent sample t-test was used in those with normal distribution, and the Mann-Whitney U test was used for those that were not normally distributed. In patients with low back pain, in the sagittal plane, the inclination angle decreased (p=0.045), there was a shift in the sacral angle with loading (p=0.037). In the sagittal and frontal planes, there was no significant difference in thoracic region angles (p=0.292;0.074) and in the lumbar region angles (p=0.369; p=0.781). In participants with low back pain, the angle of inclination decreased in the sagittal plane and a lateral shift response occurred in the sacrum with loading. It is known that the angles of the lumbopelvic region are directly related to the curvature of the spine and compensatory mechanisms against spinal deformities in the sagittal plane in this region (7). In a previous study, a shift in the inclination angle was reported by dentists with low back pain (8). The changes in the spine in dentists may be seen in the occurrence of low back pain. This should be considered for the assessment and treatment of low back pain.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of a novel assessment protocol for the knee joint velocity proprioceptive sense to investigate motor learning abilities","authors":"Anthi Kellari, Eumorphia Papapostolou, Euaggelia Papadimou, Zacharias Dimitriadis, Eleni Kapreli, George Koumantakis, Nikolaos Strimpakos, Asimakis Kanellopoulos","doi":"10.1016/j.gaitpost.2023.07.118","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.118","url":null,"abstract":"Proprioception is a significant factor in balance, coordination, joint stability and movement acuity (1). Among proprioception’s components, joint position sense (JPS) and movement detection have been mostly assessed whereas little is known about the joint velocity proprioceptive sense (2). Finding the joint angular velocity(-ies) that is more comprehensible by the human’s brain, and therefore more accurately reproduced, could be used, among others, in motor learning rehabilitation protocols. To investigate the knee angular velocities envelope inside which the joint can be moved with the most accuracy, depending on the task. 48 subjects (23 men and 25 women) without knee pathology participated in the study (age 21.4 ±3.85). Velocity replication (VR) was assessed in a spectrum of 5 different and randomly chosen low velocities (2°/s, 5°/s, 10°/s, 20°/s and 30°/s) by using concentric quadriceps contraction in an Isokinetic Dynamometer (Biodex System3 Pro). During the procedure the subjects were blindfolded, and the examiners were blind regarding the results.The passive demonstrations of each joint angular velocity were followed by active velocity replications. The number of passive demonstrations and active replications were adapted for each velocity in such a way, that each subject would stay almost the same amount of time, and therefore having the same effect or effort, in all of them. The knee angular velocities of 2°/s and 5°/s had the bigger mean percentage replication errors (68.2% and 29.0%) but the smallest mean errors in absolute value (1.4°/s for both the velocities). In the velocities of 10°/s, 20°/s and 30°/s the mean percentage replication errors were 26.3%, 26.1% and 29.0% respectively, while the mean errors in absolute value were 2.6°/s, 5.5°/s and 8.6°/s respectively. According to the present research, the knee joint can achieve a maximal precision of 1.4°/s angular velocity error, appear in joint velocities below 5°/s. Rehabilitation protocols require precision should focus is this kinematic envelope as, above this threshold, the angular velocity error increases gradually, as the joint velocity increases. For gross motor activities, where percentage joint angular velocity errors are more meaningful than the absolute error values, the kinematic envelope between 10°/s - 20°/s seem to be the ideal for motor learning tasks. According to our knowledge, this is the first attempt in the literature to investigate the knee angular velocity proprioception, and further investigation is needed on the velocity proprioceptive behavior of other joints, as well as any deviations in pathologies or trauma.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135297892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does using the hip joint distance (x-ray) as an input change the kinematic, kinetic output and is this clinically relevant?","authors":"Andreas Kranzl, Groblschegg Leonore, Attwenger Bernhard, Durstberger Sebastian, Koppenwallner Laurin Xaver, Unglaube Fabian","doi":"10.1016/j.gaitpost.2023.07.130","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.130","url":null,"abstract":"There are a number of methods for determining the centre of the hip joint (HJ). The most common are regression equations or functional methods. In individual cases, however, we do not know how well the HJ centre is actually determined. Several papers present Harrington's regression formula as the best choice (Harrington et al., 2007; Kainz et al., 2015; Peters et al., 2012). If an image of the pelvis is available, the HJCD can be determined from it, and this can be used to optimise the determination of the joint centre in the regression formula. Does using the hip joint distance (x-ray) as an input change the joint parameters? A retrospective analysis of the gait laboratory database identified patients who had a calibrated radiograph and a 3D gait analysis. The calculated HJCD from the gait data was compared with that from the radiograph. In addition, the ASIS distance was calculated using the hip joint distance from the radiograph, and again the HJ position was determined using the newly obtained ASIS distance in the Harrington formula. The gait data were statistically compared using SPM analysis and the maximum distance between the two methods was determined over all curves. This was compared with the minimal detectable changes (MDC) (Wilken et al., 2012). Data from 349 patients (legs n=698, age: 4-22 years) with anterior knee malalignment without neuromuscular disease were analysed. HJCD correlations between radiographs and 3DGA values were 0.662 (p<0.001) using the Harrington method. The Bland-Altman plots for HJCD showed minimal differences using the Harrington regression formula. However, there were differences of up to 40 mm between the two methods of determining the HJCD. A comparison of the gait results with the two calculated equations shows significant differences (SPM). In most cases the differences between the two methods were negligible, but in some patients (legs) they were above the MDC value.Download : Download high-res image (85KB)Download : Download full-size image On average, the HJ distance from the radiograph and the gait analysis data were in good agreement, but not in every patient (up to 40 mm). The gait curves show significantly different results according to SPM analysis. In most cases the differences are below the MDC, but in individual patients there may well be clinically relevant differences in the results. Therefore, if pelvic imaging is available, we recommend using it to calculate the HJ centre.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Backward and forward walking and its association with falls and fear of falling in people with multiple sclerosis","authors":"Heidi Stölzer-Hutsch, Dirk Schriefer, Katrin Trentzsch, Tjalf Ziemssen","doi":"10.1016/j.gaitpost.2023.07.238","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.238","url":null,"abstract":"Common symptoms in people with multiple sclerosis (pwMS) are walking limitations that can reduce the quality of life and lead to an increased risk of falling and fear of falling [1,2]. Instrumented gait analysis on a walkway with integrated pressure sensors can be used for assessment of both forward and backward walking. Walking backwards has been established as a more sensitive parameter to detect fallers, compared to walking forwards [3]. It is unknown whether fear of falling can be already detected by walking backwards. For possible interventions, it is important to identify patients with falls resp. fear of falling as early as possible. Is there an association between forward and backward walking and falls resp. fear of falling in pwMS? 705 pwMS (71.6% female, 82.1% with relapsing remitting MS) completed three test conditions on an eight-meter pressor sensor walking way (GAITRite® System) without shoes: (i) walking forwards at a self-selected normal speed, (ii) walking forwards at fast speed and (iii) walking backwards at the highest possible speed. In addition, fall history and fear of falling in the previous month were assessed. Velocity, step length and stance phase of gait cycle were determined in all test conditions. In walking backwards condition, time for 3-meter backward walking test (3MBWT) was additionally included in the analysis. Multiple logistic regressions adjusted for age, gender, body mass index (BMI) and Expanded Disability Status Scale (EDSS) were applied. Of 705 pwMS, 10.6% were fallers (n=75; age: 46.52 ±10.79; BMI: 26.05 ±5.66; EDSS median: 3.5), while 31.9% presented with fear of falling (n=225; age: 47.58 ±11,29; BMI: 25.73 ±5.01; EDSS median: 3.5). Step length during fast walking (odds ratio (OR) 0.982; CI 0.966-0.998) and velocity during walking backwards proved to be significant indicators of falls with an OR of 0.982 (CI 0.970-0.995). All parameters of walking backwards (velocity, step length, stance of cycle and 3MBWT) and stance of cycle in normal walking could be proven as an indicator of fear of falling (see Fig. 1). In addition to identifying patients at risk of falling [3], the results suggest that walking backwards also can identify pwMS presenting with fear of falling. Longitudinal analyses will be performed to validate the clinical utility of walking backwards. Fig. 1.Download : Download high-res image (111KB)Download : Download full-size image","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individuals with pre-obesity exhibit a more asymmetrical gait pattern","authors":"Halit Selçuk, Hilal Keklicek","doi":"10.1016/j.gaitpost.2023.07.223","DOIUrl":"https://doi.org/10.1016/j.gaitpost.2023.07.223","url":null,"abstract":"Previous studies have shown that obesity impairs body biomechanics (1-3). However, no study has been found examining the gait of individuals who are not obese but have an above-normal BMI and were considered pre-obese. Does pre-obesity affect the symmetry of the angular values of the lower extremity during walking? Thirteen individuals with normal body mass index (BMI) (21.53±2.05 kg/m) and eight individuals with pre-obesity (28.52±2.21 kg/m) were recruited for the study. Participants walked at their self-paced speed for 4-5 minutes (4) on a motorized treadmill and the data of lower limb angles were collected with inertial measurement units (Xsens Technologies B.V.). Minimum, maximum, and average values of stance and swing phase of the participants for the whole series of the ankle, knee, and hip angles, as well as; the series at heel strike and foot release phase were recorded. Differences between right and left joints were calculated to examine gait symmetry. Symmetry in ankle angles was similar between groups (p>0.05). In the pre-obese group; minimum(p=0.011) and maximum (p=0.007) knee angles were more asymmetrical in the stance phase than in the normal-weight group. Also, the minimum knee angle in the swing phase was more asymmetrical (p=0.043) in the pre-obese group. In addition, it was determined that the pre-obese group exhibited more asymmetrical knee angles at heel strike (p=0.032) and foot release (p=0.017). The maximum hip angle of the pre-obese group was more asymmetrical in the stance phase (p=0.003) and swing phase (p= 0.006). Also, in the heel strike, the hip angle (p=0.009) was found to be more asymmetrical than the normal-weight group. No difference was observed between the groups for all other measurements (p>0.05). The results of the study showed that individuals with pre-obesity level BMI exhibited a more asymmetrical gait pattern in the proximal joints during walking. It was observed that the increase in BMI negatively affected gait even if below the level of obesity.","PeriodicalId":94018,"journal":{"name":"Gait & posture","volume":"53 83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135298042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}