Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Yasar Tatar, Nejla Gercek, Nusret Ramazanoglu, Irfan Gulmez, Selda Uzun, Goktug Sanli, Cengiz Karagozoglu, Hasan Birol Cotuk
BackgroundAmputee football is a worldwide popular sport with positive physical and psychological effects on the disabled. Amputee players use their hands dominantly for locomotion. However, the effect of using upper extremity which is not accommodated to loading is not very well known.Research question: The objective of this study was to determine the load distribution of amputee football players during walking, running and kicking the ball.MethodsThis study was conducted with 15 certified amputee football players (age 24.5 ± 5.8 years, body weight 62.3 ± 10.9 kg, height 171.6 ± 7.7 cm). The loads on their non-amputated lower extremity were measured with F-Scan mobile system sensors inserted in their shoes, and the loads on their upper extremities were measured with F-Grip system sensors affixed to the gloves. The participants were asked to walk, run and kick the ball using Lofstrand Crutches.ResultsThe maximum loading on the upper extremities during walking, running and kicking the ball varied between 111% and 175% of the body weight. While loading during walking and running was similar, the loading on the upper extremity during kicking the ball exceeded that of walking by 58.1% and running by 47.4%. The maximum loading on the non-amputated lower extremity varied between 134% and 196% of the body weight. Loading during running was 46.2% higher than that of walking. The loading on the foot during kicking the ball was 45.7% higher than that of walking. The loading on the foot during running and kicking were similar.SignificanceWalking-running-kicking the ball with LC resulted in unusual loading particularly on the upper extremity. During running, the increased loading was transferred to the foot rather than the hands. During kicking, the loading increased extremely and was mainly transferred to the hands. The frequent repetition of kicking during the game may therefore increase the incidence of upper extremity injuries.
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Τρίτη 19 Ιουνίου 2018
Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis
Publication date: June 2018
Source:Gait & Posture, Volume 63
Author(s): P. Broderick, F. Horgan, C. Blake, M. Ehrensberger, D. Simpson, K. Monaghan
BackgroundMirror therapy has been proposed as an effective intervention for lower limb rehabilitation post stroke.Research questionThis systematic review with meta-analysis examined if lower limb mirror therapy improved the primary outcome measures of muscle tone and motor function and the secondary outcome measures balance characteristics, functional ambulation, walking velocity, passive range of motion (PROM) for ankle dorsiflexion and gait characteristics in patients with stroke compared to other interventions. Methods: Standardised mean differences (SMD) and mean differences (MD) were used to assess the effect of mirror therapy on lower limb functioning.ResultsNine studies were included in the review. Among the primary outcome measures there was evidence of a significant effect of mirror therapy on motor function compared with sham and non-sham interventions (SMD 0.54; 95% CI 0.24–0.93). Furthermore, among the secondary outcome measures there was evidence of a significant effect of mirror therapy for balance capacity (SMD −0.55; 95% CI −1.01 to −0.10), walking velocity (SMD 0.71; 95% CI 0.35–1.07), PROM for ankle dorsiflexion (SMD 1.20; 95% CI 0.71–1.69) and step length (SMD 0.56; 95% CI −0.00 to 1.12).SignificanceThe results indicate that using mirror therapy for the treatment of certain lower limb deficits in patients with stroke may have a positive effect. Although results are somewhat positive, overly favourable interpretation is cautioned due to methodological issues concerning included studies.
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Source:Gait & Posture, Volume 63
Author(s): P. Broderick, F. Horgan, C. Blake, M. Ehrensberger, D. Simpson, K. Monaghan
BackgroundMirror therapy has been proposed as an effective intervention for lower limb rehabilitation post stroke.Research questionThis systematic review with meta-analysis examined if lower limb mirror therapy improved the primary outcome measures of muscle tone and motor function and the secondary outcome measures balance characteristics, functional ambulation, walking velocity, passive range of motion (PROM) for ankle dorsiflexion and gait characteristics in patients with stroke compared to other interventions. Methods: Standardised mean differences (SMD) and mean differences (MD) were used to assess the effect of mirror therapy on lower limb functioning.ResultsNine studies were included in the review. Among the primary outcome measures there was evidence of a significant effect of mirror therapy on motor function compared with sham and non-sham interventions (SMD 0.54; 95% CI 0.24–0.93). Furthermore, among the secondary outcome measures there was evidence of a significant effect of mirror therapy for balance capacity (SMD −0.55; 95% CI −1.01 to −0.10), walking velocity (SMD 0.71; 95% CI 0.35–1.07), PROM for ankle dorsiflexion (SMD 1.20; 95% CI 0.71–1.69) and step length (SMD 0.56; 95% CI −0.00 to 1.12).SignificanceThe results indicate that using mirror therapy for the treatment of certain lower limb deficits in patients with stroke may have a positive effect. Although results are somewhat positive, overly favourable interpretation is cautioned due to methodological issues concerning included studies.
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Do spatiotemporal parameters and gait variability differ across the lifespan of healthy adults? A systematic review
Source:Gait & Posture, Volume 64
Author(s): Nolan Herssens, Evi Verbecque, Ann Hallemans, Luc Vereeck, Vincent Van Rompaey, Wim Saeys
BackgroundAging is often associated with changes in the musculoskeletal system, peripheral and central nervous system. These age-related changes often result in mobility problems influencing gait performance. Compensatory strategies are used as a way to adapt to these physiological changes.Research questionThe aim of this review is to investigate the differences in spatiotemporal and gait variability measures throughout the healthy adult life.MethodsThis systematic review was conducted according to the PRISMA guidelines and registered in the PROSPERO database (no. CRD42017057720). Databases MEDLINE (Pubmed), Web of Science (Web of Knowledge), Cochrane Library and ScienceDirect were systematically searched until March 2018.ResultsEighteen of the 3195 original studies met the eligibility criteria and were included in this review. The majority of studies reported spatiotemporal and gait variability measures in adults above the age of 65, followed by the young adult population, information of middle-aged adults is lacking. Spatiotemporal parameters and gait variability measures were extracted from 2112 healthy adults between 18 and 98 years old and, in general, tend to deteriorate with increasing age. Variability measures were only reported in an elderly population and show great variety between studies.SignificanceThe findings of this review suggest that most spatiotemporal parameters significantly differ across different age groups. Elderly populations show a reduction of preferred walking speed, cadence, step and stride length, all related to a more cautious gait, while gait variability measures remain stable over time. A preliminary framework of normative reference data is provided, enabling insights into the influence of aging on spatiotemporal parameters, however spatiotemporal parameters of middle-aged adults should be investigated more thoroughly.
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WALKING PATTERN EFFICIENCY DURING COLLECTIVE LOAD TRANSPORT
Source:Gait & Posture
Author(s): Guillaume Fumery, Laetitia Claverie, Vincent Fourcassié, Pierre Moretto
BackgroundWhile the locomotor behavior of humans walking alone has been extensively studied, the locomotor behavior of humans transporting a load collectively is very poorly documented in the biomechanics literature. Yet, collective transport could find potential developments in other domains such as rehabilitation and robotics.Research questionIf collective load transport is made economically one could expect that the center of mass of the ensemble formed by several individuals and the load they carry has the same pendulum-like behavior as a single individual walking alone. The main objective of our study was to assess to what extent this is the case.MethodsWe recorded the 3D kinematics of movement of the body segments of ten dyads formed by two persons carrying a load together in three successive trials. The individuals carried the load, side by side, along a 13 meters straight trajectory. Then, the recovery rate of the center of mass of the ensemble formed by the two subjects and the load they carry (i.e. the rate of transfer between potential and kinetic energy) was computed.ResultsThe values of recovery rate were similar to those found in the literature for individuals walking alone, showing that the external energetic exchanges occurring during collective transport are as efficient as those occurring in single gait. The recovery rate also increased in successive trials, suggesting an improvement of the performance with familiarization.SignificanceOur results demonstrate the ability of humans to collaborate efficiently for carrying a load. The values of recovery rate we found could be used as a benchmark for the control of collaborative robots.
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Stride-to-stride variability and complexity between novice and experienced runners during a prolonged run at anaerobic threshold speed
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Shiwei Mo, Daniel H.K. Chow
BackgroundMotor control, related to running performance and running related injuries, is affected by progression of fatigue during a prolonged run. Distance runners are usually recommended to train at or slightly above anaerobic threshold (AT) speed for improving performance. However, running at AT speed may result in accelerated fatigue. It is not clear how one adapts running gait pattern during a prolonged run at AT speed and if there are differences between runners with different training experience.PurposesTo compare characteristics of stride-to-stride variability and complexity during a prolonged run at AT speed between novice runners (NR) and experienced runners (ER).MethodsBoth NR (n = 17) and ER (n = 17) performed a treadmill run for 31 min at his/her AT speed. Stride interval dynamics was obtained throughout the run with the middle 30 min equally divided into six time intervals (denoted as T1, T2, T3, T4, T5 and T6). Mean, coefficient of variation (CV) and scaling exponent alpha of stride intervals were calculated for each interval of each group.ResultsThis study revealed mean stride interval significantly increased with running time in a non-linear trend (p<0.001). The stride interval variability (CV) maintained relatively constant for NR (p = 0.22) and changed nonlinearly for ER (p = 0.023) throughout the run. Alpha was significantly different between groups at T2, T5 and T6, and nonlinearly changed with running time for both groups with slight differences.SignificanceThese findings provided insights into how the motor control system adapts to progression of fatigue and evidences that long-term training enhances motor control. Although both ER and NR could regulate gait complexity to maintain AT speed throughout the prolonged run, ER also regulated stride interval variability to achieve the goal.
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Source:Gait & Posture, Volume 64
Author(s): Shiwei Mo, Daniel H.K. Chow
BackgroundMotor control, related to running performance and running related injuries, is affected by progression of fatigue during a prolonged run. Distance runners are usually recommended to train at or slightly above anaerobic threshold (AT) speed for improving performance. However, running at AT speed may result in accelerated fatigue. It is not clear how one adapts running gait pattern during a prolonged run at AT speed and if there are differences between runners with different training experience.PurposesTo compare characteristics of stride-to-stride variability and complexity during a prolonged run at AT speed between novice runners (NR) and experienced runners (ER).MethodsBoth NR (n = 17) and ER (n = 17) performed a treadmill run for 31 min at his/her AT speed. Stride interval dynamics was obtained throughout the run with the middle 30 min equally divided into six time intervals (denoted as T1, T2, T3, T4, T5 and T6). Mean, coefficient of variation (CV) and scaling exponent alpha of stride intervals were calculated for each interval of each group.ResultsThis study revealed mean stride interval significantly increased with running time in a non-linear trend (p<0.001). The stride interval variability (CV) maintained relatively constant for NR (p = 0.22) and changed nonlinearly for ER (p = 0.023) throughout the run. Alpha was significantly different between groups at T2, T5 and T6, and nonlinearly changed with running time for both groups with slight differences.SignificanceThese findings provided insights into how the motor control system adapts to progression of fatigue and evidences that long-term training enhances motor control. Although both ER and NR could regulate gait complexity to maintain AT speed throughout the prolonged run, ER also regulated stride interval variability to achieve the goal.
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Gender differences in postural control in people with nonspecific chronic low back pain
Source:Gait & Posture, Volume 64
Author(s): Buse Ozcan Kahraman, Turhan Kahraman, Orhan Kalemci, Yesim Salik Sengul
BackgroundMany studies have reported that there are several differences between genders which may result in altered neuromuscular control. Although the existing evidence suggests that low back pain (LBP) affects the ability to control posture, there is little evidence the gender differences in postural control in people with nonspecific chronic LBP.Research questionAre there any gender differences in postural control and correlations between postural control, pain, disability, and fear of movement in people with nonspecific chronic LBP?MethodsStatic and dynamic postural control were evaluated using a computerized postural control assessment tool including assessments for limits of stability (LOS), unilateral stance, and modified clinical test of sensory interaction on balance. Pain intensity and fear of movement were assessed using a visual analogue scale and the Tampa Scale of Kinesiophobia, respectively.ResultsThis cross-sectional study included 51 people (25 females and 26 males) with nonspecific chronic LBP. Mean reaction time in the LOS test was significantly less in male participants compared with females when adjusted for pain intensity and disability level, F(1,45) = 4.596, p = .037, ηp2 = 0.093. There was no significant difference in the remaining LOS variables as well as unilateral stance, and modified clinical test of sensory interaction on balance variables between the genders (p > .05). Many correlations were observed between the LOS variables, pain intensity, and Tampa Scale of Kinesiophobia score in female participants (p < .05). The Tampa Scale of Kinesiophobia score was also correlated with the movement velocity and endpoint excursion in the LOS test in the male participants (p < .05).SignificanceThis study suggests that there is no difference in most of the static and dynamic postural control variables between females and males; however, higher fear of movement, and pain intensity during activity are more associated with impaired dynamic balance in females with nonspecific chronic LBP.
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Effect of forward-directed aiding force on gait mechanics in healthy young adults while walking faster
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Valdeci C. Dionisio, Christopher P. Hurt, David A. Brown
BackgroundForces can be applied to people while they are walking on a treadmill in different ways that aid individuals to walk at faster walking speeds with potentially less effort. Forward-directed aiding forces (FAF) are a special class of aiding forces where “push” or “pull” forces are mechanically applied to the person’s pelvis in the forward direction.ObjectiveTo determine if FAF, applied by a robotic interface, can be effective in providing assistance to walk at a faster walking speed with reduced kinetic requirements.MethodsTwenty non-neurologically impaired physical active young adults were recruited and biomechanical gait mechanics were measured during walking at two constant treadmill belt speeds (1.0 m/s and 1.6 m/s), with the robotic device in aiding mode to provide FAF (FAF), and also outside of the robotic device (no-FAF). The spatiotemporal gait parameters, anterior-posterior force, sagittal impulse, and hip, knee and ankle power and net work were calculated from kinematic and kinetic data, comparing changes in parameters from slower to faster speeds within each mode, and then, comparing values between each mode.ResultsThe spatiotemporal gait parameters were not different between conditions, but in FAF condition, the propulsive force impulse change was not increased, there was smaller propulsion increase, and smaller maximal power generation and ankle work done at the faster speed, whereas all of these parameters were appropriately increased in the no-FAF condition.ConclusionsThese results indicate that providing FAF at the pelvis is an effective means for reducing the amount of mechanical effort required to walk faster and thus could be used as a training tool to improve walking ability.
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Source:Gait & Posture, Volume 64
Author(s): Valdeci C. Dionisio, Christopher P. Hurt, David A. Brown
BackgroundForces can be applied to people while they are walking on a treadmill in different ways that aid individuals to walk at faster walking speeds with potentially less effort. Forward-directed aiding forces (FAF) are a special class of aiding forces where “push” or “pull” forces are mechanically applied to the person’s pelvis in the forward direction.ObjectiveTo determine if FAF, applied by a robotic interface, can be effective in providing assistance to walk at a faster walking speed with reduced kinetic requirements.MethodsTwenty non-neurologically impaired physical active young adults were recruited and biomechanical gait mechanics were measured during walking at two constant treadmill belt speeds (1.0 m/s and 1.6 m/s), with the robotic device in aiding mode to provide FAF (FAF), and also outside of the robotic device (no-FAF). The spatiotemporal gait parameters, anterior-posterior force, sagittal impulse, and hip, knee and ankle power and net work were calculated from kinematic and kinetic data, comparing changes in parameters from slower to faster speeds within each mode, and then, comparing values between each mode.ResultsThe spatiotemporal gait parameters were not different between conditions, but in FAF condition, the propulsive force impulse change was not increased, there was smaller propulsion increase, and smaller maximal power generation and ankle work done at the faster speed, whereas all of these parameters were appropriately increased in the no-FAF condition.ConclusionsThese results indicate that providing FAF at the pelvis is an effective means for reducing the amount of mechanical effort required to walk faster and thus could be used as a training tool to improve walking ability.
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Quantification of Multi-Segment Trunk Kinetics during Multi-Directional Trunk Bending
Source:Gait & Posture
Author(s): Alireza Noamani, Albert H. Vette, Richard Preuss, Milos R. Popovic, Hossein Rouhani
BackgroundMotion assessment of the body’s head-arms-trunk (HAT) using linked-segment models, along with an inverse dynamics approach, can enable in vivo estimations of inter-vertebral moments. However, this mathematical approach is prone to experimental errors because of inaccuracies in (i) kinematic measurements associated with soft tissue artifacts and (ii) estimating individual-specific body segment parameters (BSPs). The inaccuracy of the BSPs is particularly challenging for the multi-segment HAT due to high inter-participant variability in the HAT’s BSPs and no study currently exists that can provide a less erroneous estimation of the joint moments along the spinal column.Research questionThis study characterized three-dimensional (3D) inter-segmental moments in a multi-segment HAT model during multi-directional trunk-bending, after minimizing the experimental errors.MethodEleven healthy individuals participated in a multi-directional trunk-bending experiment in five directions with three speeds. A seven-segment HAT model was reconstructed for each participant, and its motion was recorded. After compensating for experimental errors due to soft tissue artifacts, and using optimized individual-specific BSPs, and center of pressure offsets, the inter-segmental moments were calculated via inverse dynamics.ResultsOur results show a significant effect of the inter-segmental level and trunk-bending directions on the obtained moments. Compensating for soft tissue artifacts contributed significantly to reducing errors. Our results indicate complex, task-specific patterns of the 3D moments, with high inter-participant variability at different inter-segmental levels, which cannot be studied using single-segment models or without error compensation.SignificanceInterpretation of inter-segmental moments after compensation of experimental errors is important for clinical evaluations and developing injury prevention and rehabilitation strategies.
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Using video rasterstereography and treadmill gait analysis as a tool for evaluating postoperative outcome after lumbar spinal fusion
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Sebastian Scheidt, Sandra Endreß, Marco Gesicki, Ulf Krister Hofmann
BackgroundThe rise in the number of patients with lumbar back pain has led to an increase in the number of spinal surgeries. To avoid unfavorable outcomes, high accuracy and reliability of indication for surgery are essential. This requires critical evaluation of postoperative outcomes with its two key dimensions pain and function. While imaging findings give details about the technical dimension of the intervention, they are prone to high inter-/intra-observer variability, with limited relation to functional outcomes. Pain improvement can be directly asked from patients or documented by questionnaires. There is abundant literature on postoperative function based on questionnaires, but quantifiable data such as gait or posture analysis are scarce. Highprecision measurement tools are available and easy to implement in a clinician’s work routine.ObjectiveThis study evaluates whether lumbar fusion surgery changes gait and postural variables and how these changes are related to patients’ descriptions of alterations in their levels of pain.MethodsBack profiles and gait analyses were measured by video rasterstereography and treadmill gait analysis. Measurements were recorded before surgery, at discharge, after 3 months in a longitudinal (n = 30), and after 12 months in a cross-sectional group (n = 29). A reference group was formed (n = 28). The improvement on the Numeric Pain Rating Scale was documented and compared with changes in gait and posture.ResultsA significant reduction in kyphotic (52–43°, p = 0.014) and lordotic (28–11°, p < 0.001) angles was observed. The values again increased after 3 months, with a significant reduction in cadence (98–91 steps/min, p = 0.006). While improvements in pain were also obtained by surgery (p < 0.001), no clear correlation could be detected between 3-month alleviation in pain and changes in kyphotic/lordotic angle or cadence.ConclusionsAlthough both methods offer high-precision measurement, changes in gait and posture were not related with the patients' reported pain relief after lumbar fusion surgery.
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Source:Gait & Posture, Volume 64
Author(s): Sebastian Scheidt, Sandra Endreß, Marco Gesicki, Ulf Krister Hofmann
BackgroundThe rise in the number of patients with lumbar back pain has led to an increase in the number of spinal surgeries. To avoid unfavorable outcomes, high accuracy and reliability of indication for surgery are essential. This requires critical evaluation of postoperative outcomes with its two key dimensions pain and function. While imaging findings give details about the technical dimension of the intervention, they are prone to high inter-/intra-observer variability, with limited relation to functional outcomes. Pain improvement can be directly asked from patients or documented by questionnaires. There is abundant literature on postoperative function based on questionnaires, but quantifiable data such as gait or posture analysis are scarce. Highprecision measurement tools are available and easy to implement in a clinician’s work routine.ObjectiveThis study evaluates whether lumbar fusion surgery changes gait and postural variables and how these changes are related to patients’ descriptions of alterations in their levels of pain.MethodsBack profiles and gait analyses were measured by video rasterstereography and treadmill gait analysis. Measurements were recorded before surgery, at discharge, after 3 months in a longitudinal (n = 30), and after 12 months in a cross-sectional group (n = 29). A reference group was formed (n = 28). The improvement on the Numeric Pain Rating Scale was documented and compared with changes in gait and posture.ResultsA significant reduction in kyphotic (52–43°, p = 0.014) and lordotic (28–11°, p < 0.001) angles was observed. The values again increased after 3 months, with a significant reduction in cadence (98–91 steps/min, p = 0.006). While improvements in pain were also obtained by surgery (p < 0.001), no clear correlation could be detected between 3-month alleviation in pain and changes in kyphotic/lordotic angle or cadence.ConclusionsAlthough both methods offer high-precision measurement, changes in gait and posture were not related with the patients' reported pain relief after lumbar fusion surgery.
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Healthy 3D knee kinematics during gait: differences between women and men, and correlation with x-ray alignment
Source:Gait & Posture
Author(s): Julien Clément, Penny Toliopoulos, Nicola Hagemeister, François Desmeules, Alexandre Fuentes, Pascal-André Vendittoli
BackgroundNormal 3D knee kinematics during gait is still not well understood, especially regarding differences between women and men.Research question: The objective of the present study was to characterize 3D knee kinematics during gait in healthy women and men with a validated tool.MethodsKnee kinematics was analysed with the KneeKG™ system in 90 healthy subjects (49 females and 41 males). 3D knee rotations were compared between women and men, and between right and left knees. Each subject underwent full-length weight-bearing x-rays. Correlations between abduction-adduction angles and lower-limb alignment measures on x-rays were assessed.ResultsIn the frontal plane, 2.0-5.0° more abduction occurred in women compared to men (0.000 ≤ p ≤ 0.015) throughout the entire gait cycle. In the transverse plane, 2.4-3.7° more external tibial rotation was seen in women than in men (0.002 ≤ p ≤ 0.041) during the initial and mid-swing phases. No difference was found between the right and left knees. Low correlations (-0.52 ≤ r≤-0.41, p < 0.001) were observed between radiographic hip-knee-ankle angle (HKA) and abduction-adduction angles throughout the stance phase.SignificanceKinematic differences between women and men in the frontal plane can be partly explained by their anatomical differences: women were less in varus than men (HKA of -0.8° vs. -2.6°, p < 0.001). Our study contributes to a better understanding of healthy 3D knee kinematics during gait and highlights the need for accounting of gender differences in future investigations. Better knowledge of natural knee kinematics will be helpful in assessing pathological gait patterns or determining the efficiency of conservative and surgical treatments to restore normal kinematics.
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Influence of pelvic padding and Kinesiology Taping on pain perception, kinematics, and kinetics of falls in female volleyball athletes
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Cleopatra L.Y. Lam, Shirley S.M. Fong, Joanne W.Y. Chung, Louisa M.Y. Chung, Karen P.Y. Liu, Young-Hyeon Bae, Ada W.W. Ma
BackgroundVolleyball digging techniques may cause pelvic injuries among female volleyball athletes. Pelvic padding and Kinesiology Taping (KT) may reduce impact force and pain and improve posture during a fall. This study examined the effects of pelvic padding and KT on pain perception, fall kinematics, and kinetics among female volleyball athletes.MethodsTwenty-four female volleyball athletes were exposed to two pelvic padding scenarios (with and without padding) and two KT conditions (with and without KT applied on the rectus abdominis muscle) during a fall in the forward direction. The maximum impact force during landing and maximum acceleration of the pelvis were registered using a force platform and an accelerometer, respectively. The maximum lumbar (hyper) extension angle, forward reach distance, and total fall time were measured by video analysis. Pain level was quantified using a visual analog scale.ResultsThe application of pelvic padding (with and without KT) reduced pain when compared to the no padding condition (p < 0.008). Applying KT alone reduced forward reach distance when compared to the ‘pelvic padding and KT’ condition (p < 0.010). In fact, when both pelvic padding and KT were applied, participants reached further when compared to the ‘no pelvic padding and no KT’ condition (p < 0.001). No significant main and interaction effects were found in all other outcomes.ConclusionsVolleyball shorts with pelvic pads are recommended for female volleyball athletes to reduce pain in the digging maneuver and may help to increase their forward reach distance. However, KT is not recommended as it reduces the forward reach distance and cannot reduce pain or improve fall kinematics and kinetics.
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Source:Gait & Posture, Volume 64
Author(s): Cleopatra L.Y. Lam, Shirley S.M. Fong, Joanne W.Y. Chung, Louisa M.Y. Chung, Karen P.Y. Liu, Young-Hyeon Bae, Ada W.W. Ma
BackgroundVolleyball digging techniques may cause pelvic injuries among female volleyball athletes. Pelvic padding and Kinesiology Taping (KT) may reduce impact force and pain and improve posture during a fall. This study examined the effects of pelvic padding and KT on pain perception, fall kinematics, and kinetics among female volleyball athletes.MethodsTwenty-four female volleyball athletes were exposed to two pelvic padding scenarios (with and without padding) and two KT conditions (with and without KT applied on the rectus abdominis muscle) during a fall in the forward direction. The maximum impact force during landing and maximum acceleration of the pelvis were registered using a force platform and an accelerometer, respectively. The maximum lumbar (hyper) extension angle, forward reach distance, and total fall time were measured by video analysis. Pain level was quantified using a visual analog scale.ResultsThe application of pelvic padding (with and without KT) reduced pain when compared to the no padding condition (p < 0.008). Applying KT alone reduced forward reach distance when compared to the ‘pelvic padding and KT’ condition (p < 0.010). In fact, when both pelvic padding and KT were applied, participants reached further when compared to the ‘no pelvic padding and no KT’ condition (p < 0.001). No significant main and interaction effects were found in all other outcomes.ConclusionsVolleyball shorts with pelvic pads are recommended for female volleyball athletes to reduce pain in the digging maneuver and may help to increase their forward reach distance. However, KT is not recommended as it reduces the forward reach distance and cannot reduce pain or improve fall kinematics and kinetics.
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Examining the diagnostic accuracy of static postural stability measures in differentiating among knee osteoarthritis patients with mild and moderate to severe radiographic signs
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Nahid Pirayeh, Mohammad-Jafar Shaterzadeh-Yazdi, Hossein Negahban, Mohammad Mehravar, Neda Mostafaee, Amal Saki-Malehi
BackgroundClinicians need a reliable and accurate tools that can best identify and classify balance impairments between mild and moderate to severe grades of knee osteoarthritis (OA).Research questionThis study was designed to investigate the accuracy of postural measurements to discriminate between these two groups of knee OA.MethodsA total of 130 patients with knee OA based on the Kellgren-Lawrence (KL) grading scale were categorized into 65 patients with mild (a KL grade≤ 2) and 65 patient with moderate to severe (a KL grade≥3) radiographic sign. Static postural control was assessed on the force plate in three conditions of double leg stance with open (DO) and closed eyes (DC) and single leg stance with open eyes (SO). The accuracy for static postural control parameters was determined by calculation of sensitivity, specificity, area under the Receiver Operating Characteristic (ROC) curve (AUC) and likelihood ratios (LRs).ResultsOur results showed that standard deviation (SD) of velocity in anterior-posterior (AP) direction had the highest sensitivity and specificity in conditions of DO and DC, respectively. ROC curve analysis indicated that measures of mean and SD velocity in medio-lateral (ML) direction in conditions of DO and DC had acceptable levels of accuracy (AUC > 0.70) in discriminating between the two groups of knee OA patients. Also, based on LR results, SD of velocity in AP direction had the best ability for ruling in and ruling out moderate to severe grade of knee OA patients in conditions of DC and DO, respectively.SignificanceOur findings provide evidence for selection of mean velocity and SD of velocity in identifying and discriminating static postural performance in patients with mild and moderate to severe grades of knee OA.
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Source:Gait & Posture, Volume 64
Author(s): Nahid Pirayeh, Mohammad-Jafar Shaterzadeh-Yazdi, Hossein Negahban, Mohammad Mehravar, Neda Mostafaee, Amal Saki-Malehi
BackgroundClinicians need a reliable and accurate tools that can best identify and classify balance impairments between mild and moderate to severe grades of knee osteoarthritis (OA).Research questionThis study was designed to investigate the accuracy of postural measurements to discriminate between these two groups of knee OA.MethodsA total of 130 patients with knee OA based on the Kellgren-Lawrence (KL) grading scale were categorized into 65 patients with mild (a KL grade≤ 2) and 65 patient with moderate to severe (a KL grade≥3) radiographic sign. Static postural control was assessed on the force plate in three conditions of double leg stance with open (DO) and closed eyes (DC) and single leg stance with open eyes (SO). The accuracy for static postural control parameters was determined by calculation of sensitivity, specificity, area under the Receiver Operating Characteristic (ROC) curve (AUC) and likelihood ratios (LRs).ResultsOur results showed that standard deviation (SD) of velocity in anterior-posterior (AP) direction had the highest sensitivity and specificity in conditions of DO and DC, respectively. ROC curve analysis indicated that measures of mean and SD velocity in medio-lateral (ML) direction in conditions of DO and DC had acceptable levels of accuracy (AUC > 0.70) in discriminating between the two groups of knee OA patients. Also, based on LR results, SD of velocity in AP direction had the best ability for ruling in and ruling out moderate to severe grade of knee OA patients in conditions of DC and DO, respectively.SignificanceOur findings provide evidence for selection of mean velocity and SD of velocity in identifying and discriminating static postural performance in patients with mild and moderate to severe grades of knee OA.
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IMU-based gait analysis in lower limb prosthesis users: Comparison of step demarcation algorithms
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Gerasimos Bastas, Joshua J. Fleck, Richard A. Peters, Karl E. Zelik
BackgroundInertial Measurement Unit (IMU)-based gait analysis algorithms have previously been validated in healthy controls. However, little is known about the efficacy, performance, and applicability of these algorithms in clinical populations with gait deviations such as lower limb prosthesis users (LLPUs).Research questionTo compare the performance of 3 different IMU-based algorithms to demarcate steps from LLPUs.MethodsWe used a single IMU sensor affixed to the midline lumbopelvic region of 17 transtibial (TTA), 16 transfemoral (TFA) LLPUs, and 14 healthy controls (HC). We collected acceleration and angular velocity data during overground walking trials. Step demarcation was evaluated based on fore-aft acceleration, detecting either: (i) maximum acceleration peak, (ii) zero-crossing, or (iii) the peak immediately preceding a zero-crossing. We quantified and compared the variability (standard deviation) in acceleration waveforms from superposed step intervals, and variability in step duration, by each algorithm.ResultsWe found that the zero-crossing algorithm outperformed both peak detection algorithms in 65% of TTAs, 81% of TFAs, and 71% of HCs, as evidenced by lower standard deviations in acceleration, more consistent qualitative demarcation of steps, and more normally distributed step durations.SignificanceThe choice of feature-based algorithm with which to partition IMU waveforms into individual steps can affect the quality and interpretation of estimated gait spatiotemporal metrics in LLPUs. We conclude that the fore-aft acceleration zero-crossing serves as a more reliable feature for demarcating steps in the gait patterns of LLPUs.
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Source:Gait & Posture, Volume 64
Author(s): Gerasimos Bastas, Joshua J. Fleck, Richard A. Peters, Karl E. Zelik
BackgroundInertial Measurement Unit (IMU)-based gait analysis algorithms have previously been validated in healthy controls. However, little is known about the efficacy, performance, and applicability of these algorithms in clinical populations with gait deviations such as lower limb prosthesis users (LLPUs).Research questionTo compare the performance of 3 different IMU-based algorithms to demarcate steps from LLPUs.MethodsWe used a single IMU sensor affixed to the midline lumbopelvic region of 17 transtibial (TTA), 16 transfemoral (TFA) LLPUs, and 14 healthy controls (HC). We collected acceleration and angular velocity data during overground walking trials. Step demarcation was evaluated based on fore-aft acceleration, detecting either: (i) maximum acceleration peak, (ii) zero-crossing, or (iii) the peak immediately preceding a zero-crossing. We quantified and compared the variability (standard deviation) in acceleration waveforms from superposed step intervals, and variability in step duration, by each algorithm.ResultsWe found that the zero-crossing algorithm outperformed both peak detection algorithms in 65% of TTAs, 81% of TFAs, and 71% of HCs, as evidenced by lower standard deviations in acceleration, more consistent qualitative demarcation of steps, and more normally distributed step durations.SignificanceThe choice of feature-based algorithm with which to partition IMU waveforms into individual steps can affect the quality and interpretation of estimated gait spatiotemporal metrics in LLPUs. We conclude that the fore-aft acceleration zero-crossing serves as a more reliable feature for demarcating steps in the gait patterns of LLPUs.
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Postural stability and trunk muscle responses to the static and perturbed balance tasks in individuals with and without symptomatic degenerative lumbar disease
Source:Gait & Posture, Volume 64
Author(s): Yun-Chung Lin, Chi-Chien Niu, Mohammad Nikkhoo, Meng-Ling Lu, Wen-Chien Chen, Chen-Ju Fu, Chih-Hsiu Cheng
BackgroundDegenerative lumbar diseases (DLDs) are characterized by motor functional deficits and postural instability. In this study, we investigated the differences in the trunk muscle responses to postural control between the presurgical DLD patients and healthy individuals while performing the static and perturbed balance tasks.MethodsThirty-five DLD patients (aged 61.1 ± 8.0 years) and thirty-five asymptomatic controls (aged 62.9 ± 3.7 years) participated in this study. All participants stood on a force plate and performed the quiet standing (QS) and in situ weight-lifting (WL) tasks. The participants’ performance in the QS task was tested under the eyes-open, eyes-closed, wide-base, and narrow-base conditions. Center of pressure (CoP) movements and electromyography of the erector spinae (ES) were recorded. The Mann–Whitney U test was applied for statistical analysis.ResultsThe DLD group showed a significantly greater CoP movements and muscle activations during the QS task. Nevertheless, smaller CoP movements were noted during the WL task in the DLD group. Under the eyes-closed and narrow-base conditions, the DLD group showed even higher muscle activations and CoP movements.SignificanceThe DLD patients demonstrated a poor postural control ability and tended to rely on the visual feedback and wide-base standing posture. A rigid and restricted posture was also adopted during the perturbed WL task. A high level of ES activation was required to maintain their postural steadiness. This study reveals an aberrant pattern of postural control and trunk muscle activations in symptomatic DLD patients which potentially contributes to the development of beneficial rehabilitation programs.
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Whole body organization during a symmetric bimanual pick up task for children with unilateral cerebral palsy
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Ya-Ching Hung, Aryeh Spingarn
BackgroundInformation on whole-body coordination involving bimanual coordination for children with unilateral spastic cerebral palsy (USCP) is limited.Research QuestionThe purpose of the current study is to test the hypothesis that during a whole-body pick up task, children with USCP will organize their whole- body movements and bimanual coordination differently than typically-developing children (TDC).MethodsTwelve children with USCP (average age: 8.3; MACS levels: I–II) and twelve age-matched TDC participated in the study. Children were asked to reach down, grasp, and pick up an empty box to waist height while Kinematic and Kinetic data were recorded and analyzed using a VICON system and two AMTI force plates.ResultsChildren with USCP had longer overall movement time, reaching down time, and grasping movement time (all P < 0.05) than TDC. Less bimanual coordination was indicated by greater finger vertical position differences and movement onset and offset timing differences (all P < 0.05). Additionally, greater bilateral joint position on differences were found for shoulder, elbow, hip, and knee when reaching down and for shoulder and elbow at the end of the task (all P < 0.05). Greater asymmetric bilateral ground reaction force and greater lateral and anterior center of pressure excursion were also found in children with USCP (all P < 0.05).SignificanceImpairments in both bimanual and whole-body coordination were found during a simple whole-body task in children with USCP. Future treatments or assessments should consider whole-body tasks involving dual task constraints.
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Source:Gait & Posture, Volume 64
Author(s): Ya-Ching Hung, Aryeh Spingarn
BackgroundInformation on whole-body coordination involving bimanual coordination for children with unilateral spastic cerebral palsy (USCP) is limited.Research QuestionThe purpose of the current study is to test the hypothesis that during a whole-body pick up task, children with USCP will organize their whole- body movements and bimanual coordination differently than typically-developing children (TDC).MethodsTwelve children with USCP (average age: 8.3; MACS levels: I–II) and twelve age-matched TDC participated in the study. Children were asked to reach down, grasp, and pick up an empty box to waist height while Kinematic and Kinetic data were recorded and analyzed using a VICON system and two AMTI force plates.ResultsChildren with USCP had longer overall movement time, reaching down time, and grasping movement time (all P < 0.05) than TDC. Less bimanual coordination was indicated by greater finger vertical position differences and movement onset and offset timing differences (all P < 0.05). Additionally, greater bilateral joint position on differences were found for shoulder, elbow, hip, and knee when reaching down and for shoulder and elbow at the end of the task (all P < 0.05). Greater asymmetric bilateral ground reaction force and greater lateral and anterior center of pressure excursion were also found in children with USCP (all P < 0.05).SignificanceImpairments in both bimanual and whole-body coordination were found during a simple whole-body task in children with USCP. Future treatments or assessments should consider whole-body tasks involving dual task constraints.
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In vivo validation of patellofemoral kinematics during overground gait and stair ascent
Source:Gait & Posture, Volume 64
Author(s): Samuel Pitcairn, Bryson Lesniak, William Anderst
BackgroundThe patellofemoral (PF) joint is a common site for non-specific anterior knee pain. The pathophysiology of patellofemoral pain may be related to abnormal motion of the patella relative to the femur, leading to increased stress at the patellofemoral joint. Patellofemoral motion cannot be accurately measured using conventional motion capture.Research questionThe aim of this study was to determine the accuracy of a biplane radiography system for measuring in vivo PF motion during walking and stair ascent.MethodsFour subjects had three 1.0 mm diameter tantalum beads implanted into the patella. Participants performed three trials each of over ground walking and stair ascent while biplane radiographs were collected at 100 Hz. Patella motion was tracked using radiostereophotogrammetric analysis (RSA) as a “gold standard”, and compared to a volumetric CT model-based tracking algorithm that matched digitally reconstructed radiographs to the original biplane radiographs.ResultsThe average RMS difference between the RSA and model-based tracking was 0.41 mm and 1.97° when there was no obstruction from the contralateral leg. These differences increased by 34% and 40%, respectively, when the patella was at least partially obstructed by the contralateral leg. The average RMS difference in patellofemoral joint space between tracking methods was 0.9 mm or less.SignificancePrevious validations of biplane radiographic systems have estimated tracking accuracy by moving cadaveric knees through simulated motions. These validations were unable to replicate in vivo kinematics, including patella motion due to muscle activation, and failed to assess the imaging and tracking challenges related to contralateral limb obstruction. By replicating the muscle contraction, movement velocity, joint range of motion, and obstruction of the patella by the contralateral limb, the present study provides a realistic estimate of patellofemoral tracking accuracy for future in vivo studies.
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Comparing the effects of mechanical perturbation training with a compliant surface and manual perturbation training on joints kinematics after ACL-rupture
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Zakariya Nawasreh, Mathew Failla, Adam Marmon, David Logerstedt, Lynn Snyder-Mackler
IntroductionPerforming physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown.AimTo compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture.MethodsSixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training.ResultsSignificant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (p<0.004), with manual group significantly increased knee flexion angle at IC and PKF (p<0.03). Main effects of group were found for hip flexion angle at IC (Manual:34.34+3.51°, Mechanical:27.68+4.08°, p = 0.011), hip rotation angle at PKE (Manual:-3.40+4.78°, Mechanical:5.43+4.78°, p < 0.0001), and knee adduction angle at PKE (Manual:-2.00+2.23°, Mechanical:0.55+2.23°, p = 0.039). Main effects of time were found for hip adduction angle at PKE (Pre:6.98+4.48°, Post:8.41+4.91°, p = 0.04), knee adduction angle at IC (Pre:-2.90+3.50°, Post:-0.62+2.58°, p = 0.03), ankle adduction angle at IC (Pre:2.16+3.54, Post:3.8+3.68, p = 0.008), and ankle flexion angle at PKF (Pre:-4.55+2.77°, Post:-2.39+3.48°, p = 0.01).DiscussionTraining on a compliant surface induces different effects on joint kinematics compared to manual perturbation training after ACL-rupture. Manual perturbation improved hip alignment and increased knee flexion angles, while mechanical training decreased knee flexion angles throughout the stance phase. Administering training on a compliant surface after ACL-rupture may help improving dynamic knee stability, however, long-term effects on knee health needs to be determined.
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Source:Gait & Posture, Volume 64
Author(s): Zakariya Nawasreh, Mathew Failla, Adam Marmon, David Logerstedt, Lynn Snyder-Mackler
IntroductionPerforming physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown.AimTo compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture.MethodsSixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training.ResultsSignificant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (p<0.004), with manual group significantly increased knee flexion angle at IC and PKF (p<0.03). Main effects of group were found for hip flexion angle at IC (Manual:34.34+3.51°, Mechanical:27.68+4.08°, p = 0.011), hip rotation angle at PKE (Manual:-3.40+4.78°, Mechanical:5.43+4.78°, p < 0.0001), and knee adduction angle at PKE (Manual:-2.00+2.23°, Mechanical:0.55+2.23°, p = 0.039). Main effects of time were found for hip adduction angle at PKE (Pre:6.98+4.48°, Post:8.41+4.91°, p = 0.04), knee adduction angle at IC (Pre:-2.90+3.50°, Post:-0.62+2.58°, p = 0.03), ankle adduction angle at IC (Pre:2.16+3.54, Post:3.8+3.68, p = 0.008), and ankle flexion angle at PKF (Pre:-4.55+2.77°, Post:-2.39+3.48°, p = 0.01).DiscussionTraining on a compliant surface induces different effects on joint kinematics compared to manual perturbation training after ACL-rupture. Manual perturbation improved hip alignment and increased knee flexion angles, while mechanical training decreased knee flexion angles throughout the stance phase. Administering training on a compliant surface after ACL-rupture may help improving dynamic knee stability, however, long-term effects on knee health needs to be determined.
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O 010 - Ramp walking with abruptly changing inclines: Motion pattern of TT amputees fitted with a microprocessor-controlled and a conventional prosthetic foot
Source:Gait & Posture
Author(s): T. Schmalz, B. Altenburg, M. Ernst, M. Bellmann, D. Rosenbaum
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Analyzing the characteristics of rising from the bed in patients having undergone total hip arthroplasty immediately after surgery
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Jun Yamahara, Keisuke Hagio, Hirofumi Saka, Kohei Kushimoto, Masaki Inaba, Naotaka Tazaki, Yoichi Taniguchi, Masanobu Saito
BackgroundImmediately after patients undergo total hip arthroplasty (THA), they are often coached through the process of rising from the bed to prevent dislocation. However, motion analysis of this process, which can guide coaching methods, has not been conducted. The purpose of this study was to clarify whether there is a difference in hip joint angle, rise time, pain, and difficulty based on the method of rising from the bed in postoperative patients, immediately after THA.MethodsTwenty patients who underwent THA were enrolled in this study. Seven days after surgery, 3-D motion analysis was performed while subjects rose from the bed using six different methods that include rising from the bed using either the affected or non-affected side either with or without assistance. Hip joint angle, rise time, pain, and difficulty were evaluated.ResultsIn all six methods, the maximal hip joint angle of the affected side was in the safe range. The maximal hip adduction angle and adduction angle at maximum flexion of the affected side were significantly lower in patients who rose from the bed using their affected side than in those who rose using their non-affected side. There were no differences in maximal hip flexion angle, internal rotation angle, internal rotation angle at maximum flexion of the affected side, rise time, pain, or difficulty regardless of the direction of rising from the bed or the use of assistance.SignificanceCoaching patients to rise from the bed is better performed when using the most optimal method that takes into consideration the movement direction and patient’s individuality.
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Source:Gait & Posture, Volume 64
Author(s): Jun Yamahara, Keisuke Hagio, Hirofumi Saka, Kohei Kushimoto, Masaki Inaba, Naotaka Tazaki, Yoichi Taniguchi, Masanobu Saito
BackgroundImmediately after patients undergo total hip arthroplasty (THA), they are often coached through the process of rising from the bed to prevent dislocation. However, motion analysis of this process, which can guide coaching methods, has not been conducted. The purpose of this study was to clarify whether there is a difference in hip joint angle, rise time, pain, and difficulty based on the method of rising from the bed in postoperative patients, immediately after THA.MethodsTwenty patients who underwent THA were enrolled in this study. Seven days after surgery, 3-D motion analysis was performed while subjects rose from the bed using six different methods that include rising from the bed using either the affected or non-affected side either with or without assistance. Hip joint angle, rise time, pain, and difficulty were evaluated.ResultsIn all six methods, the maximal hip joint angle of the affected side was in the safe range. The maximal hip adduction angle and adduction angle at maximum flexion of the affected side were significantly lower in patients who rose from the bed using their affected side than in those who rose using their non-affected side. There were no differences in maximal hip flexion angle, internal rotation angle, internal rotation angle at maximum flexion of the affected side, rise time, pain, or difficulty regardless of the direction of rising from the bed or the use of assistance.SignificanceCoaching patients to rise from the bed is better performed when using the most optimal method that takes into consideration the movement direction and patient’s individuality.
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O 011 – Ankle power and energy cost during level and slope walking with Energy Storage and Return feet in transtibial amputees
Source:Gait & Posture
Author(s): J. Hijmans, L. Kouwenhove-van, D. Dijken-van, F. Dijk-van, A. Vrieling, R. Dekker
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Load distribution on the foot and lofstrand crutches of amputee football players
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Yasar Tatar, Nejla Gercek, Nusret Ramazanoglu, Irfan Gulmez, Selda Uzun, Goktug Sanli, Cengiz Karagozoglu, Hasan Birol Cotuk
BackgroundAmputee football is a worldwide popular sport with positive physical and psychological effects on the disabled. Amputee players use their hands dominantly for locomotion. However, the effect of using upper extremity which is not accommodated to loading is not very well known.Research question: The objective of this study was to determine the load distribution of amputee football players during walking, running and kicking the ball.MethodsThis study was conducted with 15 certified amputee football players (age 24.5 ± 5.8 years, body weight 62.3 ± 10.9 kg, height 171.6 ± 7.7 cm). The loads on their non-amputated lower extremity were measured with F-Scan mobile system sensors inserted in their shoes, and the loads on their upper extremities were measured with F-Grip system sensors affixed to the gloves. The participants were asked to walk, run and kick the ball using Lofstrand Crutches.ResultsThe maximum loading on the upper extremities during walking, running and kicking the ball varied between 111% and 175% of the body weight. While loading during walking and running was similar, the loading on the upper extremity during kicking the ball exceeded that of walking by 58.1% and running by 47.4%. The maximum loading on the non-amputated lower extremity varied between 134% and 196% of the body weight. Loading during running was 46.2% higher than that of walking. The loading on the foot during kicking the ball was 45.7% higher than that of walking. The loading on the foot during running and kicking were similar.SignificanceWalking-running-kicking the ball with LC resulted in unusual loading particularly on the upper extremity. During running, the increased loading was transferred to the foot rather than the hands. During kicking, the loading increased extremely and was mainly transferred to the hands. The frequent repetition of kicking during the game may therefore increase the incidence of upper extremity injuries.
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Source:Gait & Posture, Volume 64
Author(s): Yasar Tatar, Nejla Gercek, Nusret Ramazanoglu, Irfan Gulmez, Selda Uzun, Goktug Sanli, Cengiz Karagozoglu, Hasan Birol Cotuk
BackgroundAmputee football is a worldwide popular sport with positive physical and psychological effects on the disabled. Amputee players use their hands dominantly for locomotion. However, the effect of using upper extremity which is not accommodated to loading is not very well known.Research question: The objective of this study was to determine the load distribution of amputee football players during walking, running and kicking the ball.MethodsThis study was conducted with 15 certified amputee football players (age 24.5 ± 5.8 years, body weight 62.3 ± 10.9 kg, height 171.6 ± 7.7 cm). The loads on their non-amputated lower extremity were measured with F-Scan mobile system sensors inserted in their shoes, and the loads on their upper extremities were measured with F-Grip system sensors affixed to the gloves. The participants were asked to walk, run and kick the ball using Lofstrand Crutches.ResultsThe maximum loading on the upper extremities during walking, running and kicking the ball varied between 111% and 175% of the body weight. While loading during walking and running was similar, the loading on the upper extremity during kicking the ball exceeded that of walking by 58.1% and running by 47.4%. The maximum loading on the non-amputated lower extremity varied between 134% and 196% of the body weight. Loading during running was 46.2% higher than that of walking. The loading on the foot during kicking the ball was 45.7% higher than that of walking. The loading on the foot during running and kicking were similar.SignificanceWalking-running-kicking the ball with LC resulted in unusual loading particularly on the upper extremity. During running, the increased loading was transferred to the foot rather than the hands. During kicking, the loading increased extremely and was mainly transferred to the hands. The frequent repetition of kicking during the game may therefore increase the incidence of upper extremity injuries.
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Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis
Publication date: June 2018
Source:Gait & Posture, Volume 63
Author(s): P. Broderick, F. Horgan, C. Blake, M. Ehrensberger, D. Simpson, K. Monaghan
BackgroundMirror therapy has been proposed as an effective intervention for lower limb rehabilitation post stroke.Research questionThis systematic review with meta-analysis examined if lower limb mirror therapy improved the primary outcome measures of muscle tone and motor function and the secondary outcome measures balance characteristics, functional ambulation, walking velocity, passive range of motion (PROM) for ankle dorsiflexion and gait characteristics in patients with stroke compared to other interventions. Methods: Standardised mean differences (SMD) and mean differences (MD) were used to assess the effect of mirror therapy on lower limb functioning.ResultsNine studies were included in the review. Among the primary outcome measures there was evidence of a significant effect of mirror therapy on motor function compared with sham and non-sham interventions (SMD 0.54; 95% CI 0.24–0.93). Furthermore, among the secondary outcome measures there was evidence of a significant effect of mirror therapy for balance capacity (SMD −0.55; 95% CI −1.01 to −0.10), walking velocity (SMD 0.71; 95% CI 0.35–1.07), PROM for ankle dorsiflexion (SMD 1.20; 95% CI 0.71–1.69) and step length (SMD 0.56; 95% CI −0.00 to 1.12).SignificanceThe results indicate that using mirror therapy for the treatment of certain lower limb deficits in patients with stroke may have a positive effect. Although results are somewhat positive, overly favourable interpretation is cautioned due to methodological issues concerning included studies.
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Source:Gait & Posture, Volume 63
Author(s): P. Broderick, F. Horgan, C. Blake, M. Ehrensberger, D. Simpson, K. Monaghan
BackgroundMirror therapy has been proposed as an effective intervention for lower limb rehabilitation post stroke.Research questionThis systematic review with meta-analysis examined if lower limb mirror therapy improved the primary outcome measures of muscle tone and motor function and the secondary outcome measures balance characteristics, functional ambulation, walking velocity, passive range of motion (PROM) for ankle dorsiflexion and gait characteristics in patients with stroke compared to other interventions. Methods: Standardised mean differences (SMD) and mean differences (MD) were used to assess the effect of mirror therapy on lower limb functioning.ResultsNine studies were included in the review. Among the primary outcome measures there was evidence of a significant effect of mirror therapy on motor function compared with sham and non-sham interventions (SMD 0.54; 95% CI 0.24–0.93). Furthermore, among the secondary outcome measures there was evidence of a significant effect of mirror therapy for balance capacity (SMD −0.55; 95% CI −1.01 to −0.10), walking velocity (SMD 0.71; 95% CI 0.35–1.07), PROM for ankle dorsiflexion (SMD 1.20; 95% CI 0.71–1.69) and step length (SMD 0.56; 95% CI −0.00 to 1.12).SignificanceThe results indicate that using mirror therapy for the treatment of certain lower limb deficits in patients with stroke may have a positive effect. Although results are somewhat positive, overly favourable interpretation is cautioned due to methodological issues concerning included studies.
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Do spatiotemporal parameters and gait variability differ across the lifespan of healthy adults? A systematic review
Source:Gait & Posture, Volume 64
Author(s): Nolan Herssens, Evi Verbecque, Ann Hallemans, Luc Vereeck, Vincent Van Rompaey, Wim Saeys
BackgroundAging is often associated with changes in the musculoskeletal system, peripheral and central nervous system. These age-related changes often result in mobility problems influencing gait performance. Compensatory strategies are used as a way to adapt to these physiological changes.Research questionThe aim of this review is to investigate the differences in spatiotemporal and gait variability measures throughout the healthy adult life.MethodsThis systematic review was conducted according to the PRISMA guidelines and registered in the PROSPERO database (no. CRD42017057720). Databases MEDLINE (Pubmed), Web of Science (Web of Knowledge), Cochrane Library and ScienceDirect were systematically searched until March 2018.ResultsEighteen of the 3195 original studies met the eligibility criteria and were included in this review. The majority of studies reported spatiotemporal and gait variability measures in adults above the age of 65, followed by the young adult population, information of middle-aged adults is lacking. Spatiotemporal parameters and gait variability measures were extracted from 2112 healthy adults between 18 and 98 years old and, in general, tend to deteriorate with increasing age. Variability measures were only reported in an elderly population and show great variety between studies.SignificanceThe findings of this review suggest that most spatiotemporal parameters significantly differ across different age groups. Elderly populations show a reduction of preferred walking speed, cadence, step and stride length, all related to a more cautious gait, while gait variability measures remain stable over time. A preliminary framework of normative reference data is provided, enabling insights into the influence of aging on spatiotemporal parameters, however spatiotemporal parameters of middle-aged adults should be investigated more thoroughly.
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WALKING PATTERN EFFICIENCY DURING COLLECTIVE LOAD TRANSPORT
Source:Gait & Posture
Author(s): Guillaume Fumery, Laetitia Claverie, Vincent Fourcassié, Pierre Moretto
BackgroundWhile the locomotor behavior of humans walking alone has been extensively studied, the locomotor behavior of humans transporting a load collectively is very poorly documented in the biomechanics literature. Yet, collective transport could find potential developments in other domains such as rehabilitation and robotics.Research questionIf collective load transport is made economically one could expect that the center of mass of the ensemble formed by several individuals and the load they carry has the same pendulum-like behavior as a single individual walking alone. The main objective of our study was to assess to what extent this is the case.MethodsWe recorded the 3D kinematics of movement of the body segments of ten dyads formed by two persons carrying a load together in three successive trials. The individuals carried the load, side by side, along a 13 meters straight trajectory. Then, the recovery rate of the center of mass of the ensemble formed by the two subjects and the load they carry (i.e. the rate of transfer between potential and kinetic energy) was computed.ResultsThe values of recovery rate were similar to those found in the literature for individuals walking alone, showing that the external energetic exchanges occurring during collective transport are as efficient as those occurring in single gait. The recovery rate also increased in successive trials, suggesting an improvement of the performance with familiarization.SignificanceOur results demonstrate the ability of humans to collaborate efficiently for carrying a load. The values of recovery rate we found could be used as a benchmark for the control of collaborative robots.
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Stride-to-stride variability and complexity between novice and experienced runners during a prolonged run at anaerobic threshold speed
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Shiwei Mo, Daniel H.K. Chow
BackgroundMotor control, related to running performance and running related injuries, is affected by progression of fatigue during a prolonged run. Distance runners are usually recommended to train at or slightly above anaerobic threshold (AT) speed for improving performance. However, running at AT speed may result in accelerated fatigue. It is not clear how one adapts running gait pattern during a prolonged run at AT speed and if there are differences between runners with different training experience.PurposesTo compare characteristics of stride-to-stride variability and complexity during a prolonged run at AT speed between novice runners (NR) and experienced runners (ER).MethodsBoth NR (n = 17) and ER (n = 17) performed a treadmill run for 31 min at his/her AT speed. Stride interval dynamics was obtained throughout the run with the middle 30 min equally divided into six time intervals (denoted as T1, T2, T3, T4, T5 and T6). Mean, coefficient of variation (CV) and scaling exponent alpha of stride intervals were calculated for each interval of each group.ResultsThis study revealed mean stride interval significantly increased with running time in a non-linear trend (p<0.001). The stride interval variability (CV) maintained relatively constant for NR (p = 0.22) and changed nonlinearly for ER (p = 0.023) throughout the run. Alpha was significantly different between groups at T2, T5 and T6, and nonlinearly changed with running time for both groups with slight differences.SignificanceThese findings provided insights into how the motor control system adapts to progression of fatigue and evidences that long-term training enhances motor control. Although both ER and NR could regulate gait complexity to maintain AT speed throughout the prolonged run, ER also regulated stride interval variability to achieve the goal.
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Source:Gait & Posture, Volume 64
Author(s): Shiwei Mo, Daniel H.K. Chow
BackgroundMotor control, related to running performance and running related injuries, is affected by progression of fatigue during a prolonged run. Distance runners are usually recommended to train at or slightly above anaerobic threshold (AT) speed for improving performance. However, running at AT speed may result in accelerated fatigue. It is not clear how one adapts running gait pattern during a prolonged run at AT speed and if there are differences between runners with different training experience.PurposesTo compare characteristics of stride-to-stride variability and complexity during a prolonged run at AT speed between novice runners (NR) and experienced runners (ER).MethodsBoth NR (n = 17) and ER (n = 17) performed a treadmill run for 31 min at his/her AT speed. Stride interval dynamics was obtained throughout the run with the middle 30 min equally divided into six time intervals (denoted as T1, T2, T3, T4, T5 and T6). Mean, coefficient of variation (CV) and scaling exponent alpha of stride intervals were calculated for each interval of each group.ResultsThis study revealed mean stride interval significantly increased with running time in a non-linear trend (p<0.001). The stride interval variability (CV) maintained relatively constant for NR (p = 0.22) and changed nonlinearly for ER (p = 0.023) throughout the run. Alpha was significantly different between groups at T2, T5 and T6, and nonlinearly changed with running time for both groups with slight differences.SignificanceThese findings provided insights into how the motor control system adapts to progression of fatigue and evidences that long-term training enhances motor control. Although both ER and NR could regulate gait complexity to maintain AT speed throughout the prolonged run, ER also regulated stride interval variability to achieve the goal.
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Gender differences in postural control in people with nonspecific chronic low back pain
Source:Gait & Posture, Volume 64
Author(s): Buse Ozcan Kahraman, Turhan Kahraman, Orhan Kalemci, Yesim Salik Sengul
BackgroundMany studies have reported that there are several differences between genders which may result in altered neuromuscular control. Although the existing evidence suggests that low back pain (LBP) affects the ability to control posture, there is little evidence the gender differences in postural control in people with nonspecific chronic LBP.Research questionAre there any gender differences in postural control and correlations between postural control, pain, disability, and fear of movement in people with nonspecific chronic LBP?MethodsStatic and dynamic postural control were evaluated using a computerized postural control assessment tool including assessments for limits of stability (LOS), unilateral stance, and modified clinical test of sensory interaction on balance. Pain intensity and fear of movement were assessed using a visual analogue scale and the Tampa Scale of Kinesiophobia, respectively.ResultsThis cross-sectional study included 51 people (25 females and 26 males) with nonspecific chronic LBP. Mean reaction time in the LOS test was significantly less in male participants compared with females when adjusted for pain intensity and disability level, F(1,45) = 4.596, p = .037, ηp2 = 0.093. There was no significant difference in the remaining LOS variables as well as unilateral stance, and modified clinical test of sensory interaction on balance variables between the genders (p > .05). Many correlations were observed between the LOS variables, pain intensity, and Tampa Scale of Kinesiophobia score in female participants (p < .05). The Tampa Scale of Kinesiophobia score was also correlated with the movement velocity and endpoint excursion in the LOS test in the male participants (p < .05).SignificanceThis study suggests that there is no difference in most of the static and dynamic postural control variables between females and males; however, higher fear of movement, and pain intensity during activity are more associated with impaired dynamic balance in females with nonspecific chronic LBP.
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Effect of forward-directed aiding force on gait mechanics in healthy young adults while walking faster
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Valdeci C. Dionisio, Christopher P. Hurt, David A. Brown
BackgroundForces can be applied to people while they are walking on a treadmill in different ways that aid individuals to walk at faster walking speeds with potentially less effort. Forward-directed aiding forces (FAF) are a special class of aiding forces where “push” or “pull” forces are mechanically applied to the person’s pelvis in the forward direction.ObjectiveTo determine if FAF, applied by a robotic interface, can be effective in providing assistance to walk at a faster walking speed with reduced kinetic requirements.MethodsTwenty non-neurologically impaired physical active young adults were recruited and biomechanical gait mechanics were measured during walking at two constant treadmill belt speeds (1.0 m/s and 1.6 m/s), with the robotic device in aiding mode to provide FAF (FAF), and also outside of the robotic device (no-FAF). The spatiotemporal gait parameters, anterior-posterior force, sagittal impulse, and hip, knee and ankle power and net work were calculated from kinematic and kinetic data, comparing changes in parameters from slower to faster speeds within each mode, and then, comparing values between each mode.ResultsThe spatiotemporal gait parameters were not different between conditions, but in FAF condition, the propulsive force impulse change was not increased, there was smaller propulsion increase, and smaller maximal power generation and ankle work done at the faster speed, whereas all of these parameters were appropriately increased in the no-FAF condition.ConclusionsThese results indicate that providing FAF at the pelvis is an effective means for reducing the amount of mechanical effort required to walk faster and thus could be used as a training tool to improve walking ability.
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Source:Gait & Posture, Volume 64
Author(s): Valdeci C. Dionisio, Christopher P. Hurt, David A. Brown
BackgroundForces can be applied to people while they are walking on a treadmill in different ways that aid individuals to walk at faster walking speeds with potentially less effort. Forward-directed aiding forces (FAF) are a special class of aiding forces where “push” or “pull” forces are mechanically applied to the person’s pelvis in the forward direction.ObjectiveTo determine if FAF, applied by a robotic interface, can be effective in providing assistance to walk at a faster walking speed with reduced kinetic requirements.MethodsTwenty non-neurologically impaired physical active young adults were recruited and biomechanical gait mechanics were measured during walking at two constant treadmill belt speeds (1.0 m/s and 1.6 m/s), with the robotic device in aiding mode to provide FAF (FAF), and also outside of the robotic device (no-FAF). The spatiotemporal gait parameters, anterior-posterior force, sagittal impulse, and hip, knee and ankle power and net work were calculated from kinematic and kinetic data, comparing changes in parameters from slower to faster speeds within each mode, and then, comparing values between each mode.ResultsThe spatiotemporal gait parameters were not different between conditions, but in FAF condition, the propulsive force impulse change was not increased, there was smaller propulsion increase, and smaller maximal power generation and ankle work done at the faster speed, whereas all of these parameters were appropriately increased in the no-FAF condition.ConclusionsThese results indicate that providing FAF at the pelvis is an effective means for reducing the amount of mechanical effort required to walk faster and thus could be used as a training tool to improve walking ability.
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Quantification of Multi-Segment Trunk Kinetics during Multi-Directional Trunk Bending
Source:Gait & Posture
Author(s): Alireza Noamani, Albert H. Vette, Richard Preuss, Milos R. Popovic, Hossein Rouhani
BackgroundMotion assessment of the body’s head-arms-trunk (HAT) using linked-segment models, along with an inverse dynamics approach, can enable in vivo estimations of inter-vertebral moments. However, this mathematical approach is prone to experimental errors because of inaccuracies in (i) kinematic measurements associated with soft tissue artifacts and (ii) estimating individual-specific body segment parameters (BSPs). The inaccuracy of the BSPs is particularly challenging for the multi-segment HAT due to high inter-participant variability in the HAT’s BSPs and no study currently exists that can provide a less erroneous estimation of the joint moments along the spinal column.Research questionThis study characterized three-dimensional (3D) inter-segmental moments in a multi-segment HAT model during multi-directional trunk-bending, after minimizing the experimental errors.MethodEleven healthy individuals participated in a multi-directional trunk-bending experiment in five directions with three speeds. A seven-segment HAT model was reconstructed for each participant, and its motion was recorded. After compensating for experimental errors due to soft tissue artifacts, and using optimized individual-specific BSPs, and center of pressure offsets, the inter-segmental moments were calculated via inverse dynamics.ResultsOur results show a significant effect of the inter-segmental level and trunk-bending directions on the obtained moments. Compensating for soft tissue artifacts contributed significantly to reducing errors. Our results indicate complex, task-specific patterns of the 3D moments, with high inter-participant variability at different inter-segmental levels, which cannot be studied using single-segment models or without error compensation.SignificanceInterpretation of inter-segmental moments after compensation of experimental errors is important for clinical evaluations and developing injury prevention and rehabilitation strategies.
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Using video rasterstereography and treadmill gait analysis as a tool for evaluating postoperative outcome after lumbar spinal fusion
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Sebastian Scheidt, Sandra Endreß, Marco Gesicki, Ulf Krister Hofmann
BackgroundThe rise in the number of patients with lumbar back pain has led to an increase in the number of spinal surgeries. To avoid unfavorable outcomes, high accuracy and reliability of indication for surgery are essential. This requires critical evaluation of postoperative outcomes with its two key dimensions pain and function. While imaging findings give details about the technical dimension of the intervention, they are prone to high inter-/intra-observer variability, with limited relation to functional outcomes. Pain improvement can be directly asked from patients or documented by questionnaires. There is abundant literature on postoperative function based on questionnaires, but quantifiable data such as gait or posture analysis are scarce. Highprecision measurement tools are available and easy to implement in a clinician’s work routine.ObjectiveThis study evaluates whether lumbar fusion surgery changes gait and postural variables and how these changes are related to patients’ descriptions of alterations in their levels of pain.MethodsBack profiles and gait analyses were measured by video rasterstereography and treadmill gait analysis. Measurements were recorded before surgery, at discharge, after 3 months in a longitudinal (n = 30), and after 12 months in a cross-sectional group (n = 29). A reference group was formed (n = 28). The improvement on the Numeric Pain Rating Scale was documented and compared with changes in gait and posture.ResultsA significant reduction in kyphotic (52–43°, p = 0.014) and lordotic (28–11°, p < 0.001) angles was observed. The values again increased after 3 months, with a significant reduction in cadence (98–91 steps/min, p = 0.006). While improvements in pain were also obtained by surgery (p < 0.001), no clear correlation could be detected between 3-month alleviation in pain and changes in kyphotic/lordotic angle or cadence.ConclusionsAlthough both methods offer high-precision measurement, changes in gait and posture were not related with the patients' reported pain relief after lumbar fusion surgery.
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Source:Gait & Posture, Volume 64
Author(s): Sebastian Scheidt, Sandra Endreß, Marco Gesicki, Ulf Krister Hofmann
BackgroundThe rise in the number of patients with lumbar back pain has led to an increase in the number of spinal surgeries. To avoid unfavorable outcomes, high accuracy and reliability of indication for surgery are essential. This requires critical evaluation of postoperative outcomes with its two key dimensions pain and function. While imaging findings give details about the technical dimension of the intervention, they are prone to high inter-/intra-observer variability, with limited relation to functional outcomes. Pain improvement can be directly asked from patients or documented by questionnaires. There is abundant literature on postoperative function based on questionnaires, but quantifiable data such as gait or posture analysis are scarce. Highprecision measurement tools are available and easy to implement in a clinician’s work routine.ObjectiveThis study evaluates whether lumbar fusion surgery changes gait and postural variables and how these changes are related to patients’ descriptions of alterations in their levels of pain.MethodsBack profiles and gait analyses were measured by video rasterstereography and treadmill gait analysis. Measurements were recorded before surgery, at discharge, after 3 months in a longitudinal (n = 30), and after 12 months in a cross-sectional group (n = 29). A reference group was formed (n = 28). The improvement on the Numeric Pain Rating Scale was documented and compared with changes in gait and posture.ResultsA significant reduction in kyphotic (52–43°, p = 0.014) and lordotic (28–11°, p < 0.001) angles was observed. The values again increased after 3 months, with a significant reduction in cadence (98–91 steps/min, p = 0.006). While improvements in pain were also obtained by surgery (p < 0.001), no clear correlation could be detected between 3-month alleviation in pain and changes in kyphotic/lordotic angle or cadence.ConclusionsAlthough both methods offer high-precision measurement, changes in gait and posture were not related with the patients' reported pain relief after lumbar fusion surgery.
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Healthy 3D knee kinematics during gait: differences between women and men, and correlation with x-ray alignment
Source:Gait & Posture
Author(s): Julien Clément, Penny Toliopoulos, Nicola Hagemeister, François Desmeules, Alexandre Fuentes, Pascal-André Vendittoli
BackgroundNormal 3D knee kinematics during gait is still not well understood, especially regarding differences between women and men.Research question: The objective of the present study was to characterize 3D knee kinematics during gait in healthy women and men with a validated tool.MethodsKnee kinematics was analysed with the KneeKG™ system in 90 healthy subjects (49 females and 41 males). 3D knee rotations were compared between women and men, and between right and left knees. Each subject underwent full-length weight-bearing x-rays. Correlations between abduction-adduction angles and lower-limb alignment measures on x-rays were assessed.ResultsIn the frontal plane, 2.0-5.0° more abduction occurred in women compared to men (0.000 ≤ p ≤ 0.015) throughout the entire gait cycle. In the transverse plane, 2.4-3.7° more external tibial rotation was seen in women than in men (0.002 ≤ p ≤ 0.041) during the initial and mid-swing phases. No difference was found between the right and left knees. Low correlations (-0.52 ≤ r≤-0.41, p < 0.001) were observed between radiographic hip-knee-ankle angle (HKA) and abduction-adduction angles throughout the stance phase.SignificanceKinematic differences between women and men in the frontal plane can be partly explained by their anatomical differences: women were less in varus than men (HKA of -0.8° vs. -2.6°, p < 0.001). Our study contributes to a better understanding of healthy 3D knee kinematics during gait and highlights the need for accounting of gender differences in future investigations. Better knowledge of natural knee kinematics will be helpful in assessing pathological gait patterns or determining the efficiency of conservative and surgical treatments to restore normal kinematics.
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Influence of pelvic padding and Kinesiology Taping on pain perception, kinematics, and kinetics of falls in female volleyball athletes
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Cleopatra L.Y. Lam, Shirley S.M. Fong, Joanne W.Y. Chung, Louisa M.Y. Chung, Karen P.Y. Liu, Young-Hyeon Bae, Ada W.W. Ma
BackgroundVolleyball digging techniques may cause pelvic injuries among female volleyball athletes. Pelvic padding and Kinesiology Taping (KT) may reduce impact force and pain and improve posture during a fall. This study examined the effects of pelvic padding and KT on pain perception, fall kinematics, and kinetics among female volleyball athletes.MethodsTwenty-four female volleyball athletes were exposed to two pelvic padding scenarios (with and without padding) and two KT conditions (with and without KT applied on the rectus abdominis muscle) during a fall in the forward direction. The maximum impact force during landing and maximum acceleration of the pelvis were registered using a force platform and an accelerometer, respectively. The maximum lumbar (hyper) extension angle, forward reach distance, and total fall time were measured by video analysis. Pain level was quantified using a visual analog scale.ResultsThe application of pelvic padding (with and without KT) reduced pain when compared to the no padding condition (p < 0.008). Applying KT alone reduced forward reach distance when compared to the ‘pelvic padding and KT’ condition (p < 0.010). In fact, when both pelvic padding and KT were applied, participants reached further when compared to the ‘no pelvic padding and no KT’ condition (p < 0.001). No significant main and interaction effects were found in all other outcomes.ConclusionsVolleyball shorts with pelvic pads are recommended for female volleyball athletes to reduce pain in the digging maneuver and may help to increase their forward reach distance. However, KT is not recommended as it reduces the forward reach distance and cannot reduce pain or improve fall kinematics and kinetics.
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Source:Gait & Posture, Volume 64
Author(s): Cleopatra L.Y. Lam, Shirley S.M. Fong, Joanne W.Y. Chung, Louisa M.Y. Chung, Karen P.Y. Liu, Young-Hyeon Bae, Ada W.W. Ma
BackgroundVolleyball digging techniques may cause pelvic injuries among female volleyball athletes. Pelvic padding and Kinesiology Taping (KT) may reduce impact force and pain and improve posture during a fall. This study examined the effects of pelvic padding and KT on pain perception, fall kinematics, and kinetics among female volleyball athletes.MethodsTwenty-four female volleyball athletes were exposed to two pelvic padding scenarios (with and without padding) and two KT conditions (with and without KT applied on the rectus abdominis muscle) during a fall in the forward direction. The maximum impact force during landing and maximum acceleration of the pelvis were registered using a force platform and an accelerometer, respectively. The maximum lumbar (hyper) extension angle, forward reach distance, and total fall time were measured by video analysis. Pain level was quantified using a visual analog scale.ResultsThe application of pelvic padding (with and without KT) reduced pain when compared to the no padding condition (p < 0.008). Applying KT alone reduced forward reach distance when compared to the ‘pelvic padding and KT’ condition (p < 0.010). In fact, when both pelvic padding and KT were applied, participants reached further when compared to the ‘no pelvic padding and no KT’ condition (p < 0.001). No significant main and interaction effects were found in all other outcomes.ConclusionsVolleyball shorts with pelvic pads are recommended for female volleyball athletes to reduce pain in the digging maneuver and may help to increase their forward reach distance. However, KT is not recommended as it reduces the forward reach distance and cannot reduce pain or improve fall kinematics and kinetics.
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Examining the diagnostic accuracy of static postural stability measures in differentiating among knee osteoarthritis patients with mild and moderate to severe radiographic signs
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Nahid Pirayeh, Mohammad-Jafar Shaterzadeh-Yazdi, Hossein Negahban, Mohammad Mehravar, Neda Mostafaee, Amal Saki-Malehi
BackgroundClinicians need a reliable and accurate tools that can best identify and classify balance impairments between mild and moderate to severe grades of knee osteoarthritis (OA).Research questionThis study was designed to investigate the accuracy of postural measurements to discriminate between these two groups of knee OA.MethodsA total of 130 patients with knee OA based on the Kellgren-Lawrence (KL) grading scale were categorized into 65 patients with mild (a KL grade≤ 2) and 65 patient with moderate to severe (a KL grade≥3) radiographic sign. Static postural control was assessed on the force plate in three conditions of double leg stance with open (DO) and closed eyes (DC) and single leg stance with open eyes (SO). The accuracy for static postural control parameters was determined by calculation of sensitivity, specificity, area under the Receiver Operating Characteristic (ROC) curve (AUC) and likelihood ratios (LRs).ResultsOur results showed that standard deviation (SD) of velocity in anterior-posterior (AP) direction had the highest sensitivity and specificity in conditions of DO and DC, respectively. ROC curve analysis indicated that measures of mean and SD velocity in medio-lateral (ML) direction in conditions of DO and DC had acceptable levels of accuracy (AUC > 0.70) in discriminating between the two groups of knee OA patients. Also, based on LR results, SD of velocity in AP direction had the best ability for ruling in and ruling out moderate to severe grade of knee OA patients in conditions of DC and DO, respectively.SignificanceOur findings provide evidence for selection of mean velocity and SD of velocity in identifying and discriminating static postural performance in patients with mild and moderate to severe grades of knee OA.
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Source:Gait & Posture, Volume 64
Author(s): Nahid Pirayeh, Mohammad-Jafar Shaterzadeh-Yazdi, Hossein Negahban, Mohammad Mehravar, Neda Mostafaee, Amal Saki-Malehi
BackgroundClinicians need a reliable and accurate tools that can best identify and classify balance impairments between mild and moderate to severe grades of knee osteoarthritis (OA).Research questionThis study was designed to investigate the accuracy of postural measurements to discriminate between these two groups of knee OA.MethodsA total of 130 patients with knee OA based on the Kellgren-Lawrence (KL) grading scale were categorized into 65 patients with mild (a KL grade≤ 2) and 65 patient with moderate to severe (a KL grade≥3) radiographic sign. Static postural control was assessed on the force plate in three conditions of double leg stance with open (DO) and closed eyes (DC) and single leg stance with open eyes (SO). The accuracy for static postural control parameters was determined by calculation of sensitivity, specificity, area under the Receiver Operating Characteristic (ROC) curve (AUC) and likelihood ratios (LRs).ResultsOur results showed that standard deviation (SD) of velocity in anterior-posterior (AP) direction had the highest sensitivity and specificity in conditions of DO and DC, respectively. ROC curve analysis indicated that measures of mean and SD velocity in medio-lateral (ML) direction in conditions of DO and DC had acceptable levels of accuracy (AUC > 0.70) in discriminating between the two groups of knee OA patients. Also, based on LR results, SD of velocity in AP direction had the best ability for ruling in and ruling out moderate to severe grade of knee OA patients in conditions of DC and DO, respectively.SignificanceOur findings provide evidence for selection of mean velocity and SD of velocity in identifying and discriminating static postural performance in patients with mild and moderate to severe grades of knee OA.
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IMU-based gait analysis in lower limb prosthesis users: Comparison of step demarcation algorithms
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Gerasimos Bastas, Joshua J. Fleck, Richard A. Peters, Karl E. Zelik
BackgroundInertial Measurement Unit (IMU)-based gait analysis algorithms have previously been validated in healthy controls. However, little is known about the efficacy, performance, and applicability of these algorithms in clinical populations with gait deviations such as lower limb prosthesis users (LLPUs).Research questionTo compare the performance of 3 different IMU-based algorithms to demarcate steps from LLPUs.MethodsWe used a single IMU sensor affixed to the midline lumbopelvic region of 17 transtibial (TTA), 16 transfemoral (TFA) LLPUs, and 14 healthy controls (HC). We collected acceleration and angular velocity data during overground walking trials. Step demarcation was evaluated based on fore-aft acceleration, detecting either: (i) maximum acceleration peak, (ii) zero-crossing, or (iii) the peak immediately preceding a zero-crossing. We quantified and compared the variability (standard deviation) in acceleration waveforms from superposed step intervals, and variability in step duration, by each algorithm.ResultsWe found that the zero-crossing algorithm outperformed both peak detection algorithms in 65% of TTAs, 81% of TFAs, and 71% of HCs, as evidenced by lower standard deviations in acceleration, more consistent qualitative demarcation of steps, and more normally distributed step durations.SignificanceThe choice of feature-based algorithm with which to partition IMU waveforms into individual steps can affect the quality and interpretation of estimated gait spatiotemporal metrics in LLPUs. We conclude that the fore-aft acceleration zero-crossing serves as a more reliable feature for demarcating steps in the gait patterns of LLPUs.
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Source:Gait & Posture, Volume 64
Author(s): Gerasimos Bastas, Joshua J. Fleck, Richard A. Peters, Karl E. Zelik
BackgroundInertial Measurement Unit (IMU)-based gait analysis algorithms have previously been validated in healthy controls. However, little is known about the efficacy, performance, and applicability of these algorithms in clinical populations with gait deviations such as lower limb prosthesis users (LLPUs).Research questionTo compare the performance of 3 different IMU-based algorithms to demarcate steps from LLPUs.MethodsWe used a single IMU sensor affixed to the midline lumbopelvic region of 17 transtibial (TTA), 16 transfemoral (TFA) LLPUs, and 14 healthy controls (HC). We collected acceleration and angular velocity data during overground walking trials. Step demarcation was evaluated based on fore-aft acceleration, detecting either: (i) maximum acceleration peak, (ii) zero-crossing, or (iii) the peak immediately preceding a zero-crossing. We quantified and compared the variability (standard deviation) in acceleration waveforms from superposed step intervals, and variability in step duration, by each algorithm.ResultsWe found that the zero-crossing algorithm outperformed both peak detection algorithms in 65% of TTAs, 81% of TFAs, and 71% of HCs, as evidenced by lower standard deviations in acceleration, more consistent qualitative demarcation of steps, and more normally distributed step durations.SignificanceThe choice of feature-based algorithm with which to partition IMU waveforms into individual steps can affect the quality and interpretation of estimated gait spatiotemporal metrics in LLPUs. We conclude that the fore-aft acceleration zero-crossing serves as a more reliable feature for demarcating steps in the gait patterns of LLPUs.
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Postural stability and trunk muscle responses to the static and perturbed balance tasks in individuals with and without symptomatic degenerative lumbar disease
Source:Gait & Posture, Volume 64
Author(s): Yun-Chung Lin, Chi-Chien Niu, Mohammad Nikkhoo, Meng-Ling Lu, Wen-Chien Chen, Chen-Ju Fu, Chih-Hsiu Cheng
BackgroundDegenerative lumbar diseases (DLDs) are characterized by motor functional deficits and postural instability. In this study, we investigated the differences in the trunk muscle responses to postural control between the presurgical DLD patients and healthy individuals while performing the static and perturbed balance tasks.MethodsThirty-five DLD patients (aged 61.1 ± 8.0 years) and thirty-five asymptomatic controls (aged 62.9 ± 3.7 years) participated in this study. All participants stood on a force plate and performed the quiet standing (QS) and in situ weight-lifting (WL) tasks. The participants’ performance in the QS task was tested under the eyes-open, eyes-closed, wide-base, and narrow-base conditions. Center of pressure (CoP) movements and electromyography of the erector spinae (ES) were recorded. The Mann–Whitney U test was applied for statistical analysis.ResultsThe DLD group showed a significantly greater CoP movements and muscle activations during the QS task. Nevertheless, smaller CoP movements were noted during the WL task in the DLD group. Under the eyes-closed and narrow-base conditions, the DLD group showed even higher muscle activations and CoP movements.SignificanceThe DLD patients demonstrated a poor postural control ability and tended to rely on the visual feedback and wide-base standing posture. A rigid and restricted posture was also adopted during the perturbed WL task. A high level of ES activation was required to maintain their postural steadiness. This study reveals an aberrant pattern of postural control and trunk muscle activations in symptomatic DLD patients which potentially contributes to the development of beneficial rehabilitation programs.
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Whole body organization during a symmetric bimanual pick up task for children with unilateral cerebral palsy
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Ya-Ching Hung, Aryeh Spingarn
BackgroundInformation on whole-body coordination involving bimanual coordination for children with unilateral spastic cerebral palsy (USCP) is limited.Research QuestionThe purpose of the current study is to test the hypothesis that during a whole-body pick up task, children with USCP will organize their whole- body movements and bimanual coordination differently than typically-developing children (TDC).MethodsTwelve children with USCP (average age: 8.3; MACS levels: I–II) and twelve age-matched TDC participated in the study. Children were asked to reach down, grasp, and pick up an empty box to waist height while Kinematic and Kinetic data were recorded and analyzed using a VICON system and two AMTI force plates.ResultsChildren with USCP had longer overall movement time, reaching down time, and grasping movement time (all P < 0.05) than TDC. Less bimanual coordination was indicated by greater finger vertical position differences and movement onset and offset timing differences (all P < 0.05). Additionally, greater bilateral joint position on differences were found for shoulder, elbow, hip, and knee when reaching down and for shoulder and elbow at the end of the task (all P < 0.05). Greater asymmetric bilateral ground reaction force and greater lateral and anterior center of pressure excursion were also found in children with USCP (all P < 0.05).SignificanceImpairments in both bimanual and whole-body coordination were found during a simple whole-body task in children with USCP. Future treatments or assessments should consider whole-body tasks involving dual task constraints.
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Source:Gait & Posture, Volume 64
Author(s): Ya-Ching Hung, Aryeh Spingarn
BackgroundInformation on whole-body coordination involving bimanual coordination for children with unilateral spastic cerebral palsy (USCP) is limited.Research QuestionThe purpose of the current study is to test the hypothesis that during a whole-body pick up task, children with USCP will organize their whole- body movements and bimanual coordination differently than typically-developing children (TDC).MethodsTwelve children with USCP (average age: 8.3; MACS levels: I–II) and twelve age-matched TDC participated in the study. Children were asked to reach down, grasp, and pick up an empty box to waist height while Kinematic and Kinetic data were recorded and analyzed using a VICON system and two AMTI force plates.ResultsChildren with USCP had longer overall movement time, reaching down time, and grasping movement time (all P < 0.05) than TDC. Less bimanual coordination was indicated by greater finger vertical position differences and movement onset and offset timing differences (all P < 0.05). Additionally, greater bilateral joint position on differences were found for shoulder, elbow, hip, and knee when reaching down and for shoulder and elbow at the end of the task (all P < 0.05). Greater asymmetric bilateral ground reaction force and greater lateral and anterior center of pressure excursion were also found in children with USCP (all P < 0.05).SignificanceImpairments in both bimanual and whole-body coordination were found during a simple whole-body task in children with USCP. Future treatments or assessments should consider whole-body tasks involving dual task constraints.
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In vivo validation of patellofemoral kinematics during overground gait and stair ascent
Source:Gait & Posture, Volume 64
Author(s): Samuel Pitcairn, Bryson Lesniak, William Anderst
BackgroundThe patellofemoral (PF) joint is a common site for non-specific anterior knee pain. The pathophysiology of patellofemoral pain may be related to abnormal motion of the patella relative to the femur, leading to increased stress at the patellofemoral joint. Patellofemoral motion cannot be accurately measured using conventional motion capture.Research questionThe aim of this study was to determine the accuracy of a biplane radiography system for measuring in vivo PF motion during walking and stair ascent.MethodsFour subjects had three 1.0 mm diameter tantalum beads implanted into the patella. Participants performed three trials each of over ground walking and stair ascent while biplane radiographs were collected at 100 Hz. Patella motion was tracked using radiostereophotogrammetric analysis (RSA) as a “gold standard”, and compared to a volumetric CT model-based tracking algorithm that matched digitally reconstructed radiographs to the original biplane radiographs.ResultsThe average RMS difference between the RSA and model-based tracking was 0.41 mm and 1.97° when there was no obstruction from the contralateral leg. These differences increased by 34% and 40%, respectively, when the patella was at least partially obstructed by the contralateral leg. The average RMS difference in patellofemoral joint space between tracking methods was 0.9 mm or less.SignificancePrevious validations of biplane radiographic systems have estimated tracking accuracy by moving cadaveric knees through simulated motions. These validations were unable to replicate in vivo kinematics, including patella motion due to muscle activation, and failed to assess the imaging and tracking challenges related to contralateral limb obstruction. By replicating the muscle contraction, movement velocity, joint range of motion, and obstruction of the patella by the contralateral limb, the present study provides a realistic estimate of patellofemoral tracking accuracy for future in vivo studies.
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Comparing the effects of mechanical perturbation training with a compliant surface and manual perturbation training on joints kinematics after ACL-rupture
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Zakariya Nawasreh, Mathew Failla, Adam Marmon, David Logerstedt, Lynn Snyder-Mackler
IntroductionPerforming physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown.AimTo compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture.MethodsSixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training.ResultsSignificant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (p<0.004), with manual group significantly increased knee flexion angle at IC and PKF (p<0.03). Main effects of group were found for hip flexion angle at IC (Manual:34.34+3.51°, Mechanical:27.68+4.08°, p = 0.011), hip rotation angle at PKE (Manual:-3.40+4.78°, Mechanical:5.43+4.78°, p < 0.0001), and knee adduction angle at PKE (Manual:-2.00+2.23°, Mechanical:0.55+2.23°, p = 0.039). Main effects of time were found for hip adduction angle at PKE (Pre:6.98+4.48°, Post:8.41+4.91°, p = 0.04), knee adduction angle at IC (Pre:-2.90+3.50°, Post:-0.62+2.58°, p = 0.03), ankle adduction angle at IC (Pre:2.16+3.54, Post:3.8+3.68, p = 0.008), and ankle flexion angle at PKF (Pre:-4.55+2.77°, Post:-2.39+3.48°, p = 0.01).DiscussionTraining on a compliant surface induces different effects on joint kinematics compared to manual perturbation training after ACL-rupture. Manual perturbation improved hip alignment and increased knee flexion angles, while mechanical training decreased knee flexion angles throughout the stance phase. Administering training on a compliant surface after ACL-rupture may help improving dynamic knee stability, however, long-term effects on knee health needs to be determined.
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Source:Gait & Posture, Volume 64
Author(s): Zakariya Nawasreh, Mathew Failla, Adam Marmon, David Logerstedt, Lynn Snyder-Mackler
IntroductionPerforming physical activities on a compliant surface alters joint kinematics and increases joints stiffness. However, the effect of compliant surface on joint kinematics after ACL-rupture is yet unknown.AimTo compare the effects of mechanical perturbation training with a compliant surface to manual perturbation training on joint kinematics after ACL-rupture.MethodsSixteen level I/II athletes with ACL-rupture participated in this preliminary study. Eight patients received mechanical perturbation with compliant surface (Mechanical) and 8 patients received manual perturbation training (Manual). Patients completed standard gait analysis before (Pre) and after (Post) training.ResultsSignificant group-by-time interactions were found for knee flexion angle at initial contact (IC) and peak knee flexion (PKF) (p<0.004), with manual group significantly increased knee flexion angle at IC and PKF (p<0.03). Main effects of group were found for hip flexion angle at IC (Manual:34.34+3.51°, Mechanical:27.68+4.08°, p = 0.011), hip rotation angle at PKE (Manual:-3.40+4.78°, Mechanical:5.43+4.78°, p < 0.0001), and knee adduction angle at PKE (Manual:-2.00+2.23°, Mechanical:0.55+2.23°, p = 0.039). Main effects of time were found for hip adduction angle at PKE (Pre:6.98+4.48°, Post:8.41+4.91°, p = 0.04), knee adduction angle at IC (Pre:-2.90+3.50°, Post:-0.62+2.58°, p = 0.03), ankle adduction angle at IC (Pre:2.16+3.54, Post:3.8+3.68, p = 0.008), and ankle flexion angle at PKF (Pre:-4.55+2.77°, Post:-2.39+3.48°, p = 0.01).DiscussionTraining on a compliant surface induces different effects on joint kinematics compared to manual perturbation training after ACL-rupture. Manual perturbation improved hip alignment and increased knee flexion angles, while mechanical training decreased knee flexion angles throughout the stance phase. Administering training on a compliant surface after ACL-rupture may help improving dynamic knee stability, however, long-term effects on knee health needs to be determined.
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O 010 - Ramp walking with abruptly changing inclines: Motion pattern of TT amputees fitted with a microprocessor-controlled and a conventional prosthetic foot
Source:Gait & Posture
Author(s): T. Schmalz, B. Altenburg, M. Ernst, M. Bellmann, D. Rosenbaum
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Analyzing the characteristics of rising from the bed in patients having undergone total hip arthroplasty immediately after surgery
Publication date: July 2018
Source:Gait & Posture, Volume 64
Author(s): Jun Yamahara, Keisuke Hagio, Hirofumi Saka, Kohei Kushimoto, Masaki Inaba, Naotaka Tazaki, Yoichi Taniguchi, Masanobu Saito
BackgroundImmediately after patients undergo total hip arthroplasty (THA), they are often coached through the process of rising from the bed to prevent dislocation. However, motion analysis of this process, which can guide coaching methods, has not been conducted. The purpose of this study was to clarify whether there is a difference in hip joint angle, rise time, pain, and difficulty based on the method of rising from the bed in postoperative patients, immediately after THA.MethodsTwenty patients who underwent THA were enrolled in this study. Seven days after surgery, 3-D motion analysis was performed while subjects rose from the bed using six different methods that include rising from the bed using either the affected or non-affected side either with or without assistance. Hip joint angle, rise time, pain, and difficulty were evaluated.ResultsIn all six methods, the maximal hip joint angle of the affected side was in the safe range. The maximal hip adduction angle and adduction angle at maximum flexion of the affected side were significantly lower in patients who rose from the bed using their affected side than in those who rose using their non-affected side. There were no differences in maximal hip flexion angle, internal rotation angle, internal rotation angle at maximum flexion of the affected side, rise time, pain, or difficulty regardless of the direction of rising from the bed or the use of assistance.SignificanceCoaching patients to rise from the bed is better performed when using the most optimal method that takes into consideration the movement direction and patient’s individuality.
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Source:Gait & Posture, Volume 64
Author(s): Jun Yamahara, Keisuke Hagio, Hirofumi Saka, Kohei Kushimoto, Masaki Inaba, Naotaka Tazaki, Yoichi Taniguchi, Masanobu Saito
BackgroundImmediately after patients undergo total hip arthroplasty (THA), they are often coached through the process of rising from the bed to prevent dislocation. However, motion analysis of this process, which can guide coaching methods, has not been conducted. The purpose of this study was to clarify whether there is a difference in hip joint angle, rise time, pain, and difficulty based on the method of rising from the bed in postoperative patients, immediately after THA.MethodsTwenty patients who underwent THA were enrolled in this study. Seven days after surgery, 3-D motion analysis was performed while subjects rose from the bed using six different methods that include rising from the bed using either the affected or non-affected side either with or without assistance. Hip joint angle, rise time, pain, and difficulty were evaluated.ResultsIn all six methods, the maximal hip joint angle of the affected side was in the safe range. The maximal hip adduction angle and adduction angle at maximum flexion of the affected side were significantly lower in patients who rose from the bed using their affected side than in those who rose using their non-affected side. There were no differences in maximal hip flexion angle, internal rotation angle, internal rotation angle at maximum flexion of the affected side, rise time, pain, or difficulty regardless of the direction of rising from the bed or the use of assistance.SignificanceCoaching patients to rise from the bed is better performed when using the most optimal method that takes into consideration the movement direction and patient’s individuality.
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O 011 – Ankle power and energy cost during level and slope walking with Energy Storage and Return feet in transtibial amputees
Source:Gait & Posture
Author(s): J. Hijmans, L. Kouwenhove-van, D. Dijken-van, F. Dijk-van, A. Vrieling, R. Dekker
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