The Gait Deviation Index: a new comprehensive index of gait pathology

Lower limb deformity and gait deviations of osteogenesis imperfecta

BACKGROUND

Osteogenesis imperfecta is a rare genetic disorder characterized by complex lower limb deformities, resulting in various gait limitations. This study aimed to (1) investigate the incidence and association between radiographic changes and gait impairment; (2) propose a lower limb deformity index to quantify deformity severity as well as gait performance.

METHODS

Bilateral X-ray images and 3D gait analysis results were assessed retrospectively from 48 patients with osteogenesis imperfecta. Multivariate linear regression was used to investigate the contribution of each deformity to gait performance. Eight scoring approaches of the proposed index, calculated from radiographic changes, were evaluated by their linear relationship to gait deviation.

RESULTS

Patients with osteogenesis imperfecta had high incidence of anterolateral bowing of femur, and anteromedial bowing of tibia, along with abducted hip, varus knee, hip flexion and ankle dorsiflexion deformities. Their maximum joint kinematics and kinetics were less than healthy controls, which was consistent with their major deformities. However, multivariate linear regression indicated a limited contribution from each deformity to gait deviation (only mechanical axis deviation out of 14 radiographic measures showed significance). Remarkably, our proposed index presented a significant linear correlation to gait deviation (Correlation coefficient: -0.650; R square: 0.423; F value: 33.719, p < 0.001).

CONCLUSIONS

This study preliminary demonstrated the association between lower limb deformities and gait deviations of patients with osteogenesis imperfecta and proposed a lower limb deformity index to quantify the deformity severity that reflects gait performance.

Three-Dimensional Gait Analysis of School-Age Children With Angelman Syndrome: A Case-Control Study

Gait disturbance is a common motor symptom in Angelman syndrome (AS), but its characteristics have been poorly studied quantitatively. This study aimed to analyze gait characteristics in school-age children with AS using three-dimensional gait analysis (3DGA). Patients with clinically and genetically confirmed AS and healthy children aged 6-15 years were included. For gait assessments, 3DGA was performed using an eight-camera motion analysis system and eight force plates. Gait metrics, including gait speed, step length, step width, gait variability, gait deviation index, and kinematic and kinetic data of lower extremity joints were compared between the groups. Eight children with AS and 24 healthy controls were evaluated. Seven children with AS had flat feet. While step length and gait speed were similar between groups, children with AS showed greater variability in these parameters and larger step widths. Their average gait deviation index was 74.5, indicating significant gait disturbance, and characteristic features included anterior pelvic tilt, insufficient hip extension, excessive knee flexion during early stance, and reduced ankle joint power. School-age children with AS exhibit unstable, prancing gait characterized by knee flexion in the early stance phase, quantifiable using 3DGA. These findings provide foundation for evaluating therapeutic interventions.

Effect of electroacupuncture for early ankle osteoarthritis: A randomized controlled trial using three-dimensional gait analysis

BackgroundAnkle osteoarthritis (AOA) is a prevalent condition that affects joint function, often leading to pain, inflammation, and impaired mobility, significantly impacting patients' quality of life.ObjectiveThis study explores the effects of electroacupuncture treatment on clinical outcomes and gait characteristics in patients with ankle osteoarthritis (AOA).MethodsA total of 78 patients with AOA were randomly divided into a experiment group and a control group. The control group was treated with strength training, and the experiment group was additionally treated with electroacupuncture. The Ankle Osteoarthritis Scale (AOS), American Foot and Ankle Society's Ankle and Hindfoot Scale (AOFAS-AHS), and the 3D Motion Analysis System were used before and after the intervention to assess the clinical outcomes and changes in kinematic parameters in the AOA patients before and after therapy.ResultsAfter treatment, the differences in intra-group comparisons and inter-group comparisons of AOS scores, AOFAS-AHS scores, stride length, stride length, single-support phase, and gait variable scores (GVS) of ankle dorsiflexion-plantarflexion of the patients in the experiment group were statistically significant; the differences in inter-group comparisons of GVS scores of hip rotation of the patients in the experiment group were statistically significant; and the differences in the gait profile scores (GPS) and gait deviation indices of the patients in the experiment group were statistically significant. The differences in the intra-group comparisons were statistically significant. The within-group comparisons of AOS score, AOFAS-AHS score, GPS score and GVS score of ankle dorsiflexion-plantarflexion were statistically significant in the control group patients.ConclusionsElectroacupuncture has shown promise as an adjunctive therapy for patients with AOA, offering a more holistic rehabilitation strategy. By improving joint mobility and optimizing gait mechanics, electroacupuncture can effectively reduce pain, facilitate the restoration of normal gait patterns, and enhance patients' overall quality of life.

3D motion capture data into a kinematic composite score for assessing musculoskeletal impairments

Biomechanical analysis is essential for understanding and monitoring musculoskeletal impairments, with implications for clinical diagnostics and research. Current clinical methods provide isolated joint measures or qualitative observations, failing to capture motion complexity. While 3D biomechanical testing is comprehensive, its application is hindered by data volume, making it challenging to derive clinically relevant conclusions. Approaches to distill motion often neglect time-series data or are dependent on population size. To address these gaps, this study introduces the Kinematic Composite Score (K-Score), a metric that distills high-dimensional motion while preserving individual variability. The objective of this research is to outline the methodology of the K-Score algorithm, highlight its strengths, limitations, and applications. We conducted a comparative study of the K-Score Algorithm against (1) the conventional isolated kinematic measures, and (2) traditional Principal Component Analysis. The analysis was conducted with a cohort of chronic low back pain (LBP) patients, who exhibit tremendous movement heterogeneity. The K-Score outperformed traditional isolated metrics in differentiating overall motion of LBP patients from healthy controls (K-Score: controls = 94.16 ± 2.64, LBP = 85.82 ± 7.73, p < 0.001). The K-Score also demonstrated significant differences in overall motion between male and female participants, where females with LBP demonstrated higher scores than males (p < 0.001). Importantly, the K-Score was not sensitive to BMI (p = 0.49), age (p = 0.14), height (p = 0.11), or sample size. In conclusion, the K-Score addresses key limitations of traditional approaches by encapsulating full-body, time-series data within a single score that is adaptable across motion capture systems and activities, making it a powerful tool for clinical biomechanics research.

Ambulatory children with spastic cerebral palsy have smaller bone area and deficits in trabecular microarchitecture

Cerebral palsy (CP) is a non-progressive neurological syndrome resulting in abnormal muscle tone, movement, and posture. It is unclear whether ambulatory children with CP have deficits in bone quantity or quality. Furthermore, the relationship between abnormal muscle tone, altered function, and bone health remains largely unexplored. This observational study investigated bone mineral density (BMD) and microarchitecture in ambulatory children with spastic CP and associations of BMD with function, muscle spasticity, and gait. Children with spasticity in both lower limbs (n = 12) aged 3-8 years were recruited. Areal BMD was measured with dual energy x-ray absorptiometry (DXA) at the proximal femur and lateral distal femur and compared to normative data. High resolution peripheral quantitative computed tomography (HR-pQCT) was performed at the metaphyseal tibia and radius in a subset of participants (n = 5) and compared to healthy children (n = 7). Gait pathology and cardiopulmonary function were investigated with the Gait Deviation Index, Edinburgh Visual Gait Score, and energy expenditure index. DXA areal BMD (aBMD) Z-scores at the lateral distal femur were within a normal range. However, the CP group's median aBMD Z-score at the proximal femur was -1.8 (IQR: -2.2, -1.2, p = .03) indicating potential skeletal fragility. Strong correlations were found between gait pathology and DXA-based bone outcomes (correlation coefficient 0.62 [p = .04] to 0.73 [p = .01]) as well as energy expenditure index and DXA-based bone outcomes (correlation coefficient -0.63 [p = .03] to -0.98 [p ≤ .001]). At the metaphyseal tibia, children with spastic CP had significant deficits in HR-pQCT-measured bone geometry and trabecular microarchitecture: 35% lower total area, 42% lower trabecular area, and 48% lower trabecular number than controls. HR-pQCT parameters were similar between groups at the metaphyseal radius. These differences in tibial metaphysis size and trabecular microarchitecture are similar to those observed in disuse and thus could be a result of abnormal biomechanics or low levels of physical activity.

"Impact of Age on Gait Deviations and Function After Single Event Multilevel Surgery in Children With Cerebral Palsy"

BACKGROUND

Single event multi-level surgery (SEMLS) is the standard of orthopaedic care for children with cerebral palsy (CP). The optimal age to perform SEMLS is unclear, with studies showing positive results from childhood to adulthood. Few studies have combined clinical gait analysis with participation and activity outcome measures. The purpose of this study was to examine the effect of age on changes in gait parameters, activity, and participation in children with CP who underwent SEMLS with a follow-up time of 8 to 48 months.

METHODS

One hundred twenty-eight participants met the inclusion criteria. Ninety-one participants (71%) were aged under 11 years and 37 participants (29%) were 11 years or older. Changes in gait deviation index (GDI), walking velocity, stride length, functional mobility scale (FMS), and pediatric outcomes data collection instrument (PODCI) scores were calculated. The impact of age on outcomes was analyzed in age groups (<11 vs. ≥11 y) using linear and ordered logistic regression. The Gross Motor Function Classification System level was included as a covariate in all analyses.

RESULTS

There was no difference between age groups for preoperative to postoperative change in GDI, walking velocity, or FMS. The younger group significantly improved GDI, stride length, and global and upper extremity PODCI scores after SEMLS, while the older group significantly improved GDI only. The PODCI upper extremity subscale was the only variable impacted by age group (P=0.02).

CONCLUSION

Children with CP who undergo SEMLS at any age are likely to see improvements in the GDI. Those under 11 years at the time of SEMLS also show improvements in stride length and global and upper extremity PODCI scores, while those older than 11 years are likely to maintain but not improve their levels of activity and participation.

LEVEL OF EVIDENCE

Level III-retrospective comparative study.

Gait improvements in the early post-surgery rehabilitation phase in subjects receiving a total knee or hip arthroplasty: A prospective study

BACKGROUND

Rehabilitation after total knee arthroplasty (TKA) and total hip arthroplasty (THA) is fundamental for reducing pain and recovering strength, range of motion, and walking ability. Gait analysis (GA) is rarely included in the rehabilitation path. This study assesses how inpatient rehabilitation influences clinical outcomes and gait analysis (GA) parameters in TKA and THA patients, comparing these with age- and speed-matched healthy subjects (HS).

METHODS

A prospective observational study included 80 subjects (50 TKA, 30 THA) and 20 aged-matched HS. Assessments occurred at admission and discharge post inpatient rehabilitation, using clinical outcome scales (e.g., Modified Barthel Index, Knee Society Score), GA spatiotemporal parameters, and gait summary measures (e.g., Gait Profile Score, Gait Deviation Index). Statistical analyses determined the significance of improvements.

RESULTS

Post-rehabilitation, significant improvements were observed in clinical outcomes and some key spatio-temporal gait parameters (p ≤ 0.01). However, gait summary measures showed no changes. Interestingly, gait summary measures did not correlate with clinical outcome scales. Moreover, TKA and THA patients showed no differences compared with slow-walking HS.

CONCLUSION

Inpatient rehabilitation significantly enhanced clinical outcomes and spatio-temporal parameters. Additionally, no differences were observed between spatiotemporal and gait summary measures of slow-walking HS and patients at discharge, indicating that rehabilitation restored gait quality. However, gait speed remains impaired, in both TKA and THA populations. Future research should explore personalized rehabilitation protocols to address these limitations and improve gait outcomes.

TRIAL REGISTRATION NUMBER

NCT04803578.

Automated identification of clinically meaningful biomechanical phenotypes in cerebral palsy through multicenter gait data

BACKGROUND

Cerebral palsy is the most prevalent motor disability in childhood, encompassing various movement disorders that affect walking. Researchers have described gait patterns in cerebral palsy, but these are often subjective and based on clinician experience. This study introduces an automated approach to objectively identify clinically meaningful biomechanical phenotypes in cerebral palsy and test it on multicenter gait data. Utilizing instrumented gait analysis, this research aims to improve treatment strategies for gait dysfunction. This study addresses whether classification algorithms can objectively identify clinically meaningful gait patterns and if severe gait deviations are more frequent in advanced forms of cerebral palsy.

METHODS

Two novel classification algorithms (sagittal and transverse planes) were developed and automated in Python. These were based on previous work and refined using clinical expertise and data from four motion analysis centers in the Shriners Children's system, including 700 patients with cerebral palsy. The patient's gait data was applied to the treatment algorithms, and the percentage of each phenotype is presented.

FINDINGS

Novel sagittal and transverse plane gait phenotype algorithms were created. When applied to the cerebral palsy cohort, we found that more severe gait deviations, or combinations of deviations, were more apparent in the more severe forms of cerebral palsy.

INTERPRETATIONS

Classifying a patient's biomechanical phenotype provides valuable insights into therapeutic interventions. The results allow for the automation of data-driven classification algorithms, leading to efficient, accurate, and reliable classifications of biomechanical phenotypes that support evidence-based, personalized treatment decisions and clinical management.

Can External Neuromodulation Garments Improve Gait and Function in Children With Cerebral Palsy? A Prospective Single-Arm Study

Introduction

The Exopulse Mollii Suit is an external electrical stimulation garment that is designed to reduce spasticity through electrical stimulation of targeted muscles. Our aims were to study the impact of the garment in improving gait and function in children with cerebral palsy (CP).

Methods

Individuals aged 4-18 years with spastic CP, Gross Motor Function Classification System level I-III were included for a prospective single-arm study from January 2021 to January 2022. Participants wore the suit for 4 weeks 60 min a day. Outcome measures taken pre, post and 1-month-post intervention included: 3D gait analysis (gait profile score, gait deviation index and temporo-spatial parameters), gross motor function measure-88 (GMFM-88), EQ-5D-Y, compliance rate, adverse event and satisfaction. Paired t-test was used for data analysis to compare measurement time points.

Results

Twenty children (median age 7 [range: 4-16; interquartile range: 3.1] years, 55% female, 45% male were recruited. Post-intervention results showed there was no improvement in the gait profile but there was an improving trend in temporo-spatial parameters GMFM Domain C crawling and kneeling improved significantly (p = 0.03). Improvement in EQ-5D- Y usual activity was significant (p = 0.04). Compliance rate was 95% and nil major adverse event was reported. The majority (75%, n = 15) of parents and participants perceived overall positive experience.

Conclusion

The positive changes in gait profile and function were no longer significant at 1-month post-intervention. Further studies with a longer intervention period and concurrent strengthening program are required.

Implications for Physiotherapy Practice

Using the Molli Suit for 60 min a day for 4 weeks, may be useful in improving:(1) Gait cadence in children with CP. (2) Gross motor function in terms of crawling and kneeling in children with CP.

Joint Angular Kinematics and Gross Motor Function in Typically Developing Healthy Children

OBJECTIVE

The aim of this study was to establish the interactions between joint angular kinematics and gross motor function in typically developing healthy Ghanaian children.

METHODS

A descriptive cross-sectional study design was employed. A total of 150 (69 (46.0%), 3.25 ± 0.08-year-old boys and 81 (54.0%), 3.25 ± 0.06-year-old girls) 2-4-year-old children were recruited. Joint angular kinematic variables [left hip flexion (LHF), left hip extension (LHE), right hip flexion (RHF), left knee flexion (LKF), right hip extension (RHE), left knee extension (LKE), right knee flexion (RKF), left ankle dorsi-flexion (LADF), right knee extension (RKE), right ankle plantar flexion (RAPF), left ankle plantar flexion (LAPF), and right ankle dorsi-flexion (RADF)] and gross motor function (lying and rolling, sitting, crawling and kneeling, standing, and walking, running, and jumping) were measured with standard scales.

RESULTS

The correlations between lying and rolling vs. RHE (r = 0.221; p-value < 0.01), LKE (r = -0.267; p-value < 0.01), LAPF (r = 0.264; p-value < 0.01), and RADF (r = 0.240; p-value < 0.01); crawling and kneeling vs. LKE (r = 0.196; p-value < 0.05) and RADF (r = 0.188; p-value < 0.05); and walking, running, and jumping vs. LKE (r = -0.214; p-value < 0.01) and RADF (r = -0.207; p-value < 0.05) were significant.

CONCLUSIONS

There was a negative correlation between joint angular kinematics and total gross motor function in this sampled population. Typically, developing healthy children should be exposed to a range of motion, flexibility, and active transportation programs for optimal active lifestyles and improvements in gross motor skills.

The comparison of gait disorders among different motor subtypes in Parkinson's disease patients during the early and middle stages

Background and Purpose

There is a scarcity of quantitative research on gait differences among patients with different motor subtypes of Parkinson's disease (PD), especially during the early and middle stages of the condition. The purpose of this study is to describe the gait characteristics of PD with different motor subtypes in the early and middle stages and to identify the most sensitive indicators of gait impairment.

Methods

General information, including age, gender, disease duration, levodopa equivalent daily dose (LEDD), and falls, was collected. Motor and non-motor symptoms of PD were assessed using multiple scales. Patients' walking function and lower limb joint movement ability were analyzed using a 3D gait analysis system.

Results

The study included 64 patients with early and middle-stage PD, of whom 33 were classified as the TD subtype, 24 were classified as the PIGD subtype, and 7 were classified as the Mixed subtype. In addition, 5 healthy subjects were included in the evaluation as healthy controls. The PIGD patients have significantly higher LEDD (431.08 ± 250.90 mg vs. 302.08 ± 164.64 mg, p = 0.034) and a higher number of falls (0.29 vs. 0.00, p = 0.018) than the TD patients. The overall gait disturbances and motor and non-motor symptoms did not exhibit significant differences between TD and PIGD patients. However, the decrease in GDI (β = -0.730 vs. β = -0.235, p = 0.043) and hip flexion and extension range (β = -0.533 vs. β = -0.470, p < 0.001) was more pronounced in PIGD patients compared to TD patients as the MDS-UPDRS Ⅲ score increased.

Conclusion

There is no significant difference in gait severity between patients with TD and PIGD subtypes during the early and middle stages of PD. However, PIGD patients exhibit a more rapid progression of gait impairment than TD, particularly affecting hip mobility.

Motor and functional characteristics in school-age survivors of congenital diaphragmatic hernia: a cross-sectional observational study

BACKGROUND

Children born with congenital diaphragmatic hernia (CDH) are at risk of poor developmental outcomes. This study aimed to clarify the motor and functional characteristics of school-age CDH survivors and identify perinatal factors associated with motor function deficits.

METHODS

Motor function was comprehensively assessed in CDH survivors aged 6-10 years (CDH group, n=24) and in age- and sex-matched controls (n=72). Assessments included physical activity time, grip strength, the five times sit-to-stand test, one-leg standing time, 6 min walking distance and gait ability using a three-dimensional gait analysis. In the CDH group, correlations between perinatal factors and motor function outcomes were analysed.

RESULTS

In the CDH group, all children had isolated CDH. Three were extracorporeal membrane oxygenation (ECMO) treated and 21 were non-ECMO treated. The CDH group exhibited shorter stature, lower weight and reduced physical activity time than the controls. They also showed significantly lower grip strength, longer five times sit-to-stand test time, shorter one-leg standing time and decreased 6 min walking distance. No significant differences were found between the two groups regarding walking speed, step length or Gait Deviation Index. Within the CDH group, a higher observed-to-expected lung area-to-head circumference ratio (o/e LHR) was positively correlated with better grip strength.

CONCLUSIONS

School-age survivors of CDH are at risk of impaired motor function. Particularly, grip strength measurement is crucial for those born with a low o/e LHR. Implementing follow-up and intervention programmes focused on improving limb muscle strength, balance, and endurance, and promoting adequate physical activity may enhance motor function.

Inertial-Based Dual-Task Gait Normalcy Index at Turns: A Potential Novel Gait Biomarker for Early-Stage Parkinson's Disease

As one of the main motor indicators of Parkinson's disease (PD), postural instability and gait disorder (PIGD) might manifest in various but subtle symptoms at early stage resulting in relatively high misdiagnosis rate. Quantitative gait assessment under dual task or complex motor task (i.e., turning) may contribute to better understanding of PIGD and provide a better diagnostic indicator of early-stage PD. However, few studies have explored gait deviation evaluation algorithms under a complex dual task that reflect disease specificity. In this work, we proposed a novel inertial-based gait normalcy index (GNI) based on inertial-based quantitative gait assessment model to characterize the overall gait performance during both straight walking and turning with or without serial-3 subtraction task. The factor of group and task on the GNI variable was investigated and the feasibility of GNI to improve early-stage PD diagnostic performance was validated. The experimental results showed that the task paradigm is a significant factor on GNI performance where the dual-task GNI at turn had the best discriminating ability between early PD and HC (AUC =0.992) and was significantly correlated with UPDRS III (r =0.81), MMSE(r =0.57) and Mini-BEST(r =0.65). We also observed that the turning-based GNI has larger effect size compared to clinical scales, demonstrating that GNI during turning can reflect the changes of functional mobility in rehabilitation for the early PD. Our work offers an innovative and potential gait biomarker for early-stage PD diagnostics and provides a new perspective into gait performance of complex dual task and its application in early PD.

Maintained gait in persons with arthrogryposis from childhood to adulthood

BACKGROUND

Individuals with arthrogryposis multiplex congenita (AMC) exhibit a range of modes of ambulation, from walking independently to requiring a wheelchair. Presence of joint contractures and muscle strength plays a crucial role, and, in some patients, orthoses are necessary to facilitate or enable walking.

METHODS

Gait was assessed with a three-dimensional (3D) gait analysis, calculated as a gait deviation index (GDI) of nine kinematic variables, and compared between childhood and adulthood.

RESULTS

A total of 12 persons, 8 with community and 4 with household ambulation, who had undergone a 3D gait analysis in childhood (CH) and as an adult (follow-up, FU) at the same gait laboratory were enrolled in the study. At the FU, three, five, and four participants respectively were categorized based on need of joint stabilization while walking as AMC1 using knee-ankle-orthoses (KAFOs) with locked knee joints, AMC2 using KAFOs with free-articulating knee joint or ankle-foot-orthoses (AFOs) and AMC3 using insoles or shoes. Two participants in AMC2 had changed from AFOs to insoles or shoes between CH and FU. There were no differences in joint contractures between the AMC groups at CH or FU. Two participants had orthopaedic surgery between CH and FU. The GDI of the leg with the lowest GDI score at CH vs FU was median [min, max] 55.67 [41.79, 65.14] vs 48.4 [42.67, 56.30] (p = 1.000) in AMC1, 81.25 [59.42, 84.12] vs 68.96 [47.68, 70.33] (p = 0.043) in AMC2, and 73.15 [43.94, 91.72] vs 73.46 [50.82, 75.24] (p = 1.000) in AMC3. Time and distance parameters of cadence, walking speed, step length, and step width did not differ between the CH and FU, nor were there differences in satisfaction with the device or the service at the FU.

CONCLUSION

A difference in the GDI was found in one of the AMC groups between childhood and adulthood that could not be explained by factors such as contractures or muscle strength. This study reflects that gait is maintained in ambulating persons with AMC who were offered an orthosis program that has been available from childhood into adulthood.

Quality, kinematics, and self-reported comfort of gait during body weight support in young adults with gait impairments - A cross-sectional study

BACKGROUND

Body weight support (BWS) technologies offer effective gait training for individuals with neurological gait impairments. However, varying dynamic BWS levels may impact specific gait kinematics, potentially introducing maladaptive movement patterns.

AIM

To investigate the acute impact of different levels of dynamically modulated BWS during overground walking at a self-selected speed on gait quality, kinematic gait patterns, and self-reported gait comfort in young adults with gait impairments.

METHODS

Three-dimensional gait analysis was conducted on 18 individuals with neurological gait impairments during overground walking with 0, 10, 20, 30, 40, and 50 % BWS using a novel robotic unloading device. Gait quality, expressed as Gait Deviation Index (GDI), lower limb joint kinematics, and spatiotemporal parameters were obtained for one representative stride per participant at each BWS level. Gait comfort was reported on a visual analogue scale (VAS) for each unload level. Time-continuous data were analysed using statistical parametric mapping; discrete data were compared between BWS levels using paired t-tests.

RESULTS

Compared with habitual gait (0 % BWS), GDI was unaltered with increasing BWS. The relative shapes of kinematic trajectories were largely unaffected, with minor reductions in amplitude and a limited impact on temporal effects with increasing BWS. Most spatiotemporal parameters were unaltered by changes in BWS, although negative impacts on walking speed, cadence, and step length emerged at 40 % BWS, with a more pronounced impact at 50 % BWS. Gait comfort improved at 20-30 % BWS by up to 20 mm on a 0-100 mm VAS.

CONCLUSION

Participants maintained habitual (0 % BWS) biomechanical gait patterns with 10-30 % BWS, experiencing increased gait comfort at 20-30 % BWS. Dynamically modulated BWS can be applied in task-specific gait training to offer vertical body support and increased comfort with little to no impact on biomechanical movement patterns.

Understanding muscle energy expenditure variations following selective dorsal rhizotomy while maintaining consistent energy consumption

Increased energy demands during walking is a recurrent issue for children with cerebral palsy (CP). Given the high incidence of spasticity in these children, several authors have analyzed the impact of selective dorsal rhizotomy (SDR) on energy consumption during walking, typically showing minimal changes post-SDR. To further investigate muscle behavior after SDR, our recent study identified alterations in individual muscle force production without changes in muscle activation during walking. This suggests that children with CP may experience a more favorable dynamic scenario for developing sub-maximal muscle forces after SDR, due to reduced spasticity unlocking joint movement. Thus, this raises questions about whether these changes in muscle force production could lead to increased muscle energy expenditure, which may not be fully reflected in overall energy consumption. The aim of this study was to build upon our previous research on muscle behavior after SDR by evaluating the surgery's impact on individual muscle energy expenditure during walking, using neuro-musculoskeletal simulations. Our research compared two matched groups comprising 81 children with CP: those who underwent SDR and those who did not. Our results showed no significant changes in overall energy consumption or total muscle energy expenditure in either group post-surgery. However, we observed alterations in individual muscle energy expenditure during walking in the SDR group compared to children with CP who received other treatments. Compared to the findings from our first study, we observed a significant decrease in spasticity of the plantarflexor muscles, an improvement in ankle joint angle, an increase in individual muscle force during walking, and no statistically significant changes in energy expenditure of the gastrocnemius and soleus muscles post-SDR. These findings, along with the absence of changes in muscle activity post-SDR, support the hypothesis that muscle tissue alterations contribute to energy deficits observed in children with CP during walking.

Assessment of ambulation functions through kinematic analysis in individuals with stroke: a systematic review

INTRODUCTION

Although kinematic assessments for stroke-induced lower limb impairments offer a promising alternative to conventional scale evaluations, interpreting high-dimensional kinematic data remains challenging due to numerous metrics reported in past studies. This study aimed to provide an exhaustive overview of existing studies using kinematics data to assess the gait impairments in individuals with stroke, along with examining their clinimetric properties for future clinical applications.

EVIDENCE ACQUISITION

A systematic search was conducted across PubMed (08/2024), Scopus (08/2024), Web of Science (08/2024), CINAHL (08/2024), EMBASE (08/2024), and IEEE (08/2024). We included articles that recruited individuals over 18 years old with stroke and utilized motion capture technologies to evaluate lower limb kinematics. Similar metrics were consolidated in the analysis, and the COSMIN Risk of Bias Checklist was used to evaluate the methodological quality of studies investigating the clinimetric properties of kinematic metrics. Convergent validity of metrics was evaluated by examining their association with the Fugl-Meyer scale of lower limbs and walking speed. Moreover, the GRADE approach was used to rate the quality of evidence.

EVIDENCE SYNTHESIS

A total of 383 studies were classified into 10 categories. Seven studies on metric reliability were rated high for methodological quality. Metrics with satisfactory reliability included spatiotemporal, spatial metrics, and a data-driven score. Six studies with high methodological quality assessed convergent validity. The dynamic gait index, angular component of the coefficient of correspondence (ACC), change in cadence, stride length, and hip range of motion showed satisfactory validity. Among the 13 studies, 12 studies were rated as moderate quality of evidence using the GRADE approach.

CONCLUSIONS

There are significant variations in measurements across studies, and high-quality studies evaluating clinimetric properties are scarce. For a more standardized evidence-based approach to kinematic lower limb assessment, further high-quality research validating these assessments' clinimetric properties is essential.

Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke

BACKGROUND

Biomechanical gait impairments, such as reduced paretic propulsion, are common post-stroke. Studies have used biofeedback to increase paretic propulsion and reduce propulsion asymmetry, but it is unclear if these changes impact overall gait asymmetry. There is an implicit assumption that reducing propulsion asymmetry will improve overall gait symmetry, as paretic propulsion has been related to numerous biomechanical impairments. However, no work has investigated the impact of reducing propulsion asymmetry on overall gait asymmetry. We aimed to understand how within-session changes in propulsion asymmetry affect overall gait asymmetry in individuals post-stroke, operationalized as the combined gait asymmetry metric (CGAM). We hypothesized that decreasing propulsion asymmetry would reduce CGAM.

METHODS

Participants completed twenty minutes of biofeedback training designed to increase paretic propulsion. We calculated the change in propulsion asymmetry magnitude (Δ|PA|) and the change in CGAM (ΔCGAM) during biofeedback relative to baseline. Then, we fit a robust linear mixed-effects model with ΔCGAM as the outcome and a fixed effect for Δ|PA|.

RESULTS

We found a positive association between Δ|PA| and ΔCGAM (β = 2.6, p = 0.002). The average Δ|PA| was -0.09, suggesting that, on average, we would expect a CGAM change of 0.2, which is 0.5% of the average baseline CGAM value.

CONCLUSIONS

Reducing propulsive asymmetry using biofeedback is unlikely to produce substantial reductions in overall gait asymmetry, suggesting that biofeedback-based approaches to reduce propulsion asymmetry may need to be combined with other interventions to improve overall gait asymmetry.

CLINICAL TRIAL REGISTRATION

NCT04411303.

Multimodal fuzzy logic-based gait evaluation system for assessing children with cerebral palsy

Gait analysis is crucial for identifying functional deviations from the normal gait cycle and is essential for the individualized treatment of motor disorders such as cerebral palsy (CP). The primary contribution of this study is the introduction of a multimodal fuzzy logic system-based gait index (FLS-GIS), designed to provide numerical scores for gait patterns in both healthy children and those with CP, before and after surgery. This study examines and evaluates the surgical outcomes in children with CP who have undergone Achilles tendon lengthening. The FLS-GIS utilizes hierarchical feature fusion and fuzzy logic models to systematically evaluate and score gait patterns, focusing on spatial and temporal features across the hip, knee, and ankle joints. The two FLS types-1 (FLS-GIS-T1) and type-2 (FLS-GIS-T2) indices, respectively, were implemented to comprehensively study gait profiles. Starting with the gait parameters of all subjects, the changes in gait parameters in post-surgery children reflect significant improvements in gait dynamics, bringing walking patterns in CP children closer to those of their typically healthy peers. Both FLS-GIS-T1 and FLS-GIS-T2 demonstrated significant improvements in post-surgery evaluations compared to pre-surgery assessments, with p values < 0.05 and < 0.001, respectively, when compared to traditional indices. The proposed FLS-based index offers clinicians a robust and standardized gait evaluation tool, characterized by a fixed range of values, enabling consistent assessment across various gait conditions.

Gait asymmetry assessment through Eigen-Gait components on dissimilarity maps

Motor impairments caused by neurological diseases have an important impact on gait, particularly on the coordination between left and right lower limbs. Deviation from normal gait is often measured to assess this impact on gross motor functions, and to monitor the progress of patients during rehabilitation. The concept of gait dissimilarity map is introduced to represent bilateral raw gait signals, while accounting for their respective spatiotemporal dynamics. A model of gait for the healthy population is constructed through Singular Value Decomposition, considering both lower limbs. The obtained eigenvectors synthesize the symmetry present in gait. Then, by projecting the dissimilarity maps of patients with gait disorders on the space formed by such eigenvectors, we compute their associated Eigen-Gait Asymmetry Index (EGAI) relatively to an average normal gait reference vector. For the knee joint in the sagittal plane, EGAI values of patients are higher (9.73 ±2.16) than those of healthy controls (3.86 ±0.9), reflecting the asymmetry induced by neurological diseases. Patients with hemiparesis show the highest EGAI (10.4 ±1.8), followed by patients with paraparesis (9.9 ±1.8) and patients with tetraparesis (8.6 ±2.5). Indeed, patients with hemiparesis show a more asymmetrical gait since only one side of the body is affected. EGAI for hip, ankle and pelvis joints in the sagittal plane show similar trends. Our innovative method characterizes bilateral gait, enriching traditional unilateral assessments. Our method yields a comprehensive score reflecting both asymmetry and gait deviations, aiming to provide clinicians with an effective and precise monitoring tool.

A novel gait quality measure for characterizing pathological gait based on Hidden Markov Models

This study addresses the characterization of normal gait and pathological deviations caused by neurological diseases. We focus on the angular knee kinematics in the sagittal plane and we propose to exploit Hidden Markov Models to build a statistical model of normal gait. Such model provides a log-likelihood score that quantifies gait quality. Hence allowing to assess deviations of pathological cycles from normal gait. Our approach allows a refined characterization of motor impairments of three different patients' groups. In particular, it detects the affected lower limb in Hemiparetic patients. Comparatively to the Gait Variable Score and a Dynamic Time Warping-based metric, our results show that our statistical method is more effective for finely quantifying pathological deviations. Finally, we show the potential use of our methodology to assess therapeutic impacts during gait rehabilitation, which represents a promising avenue for improving patient care.

Comparison of gait deviation index (GDI) and gait variability index (GVI) measured by marker-based and markerless motion capture systems in children with cerebral palsy (CP)

BACKGROUND

The Gait Deviation Index (GDI) is a metric clinicians use to assess overall gait pathology in children with cerebral palsy (CP) by comparing kinematic data to a normative sample. The Gait Variability Index (GVI) is a related metric that quantifies the variability in spatio-temporal variables during gait. The GDI and GVI have been verified using marker-based motion capture approaches, but video-based markerless motion capture has not been compared using these tools in children with CP.

RESEARCH QUESTION

Do GDI and GVI scores differ when measured using markerlessTheia3D and a marker-based approach between the more and less affected legs in children with CP?

METHODS

Fifteen children with CP (GMFCS levels I-IV) and 24 typically developing children aged 6-18 years were recruited for this study. Overground walking was performed at a self-selected pace while the pelvis and lower limb kinematics were simultaneously recorded using both motion capture systems. Differences in GDI and GVI scores when considering the effect of system and limb impairment were analyzed using two-way repeated-measures ANOVAs.

RESULTS

GDI scores were 6.9 points lower (p < 0.05) when measured using Theia3D compared to the marker-based approach and 6.8 points lower (p < 0.05) in the more affected limbs than in the less affected limbs. These GDI score differences are considered clinically significant. No differences were identified in GVI scores between systems or limb impairment. Differences in kinematic measurements were found in children with CP, including pelvic tilt, hip flexion/extension, hip rotation, and foot progression angle, where root mean square differences between systems exceeded 10°.

SIGNIFICANCE

Theia3D can adequately measure variability in spatio-temporal gait parameters for quantifying GVI scores in children with CP compared to the marker-based approach. However, caution is needed when quantifying lower limb kinematics and interpreting GDI and GVI scores using Theia3D in children with CP.

Within-session propulsion asymmetry changes have a limited effect on gait asymmetry post-stroke

Biomechanical gait impairments, such as reduced paretic propulsion, are common post-stroke. Studies have used biofeedback to increase paretic propulsion and reduce propulsion asymmetry, but it is unclear if these changes impact overall gait asymmetry. There is an implicit assumption that reducing propulsion asymmetry will improve overall gait symmetry, as paretic propulsion has been related to numerous biomechanical impairments. However, no work has investigated the impact of reducing propulsion asymmetry on overall gait asymmetry. We aimed to understand how within-session changes in propulsion asymmetry affect overall gait asymmetry, operationalized as the combined gait asymmetry metric (CGAM). We hypothesized that decreasing propulsion asymmetry would reduce CGAM. Methods. Participants completed twenty minutes of biofeedback training designed to increase paretic propulsion. We calculated the change in propulsion asymmetry magnitude ( Δ | PA | ) and the change in CGAM (ΔCGAM) during biofeedback relative to baseline. Then, we fit a robust linear mixed-effects model with ΔCGAM as the outcome and a fixed effect for Δ | PA | . Results. We found a positive association between Δ | PA | and ΔCGAM (β = 2.6, p = 0.002). The average Δ | PA | was - 0.09, suggesting that, on average, we would expect a CGAM change of 0.2, which is 0.5% of the average baseline CGAM value. Conclusions. Reducing propulsive asymmetry using biofeedback is unlikely to produce substantial reductions in overall gait asymmetry, suggesting that biofeedback-based approaches to reduce propulsion asymmetry may need to be combined with other interventions to improve overall gait asymmetry. Clinical Trial Registration. NCT04411303.

A research protocol to study the critical time window for rehabilitation after incomplete spinal cord injury: early vs. late locomotor training

Spinal cord injury (SCI) often results in severe motor and sensory deficits, leading to significant disability. Preclinical studies and retrospective studies suggest that a critical window of enhanced neuroplasticity may exist immediately after SCI, during which therapeutic interventions could yield greater functional improvements. The impact of time interval since SCI on efficacy of rehabilitation has not been directly assessed and is the focus of this clinical trial. This study will compare the efficacy of high-intensity gait training, initiated at different time intervals post-injury, on walking performance in individuals with SCI. We hypothesize that early intervention will yield the greatest improvements in walking ability and community ambulation, compared to training initiated at 3 or 6 months after SCI, or standard of care. This randomized, multi-site clinical trial will enroll 108 participants with acute, traumatic SCI. Participants will be randomized to receive 20 h of high-intensity gait training that will be initiated either early (< 60 days post-SCI), sub-acute (3 months), chronic (6 months), or to a control group receiving standard of care. Primary outcomes include gait speed (10 m Walk Test) and walking endurance (6-Minute Walk Test). Secondary outcomes include daily step count via wearable sensors, lower extremity strength, and quality of life measures. Assessments will occur at baseline, pre/post-intervention, and at 3, 6, 9, and 12 months post-SCI. This study will provide insights into the optimal timing of rehabilitation post-SCI and could have profound effects on our approach to training individuals with SCI in the healthcare setting as well as long term recovery outcomes. Trial registration ClinicalTrials.gov NCT06176833 was completed on 12/11/2023.

A Prospective Study on Gait Impairment in Patients With Symptomatic Lumbar Canal Stenosis and Impact of Surgical Intervention on Gait Function

STUDY DESIGN

Prospective observational cohort study.

OBJECTIVE

To analyze the effect of decompression surgery on gait characteristics in patients with stenosis. Also, to test the hypothesis that patient-reported functional outcomes and gait parameters (spatiotemporal, kinetic, and kinematic measures) will improve postoperatively and achieve normal values when compared with matched healthy controls.

SUMMARY OF BACKGROUND DATA

Lumbar spinal stenosis is one of the leading causes of disability among elderly population. Gait impairment is one of the primary symptoms of degenerative conditions involving lumbar spine. Research suggests that decompressive surgery can positively influence gait parameters in patients with spinal stenosis. Studies have shown improvements in walking speed, stride length, and balance post-surgery.

METHODS

Thirty-two patients with single-level lumbar stenosis and 32 healthy volunteers were prospectively recruited. All patients underwent gait analysis preoperatively and 6 months postoperatively as per standard protocol. Spatiotemporal, kinematic, and kinetic parameters were analyzed. Stepwise linear regression models were used to detect significant relationships between changes in functional score (Visual Analogue Scale/Oswestry Disability Index) and gait parameters.

RESULTS

Significant improvement was noted in functional scores(P<0.05) 6 months post-surgery. Spatiotemporal (swing phase, mean velocity, cadence, stride length, step length, and step width) and kinetic parameters (hip, knee, and ankle power) were significantly better after surgery, reaching normal levels. Kinematic parameters significantly improved after surgery but did not reach normal levels when compared with controls. A significant correlation was found between changes in functional scores with changes in certain kinematic parameters (knee-power, ankle plantarflexion, swing time, peak ankle dorsiflexion in swing, peak-hip, and knee flexor moment).

CONCLUSION

Decompression surgery in lumbar stenosis produces improvement in gait parameters, pain scores, and functional outcomes that significantly improve gait posture and speed.

Multi-session adaptation to audiovisual and sensorimotor biofeedback is heterogeneous among adolescents with cerebral palsy

BACKGROUND

There is growing interest in the use of biofeedback-augmented gait training in cerebral palsy (CP). Audiovisual, sensorimotor, and immersive biofeedback paradigms are commonly used to elicit short-term gait improvements; however, outcomes remain variable. Because biofeedback training requires that individuals have the capacity to both adapt their gait in response to feedback and retain improvements across sessions, changes in either capacity may affect outcomes. Yet, neither has been explored extensively in CP.

METHODS

In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 years (12.5,15.26)) could adapt gait and retain improvements across four, 20-minute sessions using combined audiovisual and sensorimotor biofeedback. Both systems were designed to target plantarflexor activity. Audiovisual biofeedback displayed real-time soleus activity and sensorimotor biofeedback was provided using a bilateral resistive ankle exoskeleton. We quantified the time-course of change in muscle activity within and across sessions and overground walking function before and after the four sessions.

RESULTS

All individuals were able to significantly increase soleus activity from baseline using multimodal biofeedback (p < 0.031) but demonstrated heterogeneous adaptation strategies. In-session soleus adaptation had a moderate positive correlation with short-term retention of the adapted gait patterns (0.40 ≤ ρ ≤ 0.81), but generally weak correlations with baseline walking function (GMFCS Level) and motor control complexity (ρ ≤ 0.43). The latter indicates that adaptation capacity may be a critical and unique metric underlying response to biofeedback. Notably, in-session gains did not correspond to significant improvements in overground walking function (p > 0.11).

CONCLUSIONS

This work suggests that individuals with CP have the capacity to adapt their gait using biofeedback, but responses are highly variable. Characterizing the factors driving adaptation to biofeedback may be a promising avenue to understand the heterogeneity of existing biofeedback training outcomes and inform future system optimization for integration into clinical care.

Efficacy of acupuncture combined with mirror therapy in the treatment of post-stroke limb movement disorders: a systematic review and meta-analysis of randomised controlled trials

Objective

To investigate whether the combination of acupuncture and mirror therapy can improve motor impairment in stroke patients.

Design

A systematic review and meta-analysis of randomised controlled trials.

Data sources

CNKI, Wanfang, PubMed, Embase, Vip, web of since, Cochrane database and CBM database.

Eligibility criteria for selecting studies

The included randomized controlled trials compared the efficacy of acupuncture therapy (AT) combined with mirror therapy (MT) against AT, MT, and conventional rehabilitation therapy on limb motor impairment in stroke patients, with independent data extraction and study quality assessment conducted. A META analysis using fixed-effect and random-effect models was performed to calculate the mean difference (MD) in motor scores and the Total effective rate RR (Risk ratio) between the AT combined with MT group and the control group.

Main outcome measures

The Fugl-Meyer Assessment (FMA) for motor function includes the FMA-T (total FMA), FMA-UE (upper extremity FMA), and FMA-L (lower extremity FMA).

Results

A total of 42 randomized controlled trials were included, involving 3,340 patients with post-stroke motor impairment. AT combined with MT was more favorable for FMA-UE (mean difference [MD] = 6.67, 95% CI [5.60-7.93], Z = 11.42, P < 0.0001), FMA-L [MD = 3.37, 95% CI (2.99-3.76), Z = 17.31, P < 0.001], and FMA-T [MD = 6.84, 95% CI (5.92-7.77), Z = 14.48, P < 0.001]. The combined AT and MT treatment was more favorable for the Modified Barthel Index (MBI) score in post-stroke motor impairment [MD = 10.82, 95% CI (8.52-13.12), Z = 9.22, P < 0.001]. AT combined with MT was more favorable for the Modified Ashworth Scale (MAS) [MD = -0.34, 95% CI (-0.66 to -0.03), Z = 14.48, P < 0.001]. AT combined with MT was more favorable for the Total effective rate in treating post-stroke motor impairment (relative risk = 1.27, 95% confidence interval [CI] [1.19-1.37], Z = 6.54, P < 0.001).

Conclusions

AT combined with MT can effectively improve patients' motor function and daily living abilities.

Systematic Review Registration

PROSPERO, identifier, CRD42024559992.

Effect of adapted dance program on gait in adults with cerebral palsy: a pilot study

Background

The gait function in adults with cerebral palsy (CP) deteriorates rapidly with age. Dance has been used as an effective intervention to improve balance, postural control, and gait. This study aimed to investigate the feasibility and effects of an adapted dance program (ADP) on the gait in adults with CP. The ADP, which consists of floor and barre workouts, was designed to be adapted for individuals with CP.

Method

Ten female adults with spastic diplegic CP (mean age 52.3 ± 6.34, Gross Motor Function Classification System level II) participated in this study. Outcome measures, examined using 3D gait analysis, included spatiotemporal gait parameters and the Gait Deviation Index (GDI) based on nine kinematic variables in all planes of motion. To assess feasibility, we conducted post-questionnaires and a group interview. The ADP, each lasting 90 min, was held twice per week for 12 weeks.

Results

A statistically significant improvement was observed in GDI (Δ5.74 points, p = 0.014), with a large effect size (d = 0.76). Foot off (Δ-0.72%), first double support (Δ-0.2%), second double support (Δ1.5%), and single support (Δ0.64%) showed no significant differences. Step length (Δ1.48 cm), cadence (Δ3.95 steps/min), and walking speed (Δ6.41 cm/s) tended to increase, though the differences were not statistically significant. Participants expressed high levels of physical and emotional satisfaction, suggesting a need for early intervention.

Conclusion

The ADP may improve gait patterns in adults with spastic diplegic CP. The feasibility results indicated that the ADP is suitable for adults with spastic diplegic CP. This study provides evidence for improvement in gait patterns through dance, which has not been reported in previous dance studies on individuals with CP, offering additional information on the benefits of dance.

Improvement of the gait deviation index for spinal cord injury to broaden its applicability: the reduced gait deviation index for spinal cord injury (rSCI-GDI)

Background

The SCI-GDI is an accurate and effective metric to summarize gait kinematics in adults with SCI. It is usually computed with the information registered with a photogrammetry system because it requires accurate information of pelvic and hip movement in the three anatomic planes, which is hard to record with simpler systems. Additionally, due to being developed from the GDI, the SCI-GDI is built upon nine joint movements selected for a pediatric population with cerebral palsy, for which the GDI was originally developed, but those nine movements are not necessarily as meaningful for adults with SCI. Nevertheless, pelvic movement and hip rotation have been proven to have low reliability even when acquired with gold-standard photogrammetry systems. Additionally, the use of photogrammetry is limited in real-life scenarios and when used with rehabilitation technologies, which limits the use of the SCI-GDI to evaluate gait in alternative scenarios to gait laboratories and to evaluate technologies for gait assistance. This research aimed to improve the SCI-GDI to broaden its applicability beyond the use of photogrammetry.

Methods

An exploration of the mathematical relevance of each joint movement included in the original GDI for the performance of the metric is performed. Considering the results obtained and the clinical relevance of each of the 9 joints used to compute the SCI-GDI in the gait pattern of the SCI population, a more adaptable SCI-GDI is proposed using four joint movements that can be precisely captured with simpler systems than photogrammetry: sagittal planes of hip, knee and ankle and hip abduction/adduction.

Results

The reduced SCI-GDI (rSCI-GDI) effectively represents gait variability of adults with SCI as does the SCI-GDI, while providing more generalizable results and equivalent or stronger correlations with clinical tests validated in the population. During the derivation of the improved index, it was demonstrated that pelvic movements, hip rotation, and foot progression angle introduce high variability to the dataset of gait patterns of the adult population with SCI, but they have low relevance to characterize gait kinematics of this population. The rSCI-GDI can be calculated using the 14-feature vectorial basis included in the electronic addendum provided.

Neuromuscular impairments of cerebral palsy: contributions to gait abnormalities and implications for treatment

Identification of neuromuscular impairments in cerebral palsy (CP) is essential to providing effective treatment. However, clinical recognition of neuromuscular impairments in CP and their contribution to gait abnormalities is limited, resulting in suboptimal treatment outcomes. While CP is the most common childhood movement disorder, clinical evaluations often do not accurately identify and delineate the primary neuromuscular and secondary musculoskeletal impairments or their specific impact on mobility. Here we discuss the primary neuromuscular impairments of CP that arise from early brain injury and the progressive secondary musculoskeletal impairments, with a focus on spastic CP, the most common form of CP. Spastic CP is characterized by four primary interrelated neuromuscular impairments: 1. muscle weakness, 2. short muscle-tendon units due to slow muscle growth relative to skeletal growth, 3. muscle spasticity characterized by increased sensitivity to stretch, and 4. impaired selective motor control including flexor and extensor muscle synergies. Specific gait events are affected by the four primary neuromuscular impairments of spastic CP and their delineation can improve evaluation to guide targeted treatment, prevent deformities and improve mobility. Emerging information on neural correlates of neuromuscular impairments in CP provides the clinician with a more complete context with which to evaluate and develop effective treatment plans. Specifically, addressing the primary neuromuscular impairments and reducing secondary musculoskeletal impairments are important treatment goals. This perspective on neuromuscular mechanisms underlying gait abnormalities in spastic CP aims to inform clinical evaluation of CP, focus treatment more strategically, and guide research priorities to provide targeted treatments for CP.

Position paper on how technology for human motion analysis and relevant clinical applications have evolved over the past decades: Striking a balance between accuracy and convenience

BACKGROUND

Over the past decades, tremendous technological advances have emerged in human motion analysis (HMA).

RESEARCH QUESTION

How has technology for analysing human motion evolved over the past decades, and what clinical applications has it enabled?

METHODS

The literature on HMA has been extensively reviewed, focusing on three main approaches: Fully-Instrumented Gait Analysis (FGA), Wearable Sensor Analysis (WSA), and Deep-Learning Video Analysis (DVA), considering both technical and clinical aspects.

RESULTS

FGA techniques relying on data collected using stereophotogrammetric systems, force plates, and electromyographic sensors have been dramatically improved providing highly accurate estimates of the biomechanics of motion. WSA techniques have been developed with the advances in data collection at home and in community settings. DVA techniques have emerged through artificial intelligence, which has marked the last decade. Some authors have considered WSA and DVA techniques as alternatives to "traditional" HMA techniques. They have suggested that WSA and DVA techniques are destined to replace FGA.

SIGNIFICANCE

We argue that FGA, WSA, and DVA complement each other and hence should be accounted as "synergistic" in the context of modern HMA and its clinical applications. We point out that DVA techniques are especially attractive as screening techniques, WSA methods enable data collection in the home and community for extensive periods of time, and FGA does maintain superior accuracy and should be the preferred technique when a complete and highly accurate biomechanical data is required. Accordingly, we envision that future clinical applications of HMA would favour screening patients using DVA in the outpatient setting. If deemed clinically appropriate, then WSA would be used to collect data in the home and community to derive relevant information. If accurate kinetic data is needed, then patients should be referred to specialized centres where an FGA system is available, together with medical imaging and thorough clinical assessments.

Body composition and motor function in children born large for gestational age at term

BACKGROUND

This cross-sectional study compared body composition and motor function between children who were born large for gestational age (LGA) and those born appropriate for gestational age (AGA) and to investigate the association between gait quality and other variables.

METHODS

Body composition was determined using a bioelectrical impedance analyzer. Motor functions were assessed using one-leg standing time, timed up-and-go test, five times sit-to-stand test, and three-dimensional gait analysis. We compared the results between two groups. We performed multiple regression analysis to evaluate the association between gait deviation index and variables of LGA, fat mass index, and motor functions (adjusted for age and sex).

RESULTS

Children aged 6-12 years who were born LGA at term (n = 23) and those who were born AGA at term (n = 147) were enrolled. The LGA group had a higher fat mass index (2.9 vs. 2.2, p = 0.006) and lower gait deviation index (91.4 vs. 95.4, p = 0.011) than the AGA group. On multiple regression analysis, gait deviation index was associated with being LGA and fat mass index.

CONCLUSIONS

In school-aged children who were born LGA, monitoring increased fat mass index and decreased gait deviation index could lessen the risk of metabolic syndrome and reduced gait function.

IMPACT

Children aged 6-12 years who were born large for gestational age (LGA) at term showed a higher fat mass index and lower gait deviation index than those who were born appropriate for gestational age at term. No significant differences in balance function or muscle strength were observed between groups. On multiple regression analysis, gait deviation index was associated with being LGA at birth and fat mass index. In school-aged children who were born LGA, monitoring increased fat mass index and decreased gait deviation index could lessen the risk of metabolic syndrome and reduced gait function.

Investigating the association between self-reported physical function, temporo-spatial parameters, walking kinematics and community-based ambulatory activity: Analysis of post-operative hip preservation patients

INTRODUCTION

Wearable sensors provide the ability to assess ambulatory activity in the community after hip preservation surgery (HPS). In combination with gait analysis and patient reported outcomes, more perspective on post-operative function is gained. The purpose of this study was to assess the relationship between self-reported function/activity, temporo-spatial parameters and walking kinematics to objectively measured ambulatory activity.

METHODS

Forty-nine participants (38 Females; age range 16-38 years) who were five years or more post-surgery and the following diagnoses were included: Acetabular Dysplasia (n=34), Femoroacetabular Impingement (n=12) and Legg-Calvé Perthes disease (n=3). Participants underwent 3D gait analysis and gait deviations were quantified using the Gait Deviation Index (GDI) and Gait Profile Score (GPS). Temporo-spatial parameters were also calculated. Self-reported pain/function and activity level were assessed via the Harris Hip Score (HHS) and UCLA Activity Scale (UCLA). Participants wore a StepWatch Activity Monitor in their community and the Intensity/Duration of ambulatory bouts were analyzed. Spearman correlation coefficients were run to assess the following relationships: in-lab walking measures, self-reported function/activity vs.community ambulatory activity.

RESULTS

There were no statistically significant correlations between HHS, UCLA or temporospatial parameters with ambulatory activity (p>0.05). Worsening gait deviations (GDI/GPS scores) correlated with daily total ambulatory time (ρ=0.284/-0.284, p<0.05), time spent in Short duration ambulatory bouts (ρ=-0.321/0.321, p<0.05) and the amount of time in Long duration ambulatory bouts (ρ=0.366/-0.366, p<0.05). The amount of time spent in Easy intensity/Short duration and Easy intensity/Long duration ambulatory bouts did have a weak correlation with the GDI and GPS (p<0.05).

CONCLUSIONS

In HPS patients after long-term follow up, ambulatory activity in the community did not correlate with patient reported outcomes but there was a weak correlation with the presence of gait deviations. Incorporating wearable sensors to assess community ambulatory bout intensity/duration, provides additional quantifiable measures into the overall function of patients following HPS.

Functional impairments in NBIA patients: Preliminary results

Neurodegeneration with brain iron accumulation (NBIA) is a heterogeneous group (genetically and phenotypically) of genetically determined disorders. Up to date there is no cure for this disease, so the applied treatments focus on symptoms control and palliative care. The main problems are delayed motor development, gait deterioration, postural instability, cognitive dysfunctions, abnormal muscle tone and many others. As gait and balance deficits are predominant features of NBIA patients this study aimed at the use of the objective, instrumented functional tests as well as functional assessment scales to assess their functional impairments. Twenty three NBIA patients recruited for the study underwent objective, instrumented gait analysis, balance assessment, pedobarography and functional evaluation with Gross Motor Function Measure (GMFM-88). The results showed high variability and heterogeneity of NBIA functional status (GMFM from 27.5 to 100.0), but also showed some differences in gait pattern between their types (p < 0.05 at the pelvis, hip and knee). We think that these results could help design objective assessment protocols in future clinical studies.

Phase-Based Gait Prediction after Botulinum Toxin Treatment Using Deep Learning

Gait disorders in neurological diseases are frequently associated with spasticity. Intramuscular injection of Botulinum Toxin Type A (BTX-A) can be used to treat spasticity. Providing optimal treatment with the highest possible benefit-risk ratio is a crucial consideration. This paper presents a novel approach for predicting knee and ankle kinematics after BTX-A treatment based on pre-treatment kinematics and treatment information. The proposed method is based on a Bidirectional Long Short-Term Memory (Bi-LSTM) deep learning architecture. Our study's objective is to investigate this approach's effectiveness in accurately predicting the kinematics of each phase of the gait cycle separately after BTX-A treatment. Two deep learning models are designed to incorporate categorical medical treatment data corresponding to the injected muscles: (1) within the hidden layers of the Bi-LSTM network, (2) through a gating mechanism. Since several muscles can be injected during the same session, the proposed architectures aim to model the interactions between the different treatment combinations. In this study, we conduct a comparative analysis of our prediction results with the current state of the art. The best results are obtained with the incorporation of the gating mechanism. The average prediction root mean squared error is 2.99° (R2 = 0.85) and 2.21° (R2 = 0.84) for the knee and the ankle kinematics, respectively. Our findings indicate that our approach outperforms the existing methods, yielding a significantly improved prediction accuracy.

Validation of IMU against optical reference and development of open-source pipeline: proof of concept case report in a participant with transfemoral amputation fitted with a Percutaneous Osseointegrated Implant

BACKGROUND

Systems that capture motion under laboratory conditions limit validity in real-world environments. Mobile motion capture solutions such as Inertial Measurement Units (IMUs) can progress our understanding of "real" human movement. IMU data must be validated in each application to interpret with clinical applicability; this is particularly true for diverse populations. Our IMU analysis method builds on the OpenSim IMU Inverse Kinematics toolkit integrating the Versatile Quaternion-based Filter and incorporates realistic constraints to the underlying biomechanical model. We validate our processing method against the reference standard optical motion capture in a case report with participants with transfemoral amputation fitted with a Percutaneous Osseointegrated Implant (POI) and without amputation walking over level ground. We hypothesis that by using this novel pipeline, we can validate IMU motion capture data, to a clinically acceptable degree.

RESULTS

Average RMSE (across all joints) between the two systems from the participant with a unilateral transfemoral amputation (TFA) on the amputated and the intact sides were 2.35° (IQR = 1.45°) and 3.59° (IQR = 2.00°) respectively. Equivalent results in the non-amputated participant were 2.26° (IQR = 1.08°). Joint level average RMSE between the two systems from the TFA ranged from 1.66° to 3.82° and from 1.21° to 5.46° in the non-amputated participant. In plane average RMSE between the two systems from the TFA ranged from 2.17° (coronal) to 3.91° (sagittal) and from 1.96° (transverse) to 2.32° (sagittal) in the non-amputated participant. Coefficients of Multiple Correlation (CMC) results between the two systems in the TFA ranged from 0.74 to > 0.99 and from 0.72 to > 0.99 in the non-amputated participant and resulted in 'excellent' similarity in each data set average, in every plane and at all joint levels. Normalized RMSE between the two systems from the TFA ranged from 3.40% (knee level) to 54.54% (pelvis level) and from 2.18% to 36.01% in the non-amputated participant.

CONCLUSIONS

We offer a modular processing pipeline that enables the addition of extra layers, facilitates changes to the underlying biomechanical model, and can accept raw IMU data from any vendor. We successfully validate the pipeline using data, for the first time, from a TFA participant using a POI and have proved our hypothesis.

MovePort: Multimodal Dataset of EMG, IMU, MoCap, and Insole Pressure for Analyzing Abnormal Movements and Postures in Rehabilitation Training

In most real world rehabilitation training, patients are trained to regain motion capabilities with the aid of functional/epidural electrical stimulation (FES/EES), under the support of gravity-assist systems to prevent falls. However, the lack of motion analysis dataset designed specifically for rehabilitation-related applications largely limits the conduct of pilot research. We provide an open access dataset, consisting of multimodal data collected via 16 electromyography (EMG) sensors, 6 inertial measurement unit (IMU) sensors, and 230 insole pressure sensors (IPS) per foot, together with a 26-sensor motion capture system, under different MOVEments and POstures for Rehabilitation Training (MovePort). Data were collected under diverse experimental paradigms. Twenty four participants first imitated multiple normal and abnormal body postures including (1) normal standing still, (2) leaning forward, (3) leaning back, and (4) half-squat, which in practical applications, can be detected as feedback to tune the parameters of FES/EES and gravity-assist systems to keep patients in a target body posture. Data under imitated abnormal gaits, e.g., (1) with legs raised higher under excessive electrical stimulation, and (2) with dragging legs under insufficient stimulation, were also collected. Data under normal gaits with low, medium and high speeds are also included. Pathological gait data from a subject with spastic paraplegia further increases the clinical value of our dataset. We also provide source codes to perform both intra- and inter-participant motion analyses of our dataset. We expect our dataset can provide a unique platform to promote collaboration among neurorehabilitation engineers.

Improvement of gait and balance function in chronic post-stroke patients induced by Lower Extremity - Constraint Induced Movement Therapy: a randomized controlled clinical trial

OBJECTIVE

To evaluate the effects of Lower Extremity - Constraint Induced Movement Therapy on gait function and balance in chronic hemiparetic patients.

METHODS

Randomized, controlled, single-blinded study. We recruited chronic post stroke patients and allocated them to Lower Extremity - Constraint Induced Movement Tharapy (LE-CIMT) or Control Group. The LE-CIMT group received this protocol 2.5 hour/day for 15 followed days, including: 1) intensive supervised training, 2) use of shaping as a strategy for motor training, and 3) application of a transfer package. The control group received conventional physiotherapy for 2.5 hours/day for 15 followed days. Outcomes were assessed at baseline, after the interventions, and after 6 months, through 6-minute walk test and Mini-Balance Evaluation Systems Test; 10-meter walk test, Timed Up and Go, 3-D gait analysis, and Lower Extremity - Motor Activity Log.

RESULTS

LE-CIMT was superior on the Assistance and confidence subscale of Lower Extremity - Motor Activity Log, Mini-BESTest and 6-minute walk test. The effect size for all outcomes was small when comparing both groups. LE-CIMT showed clinically significant differences in daily activities, balance, and gait capacity, with no clinically significant difference for spatiotemporal parameters.

CONCLUSION

The LE-CIMT protocol had positive outcomes on balance, performance, and confidence perception.

Clinical Feasibility of a Markerless Gait Analysis System

Background

The gait analysis method that has been used in clinical practice to date is an optical tracking system (OTS) using a marker, but a markerless gait analysis (MGA) system is being developed because of the expensive cost and complicated examination of the OTS. To apply this MGA clinically, a comparative study of the MGA and OTS methods is necessary. The purpose of this study was to evaluate the compatibility between the OTS and the MGA methods and to evaluate the usefulness of the MGA system in actual clinical settings.

Methods

From March 2021 to August 2021, 14 patients underwent gait analysis using the OTS and MGA system, and the spatiotemporal parameters and kinematic results obtained by the 2 methods were compared. To evaluate the practicality of the MGA system in an actual clinical setting, MGA was performed on 14 symptomatic children with idiopathic toe walking, who had been treated with a corrective cast, and the pre-cast and post-cast results were compared. For the OTS, the Motion Analysis Eagle system was used, and for MGA, DH Walk was used.

Results

The spatiotemporal parameters showed no significant difference between the OTS and MGA system. The joint angle graphs of the kinematics along the sagittal plane showed similar shapes as a whole, with particularly high correlations in the hip and knee (pelvis: 29.4%, hip joint: 96.7%, knee joint: 94.9%, and ankle joint: 68.5%). A quantified comparison using the CORrelation and Analysis (CORA) score also showed high similarity between the 2 methods. The MGA results of pre-cast application and post-cast removal for children with idiopathic toe walking showed a statistically significant improvement in ankle dorsiflexion after treatment (p < 0.001).

Conclusions

MGA showed a good correlation with the conventional OTS in terms of spatiotemporal parameters and kinematics. We demonstrated that ankle sagittal kinematics improved after treatment by corrective cast in children with idiopathic toe walking using the MGA method. Thus, after the improvement of a few limitations, the MGA system may soon be able to be clinically applied.

Machine learning applied to gait analysis data in cerebral palsy and stroke: A systematic review

BACKGROUND

Among neurological pathologies, cerebral palsy and stroke are the main contributors to walking disorders. Machine learning methods have been proposed in the recent literature to analyze gait data from these patients. However, machine learning methods still fail to translate effectively into clinical applications. This systematic review addressed the gaps hindering the use of machine learning data analysis in the clinical assessment of cerebral palsy and stroke patients.

RESEARCH QUESTION

What are the main challenges in transferring proposed machine learning methods to clinical applications?

METHODS

PubMed, Web of Science, Scopus, and IEEE databases were searched for relevant publications on machine learning methods applied to gait analysis data from stroke and cerebral palsy patients until February the 23rd, 2023. Information related to the suitability, feasibility, and reliability of the proposed methods for their effective translation to clinical use was extracted, and quality was assessed based on a set of predefined questions.

RESULTS

From 4120 resulting references, 63 met the inclusion criteria. Thirty-one studies used supervised, and 32 used unsupervised machine learning methods. Artificial neural networks and k-means clustering were the most used methods in each category. The lack of rationale for features and algorithm selection, the use of unrepresentative datasets, and the lack of clinical interpretability of the clustering outputs were the main factors hindering the clinical reliability and applicability of these methods.

SIGNIFICANCE

The literature offers numerous machine learning methods for clustering gait data from cerebral palsy and stroke patients. However, the clinical significance of the proposed methods is still lacking, limiting their translation to real-world applications. The design of future studies must take into account clinical question, dataset significance, feature and model selection, and interpretability of the results, given their criticality for clinical translation.

A Protocol for Comprehensive Analysis of Gait in Individuals with Incomplete Spinal Cord Injury

This is a protocol for comprehensive analysis of gait and affecting factors in individuals with incomplete paraplegia due to spinal cord injury (SCI). A SCI is a devastating event affecting both sensory and motor functions. Due to better care, the SCI population is changing, with a greater proportion retaining impaired ambulatory function. Optimizing ambulatory function after SCI remains challenging. To investigate factors influencing optimal ambulation, a multi-professional research project was grounded with expertise from clinical rehabilitation, neurophysiology, and biomechanical engineering from Karolinska Institutet, the Spinalis Unit at Aleris Rehab Station (Sweden's largest center for specialized neurorehabilitation), and the Promobilia MoveAbility Lab at KTH Royal Institute of Technology. Ambulatory adults with paraplegia will be consecutively invited to participate. Muscle strength, sensitivity, and spasticity will be assessed, and energy expenditure, 3D movements, and muscle function (EMG) during gait and submaximal contractions will be analyzed. Innovative computational modeling and data-driven analyses will be performed, including the identification of clusters of similar movement patterns among the heterogeneous population and analyses that study the link between complex sensorimotor function and movement performance. These results may help optimize ambulatory function for persons with SCI and decrease the risk of secondary conditions during gait with a life-long perspective.

Three-Dimensional Gait Analysis as a Biomarker for GTP Cyclohydrolase 1-Deficient Dopa-Responsive Dystonia

BACKGROUND

GTP-cyclohydrolase 1-deficient dopa-responsive dystonia (GTPCH1-deficient DRD) typically presents in childhood with dystonic posture of the lower extremities, gait impairment, and a significant response to levodopa. We performed three-dimensional gait analysis (3DGA) to quantitatively assess the gait characteristics and changes associated with levodopa treatment in patients with GTPCH1-deficient DRD.

METHODS

Three levodopa-treated patients with GTPCH1-deficient DRD underwent 3DGA twice, longitudinally. Changes were evaluated for cadence; gait speed; step length; gait deviation index; kinematic data of the pelvis, hip, knee, and ankle joints; and foot progression angle.

RESULTS

Levodopa treatment increased the cadence and gait speed in one of three patients and increased the gait deviation index in two of three patients. The kinematic data for each joint exhibited different characteristics, with some improvement observed in each of the three patients. There was consistent marked improvement in the abnormal foot progression angle; one patient had excessive external rotation of one foot, another had excessive bilateral internal rotation, and the other had excessive internal rotation of one foot and excessive external rotation of the opposite foot, all of which improved.

CONCLUSION

The 3DGA findings demonstrate that the gait pathology and recovery process in GTPCH1-deficient DRD vary from case to case. Changes in the foot progression angle and gait deviation index can enable the effects of treatment to be more easily evaluated.

Creating an autoencoder single summary metric to assess gait quality to compare surgical outcomes in children with cerebral palsy: The Shriners Gait Index (SGI)

Gait for individuals with movement disorders varies widely and the variability makes it difficult to assess outcomes of surgical and therapeutic interventions. Although specific joints can be assessed by fewer individual measures, gait depends on multiple parameters making an overall assessment metric difficult to determine. A holistic, summary measure can permit a standard comparison of progress throughout treatments and interventions, and permit more straightforward comparison across varied subjects. We propose a single summary metric (the Shriners Gait Index (SGI)) to represent the quality of gait using a deep learning autoencoder model, which helps to capture the nonlinear statistical relationships among a number of disparate gait metrics. We utilized gait data of 412 individuals under the age of 18 collected from the Motion Analysis Center (MAC) at the Shriners Children's - Chicago. The gait data includes a total of 114 features: temporo-spatial parameters (7), lower extremity kinematics (64), and lower extremity kinetics (43) which were min-max normalized. The developed SGI score captured more than 89% variance of all 144 features using subject-wise cross-validation. Such summary metrics holistically quantify an individual's gait which can then be used to assess the impact of therapeutic interventions. The machine learning approach utilized can be leveraged to create such metrics in a variety of contexts depending on the data available. We also utilized the SGI to compare overall changes to gait after surgery with the goal of improving mobility for individuals with gait disabilities such as Cerebral Palsy.

Global Sagittal Angle and T9-tilt seem to be the most clinically and functionally relevant global alignment parameters in patients with Adult Spinal Deformity

Introduction

Radiographic analysis is necessary for the assessment and the surgical planning in adults with spinal deformity (ASD). Restoration of global alignment is key to improving patient's quality of life. However, the large number of existing global alignment parameters can be confusing for surgeons.

Research question

To determine the most clinically and functionally relevant global alignment parameters in ASD.

Material and methods

ASD and controls underwent full body biplanar X-ray to calculate global alignment parameters: odontoid to hip axis angle (OD-HA), global sagittal angle (GSA), global tilt (GT), SVA, center of auditory meatus to hip axis (CAM-HA), SSA, T1-tilt and T9-tilt. All subjects filled HRQoL questionnaires: ODI, SF-36, VAS for pain and BDI (Beck's Depression Inventory). 3D gait analysis was performed to calculate kinematic and spatio-temporal parameters. A machine learning model predicted gait parameters and HRQoL scores from global alignment parameters.

Results

124 primary ASD and 47 controls were enrolled. T9 tilt predicted the most BDI (31%), hip flexion/extension during gait (36%), and double support time (39%). GSA predicted the most ODI (26%), thorax flexion/extension during gait (33%), and cadence (36%).

Discussion and conclusion

Among all global alignment parameters, GSA, evaluating both trunk shift and knee flexion, and T9 tilt, evaluating the shift of the center of mass, were the best predictors for most of HRQoL scores and gait kinematics. Therefore, we recommend using GSA and T9 tilt in clinical practice when evaluating ASD because they represent the most quality of life and functional kinematic of these patients.

Demonstrating the utility of Instrumented Gait Analysis in the treatment of children with cerebral palsy

BACKGROUND

Instrumented gait analysis (IGA) has been around for a long time but has never been shown to be useful for improving patient outcomes. In this study we demonstrate the potential utility of IGA by showing that machine learning models are better able to estimate treatment outcomes when they include both IGA and clinical (CLI) features compared to when they include CLI features alone.

DESIGN

We carried out a retrospective analysis of data from ambulatory children diagnosed with cerebral palsy who were seen at least twice at our gait analysis center. Individuals underwent a variety of treatments (including no treatment) between sequential gait analyses. We fit Bayesian Additive Regression Tree (BART) models that estimated outcomes for mean stance foot progression to demonstrate the approach. We built two models: one using CLI features only, and one using CLI and IGA features. We then compared the models' performance in detail. We performed similar, but less detailed, analyses for a number of other outcomes. All results were based on independent test data from a 70%/30% training/testing split.

RESULTS

The IGA model was more accurate than the CLI model for mean stance-phase foot progression outcomes (RMSEIGA = 11∘, RMSECLI = 13∘) and explained more than 1.5 × as much of the variance (R2IGA = .45, R2CLI = .28). The IGA model outperformed the CLI model for every level of treatment complexity, as measured by number of simultaneous surgeries. The IGA model also exhibited superior performance for estimating outcomes of mean stance-phase knee flexion, mean stance-phase ankle dorsiflexion, maximum swing-phase knee flexion, gait deviation index (GDI), and dimensionless speed.

INTERPRETATION

The results show that IGA has the potential to be useful in the treatment planning process for ambulatory children diagnosed with cerebral palsy. We propose that the results of machine learning outcome estimators-including estimates of uncertainty-become the primary IGA tool utilized in the clinical process, complementing the standard medical practice of conducting a through patient history and physical exam, eliciting patient goals, reviewing relevant imaging data, and so on.

Drop Foot With Posterior Tibialis Weakness Treated With Peroneus Longus Transfer in a Child: A Case Report

CASE

An 8-year-old girl with a history of acute flaccid paralysis presented with chronic valgus drop foot causing tripping and falling. Traditionally surgical correction of this deformity is accomplished by transferring the posterior tibialis tendon to enhance dorsiflexion. The authors describe a new technique which transfers the peroneus longus tendon to the dorsum of the foot in a patient with weakness of the posterior tibialis muscle. The patient's drop foot and gait were improved at the 22-month follow-up.

CONCLUSION

Successful transfer of the peroneus longus was accomplished with improved limb clearance during gait and coronal alignment in stance.

Selective dorsal rhizotomy: Analysis of two rootlet sectioning techniques

OBJECTIVE

To analyze and compare the efficacy of two selective dorsal rhizotomy (SDR) techniques with intraoperative neurophysiological monitoring, using instrumented three-dimensional gait analysis.

INTRODUCTION

SDR is a common, irreversible surgical treatment increasingly used to address gait disturbances in children with chronic non-progressive encephalopathy by reducing spasticity. Various techniques have been used, which mainly differ in the percentage of rootlets selected for sectioning. A greater proportion of rootlets sectioned leads to a more effective reduction of spasticity; however, there is a potential risk of unwanted neurological effects resulting from excessive deafferentation. While there is evidence of the short- and long-term benefits and complications of SDR, no studies have compared the effectiveness of each technique regarding gait function and preservation of the force-generating capacity of the muscles.

MATERIALS AND METHODS

Instrumented three-dimensional gait analysis was used to evaluate two groups of patients with spastic cerebral palsy treated by the same neurosurgeon in different time periods, initially using a classic technique (cutting 50% of the nerve rootlets) and subsequently a conservative technique (cutting no more than 33% the nerve rootlets).

RESULTS

In addition to an increase in knee joint range of motion (ROM), in children who underwent SDR with the conservative technique, a statistically significant increase (p = 0.04) in the net joint power developed by the ankle was observed. Patients who underwent SDR with the conservative technique developed a maximum net ankle joint power of 1.37 ± 0.61 (unit: W/BW), whereas those who were operated with the classic technique developed a maximum net ankle joint power of 0.98 ± 0.18 (unit: W/BW). The conservative group not only showed greater improvement in net ankle joint power but also demonstrated more significant enhancements in minimum knee flexion during the stance phase and knee extension at initial contact.

CONCLUSION

Our results show that both techniques led to a reduction in spasticity with a positive impact on the gait pattern. In addition, patients treated with the conservative technique were able to develop greater net ankle joint power, leading to a better scenario for rehabilitation and subsequent gait.

Three-Dimensional Instrumented Gait Analysis for Children With Cerebral Palsy: An Evidence-Based Clinical Practice Guideline

BACKGROUND

Children with cerebral palsy (CP) who walk have complex gait patterns and deviations often requiring physical therapy (PT)/medical/surgical interventions. Walking in children with CP can be assessed with 3-dimensional instrumented gait analysis (3D-IGA) providing kinematics (joint angles), kinetics (joint moments/powers), and muscle activity.

PURPOSE

This clinical practice guideline provides PTs, physicians, and associated clinicians involved in the care of children with CP, with 7 action statements on when and how 3D-IGA can inform clinical assessments and potential interventions. It links the action statement grades with specific levels of evidence based on a critical appraisal of the literature.

CONCLUSIONS

This clinical practice guideline addresses 3D-IGA's utility to inform surgical and non-surgical interventions, to identify gait deviations among segments/joints and planes and to evaluate the effectiveness of interventions. Best practice statements provide guidance for clinicians about the preferred characteristics of 3D-IGA laboratories including instrumentation, staffing, and reporting practices.Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A524.

Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases

Walking is an indispensable mode of transportation for human survival. Gait is a characteristic of walking. In the clinic, patients with different diseases exhibit different gait characteristics. Gait analysis describes the specific situation of human gait abnormalities by observing and studying the kinematics and dynamics of limbs and joints during human walking and depicting the corresponding geometric curves and values. In foot and ankle diseases, gait analysis can evaluate the degree and nature of gait abnormalities in patients and provide an important basis for the diagnosis of patients' diseases, the correction of abnormal gait and related treatment methods. This article reviews the relevant literature, expounds on the clinical consensus on gait, and summarizes the gait characteristics of patients with common ankle and foot diseases. Starting from the gait characteristics of individuals with different diseases, we hope to provide support and reference for the diagnosis, treatment and rehabilitation of clinically related diseases.

Selective dorsal rhizotomy and its effect on muscle force during walking: A comprehensive study

Selective dorsal rhizotomy (SDR) is commonly used to permanently reduce spasticity in children with cerebral palsy (CP). However, studies have yielded varying results regarding muscle strength and activity after SDR. Some studies indicate weakness or no changes, while a recent study using NMSK simulations demonstrates improvements in muscle forces during walking. These findings suggest that SDR may alleviate spasticity, reducing dynamic muscle constraints and enhancing muscle force without altering muscle activity during walking in children with CP. In this study, we combined NMSK simulations with physical examinations to assess children with CP who underwent SDR, comparing them to well-matched peers who did not undergo the procedure. Each group (SDR and No-SDR) included 81 children, with pre- and post-SDR assessments. Both groups were well-matched in terms of demographics, clinical characteristics, and gait parameters. The results of the physical examination indicate that SDR significantly reduces spasticity without impacting muscle strength. Furthermore, our findings show no significant differences in gait deviation index improvements and walking speed between the two groups. Additionally, there were no statistically significant changes in muscle activity during walking before and after SDR for both groups. NMSK results demonstrate a significant increase in muscle force in the semimembranosus and calf muscles during walking, compared to children with CP who received other clinical treatments. Our findings confirm that although SDR does not significantly impact muscle strength compared to other treatments, it creates a more favorable dynamic environment for suboptimal muscle force production, which is essential for walking.