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Böhm H, Reinhold SM, Dussa CU. Anatomical leg length discrepancy in children: Can it be accurately determined using 3-D motion capturing? Gait Posture 2024; 109:311-317. [PMID: 38412684 DOI: 10.1016/j.gaitpost.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Leg length discrepancy (LLD) is common in youth and is cause by several conditions. Long leg X-rays is the gold standard technique of measuring LLD. It is highly accurate and reliable compared to clinical method, but expose the subject to radiation. Instrumented Gait Analysis (IGA) serves not only as a means to measure joint kinematics during gait but also as a valuable tool for assessing Leg Length Discrepancy (LLD) while standing. RESEARCH QUESTION The purpose of this study was to compare different methods of determining the LLD in paediatric population. We hypothesize that IGA using joint centres is more accurate and precise than the tape measurement. METHODS Thirty-one patients with mean age 12.3 (SD=2.4) years were retrospectively included in the study. Their LLD varied between 0 and 36 mm. Three methods for determining LLD were compared to radiography using Bland-Altman analysis: 1. Tape measurement, 2. IGA, summarizing the distance from the spina iliaca anterior superior to the medial malleolus marker via the medial knee condyle marker. 3. IGA, summarizing distances between ankle, knee, and hip joints centres where the latter is calculated with different equations. RESULTS The IGA joints method performed better than the tape measurement or IGA markers method. The equations of Davis calculating the hip joint centre had the highest accuracy with mean difference to radiography of 0.7 mm (SD=6.3). The simple Harrington method resulted in a slightly reduced accuracy but higher precision 0.9 mm (SD=6.2). The Harrington method with leg length as input was less accurate 1.0 mm (SD=6.7), but was still considerably better than the tape measurement 1.8 mm (SD=7.0) or IGA markers method 1.1 mm (SD=11.5). SIGNIFICANCE Determining LLD with IGA using the distances between ankle, knee and hip joints centres is a feasible method that can be applied in clinical practice to calculate LLD.
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Affiliation(s)
- Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, Aschau i. Chiemgau 83229, Germany; HAWK University of Applied Sciences and Arts, Faculty of Engineering and Health Göttingen, Annastr 25, Göttingen 37075, Germany.
| | - Sophie M Reinhold
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, Aschau i. Chiemgau 83229, Germany; University of Applied Sciences Technikum Wien, Department of Biomedical, Health & Sports Engineering, Höchstädtpl. 6, Wien 1200, Austria
| | - Chakravarty U Dussa
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstr. 18, Aschau i. Chiemgau 83229, Germany; Friedrich-Alexander-University of Erlangen-Nürnberg, Department of Orthopaedic Surgery, Rathsberger str 57, Erlangen 91054, Germany
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Öztürk O, Salami F, Musagara AR, Demirbüken İ, Polat MG, Wolf SI, Götze M. Functional hip joint centre determination in children with cerebral palsy. Gait Posture 2021; 90:185-189. [PMID: 34500219 DOI: 10.1016/j.gaitpost.2021.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although functional methods determining the hip joint center (HJC) are becoming increasingly popular, no systematic investigation has been conducted yet to assess the reliability of functional hip joint calibration in patients with cerebral palsy (CP). RESEARCH QUESTION What is the most reliable way to conduct functional calibration motions for estimating HJC location in children with CP and movement disorders? METHODS Twenty-two patients with CP were included in the study. A marker set for Plug-in Gait with additional cluster markers was used. Two functional calibration movements, including a new movement, were proposed and tested with one and three repetitions each. Functional HJCs were determined using the SCoRE approach and compared to results obtained by applying the conventional regression method for assessing face validity. RESULTS The choice of calibration movement had significant impact on SCoRE residuals and HJC location. Increasingly repeating calibration movements did not improve results. A modified star movement by allowing the toes to tip the ground provided the most reliable data and is feasible for children with GMFCS level I-III. The feasibility of the method is further improved by analyzing hip motion in the contralateral stance limb and, among the calibration movements, gave the most precise HJC estimation. SIGNIFICANCE Type and performance of the functional calibration movement is one key factor for determining a robust HJC. Analyzing the data in the stance leg via the modified star motion yielded robust and reasonable results for the HJC location, which should be validated in further studies that include imaging methods. Using one repetition instead of three seems promising in terms of feasibility for patients with movement disorder.
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Affiliation(s)
- Orhan Öztürk
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - Firooz Salami
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - Arik Rehani Musagara
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - İlkşan Demirbüken
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - M Gülden Polat
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - Sebastian I Wolf
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany.
| | - Marco Götze
- Heidelberg University Hospital, Centre of Orthopedics and Trauma Surgery, Heidelberg, Germany
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Fiorentino NM, Atkins PR, Kutschke MJ, Bo Foreman K, Anderson AE. Soft tissue artifact causes underestimation of hip joint kinematics and kinetics in a rigid-body musculoskeletal model. J Biomech 2020; 108:109890. [PMID: 32636003 DOI: 10.1016/j.jbiomech.2020.109890] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Rigid body musculoskeletal models have been applied to study kinematics, moments, muscle forces, and joint reaction forces in the hip. Most often, models are driven with segment motions calculated through optical tracking of markers adhered to the skin. One limitation of optical tracking is soft tissue artifact (STA), which occurs due to motion of the skin surface relative to the underlying skeleton. The purpose of this study was to quantify differences in musculoskeletal model outputs when tracking body segment positions with skin markers as compared to bony landmarks measured by direct imaging of bone motion with dual fluoroscopy (DF). Eleven asymptomatic participants with normally developed hip anatomy were imaged with DF during level treadmill walking at a self-selected speed. Hip joint kinematics and kinetics were generated using inverse kinematics, inverse dynamics, static optimization and joint reaction force analysis. The effect of STA was assessed by comparing the difference in estimates from simulations based on skin marker positions (SM) versus virtual markers on bony landmarks from DF. While patterns were similar, STA caused underestimation of kinematics, range of motion (ROM), moments, and reaction forces at the hip, including flexion-extension ROM, maximum internal rotation joint moment and peak joint reaction force magnitude. Still, kinetic differences were relatively small, and thus they may not be relevant nor clinically meaningful.
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Affiliation(s)
- Niccolo M Fiorentino
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Mechanical Engineering, University of Vermont, 33 Colchester Ave, Burlington, VT 05403, USA
| | - Penny R Atkins
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA
| | - Michael J Kutschke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - K Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Physical Therapy, University of Utah, 520 Wakara Way, Suite 240, Salt Lake City, UT 84108, USA
| | - Andrew E Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S. Wasatch Drive, Room 3100, Salt Lake City, UT 84112, USA; Scientific Computing and Imaging Institute, University of Utah, 72 S. Central Campus Drive, Room 3750, Salt Lake City, UT 84112, USA.
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Brady K, Kiernan D. The impact of centre of pressure error on predicted joint kinetics during cerebral palsy and typically developed gait: A clinical perspective. J Biomech 2019; 92:155-161. [PMID: 31153622 DOI: 10.1016/j.jbiomech.2019.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
Centre of Pressure (CoP) location error is common when using kinematic and kinetic data to predict intersegmental forces and net joint moments during gait. Changes in peak moments due to CoP error have been reported in the literature. However, debate exists as to what levels of error are acceptable. The aim of this study was to examine the impact of CoP error on the kinetic profiles of children with typical development (TD) and children with cerebral palsy (CP) during gait. Three-dimensional kinematic and kinetic data were recorded and simulated CoP errors were applied at 3 mm, 6 mm, 9 mm, 12 mm increments in both positive and negative anteroposterior and mediolateral directions. Absolute differences in maximum kinetic parameters between increments were assessed in conjunction with changes in the Gait Deviation Index-Kinetic (GDI-Kinetic). Changes in GDI-Kinetic above 3.6 points were considered clinically significant. Maximum peak changes of up to 24.8% (CP) and 34.7% (TD) (sagittal plane) and up to 36.8% (CP) and 61.5% (TD) (coronal plane) were demonstrated at the knee. While absolute percentage differences were high at some error increments, GDI-Kinetic results suggested that such large percentage differences may still be clinically acceptable. Children with TD demonstrated clinically significant changes in GDI-Kinetic for CoP displacements of 9 mm and 12 mm, corresponding to 23% and 35% absolute differences in maximum moments. In contrast, the clinically significant threshold was not reached for children with CP that may be related to a slower walking speed. The findings of this study highlight the need for laboratories to consider the thresholds currently used for CoP error, which will help guide quality assurance procedures.
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Affiliation(s)
- Karen Brady
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - Damien Kiernan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Cinnamon CC, Longworth JA, Brunner JH, Chau VK, Ryan CA, Dapiton KR, Chmell SJ, Foucher KC. Static and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2019; 67:127-133. [PMID: 31103962 DOI: 10.1016/j.clinbiomech.2019.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND A subset of total hip arthroplasty patients experience functional impairments past the first postoperative year. Poor hip abductor function is common before and in the early postoperative period. It is not known if abductor impairment is associated with long-term functional impairment. This study evaluated the relationships between static and dynamic abductor function and performance-based and self-reported function >1 year post-total hip arthroplasty. METHODS Eighteen adults 1-5 years post-total hip arthroplasty participated. Static and dynamic abductor function were assessed through dynamometry and gait analysis, respectively. Subjects completed four physical performance tests and two self-report instruments. FINDINGS Higher peak isometric abductor strength was associated with better performance-based function (P ≤ 0.001-0.030) and with self-reported function (P ≤ 0.001-0.012). Higher peak external adduction moment was associated with better results on 3 of 4 performance tests (P = 0.007-0.026). Together, static and dynamic abductor function predicted 35-77% of the variation in physical function. Abductor strength best predicted walking test results and self-reported function, while dynamic abductor function best predicted tests involving sit-to-stand INTERPRETATION: Static and dynamic abductor function were associated with physical function 1-5 years after total hip arthroplasty. These results support further investigation of interventions targeting abductor function for persons experiencing persistent impairments.
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Affiliation(s)
- Christopher C Cinnamon
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica A Longworth
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - J Heather Brunner
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Vivian K Chau
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Colleen A Ryan
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; School of Nursing, DePaul University, Chicago, Illinois, Chicago, IL, USA
| | - Kris R Dapiton
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Samuel J Chmell
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA.
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Leboeuf F, Reay J, Jones R, Sangeux M. The effect on conventional gait model kinematics and kinetics of hip joint centre equations in adult healthy gait. J Biomech 2019; 87:167-171. [DOI: 10.1016/j.jbiomech.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
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Detecting Anatomical Leg Length Discrepancy Using the Plug-in-Gait Model. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7090926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Camomilla V, Cereatti A, Cutti AG, Fantozzi S, Stagni R, Vannozzi G. Methodological factors affecting joint moments estimation in clinical gait analysis: a systematic review. Biomed Eng Online 2017; 16:106. [PMID: 28821242 PMCID: PMC5563001 DOI: 10.1186/s12938-017-0396-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/08/2017] [Indexed: 01/29/2023] Open
Abstract
Quantitative gait analysis can provide a description of joint kinematics and dynamics, and it is recognized as a clinically useful tool for functional assessment, diagnosis and intervention planning. Clinically interpretable parameters are estimated from quantitative measures (i.e. ground reaction forces, skin marker trajectories, etc.) through biomechanical modelling. In particular, the estimation of joint moments during motion is grounded on several modelling assumptions: (1) body segmental and joint kinematics is derived from the trajectories of markers and by modelling the human body as a kinematic chain; (2) joint resultant (net) loads are, usually, derived from force plate measurements through a model of segmental dynamics. Therefore, both measurement errors and modelling assumptions can affect the results, to an extent that also depends on the characteristics of the motor task analysed (i.e. gait speed). Errors affecting the trajectories of joint centres, the orientation of joint functional axes, the joint angular velocities, the accuracy of inertial parameters and force measurements (concurring to the definition of the dynamic model), can weigh differently in the estimation of clinically interpretable joint moments. Numerous studies addressed all these methodological aspects separately, but a critical analysis of how these aspects may affect the clinical interpretation of joint dynamics is still missing. This article aims at filling this gap through a systematic review of the literature, conducted on Web of Science, Scopus and PubMed. The final objective is hence to provide clear take-home messages to guide laboratories in the estimation of joint moments for the clinical practice.
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Affiliation(s)
- Valentina Camomilla
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza de Bosis 15, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza de Bosis 15, 00135 Rome, Italy
| | - Andrea Cereatti
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza de Bosis 15, 00135 Rome, Italy
- Information Engineering Unit, POLCOMING Department, University of Sassari, Viale Mancini, 5, 007100 Sassari, Italy
- Department of Electronics and Telecommunications, Politecnico di Torino, Corso Castelfidardo, 39, 10129 Turin, Italy
| | - Andrea Giovanni Cutti
- Centro Protesi INAIL, Production Directorate - Applied Research, Via Rabuina 14, 40054 Vigorso di Budrio (BO), Italy
| | - Silvia Fantozzi
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, Alma Mater Studiorum University of Bologna, Via Risorgimento 2, 40136 Bologna, Italy
| | - Rita Stagni
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, Alma Mater Studiorum University of Bologna, Via Risorgimento 2, 40136 Bologna, Italy
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza de Bosis 15, 00135 Rome, Italy
- Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, University of Rome “Foro Italico”, Piazza de Bosis 15, 00135 Rome, Italy
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9
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Kainz H, Hajek M, Modenese L, Saxby DJ, Lloyd DG, Carty CP. Reliability of functional and predictive methods to estimate the hip joint centre in human motion analysis in healthy adults. Gait Posture 2017; 53:179-184. [PMID: 28171844 DOI: 10.1016/j.gaitpost.2017.01.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 01/21/2017] [Accepted: 01/24/2017] [Indexed: 02/02/2023]
Abstract
In human motion analysis predictive or functional methods are used to estimate the location of the hip joint centre (HJC). It has been shown that the Harrington regression equations (HRE) and geometric sphere fit (GSF) method are the most accurate predictive and functional methods, respectively. To date, the comparative reliability of both approaches has not been assessed. The aims of this study were to (1) compare the reliability of the HRE and the GSF methods, (2) analyse the impact of the number of thigh markers used in the GSF method on the reliability, (3) evaluate how alterations to the movements that comprise the functional trials impact HJC estimations using the GSF method, and (4) assess the influence of the initial guess in the GSF method on the HJC estimation. Fourteen healthy adults were tested on two occasions using a three-dimensional motion capturing system. Skin surface marker positions were acquired while participants performed quite stance, perturbed and non-perturbed functional trials, and walking trials. Results showed that the HRE were more reliable in locating the HJC than the GSF method. However, comparison of inter-session hip kinematics during gait did not show any significant difference between the approaches. Different initial guesses in the GSF method did not result in significant differences in the final HJC location. The GSF method was sensitive to the functional trial performance and therefore it is important to standardize the functional trial performance to ensure a repeatable estimate of the HJC when using the GSF method.
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Affiliation(s)
- Hans Kainz
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Services, Brisbane, Australia.
| | - Martin Hajek
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; University of Applied Sciences Technikum Wien, Vienna, Austria.
| | - Luca Modenese
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Department of Mechanical Engineering, University of Sheffield, United Kingdom; INSIGNEO Institute for in Silico Medicine, The University of Sheffield, United Kingdom.
| | - David J Saxby
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - David G Lloyd
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - Christopher P Carty
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Services, Brisbane, Australia.
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10
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"Children with cerebral palsy experience greater levels of loading at the low back during gait compared to healthy controls". Gait Posture 2016; 48:249-255. [PMID: 27343832 DOI: 10.1016/j.gaitpost.2016.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/03/2016] [Accepted: 06/05/2016] [Indexed: 02/02/2023]
Abstract
Excessive trunk motion has been shown to be characteristic of cerebral palsy (CP) gait. However, the associated demands on the lower spine are unknown. This study investigated 3-dimensional reactive forces and moments at the low back in CP children compared to healthy controls. In addition, the impact of functional level of impairment was investigated (GMFCS levels). Fifty-two children with CP (26 GMFCS I and 26 GMFCS II) and 26 controls were recruited to the study. Three-dimensional thorax kinematics and reactive forces and moments at the low back (L5/S1 spine) were examined. Discrete kinematic and kinetic parameters were assessed between groups. Thorax movement demonstrated increased range for CP children in all 3 planes while L5/S1 reactive forces and moments increased with increasing level of functional impairment. Peak reactive force data were increased by up to 57% for GMFCS I and 63% for GMFCS II children compared to controls. Peak moment data were increased by up to 21% for GMFCS II children compared to GMFCS I and up to 90% for GMFCS II compared to control. In addition, a strong correlation was demonstrated between thorax side flexion and L5/S1 lateral bend moment (r=0.519, p<0.01) and medial/lateral force (r=0.352, p<0.01). Children with CP demonstrated increased lower spinal loading compared to TD. Furthermore, GMFCS II children demonstrated significantly more involvement. Intervention should be aimed at reducing excessive thorax movement, especially in the coronal plane, in order to reduce abnormal loading on the spine in this population.
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Assi A, Sauret C, Massaad A, Bakouny Z, Pillet H, Skalli W, Ghanem I. Validation of hip joint center localization methods during gait analysis using 3D EOS imaging in typically developing and cerebral palsy children. Gait Posture 2016; 48:30-35. [PMID: 27477704 DOI: 10.1016/j.gaitpost.2016.04.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Localization of the hip joint center (HJC) is essential in computation of gait data. EOS low dose biplanar X-rays have been shown to be a good reference in evaluating various methods of HJC localization in adults. The aim is to evaluate predictive and functional techniques for HJC localization in typically developing (TD) and cerebral palsy (CP) children, using EOS as an image based reference. Eleven TD and 17 CP children underwent 3D gait analysis. Six HJC localization methods were evaluated in each group bilaterally: 3 predictive (Plug in Gait, Bell and Harrington) and 3 functional methods based on the star arc technique (symmetrical center of rotation estimate, center transformation technique and geometrical sphere fitting). All children then underwent EOS low dose biplanar radiographs. Pelvis, lower limbs and their corresponding external markers were reconstructed in 3D. The center of the femoral head was considered as the reference (HJCEOS). Euclidean distances between HJCs estimated by each of the 6 methods and the HJCEOS were calculated; distances were shown to be lower in predictive compared to functional methods (p<0.0001). Contrarily to findings in adults, functional methods were shown to be less accurate than predictive methods in TD and CP children, which could be mainly due to the shorter thigh segment in children. Harrington method was shown to be the most accurate in the prediction of HJC (mean error≈18mm, SD=9mm) and quasi-equivalent to the Bell method. The bias for each method was quantified, allowing its correction for an improved HJC estimation.
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Affiliation(s)
- Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France; Gait Laboratory, SESOBEL, Beirut, Lebanon.
| | - Christophe Sauret
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; Gait Laboratory, SESOBEL, Beirut, Lebanon
| | - Ziad Bakouny
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; Gait Laboratory, SESOBEL, Beirut, Lebanon; Hôtel-Dieu de France Hospital, Beirut, Lebanon
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12
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Kiernan D, Hosking J, O'Brien T. Is adult gait less susceptible than paediatric gait to hip joint centre regression equation error? Gait Posture 2016; 45:133-6. [PMID: 26979895 DOI: 10.1016/j.gaitpost.2016.01.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/30/2015] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
Hip joint centre (HJC) regression equation error during paediatric gait has recently been shown to have clinical significance. In relation to adult gait, it has been inferred that comparable errors with children in absolute HJC position may in fact result in less significant kinematic and kinetic error. This study investigated the clinical agreement of three commonly used regression equation sets (Bell et al., Davis et al. and Orthotrak) for adult subjects against the equations of Harrington et al. The relationship between HJC position error and subject size was also investigated for the Davis et al. set. Full 3-dimensional gait analysis was performed on 12 healthy adult subjects with data for each set compared to Harrington et al. The Gait Profile Score, Gait Variable Score and GDI-kinetic were used to assess clinical significance while differences in HJC position between the Davis and Harrington sets were compared to leg length and subject height using regression analysis. A number of statistically significant differences were present in absolute HJC position. However, all sets fell below the clinically significant thresholds (GPS <1.6°, GDI-Kinetic <3.6 points). Linear regression revealed a statistically significant relationship for both increasing leg length and increasing subject height with decreasing error in anterior/posterior and superior/inferior directions. Results confirm a negligible clinical error for adult subjects suggesting that any of the examined sets could be used interchangeably. Decreasing error with both increasing leg length and increasing subject height suggests that the Davis set should be used cautiously on smaller subjects.
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Affiliation(s)
- D Kiernan
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland.
| | - J Hosking
- Rehabilitation Engineering Unit, Posture and Mobility Centre, Cardiff and Vale NHS Trust, UK
| | - T O'Brien
- Gait Laboratory, Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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