Normative 3D opto-electronic stereo-photogrammetric sagittal alignment parameters in a young healthy adult population

Kinematic Evaluation of the Sagittal Posture during Walking in Healthy Subjects by 3D Motion Analysis Using DB-Total Protocol

Posture can be evaluated by clinical and instrumental methods. Three-dimensional motion analysis is the gold standard for the static and dynamic postural assessment. Conventional stereophotogrammetric protocols are used to assess the posture of pelvis, hip, knee, ankle, trunk (considered as a single segment) and rarely head and upper limbs during walking. A few studies also analyzed the multi-segmental trunk and whole-body kinematics. Aim of our study was to evaluate the sagittal spine and the whole-body during walking in healthy subjects by 3D motion analysis using a new marker set. Fourteen healthy subjects were assessed by 3D-Stereophotogrammetry using the DB-Total protocol. Excursion Range, Absolute Excursion Range, Average, intra-subject Coefficient of Variation (CV) and inter-subject Standard Deviation Average (SD Average) of eighteen new kinematic parameters related to sagittal spine and whole-body posture were calculated. The analysis of the DB-Total parameters showed a high intra-subject (CV < 50%) and a high inter-subject (SD Average < 1) repeatability for the most of them. Kinematic curves and new additional values were reported. The present study introduced new postural values characterizing the sagittal spinal and whole-body alignment of healthy subjects during walking. DB-Total parameters may be useful for understanding multi-segmental body biomechanics and as a benchmark for pathological patterns.

Movement Analysis Could Help in the Assessment of Chronic Low Back Pain Patients: Results from a Preliminary Explorative Study

Introduction: This study aimed to assess the reliability of a qualitative scoring system based on the movement analysis of the spine in different populations and after usual care rehabilitative intervention. If proven true, the results could further future research development in quantitative indexes, leading to a possible subclassification of chronic low back pain (cLBP). Methods: This was a preliminary exploratory observational study. Data of an optoelectronic spine movement analysis from a pathological population (cLBP population, 5 male, 5 female, age 58 ± 16 years) were compared to young healthy participants (5M, 5F, age 22 ± 1) and were analysed via a new qualitative score of the pattern of movement. Internal consistency was calculated. Two independent assessors (experienced and inexperienced) assessed the blinded data, and we calculated inter- and intrarater reliability. We performed an analysis for cLBP pre and post a ten session group rehabilitation program between and within groups. Results: Internal consistency was good for all movements (α = 0.84-0.88). Intra-rater reliability (Intraclass correlation coefficient-ICC) was excellent for overall scores of all movements (ICC_(1,k) = 0.95-0.99), while inter-rater reliability was poor to moderate (ICC_(1,k) = 0.39-0.78). We found a significant difference in the total movement scores between cLBP and healthy participants (p = 0.001). Within-group comparison (cLBP) showed no significant difference in the total movement score in pre and post-treatment. Conclusion: The perception of differences between normal and pathological movements has been confirmed through the proposed scoring system, which proved to be able to distinguish different populations. This study has many limitations, but these results show that movement analysis could be a useful tool and open the door to quantifying the identified parameters through future studies.

Leg Length Discrepancy and Nonspecific Low Back Pain: 3-D Stereophotogrammetric Quantitative Posture Evaluation Confirms Positive Effects of Customized Heel-Lift Orthotics

Background: The literature reports evidence of leg length discrepancy (LLD) associated with musculoskeletal disorders, alterations in spinopelvic alignment, and body posture, leading to low back pain and lumbar scoliosis. The most common conservative treatment for LLD is the use of internal or external shoe lifts although no treatment guidelines have been established.

Aim: The study aimed to contribute to low back pain–LLD relationship comprehension, highlighting the benefits of LLD correction in the nonspecific low back pain (NSLBP) population.

Methods: A cross-sectional observational study recruited a cohort of 80 NSLBP patients (48 females, 32 males) with LLD, age (μ = 35 ± 17.2). Entire body posture, including 3-D spine shape reconstruction, was measured using a nonionizing 3-D optoelectronic stereophotogrammetric approach. After the first 3-D posture evaluation, patients were provided with customized orthotics, including 100% LLD heel lift correction. No other therapeutic interventions were considered. Pain level was assessed using the numerical pain rating scale (NPRS). The gender, age-related, and time-dependent effects of LLD equalization treatment in NSLBP patients was investigated during 2 years of follow-up. The statistical analysis was performed at the global level using multivariate methods by Hotelling T² tests and intrasubject-level using t-test.

Results and Discussion: An initial average NPRS = 7.8 was determined. In the medium-term follow-up group (4 months), the NPRS dramatically decreased (NPRS = 1.1). The pain disappeared in the long-term (2 years) follow-up group (NPRS = 0). The study results highlight that LLD equalization treatment led to clear statistically significant improvements in all the postural parameters of the frontal plane, including the underfoot load asymmetry. No worsening has been detected. An adaptation period long enough is needed to obtain progressive pain relief improvements and structural posture changes. Younger NSLBP patients showed slightly better improvements than older ones. Minimal differences between healthy young adults’ and NSLBP patients’ postures were found either in natural erect standing posture or when LLD equalization is applied.

Conclusion: Heel-lift customized orthotics with 100% LLD correction are an effective short- and long-term treatment in patients with nonspecific LBP, inducing pain symptom recession and stimulating the improvement of postural parameters without contraindications.

3D Stereophotogrammetric Quantitative Evaluation of Posture and Spine Proprioception in Subacute and Chronic Nonspecific Low Back Pain

The literature shows that low back pain causes a reduced lumbar range of movement, affecting patients’ proprioception and motor control. Nevertheless, studies have found that proprioception and motor control of the spine and posture are vague and individually expressed even in healthy young adults. This study aimed to investigate the standing posture and its modifications induced by an instinctive self-correction manoeuvre in subacute and chronic nonspecific low back pain (NSLBP) patients to clarify how NSLBP relates to body upright posture, proprioception, and motor control and how these are modified in patients compared to healthy young adults (121 healthy young adults: 57 females and 64 males). A cohort of 83 NSLBP patients (43 females, 40 males) were recruited in a cross-sectional observational study. Patients’ entire body posture, including 3D spine shape reconstruction, was measured using a non-ionising 3D optoelectronic stereophotogrammetric approach. Thirteen quantitative biomechanical parameters describing the nature of body posture were computed. The statistical analysis was performed using multivariate methods. NSLBP patients did not present an altered proprioception and motor control ability compared to healthy young adults. Furthermore, as for healthy subjects, NSLBP patients could not focus and control their posture globally. Proprioception and motor control in natural erect standing are vague for most people regardless of gender and concurrent nonspecific low back pain. Self-correction manoeuvres improving body posture and spine shape must be learned with specific postural training focusing on the lumbar spine.

Influence of Footwear on Posture and Comfort in Elite Rugby Players

Influence of footwear on posture in athletes is poorly documented despite its potential impact on biomechanics and injury risk. The aim of this study was to investigate effects of different footwear geometries on comfort and posture on a cohort of 48 elite rugby players. Spine posture was characterized by photogrammetry, while center of pressure was measured by means of a force platform. Three different footwear outsoles architectures (one rugby shoe with flat outsole, one rugby shoe with a 10 mm heel rise and foot arch support, and a running shoe with a 10mm heel rise and foot arch support) were compared to non-shod in randomized order. Then comfort felt at the level of foot and spine was also estimated by subjective questionnaires. Compared to the flat rugby model, both other models induced significantly (p<0.05) greater comfort at the level of foot and spine, a slight shift toward of center of pressure and a spinal posture closer to that observed when non-shod. The footwear geometry influences comfort and posture at the level of the foot as well as spine and should be considered in a dual purpose of injury prevention and performance.

Quantitative Evaluation of Upright Posture by x-Ray and 3D Stereophotogrammetry with a New Marker Set Protocol in Late Onset Pompe Disease

BACKGROUND

Late Onset Pompe Disease(LOPD) is a rare myopathy characterized by prevailing weakness of trunk and pelvic girdle muscles that causes motor disabilities. Spinal deformities have been reported unclearly on clinical examination. No study quantitatively assessed upright posture defining specific alterations of LOPD various phenotype.

OBJECTIVE

Identify postural abnormalities in a homogeneous group of LOPD patients using 3D-Stereophotogrammetry(St) and x-Ray(xR).

METHODS

Seven LOPD siblings were recruited. They were assessed by clinical scales and, in upright posture, using xR and 3D-St with a new marker set protocol. Fourteen healthy individuals, age and sex-matched, were used as controls for St-parameters; normative xR-values were found in literature.

RESULTS

LOPD patients showed a significant weakness of trunk and tibialis anterior muscles. Statistical analysis of St-parameters showed a larger ankle, knee, elbow, dorsal, S2-C7, heel-S2-C7, heel-S2-nasion angles and a lower sagittal vertical axis(SVA) than controls.xR-analysis highlighted an absence of scoliosis and a lower occipito-cervical, C2-C7 cervical and Cobb dorsal angles, and a trend to lower lumbar lordosis and SVA compared to normal values. Significant correlation was found in dorsal and lumbar angles calculated using xR-markers placed on spiny apophysis, xR-centre of vertebral bodies, Cobb-method and St-markers.

CONCLUSION

This is the first quantitative study of postural abnormalities in LOPD patients using 3D-St and xR, highlighting sagittal standing alignment changes,difficult to assess to direct exam.Our new St-protocol showed a high reliability compared to xR. Further studies on larger population of LOPD might confirm the usefulness of these instrumental methods for monitoring disease course.

A Self-Contained 3D Biomechanical Analysis Lab for Complete Automatic Spine and Full Skeleton Assessment of Posture, Gait and Run

Quantitative functional assessment of Posture and Motion Analysis of the entire skeleton and spine is highly desirable. Nonetheless, in most studies focused on posture and movement biomechanics, the spine is only grossly depicted because of its required level of complexity. Approaches integrating pressure measurement devices with stereophotogrammetric systems have been presented in the literature, but spine biomechanics studies have rarely been linked to baropodometry. A new multi-sensor system called GOALS-E.G.G. (Global Opto-electronic Approach for Locomotion and Spine-Expert Gait Guru), integrating a fully genlock-synched baropodometric treadmill with a stereophotogrammetric device, is introduced to overcome the above-described limitations. The GOALS-EGG extends the features of a complete 3D parametric biomechanical skeleton model, developed in an original way for static 3D posture analysis, to kinematic and kinetic analysis of movement, gait and run. By integrating baropodometric data, the model allows the estimation of lower limb net-joint forces, torques and muscle power. Net forces and torques are also assessed at intervertebral levels. All the elaborations are completely automatised up to the mean behaviour extraction for both posture and cyclic-repetitive tasks, allowing the clinician/researcher to perform, per each patient, multiple postural/movement tests and compare them in a unified statistically reliable framework.

3D Quantitative Evaluation of Posture and Spine Proprioceptive Perception Through Instinctive Self-Correction Maneuver in Adolescent Idiopathic Scoliosis

Background

Conservative treatment in the adolescent idiopathic scoliosis (AIS) population is based on individual proprioceptive and motor control training. Such training includes physiotherapeutic scoliosis-specific exercises (PSSEs) stimulating the individual capacity to perceive and control his/her posture, particularly the shape of the spine. However, limited knowledge about basic proprioception capability in AIS patients is reported in the literature.

Questions

(1) How do AIS patients, who did not receive any previous specific postural education treatment, perceive their posture and 3D spine shape? Are they able to modify their posture and 3D spine shape correctly through an instinctive self-correction (ISCO) maneuver? (2) Are posture and ISCO maneuver ability gender dependent in AIS patients? (3) Do AIS patients present different posture and spine shape characteristics as well as different ISCO ability compared with the healthy young adult population?

Methods

Cross-sectional observational study. 132 (75 females, 57 males) AIS patients’ posture and 3D spine shape have been measured comparing indifferent orthostasis (IO) (neutral erect posture) to ISCO using a non-ionizing 3D optoelectronic stereophotogrammetric approach. Thirteen quantitative biomechanical parameters described the AIS patients body posture. The statistical analysis was performed using a multivariate approach to compare genders in IO, ISCO, and AIS patients vs. healthy young adults–previously published data (57 females, 64 males).

Results

Males (87.7%) and females (93.3%) of AIS patients were unable to modify posture and 3D spine shape globally. AIS patients gender differences were found in IO, ISCO, and the comparison vs. healthy young adults. When changes occurred, subjects could not focus and control their posture globally, but only in a few aspects at a time.

Conclusion

Self-correction maneuver producing an improvement in body posture and spine shape is not instinctive and must be trained. In such characteristics, AIS patients are not so dissimilar to healthy young adults. Sagittal plane control is the highest, but ISCO in AIS patients led to worsening in this plane. Control at the lumbar level is neglected in both genders. Such outcomes support the necessity of customized PSSEs to treat AIS patients. The 3D stereo-photogrammetric approach is effective in quantitatively describing the subject’s posture, motor control, and proprioception.

General method for automated feature extraction and selection and its application for gender classification and biomechanical knowledge discovery of sex differences in spinal posture during stance and gait

Modern technologies enable to capture multiple biomechanical parameters often resulting in relational data. The current work proposes a generally applicable method comprising automated feature extraction, ensemble feature selection and classification to best capture the potentials of the data also for generating new biomechanical knowledge. Its benefits are demonstrated in the concrete biomechanically and medically relevant use case of gender classification based on spinal data for stance and gait. Very good results for accuracy were obtained using gait data. Dynamic movements of the lumbar spine in sagittal and frontal plane and of the pelvis in frontal plane best map gender differences.